Physiotherapy Volume 93 Supplement 1
Keynote Presentations
Keynote Presentation
3473 Sunday 3 June 09:00
VCEC, Exhibit Hall A
FROM PATIENT TO CITIZEN: IMPLICATIONS OF THE UN
INTERNATIONAL CONVENTION ON THE RIGHTS OF PERSONS
WITH DISABILITIES
Heumann J; President, Heumann & Associates, Washington DC,
USA
On March 30, 2007 the UN Convention on the Rights of Persons
with Disabilities was opened for governments to sign and ratify. This
is a historic period for disabled people and all those who believe that
disabled people have been denied equal opportunities. Equality and
dignity are central to the theme of the Disability Rights Movement.
Effective implementation of this UN Convention will, for the first time in
history, ensure human rights for the more than 650 million disabled
people around the world. Human rights protections will only occur
when governments, DPOs, donors, and concerned organizations
such as the World Confederation for Physical Therapy, actively
collaborate to ensure that the spirit and intent of the Convention
becomes a reality.
The last few decades witnessed the rise of organizations run by and
for disabled people. They saw that the broader society, including
the helping professions, were not focusing on removing barriers
that were limiting their ability to participate as equal members of
their community. From the poorest to the richest countries, disabled
people have been organizing to create voices that enable them to
be empowered, participating citizens. Like other movements before
the absence of the voices of the effected group result in a belief that
people are not capable.
Non-disabled people looked to the helping professions as the
disability experts. Yet, for all their professional strengths and skills,
these experts had little direct experience fighting for the human rights
disabled people were really striving for, the same rights afforded
to others, but denied to them. Exclusion resulted in the denial
of opportunities in education, employment, housing, health care,
rehabilitation, the right to free travel, to marry, to have and raise
children, etc. People see disabled people as poor and have little
belief that the state of poverty is not because they have a disability
but rather because of the denial of equal opportunity.
People in the helping professions, need to learn how to work with
DPOs. For some this will be easy for others not. This session will
discuss some of the following questions:
1. What role can the World Confederation for Physical Therapy play
in the effective implementation of the Convention?
2. What do WCPT members need to know in order to reform their
policies and practices to be more inclusive of the views of those
they are to serve?
3. What changes need to be made in PT, classroom instruction,
field training, and continuing education? What role can the WCPT
play to engage other professionals who must also contribute to
reforms?
4. How can professionals learn to actively seek out and listen to the
voices of disabled people?
5. Are you willing to become engaged in political activities and policy
reforms aimed at assisting in the implementation constructive
reforms?
6. Will you add your voices to those of disabled people?
S1
Keynote Presentation
3485 Tuesday 5 June 09:00
VCEC, Exhibit Hall A
CAPITALIZING IN TIMES OF DIFFICULTY
Delitto A; Department of Physical Therapy, School of Health and
Rehabilitation Sciences, University of Pittsburgh, USA
The $1 trillion U.S. health-care system has been described as the
modern-day equivalent of a medieval patchwork of fiefdoms, with
doctors, hospitals, and insurance companies allied to form local
power structures. Disparities and inequities still exist, outcomes vary
and treatments are not received equally. It is an industry that has
become a high-volume, low-margin business that is riddled with
inefficiencies, outrageous costs, and outmoded technology. With
health care now accounting for a record 16% of the nation’s gross
domestic product, the system is under crippling financial pressure
as medical spending continues to skyrocket. I will argue that as
physical therapists, we are in a unique position to become a major
part of the solution to some of these problems. For example,
musculoskeletal disorders are fast becoming one of the leading
categories of costs for payers. In some instances, costs for low back
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
evidence-based guidelines or inordinate treatment variability) and,
more importantly, how much could be saved if we were to change our
behavior with regard to an evidence-based approach? I will attempt
to answer some of these questions using data from our own health
plan in a small-scale initiative. Our field’s contribution to the health
care dilemma we face in every country can only be realized if we
face the problems and perform to our highest capabilities. If we take
on this challenge, our place in health care will be very secure.
Keynote Presentation
3476 Wednesday 6 June 09:00
VCEC, Exhibit Hall A
CRANIOVERTEBRAL–CRANIOMANDIBULAR DISORDERS IN
HEADACHE PATIENTS
Rocabado M; Universidad Andres Bello Facultad de Ciencias de
la Rehabilitación. Santiago, Chile
“If I wished to show a student the difficulties of practice, I should give
him a headache to treat.” “Si yo quisiera demostrarle a un alumno
las dificultades de la práctica clı́nica le darı́a una cefalea para tratar.”
(Oliver Wendell Holmes).
For centuries headaches have troubled mankind. It is known that
since 3000 B.C. drastic measures were adopted to alleviate a
headache. They penetrated the bony skeleton to free the evil demons
who were responsible to cause the “untreatable headache symptom”.
Later in 400 B.C. Hippocrates described the combination of visual
disturbances, headache and nausea. 200 years later Galenus named
this combination of symptoms “Hemicrania” (1).
In 1934 Costen (2), ENT specialist, described a combination of signs
and symptoms connected with the pathological Temporomandibular
Joints. Later, the Costen Syndrome became the most important
concept of dysfunction of the Masticatory system related to facial
Pain. At present the pathology only until approximately 10 years ago
it was generally accepted as a TMJ or a Craniomandibular Disorder
or Alterations. At present most of the International Academies
have merged into the concept of Facial Pain or Orofacial Pain or
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
been the Academia Iberolatino Americana de Fisiopatologı́a Craneo-
cervicomandibular y Dolor Facial (Iberian–Latinamerican Academy of
Craniocervical–mandibular Physiopathology and Orofacial Pain). We
are proud of our influence as OMT, to be part of this open minded
and progressive academy.
Although Costen (2), mentioned headaches as the most prevalent
symptoms in his article. Many others such as Berlin et al (3) were
the first ones to mention the close relation between Craniomandibular
disorders and Headaches. Later many studies confirmed this
association (4-8). These studies demonstrated the incidence of
Craniomandibular disorders in headache patients and showed an
alleviation of headaches after treatment of the musculoskeletal
system of the Temporomandibular joints, occlusion and related
structures. Later in 1982 Lous and Oleson (9) and Forssel in 1985
(10), were the first ones to consider the neurological diagnosis of the
headaches in studies on the prevalence of CMD, in general headache
patients.
9. Lous I, Oleson J. Evaluation of pericraneal tenderness and oral
function in patients with common migraine, muscle contraction
headaches and combination headache. Pain 1982;12: 385-393.
10. Forsell H. Mandibular Dysfunction and headache. Thesis.
University of Turku. Turkey.
11. Rocabado M, Tapia V. Radiographic Study of the Craniocervical
relation in patients under Orthodontic treatment and the
incidence of related symptoms. J Craniomandibular Practice
1987;5(1):36-42.
12. Rocabado M. The importance of soft tissue mechanics in
Stability and Instability of the Cervical Spine: A functional
diagnosis for treatment planning. J Craniomandibular Practice
1987:5(2):130-8.
13. Rocabado M. Análisis biomecánico cráneo cervical a través
de una teleradiografı́a lateral. Revista Chilena de Ortodon-
cia,19841:42-52.
14. Nagasawa A, Sakakibara T, Takahashi A. Roentgenographic
findings of the Cervical Spine in Tension type headache (TTH).
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.
Physiotherapy Volume 93 Supplement 1
Focused Symposium Overviews
Focused Symposium Overview
3329 Sunday 3 June 10:45
VCEC Ballroom B & C
THE FIRST PHYSICAL THERAPY SUMMIT ON GLOBAL HEALTH
Dean E; University of British Columbia, School of Rehabilitation
Sciences, T325-2211 Westbrook Mall, Vancouver, Canada, R6T 2B5
LEARNING OBJECTIVES: The principal outcome of this sym-
posoium is the provision of a Summit designed for international
colleagues, to examine physical therapy’s role in global health issues
in the 21st century. The discussion generated during this Summit will
be used to prepare a position paper, and potentially a publication
entitled “The First Physical Therapy Summit on Global Health: The
Issues and the 2007-2011 Implementation Plan”. Participants will
contribute in this symposium in the format of a Summit. The learning
objectives include: 1. To review global health issues by WCPT region
with special attention to the diseases of civilization, ie, ischemic
heart disease, cancer, chronic lung disease, hypertension and stroke,
diabetes, and osteoporosis. 2. To examine the evidence supporting
the degree to which physical therapy is addressing these issues
by WCPT region. 3. To discuss the facilitators and barriers to
physical therapy in addressing the global health issues identified, and
how symposium participants believe these can be best addressed
through the international physical therapy community. SUMMARY:
The leading global health care problems of this millennium are largely
related to lifestyle choices and therefore largely preventable (see
Dean et al, Phys Ther, 80:1275-8, 2000; World Health Organization
Annual Reports over the last decade). These killers, the so-called
“diseases of civilization or affluence”, include heart disease, smoking-
related diseases, hypertension and stroke, diabetes, obesity, and
cancers. These deadly progressive conditions are prevalent in
developed countries and fast becoming epidemic in the Middle
East and Asia as well. AIDS/HIV is prevalent in African countries,
and increasing globally. Physical therapy is an internationally-
recognized, primary health care profession that exploits primarily
non invasive practices to prevent, cure, and treat disease. Non
invasive approaches including nutrition, physical activity and exercise,
smoking cessation, and stress management have proven efficacy
in preventing, curing, and treating the “diseases of civilization”. The
extent of this evidence will be critically reviewed. Not only are non in-
vasive prevention and management of these conditions insufficiently
exploited globally in health care, but often underused in favor of
risky, less indicated, and costly invasive interventions associated with
the traditional medical model of illness care. A position paper will
summarize the findings of this symposium, including a statement
of the prevalence of these conditions in the CPT regions, and
recommendations for physical therapy involvement and intervention,
education, and research. IMPLICATIONS/CONCLUSIONS: This
symposium provides an opportunity for participants to reflect on the
leading health care priorities of their respective countries, familiarize
themselves with the literature supporting physical therapy’s role in
the prevention and in some cases ‘cure’, as well as the management
of the “diseases of civilization”, and consider ways in which, in their
unique contexts, the role of physical therapy can be facilitated in
addressing these leading health priorities that are contributing to
significant human suffering and economic burden worldwide. The role
of genetic predisposition in people of some ethniticies is discussed.
The outcomes of the Summit will lead to a systematic action plan for
the next 4 years. KEYWORDS: health issues, Diseases of civilization,
Ischemic heart disease, Cancer, Hypetension and stroke, Diabetes,
Obesity, Osteoporosis, Physical therapy’s role, Prevention, Cure,
Management. FUNDING ACKNOWLEDGEMENTS: None
S3
Focused Symposium Overview
193 Sunday 3 June 14:00
VCEC Ballroom B & C
GAIT ANALYSIS AND TRAINING: STEPPING FROM
MECHANISTIC RESEARCH TO PRACTICE
Eng J; University of British Columbia, Vancouver, Canada
LEARNING OBJECTIVES: Following the symposium, the participant
should be able to: 1. Discuss neural and biomechanical mechanisms
which influence gait function. 2. Be able to evaluate treatment ap-
proaches to improve gait with respect to mechanisms underlying im-
paired gait. 3. Formulate treatment decisions for improving gait based
on an understanding of the mechanisms contributing to impaired gait.
SUMMARY: One of the key roles of physical therapists is to assess
gait disorders and re-train gait function. Gait requires the integration
of many systems (e.g., muscle, neural, cognitive, cardiovascular, pro-
prioceptive, visual) to generate a multi-degree, rhythmical human gait
pattern which is robust, yet adaptable depending on the environment
and task. This presentation, in addition to the other three, will evaluate
the role of different mechanisms underlying impaired gait and discuss
the development of new and innovative, evidence-based treatments
to improve gait function. Although different populations will be
discussed, commonalities in the presentations include the use of gait
kinematics and kinetics, the knowledge of muscle and neural require-
ments during gait, and the appreciation of the complex coordination of
multiple systems for effective gait. Stroke is one example of a chronic
condition which affects multiple body systems and the ability to walk.
Our interventions to improve gait in people with stroke are based on
a series of mechanistic studies. Kinematic and kinetic gait analyses
have demonstrated the critical importance of the ankle plantarflexors
for an effective push-off and the hip flexors for an exaggerated late
stance “pull-off” which is not observed in healthy gait. We have also
found that the ability to load the paretic limb during the stance phase
is a strong predictor of gait performance. However, altered gait motor
patterns do not necessarily indicate a failure of the task, but may
be adaptive in response to the impairments. In fact, some of our
observed compensations (e.g., abducting the paretic hip during the
swing phase) deter from the “normal” gait pattern, but result in better
function (faster gait). These findings challenge the notion that treat-
ment approaches should only be directed towards restoring “normal”
patterns if the goal is to achieve optimal functional performance rather
than an aesthetic one. At a muscle level, we have found that that the
paretic leg muscles of people with chronic stroke have a reduced rate
of force production, in addition to an inability to generate sufficient
magnitude of force, and these variables correlate with gait speed.
Such data suggests that improving muscle strength and speed across
joint range may enhance gait performance. We have also found that
balance ability has a high correlation, while cardiovascular fitness,
has a low correlation with gait speed. Based on our mechanistic
findings, we have undertaken a series of controlled clinical trials
in people with stroke which focus on dynamic weight-bearing,
functional muscle strengthening (with emphasis on fast movements)
and balance tasks. The results have demonstrated improvement
in gait speed, mobility, fear of falling, and a reduction in falls.
IMPLICATIONS/CONCLUSIONS: Gait impairments following stroke
result from multiple systems and understanding these mechanisms
may help to direct treatment programs to improve gait. KEYWORDS:
Gait, Walking, Treatment. FUNDING ACKNOWLEDGEMENTS:
Funding for these studies was provided by the Canadian Institutes
of Health Research, Michael Smith Foundation for Health Research
and Heart and Stroke Foundation of BC and Yukon.
S4
Focused Symposium Overview
255 Sunday 3 June 14:00
VCEC Meeting Rooms 1-3
PHYSIOTHERAPY MANAGEMENT AND ORGANISATIONAL
ARRANGEMENTS, IS THERE A “BEST” MODEL?
Jones R; National Health Service, United Kingdom
LEARNING OBJECTIVES: 1. To understand the effects and
importance of management structure and organisation on the
provision of “quality” physiotherapy and other health professions
services. 2. To explore the different organisational and management
arrangements for physiotherapy services internationally. 3. To
consider important factors required for the effective and efficient
management of physiotherapy and other health professions services.
SUMMARY: Changes in health care are driven by several factors:
financial, political, economic and social. Consumer changes, with
increasing life expectancy, the increasing number of people with
long term illnesses, widespread access to health information and
increasing demand for both quality and quantity of health care
has required health strategists to re-evaluate the organisation
and structure of health care services worldwide. In response to
the increasingly competitive and demanding health environment,
physiotherapy managers have frequently been required to consider
what might be the “best” organisational structures for their services,
in order to manage effective clinical service provision and improve
patient outcomes within resource constraints. Structural changes
have caused concerns for physiotherapy services. These have
related to service fragmentation into small teams often managed by
directorates, divisions or general managers. The individual issues
included; fears that staff would not get the professional support
needed and professional standards would drop, difficulties with
recruiting and retaining staff, lack of career progression and the
Head of Service being accountable for professional standards without
authority. The introduction of relatively decentralised management
units based largely on medical speciality groupings has often
been perceived by physiotherapists as a need to “make them
fit” with a desire for neat organisational boxes on organisational
charts. Management arrangements for physiotherapists are not
uniform. In some places a single Head of Service manages each
of the health professions as individual entities. In others they
are managed in a variety of different groupings, for example
in directorate structures, combined health professions groups or
matrix management models. Despite the recognised contribution to
patient care, research into physiotherapy management has been
limited. Physiotherapy and other health professions have lacked
influence in comparison with medical and nursing colleagues in the
larger policy process of structural reforms at national, regional and
local levels throughout the world. Thus, the potential for strategic
influence has been fragmented and diluted. Organisational structures
for health professions services appear to have “swung” between
full devolution to localities and centralisation to health professions
directorates, without full consideration for the impact of these
decisions on patient care and the many factors affecting clinical
governance. IMPLICATIONS/CONCLUSIONS: The importance of
organisational structures cannot be ignored. They establish the
context for many aspects of healthcare; commissioning, patient flows,
cross-organisational boundary working, information management,
communication processes, clinical governance and the management
of risk. Management structures should be defined after the functions
of a service are determined. Organisational structure directly influ-
ences the provision of patient care, affecting both staffing and service
issues. KEYWORDS: Physiotherapy; Management; Organisational
Structures. FUNDING ACKNOWLEDGEMENTS: None
WCPT 2007, Focused Symposium Overviews
Focused Symposium Overview
243 Monday 4 June 10:45
VCEC Ballroom A
BREAST CANCER AND EXERCISE
Harris S; University of British Columbia – School of Rehabilitation
Sciences, Vancouver, BC, Canada
LEARNING OBJECTIVES: At the completion of this symposium,
attending participants will be able to: 1) cite current literature on
the role of physical activity for women living with breast cancer and
provide implications for clinical practice; 2) cite recent research on
upper extremity rehabilitation for women living with breast cancer and
present guidelines for upper extremity rehabilitation and; 3) describe
the mechanisms for musculo-skeletal dysfunction in women with
breast cancer as well as the clinical implications of surgery, radiation
therapy, and lymphedema. 4) discuss how the material presented
in this symposium will be used to guide their clinical or educational
practice. SUMMARY: The goals of this focused symposium are to
update learners on the most recent research relating to the role and
effects of physical activity for women living with breast cancer and to
describe recent research and clinical implications of upper extremity
(UE) rehabilitation for women living with breast cancer. Research on
the effects of physical activity for women undergoing breast cancer
treatments (surgery, radiation and chemotherapy) and following
completion of treatments has grown substantially in the past decade.
Dr. Campbell will summarize this body of research and define the
role of physical therapists in incorporating physical activity into their
treatment plans for women with breast cancer. The two most frequent
impairments resulting from breast cancer treatment are shoulder
dysfunction (ROM limitations) and UE swelling (lymphedema). Ms.
McNeely will present results of a systematic review that examined
evidence from randomized controlled trials on the benefit of
therapeutic exercise interventions in preventing or minimizing UE
morbidity due to breast cancer treatment. Clinical implications of
the findings will be shared. In the third session of the symposium,
Ms. Binkley, a physical therapist who works clinically with women
with breast cancer, will describe the mechanisms of musculoskeletal
dysfunction in the shoulder that result from surgery and radiation.
As well, she will describe the effects of UE lymphedema on
shoulder dysfunction and provide clinical implications for practition-
ers. IMPLICATIONS/CONCLUSIONS: Breast cancer is the most
common cancer affecting women. The life-prolonging treatments,
including axillary and chest surgery, chemotherapy and radiation
therapy, often result in significant morbidity to the women treated,
e.g. loss of shoulder ROM, lymphedema, post-treatment fatigue, and
depression. To function as evidence-based practitioners, physical
therapists working in women’s health, oncology or general practice
must be aware of the latest research that should then be translated
to guide their practice. This evidence-based, focused symposium will
enable practitioners, educators and other women’s health/oncology
researchers to become aware of the latest research advances in the
care of women living with breast cancer. KEYWORDS: breast cancer,
upper extremity, rehabilitation. FUNDING ACKNOWLEDGEMENTS:
ML McNeely and KL Campbell were supported by studentships from
the Alberta Heritage Foundation for Medical Research.
Focused Symposium Overview
246 Monday 4 June 10:45
VCEC Ballroom B & C
MOVING ELECTROPHYSICAL AGENTS FORWARD IN AN
EVIDENCE-BASED PRACTICE ENVIRONMENT
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
practice, education and research. 3. To propose the formation of
an EPA sub-group within WCPT to co-ordinate these changes.
SUMMARY: Together with massage and exercise, the use of EPA
has been one of our core skills since the profession started. However,
the clinical usage of EPA has often been criticised as ineffective
through recently published meta-analyses and critical appraisals, and
the continued teaching of EPA in many schools has been questioned
in journal editorials and meetings. It is necessary to address
these issues before appropriate changes can be proposed and
implemented on a global scale through international collaboration.
While we do not claim to have all the answers, research evidence
do suggest that the practice of EPA in an evidence based practice
environment is possible for most of the modalities we currently use,
if not all. However, the transition from “evidence” to an “evidence-
based practice environment” requires a strategy which goes beyond
producing more evidence through clinical research. In order to make
a successful transition, it is necessary to change the mindsets
and practice patterns of clinicians; with the way we educate our
future clinicians in undergraduate programs across the world; and
with the way we coordinate and prioritise our research efforts
in this area. In 1999, at the WCPT congress in Yokohama, a
meeting was held to address some of these issues. The meeting
demonstrated that there was global interest and support for proposed
changes in EPA, with the formation of an on-line discussion group.
An inaugural International Electrophysical Agents Congress was
planned for in 2001 / 2002, with the aim of promoting further
discussions on these issues, under the organisation of Professor
Luther Kloth (Marquette University, USA), but this was cancelled due
to the September 11, 2001 terrorist attack in New York. A follow-
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
that discussions on issues related to EPA can be reinstated and
new interests generated with the focussed symposia at the WCPT
congress in 2007. KEYWORDS: Electrophysical Agents, Evidence-
based practice environment, international collaboration. FUNDING
ACKNOWLEDGEMENTS: None.
Focused Symposium Overview
298 Monday 4 June 14:00
VCEC Ballroom B & C
ADVANCES IN PULMONARY REHABILITATION: PERIPHERAL
AND RESPIRATORY MUSCLE ADAPTATIONS
Brooks D; Toronto University, Toronto, Canada
LEARNING OBJECTIVES: Essentially, this symposium should
help the audience to appreciate the clinical consequences of
peripheral and respiratory muscle dysfunction in chronic obstructive
pulmonary disease (COPD) and realize the beneficial effects
of inspiratory muscle training and pulmonary rehabilitation this
population. SUMMARY: Actually, there is an estimation of 14
million Americans and 750 000 Canadians having COPD. There
continues to be an increase in the prevalence of and mortality
from COPD. By 2020, the World Health Organization predicts that
COPD will rise from the 12th most prevalent disease worldwide
to the 5th and from the 6th most common cause of death to
the 3rd. Clinical consequences of COPD are dramatic. Besides
debilitating dyspnea, peripheral and inspiratory muscle dysfunction,
fatigue, decrease endurance and reduced exercise capacity are all
contributing to impair functional capacity, reduce quality of life and
increase mortality in this population. Concretely, COPD patients are
loosing 30% of their peripheral muscle mass during the progression
of the lung disease. Intense research is ongoing to unravel factors
responsible in the initiation and the development of muscle wasting
in COPD. Muscle wasting is not exclusive to COPD. Indeed,
in vitro and in vivo investigations have clearly demonstrated, in
numerous catabolic models, that the Ubiquitin-Proteasome system,
an ATP-dependant proteolytic pathway, is involved in contractile
S5
protein degradation. The first symposia lecture will present recent
investigations aimed at studying factors that triggers muscle atrophy
and identify the proteolytic system responsible for contractile
protein degradation. Combined effects of multiple factors such as
hyperinflation, malnutrition and increased work of breathing are
potentially responsible for the development of inspiratory muscle
dysfunction in CPOPD. Inspiratory muscle training is one strategy
used by clinician that may help to relieve patients from symptoms
such as dyspnea. The second lecture will review the literature to
expose the audience to the known effect of inspiratory muscle
training in adults with COPD. Pulmonary rehabilitation programs
consistently have improved exercise capacity, quality of life, and
symptoms over the past decade. Although training has been shown
to be an essential component of the rehabilitation program, individual
patients do not always benefit to the same extent. The third allocution
will discuss the concept of responders and nonresponders in COPD
patients exposed to exercise training and how to distinguish both
groups. IMPLICATIONS/CONCLUSIONS: Actually, worldwide COPD
population is increasing and multiple evidences prove that their
peripheral and respiratory muscles experience changes in terms
of quantity and quality. These muscle alterations have detrimental
effects on the clinical status of these patients. Fortunately, inspiratory
and peripheral muscle trainings are powerful tools available for
clinicians. Judicious application of these training modalities in
selected patients can enhance their muscle strength and endurance,
exercise capacity, dyspnea and quality of life. KEYWORDS: COPD,
muscle atrophy, proteolysis, respiratory muscle, exercise training,
inspiratory muscle training, pulmonary rehabilitation, responder,
nonresponder. FUNDING ACKNOWLEDGEMENTS: None.
Focused Symposium Overview
417 Tuesday 5 June 09:00
VCEC Ballroom B & C
FES THERAPY AFTER SCI: FUNCTIONAL, PHYSIOLOGICAL,
PSYCHOSOCIAL, BIOENGINEERING OUTCOMES
Field-Fote E; The Miami Project to Cure Paralysis and the
Department of Physical Therapy, University of Miami School of
Medicine, Miami, USA
LEARNING OBJECTIVES: Following this symposium participants
will be able to: 1) Discuss how training with FES influences physiology
and neurophysiology; 2) Describe the how FES is being used for
upright mobility; 3) Understand how FES may influence quality of
life and societal participation; 4) Appreciate the future directions
of FES technology. SUMMARY: The effects of spinal cord injury
on mobility and function are the most obvious consequences of
this disorder. However, the injury also affects the way the nervous
system processes sensory information and contributes to motor
output. Fortunately, evidence suggests that the nervous system
responds to training even in individuals with chronic SCI. The
disability associated with SCI profoundly influences the individual’s
life roles, affecting work, family and social participation. Enhanced
function and mobility can have a meaningful influence on the
development of effective coping strategies, and therefore functional
electrical stimulation has the potential to significantly impact quality
of life by contributing to the achievement of patient-centered goals.
Progress in biotechnology hold promise for future advancements that
may make FES systems even more functional, practical and useful
for individuals with SCI. Changes in engineering processes and
miniaturization may also make these devices more readily accessible
to individuals with SCI. IMPLICATIONS/CONCLUSIONS: Functional
electrical stimulation has the potential to influence all the domains of
disability. Improvements in physiology, neural control, body function
and movement abilities are associated with enhanced health and
wellness as well as improved quality of life and societal participation.
KEYWORDS: Activity, plasticity, biotechnology, participation, quality
of life. FUNDING ACKNOWLEDGEMENTS: None.
S6
Focused Symposium Overview
287 Tuesday 5 June 14:00
VCEC Ballroom B & C
PROMOTING EFFECTIVE INTERVENTIONS FOR UPPER
EXTREMITY RECOVERY IN NEUROLOGICAL CONDITIONS
Levin M; Director, Physical Therapy Program, School of Physical
and Occupational Therapy, McGill University, 3654 Prom. Sir
William Osler, Montreal, Quebec. H3G 1Y5, CANADA
LEARNING OBJECTIVES: Participants in this Focused Sympo-
sium will: 1) understand how findings of animal research inform
rehabilitation of the upper limb in patients with stroke; 2) be able
to differentiate between different training approaches based on
repetitive use of the more affected arm of patients with stroke
and determine their applicability; 3) understand the role of the
therapist in promoting client involvement in decision making and
treatment planning. SUMMARY: This symposium will examine the
evidence for the effectiveness of treatment interventions for the
affected upper limb in patients with hemiparesis due to stroke.
Discussion will be based on current high-level evidence resulting
from basic science research and randomized control trials. The first
speaker (Wolf) will present the evidence for the effectiveness of
such rehabilitation techniques as repetitive task practice, constraint-
induced therapy, forced use therapy and muscle strengthening
techniques. The second speaker (Levin) will discuss basic motor
control studies that investigate the role of the trunk in reaching and
how the trunk may be used to compensate for distal motor control
deficits. Results of recent randomized controlled trials using trunk
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
mechanisms of neuronal plasticity. All speakers will emphasize how
results from basic research can be utilized to maximize therapeutic
effectiveness. The presentations will be followed by a 20 minute
question and answer period in which questions from the audience
will be solicited and discussed among the Symposium participants.
The Symposium will conclude with a summary in which the main
points will be reiterated. IMPLICATIONS/CONCLUSIONS: Recent
animal research has provided evidence of a great potential for
cortical reorganization after focal brain injuries such as stroke.
This symposium will focus on the translation of basic findings and
principals of motor relearning based on neuronal plasticity into the
clinical setting. KEYWORDS: Knowledge translation, motor control,
motor learning, upper limb rehabilitation, treatment effectiveness,
evidence-based practice, client-centered practice, constraint-induced
therapy. FUNDING ACKNOWLEDGEMENTS: Canadian Institutes of
Health Research (CIHR), National Science and Engineering Council
of Canada (NSERC), National Institutes of Health (NIH)
Focused Symposium Overview
209 Tuesday 5 June 16:15
VCEC Ballroom B & C
CONSERVATIVE TREATMENT OF PATELLOFEMORAL PAIN
SYNDROME
Witvrouw E; Ghent University, Faculty of Medicine and Health
Sciences, Department of Rehabilitation Science and Physiotherapy,
Ghent, Belgium, Europe
LEARNING OBJECTIVES: The objective of this symposium is to give
the attendees up-to-date information concerning the conservative
treatment of the patellofemoral pain patient. The attendees should
be able to understand this information, and incorporate the given
clinical guidelines in the future treatment of their PFPS patients.
SUMMARY: Patellofemoral pain syndrome (PFPS) is a common
condition for which patients are referred to rehabilitation. Despite
its high incidence, PFPS remains a challenging musculoskeletal
entity. Reviewing the literature, conflicting data and approaches seem
to exist regarding the conservative treatment. Some authors state
WCPT 2007, Focused Symposium Overviews
that quadriceps strengthening should be the main focus of the
conservative treatment of PFPS. Some randomized clinical trials have
shown consistent improvement of short-term pain and function after
quadriceps strengthening exercises. However, it remains enigmatic
as to why these exercises improves the patients’ symptoms, and
why not all patients benefit from it. In contrast to the importance
of the strength of the quadriceps, some authors state that the neu-
romuscular timing of the hip muscles and vastus medialis obliquus
of the quadriceps plays a major role in the development of PFPS.
Consequently, the neuromuscular training of these muscles should
be the most essential aspect in the rehabilitation of these patients.
Again, conflicting research results are found concerning the effect
and importance of neuromuscular training in PFPS. In addition, many
authors have shown in biomechanical studies that PFPS patients
suffer from important malalignment characteristics of the lower
extremity. As a result, PFPS patients should be evaluated and treated
for existing malalignment patterns. IMPLICATIONS/CONCLUSIONS:
It can be concluded that after reviewing the literature no clear
consensus exists concerning the predisposing factors of PFPS.
Consequently, today many different treatment approaches exist, with
sometimes conflicting research results. The aim of this symposium
is to identify these different approaches, to clarify the conflicting
results, and to present up-to-date clinical guidelines which can be
used in the treatment of PFPS. In addition, this symposium will
elucidate the benefit of future studies on the conservative treatment
of PFPS. KEYWORDS: patellofemoral pain syndrome – conservative
treatment – malalignment – neuromuscular control – quadriceps
strengthening. FUNDING ACKNOWLEDGEMENTS: None.
Focused Symposium Overview
291 Wednesday 6 June 10:45
VCEC Ballroom B & C
RANDOMIZED TRIALS IN COMMON MUSCULOSKELETAL
PROBLEMS: CHALLENGES AND FUTURE DIRECTIONS
Foster N; Clinical Trials Unit, Primary Care Sciences Research
Centre, Keele University, UK
LEARNING OBJECTIVES: This symposium will provide a much
needed opportunity for experienced clinical trialists, practitioners
and others, interested in improving the quality of the evidence
from randomized controlled trials (RCTs), to: 1. Examine what
can be learned from available, high quality RCTs of physical
therapy for common musculoskeletal problems, 2. Understand the
challenges of designing and conducting high quality RCTs in physical
therapy musculoskeletal practice, and how to overcome them, 3.
Prioritise the key issues for inclusion in future RCTs of physical
therapy for musculoskeletal problems, 4. Provide recommendations
to improve future RCTs in musculoskeletal physical therapy.
SUMMARY: Common musculoskeletal problems such as low back
pain, neck pain, knee pain and shoulder pain are commonly treated
by physical therapists. The randomised controlled trial (RCT) is
the most appropriate tool to test the effectiveness of physical
therapy interventions. Designing RCTs of complex physiotherapy
interventions, however, comes with considerable challenges. There
is a clear trend towards large, high quality RCTs showing either
no differences or very small differences between physiotherapy
approaches in the management of musculoskeletal problems. Where
differences are seen, these may be statistically significant but
of questionable clinical importance. Such results seem strongly
at odds with the experiences of physiotherapy practitioners who
see individual patients improve, often dramatically with specific
physiotherapy approaches and whose clinical experience leads
them to firmly believe in the effectiveness of specific interventions.
IMPLICATIONS/CONCLUSIONS: There are a range of possible
explanations for the mismatch beween the results of high quality
RCTs of physical therapy interventions and the strongly held
beliefs of practitioners. For example, there may be overestimation
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.
Physiotherapy Volume 93 Supplement 1
Focused Symposium Contributions
Focused Symposium Contribution
3330 Sunday 3 June 10:45
VCEC Ballroom B & C
This contribution is part of Focused Symposium “THE FIRST PHYS-
ICAL THERAPY SUMMIT ON GLOBAL HEALTH” number 3329
STATUS OF THE DISEASES OF CIVILIZATION IN THE NORTH
AMERICA CARIBBEAN REGION AND RELATED PHYSICAL
THERAPY PRACTICE
Dean E; Professor, School of Rehabilitation Sciences, University
of British Columbia, Vancouver, Canada
LEARNING OBJECTIVES: 1. To review health and mortality of
the North America Caribbean (NAC) Region of WCPT with special
attention to the diseases of civilization, ie, ischemic heart disease,
cancer, chronic lung disease, hypertension and stroke, diabetes, and
osteoporosis. 2. To examine the evidence supporting the degree to
which physical therapy is addressing these issues in this WCPT
region clinically, professional education, and research. SUMMARY:
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
articles published related to these conditions for an index of related
scientific research. IMPLICATIONS/CONCLUSIONS: Ischemic heart
disease, cancer, smoking-related conditions, hypertension and
stroke, obesity and diabetes, and osteoporosis have high prevalence,
and are underrepresented in physical therapy practice, professional
education, and research.The indigenous people of Canada and
the United States are at particularly high risk. Preliminary analysis
supports gaps between the need for a higher level of visibiltiy
of physical therapy in the prevention, ‘cure’, and management
of the diseases of civilization in the NAC Region, proportion of
professional curricula dedicated to these conditions, and physical
therapy research. KEYWORDS: North America Caribbean Region,
diseases of civilization, AIDS/HIV, clinical practice, physical therapy
education, and research. FUNDING ACKNOWLEDGEMENTS: None
Focused Symposium Contribution
3331 Sunday 3 June 10:45
VCEC Ballroom B & C
This contribution is part of Focused Symposium “THE FIRST PHYS-
ICAL THERAPY SUMMIT ON GLOBAL HEALTH” number 3329
STATUS OF THE DISEASES OF CIVILIZATION IN THE SOUTH
AMERICA REGION AND RELATED PHYSICAL THERAPY
PRACTICE
Dornelas de Andrade A; Professor, Physiotherapy Department,
Federal University of Pernambuco, Recife, Brazil
LEARNING OBJECTIVES: 1. To review health and mortality and
disabilty in the South America (SA) Region of WCPT with special
attention to the diseases of civilization, ie, ischemic heart disease,
cancer, chronic lung disease, hypertension and stroke, diabetes, and
osteoporosis. 2. To examine the evidence supporting the degree to
which physical therapy is addressing these issues in this WCPT
region clinically, professional education, and research. SUMMARY:
Data are being tabulated from: the WHO and Pan American Health
Organziation 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 SA Region; and the physical therapy journals in the SA
S9
Region with respect to articles published related to these conditions
for an index of scientific research. IMPLICATIONS/CONCLUSIONS:
Preliminary analysis supports gaps between the need for a higher
level of visibiltiy of physical therapy in the prevention, ‘cure’, and
management of the diseases of civilization in the SA Region, the
proportion of professional curricula dedicated to these conditions,
and physical therapy research. Physical therapy education is typically
based on the biomedical model and impairment-focused interven-
tions, rather than a health model focused on interventions to promote
health, prevent and ‘cure’ disease, in addition to management.
Most physical therapy programs surveyed, report minimal to no
content related to prevention (<2%), and if included, was usually
in the musculoskeletal area, e.g., ergonomics. Reframing of the
profession is indicated based on inconsistency between epidemiology
and physical therapy practice in South America. KEYWORDS:
South America Region, diseases of civilization, AIDS/HIV, clinical
practice, physical therapy education, and research. FUNDING
ACKNOWLEDGEMENTS: None
Focused Symposium Contribution
3332 Sunday 3 June 10:45
VCEC Ballroom B & C
This contribution is part of Focused Symposium “THE FIRST PHYS-
ICAL THERAPY SUMMIT ON GLOBAL HEALTH” number 3329
STATUS OF THE DISEASES OF CIVILIZATION IN THE EUROPE
REGION AND RELATED PHYSICAL THERAPY PRACTICE
Gosselink R; Professor, Rehabilitation Sciences, Dean Faculty of
Kinesiology and Rehabilitation Sciences, Respiratory Rehabilitation,
Universitaire Ziekenhuizen Leuven, Katholieke Universiteit Leuven,
Belgium
LEARNING OBJECTIVES: 1. To review health and mortality in the
Europe Region of WCPT with special attention to the diseases of
civilization, ie, ischemic heart disease, cancer, chronic lung disease,
hypertension and stroke, diabetes, and osteoporosis. 2. To examine
the evidence supporting the degree to which physical therapy is
addressing these issues in this WCPT region clinically, professional
education and research. SUMMARY: Data are being tabulated from:
the WHO and the ministries of health of the European Region
countries 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 Europe
Region; and the physical therapy journals in the Europe Region
with respect to articles published related to these conditions for an
index of scientific research. IMPLICATIONS/CONCLUSIONS: There
are marked differences in prevalence of the diseases of civilization
across the countries of the Europe Region, e.g., eastern Europe
has among the highest rates of smoking globally; Scotland has the
highest rate of heart disease in the world; and Mediterrean countries
having lower rates of heart disease. Preliminary analysis supports
gaps between the need for a higher level of visibiltiy of physical
therapy in the prevention, ‘cure’, and management of the diseases of
civilization in the Europe Region, proportion of professional curricula
dedicated to these conditions, and physical therapy research.
Regional differences are highlighted. KEYWORDS: Europe Region,
diseases of civilization, AIDS/HIV, clinical practice, physical therapy
education, and research. FUNDING ACKNOWLEDGEMENTS: None
S10
Focused Symposium Contribution
3333 Sunday 3 June 10:45
VCEC Ballroom B & C
This contribution is part of Focused Symposium “THE FIRST PHYS-
ICAL THERAPY SUMMIT ON GLOBAL HEALTH” number 3329
STATUS OF THE DISEASES OF CIVILIZATION IN THE ASIA
WESTERN PACIFIC REGION AND RELATED PHYSICAL
THERAPY PRACTICE
Al-Obaidi S; Associate Professor, Physical Therapy Department,
Kuwait University, Kuwait
LEARNING OBJECTIVES: 1. To review health and mortality the Asia
Western Pacific (AWP) Region of WCPT with special attention to the
diseases of civilization, ie, ischemic heart disease, cancer, chronic
lung disease, hypertension and stroke, diabetes, and osteoporosis.
2. To examine the evidence supporting the degree to which physical
therapy is addressing these issues in this WCPT region clinically,
professional education, and research. SUMMARY: Data are being
tabulated from: the WHO 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 AWP Region; and the physical therapy journals in the AWP
Region with respect to articles published related to these conditions
for an index of scientific research. IMPLICATIONS/CONCLUSIONS:
The AWP Region is perhaps the most culturally diverse of the WCPT
regions. Even its low-income countries are exhibiting increasing
prevalence of the diseases of civilization with increasing affluence.
In wealthy oil-rich countries, a major health priority in adults and
children is metabolic syndrome including obesity, hypertension, and
abnormal blood lipids, particularly in the wealthy oil-rich countries.
Preliminary analysis supports gaps between the need for a higher
level of visibiltiy of physical therapy in the prevention, ‘cure’, and
management of the diseases of civilization in the AWP Region,
proportion of professional curricula dedicated to these conditions, and
physical therapy research. KEYWORDS: Asia West Pacific Region,
diseases of civilization, AIDS/HIV, clinical practice, physical therapy
education, and research. FUNDING ACKNOWLEDGEMENTS: None
Focused Symposium Contribution
3335 Sunday 3 June 10:45
VCEC Ballroom B & C
This contribution is part of Focused Symposium “THE FIRST PHYS-
ICAL THERAPY SUMMIT ON GLOBAL HEALTH” number 3329
STATUS OF THE DISEASES OF CIVILIZATION IN THE AFRICA
REGION AND RELATED PHYSICAL THERAPY PRACTICE
Umerah G; Assistant Director, Physiotherapy Dept, University of
Nigeria Teaching Hospital (UNTH), Enugu, Enugu State, Nigeria
LEARNING OBJECTIVES: 1. To review health and mortality in
the Africa Region of wCPT with special attention to the diseases
of civilization, ie, ischemic heart disease, cancer, chronic lung
disease, hypertension and stroke, diabetes, and osteoporosis. 2.
To examine the evidence supporting the degree to which physical
therapy is addressing these issues in this WCPT region clinically,
professional education and research. SUMMARY: Data are being
tabulated from: the WHO for prevalence of the diseases of civilization
and AIDS/HIV (credibility of national data questionable); proportion
of curriculum on the prevention, ‘cure’, and management from the
schools of physical therapy in the countries of the Africa Region;
and the physical therapy journals in the Africa Region with respect
to articles published related to these conditions for an index of
scientific research. IMPLICATIONS/CONCLUSIONS: With economic
development in Africa, the diseases of civilization are becoming a
greater priority. Obesity is beginning to offset malnutrition in the
extreme economic groups. HIV/AIDS is a major health priority which
is often coupled with tuberculosis. Preliminary analysis supports
gaps between the need for a higher level of visibiltiy of physical
therapy in the prevention, ‘cure’, and management of the diseases
WCPT 2007, Focused Symposium Contributions
of civilization in the Africa Region commensurate with its economic
development in the 21st century, proportion of professional curricula
dedicated to these conditions, and physical therapy research.
KEYWORDS: Africa Region, diseases of civilization, AIDS/HIV,
clinical practice, physical therapy education, and research. FUNDING
ACKNOWLEDGEMENTS: None
Focused Symposium Contribution
307 Sunday 3 June 14:00
VCEC Ballroom B & C
This contribution is part of Focused Symposium “GAIT ANALYSIS
AND TRAINING: STEPPING FROM MECHANISTIC RESEARCH TO
PRACTICE.” number 193
3-D ANALYSIS OF NOVEL STRATEGIES TO IMPROVE GAIT IN CP
Damiano D; Washington University
LEARNING OBJECTIVES: 1.appreciate the history of gait analysis
with respect to physical therapy applications, with specific attention
here on cerebral palsy; 2.recognize the effects of strength training
on gait performance and patterns; 3.discuss task-related intervention
approaches and mechanisms by which these enhance gait function.
SUMMARY:: The proliferation of 3-D gait analysis laboratories lead
to an exponential increase in outcomes studies on patients with
cerebral palsy (CP). These laboratories were initially set up by
orthopaedic surgeons with the desire to better understand and treat
gait deviations in CP, with the surgical decision making process
of paramount interest. In the past two decades, the use of gait
analysis has expanded to other clinical populations and to multiple
disciplines asking questions relative to their practices. This talk will
focus on the use of gait analysis to assess outcomes of physiotherapy
interventions for persons with CP, so as to design more effective
treatment strategies. Much rehabilitative effort in CP is expended
towards the goal of improving gait. The effectiveness of interventions
such as strength training has been evaluated using gait analysis
under the assumption that gait performance is adversely affected by
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
seen when asking subjects to walk as fast as possible. Kinematic
changes as a result of strengthening alone have been less commonly
reported and responses seem to be quite variable across individuals.
This suggests that for those in whom walking is limited mostly by
weakness, strengthening may improve their ability to move against
gravity, depending on which muscle groups were trained. However,
the influence of muscle contractures or spasticity on gait may
dominate in others, and strengthening alone in those individuals, even
when considerable weakness is present, is likely to be ineffective.
Even more intriguingly, it has been predicted by muscle modelling
that strength training in CP that focused on improving hip and
knee extension would also improve rotational abnormalities due
to positional alterations in the muscle lever arms, and we will
present experimental data testing that hypothesis in children with
spastic diplegia. More recently, treadmill training and other intense
repetitive leg exercise protocols have shown a positive effect on
gait, which is hardly surprisingly since the training involves similar
or identical motions as the target task. While immensely useful
for many rehabilitation applications, 3-D gait analysis is limited
due to its somewhat artificial environment that typically involves
walking over a short distance on a level surface with minimal
environmental distractions, Therefore, it is recommended that these
measures be compared to or complemented by those with greater
ecological validly. IMPLICATIONS/CONCLUSIONS: Physical therapy
treatment options in CP and other disorders for improving gait have
expanded greatly in recent years, with efficacy demonstrated by 3-D
gait analysis and other measures. Strategies include strengthening,
endurance training, and repetitive practice under varying conditions
to improve motor coordination. KEYWORDS: strength, cerebral
palsy. cycling. FUNDING ACKNOWLEDGEMENTS: Work cited and
Focused Symposium Contributions
conducted by author has been funded by the National Institutes
of Health, specifically NCMRR/NICHD and NINDS, and by United
Cerebral Palsy Education and Research Foundation.
Focused Symposium Contribution
319 Sunday 3 June 14:00
VCEC Ballroom B & C
This contribution is part of Focused Symposium “GAIT ANALYSIS
AND TRAINING: STEPPING FROM MECHANISTIC RESEARCH TO
PRACTICE.” number 193
USING GAIT ANALYSIS IN PARKINSON DISEASE TO ENHANCE
THERAPY OUTCOMES
Morris M; The University of Melbourne
LEARNING OBJECTIVES: Following the symposium, the participant
should be able to: 1. Discuss the biomechanics and motor control
of gait in people with idiopathic Parkinson’s disease. 2. Formulate
treatment decisions for improving gait based on an understanding of
the mechanisms contributing to impaired gait in PwPD. SUMMARY:
This presentation will explore the biomechanics, motor control and
objective measurement of gait in people with idiopathic Parkinson’s
disease (PwPD) as the basis for clinical decision making in physical
therapy practice. Idiopathic Parkinson’s disease occurs frequently in
older people and usually progresses relatively slowly over periods of
15-25 years. Gait, balance and posture are compromised due to a
progressive loss of dopamine producing neurons in the substantia
nigra pars compacta of the basal ganglia. The resulting neurotrans-
mitter imbalance that occurs in the basal ganglia affects the person’s
ability to perform repetitive movement sequences and motor skills
with speed and normal amplitude. In addition, because most PwPD
are senior citizens and many have a sedentary lifestyle, impairments
of musculoskeletal and cardiopulmonary systems can contribute to
gait deviations. At Kingston Centre, within the Rehabilitation and
Aged Care Program of Southern Health (Australia), we have a multi-
disciplinary team of clinicians and clinical researchers who work
together to ensure evidence-based clinical practice. Our international
standard gait laboratory is situated within the hospital above the
Parkinson’s disease ward and clinicians, researchers and patients
communicate on a daily basis. Based on 3-D motion analysis and
validated methods of clinical observation, we have shown that PwPD
hypokinesia have a fundamental deficit in footstep regulation as well
as a marked reduction in gait speed. These are correlated with
reduced community ambulation and an increase risk of falls. Gait
disorders and falls are a particular risk during dual task performance
and when PwPD have to make a rapid adjustment to changes in
task goals, floor surface conditions or when there is the need to walk
as part of a long or complex motor skill. Gait impairments not only
affect quality of life in the person with the disease, they can also
contribute to “caregiver burden” in family members such as partners
and adult children. Current research is focusing on the biomechanics
of turning, the effects of PD on ability to make transitions from one
support surface to another, the effects of dual motor and cognitive
tasks on gait and the relationship between gait dysfunction and
falls. We have also recently completed a randomized controlled
clinical trial comparing the outcomes of two methods of physical
therapy for in-patients with PD. IMPLICATIONS/CONCLUSIONS:
People with parkinson’s disease have a short stepped, slow, shuffling
gait with reduced arm swing, reduced trunk rotation, a forward
stooped posture and reduced ankle power generation. The relative
contributing factors to gait dysfunction in PwPD vary widely according
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
S11
Focused Symposium Contribution
333 Sunday 3 June 14:00
VCEC Ballroom B & C
This contribution is part of Focused Symposium “GAIT ANALYSIS
AND TRAINING: STEPPING FROM MECHANISTIC RESEARCH TO
PRACTICE.” number 193
BIOMECHANICAL INSIGHT INTO QUESTIONS ABOUT GAIT IN
PERSONS WITH STROKE
Olney S; Motor Performance Group, School of Rehabilitation
Therapy, Queen’s University, Kingston, Ontario, Canada
LEARNING OBJECTIVES: The audience will: 1) understand the
major biomechanical principles underlying the gait of persons with
stroke, 2) know the gait compensations frequently used by persons
with stroke that can be used to develop treatment objectives, and 3)
be able to use biomechanical principles to make clinical decisions
in the treatment of persons with stroke. SUMMARY: The aim of this
presentation is to develop an understanding of the biomechanical
features in the gait of persons who have sustained a stroke by
considering five common clinical questions that can be addressed
from a biomechanical point of view. The first question is, “What
is good walking – what should we be aiming for?” Although there
is agreement that safety is a prime concern, there is conflict
between speed and ‘gait pattern’ as an indicator of good walking.
Biomechanical arguments based on mechanical energy analyses and
joint power profiles can answer this important question. The second
question is, “Why does my patient walk slowly?” Slow speeds of
walking are caused by inadequate input of concentric muscle groups
at specific times in the gait cycle, or eccentric muscle activity at the
same time as the concentric activity. Examples and approaches to
increasing speed will be presented. The third question is, “Do other
muscle groups compensate for deficient muscle groups in gait and, if
so, is there a predictable pattern to this?” The redundancy of muscles
acting across one or two joints means that compensations may occur
in the affected limb (intra-limb) or in the unaffected limb (inter-limb).
It appears that the most common patterns are 1) an increase in
the power burst in early stance caused by hip extension (H1) on
the affected side with an increase H1 on the unaffected side, or 2)
an increase in H1 on the unaffected side coupled with an increase
in push-off of the affected side. The fourth question is, “Increased
walking speed frequently results in a poorer gait pattern; how do
I decide what is most important?” One must first determine upon
what factors the pattern can be said to be poorer, then determine
priorities with input from the client. At the same time, one must
ascertain whether the poor pattern can be reduced or eliminated
by making footwear, orthotic or training modifications. Examples will
be given. The fifth question is, “What are the biomechanical guiding
principles for choosing an ankle-foot orthosis for a person affected
by stroke?” Orthoses are used for three reasons, 1) to facilitate
foot clearance in swing, 2) to prevent excessive ankle dorsiflexion in
stance, and/or 3) to hold the foot in a balanced position if it tends to
invert or evert. Each requires different biomechanical considerations.
IMPLICATIONS/CONCLUSIONS: Clinical decision-making can be
enhanced if physical therapists understand the biomechanics of
gait in persons with stroke, the typical biomechanical differences
from normal gait and the biomechanical compensations that are
frequently used. KEYWORDS: gait, stroke, biomechanics. FUNDING
ACKNOWLEDGEMENTS: Main financial support provided by: Heart
and Stroke Foundation of Ontario (Grants T-4649 and ST-2714);
Medical Research Council of Canada or Canadian Institutes of Health
Research (MA-8178, ME-8296, MOP-57664), Health and Welfare
Canada, and Ministry of Health, Ontario, (#04121).
S12
Focused Symposium Contribution
302 Sunday 3 June 14:00
VCEC Meeting Rooms 1-3
This contribution is part of Focused Symposium “PHYSIOTHERAPY
MANAGEMENT AND ORGANISATIONAL ARRANGEMENTS, IS
THERE A “BEST” MODEL?” number 255
PHYSIOTHERAPY AND ORGANISATIONAL STRUCTURE:
MASSAGING THE ORGANISATION TO FACILITATE OUTCOMES
Mueller J; Auckland District Health Board, Auckland, New Zealand
LEARNING OBJECTIVES: 1 To describe organisational structures
as they impact on physiotherapists in a hospital-based setting. 2
To develop an understanding of change management challenges
and issues for health professionals associated with significant
organisational change. 3 To describe a model of organisational
structure for hospital-based physiotherapists designed to provide
consumer-focussed quality care with a large health-care organ-
isation in New Zealand SUMMARY: This presentation outlines
the professional issue of changes to the organisational structure
of the allied health service at Auckland District Health Board
(ADHB) in New Zealand as it has impacted upon hospital-based
physiotherapists. It traces the initial steps of a journey on which
ADHB hospital-based health professionals embarked to support a
vision of interdisciplinary and client centred work practices for all
professional groups. While this project leveraged learnings from
existing experience and literature, ADHB’s scale, organisational
culture and the limited timeframe created unique problems and
solutions. IMPLICATIONS/CONCLUSIONS: A significant change
management process was undertaken for hospital-based allied
health staff, to restructure the work environment from the traditional
single discipline departments to a mixed model of a health division
supported by a clearly defined professional leadership structure.
This work is contextualised within the New Zealand health-care
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:
Physiotherapy, Organisational Structure, Interdisciplinary Teams.
FUNDING ACKNOWLEDGEMENTS: Nil.
Focused Symposium Contribution
320 Sunday 3 June 14:00
VCEC Meeting Rooms 1-3
This contribution is part of Focused Symposium “PHYSIOTHERAPY
MANAGEMENT AND ORGANISATIONAL ARRANGEMENTS, IS
THERE A “BEST” MODEL?” number 255
STRATEGIC CHOICES FOR AUSTRALIAN PROFESSIONAL
ORGANIZATION: A DECADE OF CHANGE
Boyce R; University of Queensland, Brisbane, Australia
LEARNING OBJECTIVES: (1) to describe and explain the
historical trajectory, organisational models and strategic initiatives
via which Australian health professionals have attained significant
and sustained political and policy influence at the level of national,
state and local health agencies and decision-making bodies.
SUMMARY: In the late 1980s there was one universal way of
organizing health professionals such as physiotherapists in Australian
healthcare agencies. That organisational model was based on
medical management with very limited leadership and influence
opportunities for health professionals. The 1990s saw a period of
multiple policy reforms such as casemix funding, purchaser-provider
split, internal market reforms, patient-focused care, decentralized
management structures, clinical directorates and evidence-based
practice. During this period of change the question of “who should
manage the health professions?” was addressed for the first time
in a structured way in which professionals were able to play a
role in determining their own future. This presentation describes,
WCPT 2007, Focused Symposium Contributions
explains and evaluates the new organisational models within health
service agencies that have been responsible for a renaissance in the
influence of health professionals in Australian healthcare agencies.
Subsequently, these models, and the new professional identities
and managerial competencies that emerged as a result of them,
were leveraged to create further opportunities for influence at the
state and national health system levels. Today, Australian health
professionals routinely obtain seats on executive level management
teams in health care agencies, they are a vital part of the decision-
making apparatus that feeds into government policy and they are
recognised by politicians as equal partners with medicine and
nursing as key members of the health workforce. In 2005, the
culmination of this change agenda was the formation of a national
health alliance drawing together health interests from all sectors
(health, higher education, community services) (private and public
sectors) (urban and rural) into one organisation – Allied Health
Professions Australia (AHPA). IMPLICATIONS/CONCLUSIONS: The
research outcomes associated with this study concludes that the
organisational models in which health professionals find themselves
are important determinates of their influences within local, state
and national health services. Without contextually appropriate
organisational models the health professional voice can not be
heard, nor incorporated within higher level decision-making circles.
Underpinning the success of the new organisational models was the
recognition by health professionals that significant influence could
only be achieved by reducing the tyranny of tribalism and joining
with others professions under the umbrella of “allied health” to
create a new identity. That identity has involved a shift from a self-
concept of “allied to medicine” to one of “allied to each other and
the communities we serve”. KEYWORDS: Professional organisation,
organisational structure, professional power and influence. FUNDING
ACKNOWLEDGEMENTS: University of Queensland Research Fel-
lowship Scheme; Australian Research Council.
Focused Symposium Contribution
328 Sunday 3 June 14:00
VCEC Meeting Rooms 1-3
This contribution is part of Focused Symposium “PHYSIOTHERAPY
MANAGEMENT AND ORGANISATIONAL ARRANGEMENTS, IS
THERE A “BEST” MODEL?” number 255
MANAGEMENT ARRANGEMENTS FOR HEALTH PROFESSIONS
Jenkins F; South Devon Health Services, England
LEARNING OBJECTIVES: 1. To describe roles, responsibilities and
duties of health professions managers 2. To communicate health
professions managers’ views about the benefits and disadvantages
of their current management arrangements. 3. To recommend
the management domains that need to be considered when
evaluating the management structure of health professions services.
SUMMARY: This presentation reviews the tasks undertaken by
health professions managers, the majority of whom were physio-
therapists. Their opinions regarding the strengths and weaknesses
of their management arrangements are considered, and compared
with views on those who were employed in professional advisory
non-managerial roles. An assessment tool was jointly developed by
Robert Jones and Fiona Jenkins following the study, which has been
designed to assist those evaluating different management models
for health professions services to enable objective assessment of
possible management structures. IMPLICATIONS/CONCLUSIONS:
Health professions managers are frequently challenged to consider
the “best” management structure for their services. There continues
to be management restructuring of health professions services
world wide, with many different models in place. Health professions
managers have experience of working in different structures and
have opinions about what works well and where management
reorganisation has had a detrimental effect of their ability to
provide quality patient care. The assessment tool developed draws
Focused Symposium Contributions
together research in this subject spanning thirty years, and provides
managers with a method of comparing the merits of different
management structures enabling them to ensure that a secure
evidence base underpins service management. KEYWORDS: Health
Professions, Management Arrangements, Management Domains.
FUNDING ACKNOWLEDGEMENTS: Nil
Focused Symposium Contribution
399 Monday 4 June 10:45
VCEC Ballroom A
This contribution is part of Focused Symposium “BREAST CANCER
AND EXERCISE” number 243
MUSCULOSKELETAL DYSFUNCTION IN WOMEN WITH BREAST
CANCER
Binkley J; TurningPoint Women’s Healthcare
LEARNING OBJECTIVES: 1. Understand the mechanisms of
musuloskeletal dysfunction in women with breast cancer, including
implications of surgery, radiation and lymphedema. 2. Understand the
clinical implications and role of exercise in women with breast cancer
through an evidence-based case study. SUMMARY: Treatment
for breast cancer has a multitude of physical and psychosocial
implications relevant to physical therapy. The mechanisms of
musculoskeletal dysfunction, including lymphedema, related to breast
cancer will be addressed. The presentation will include an evidence-
based case study that will highlight the role of physical therapy
and exercise for women with breast cancer, including lymphedema
and musculoskeletal dysfunction. IMPLICATIONS/CONCLUSIONS:
The residual effects of breast cancer treatment and the subsequent
role of physical therapy is not are not well identified. There is
significant evidence to support a more well-defined role for physical
therapists in supporting wellness and quality of life following breast
cancer. KEYWORDS: breast cancer, exercise, radiation effects,
lymphedema. FUNDING ACKNOWLEDGEMENTS: Not Applicable.
Focused Symposium Contribution
400 Monday 4 June 10:45
VCEC Ballroom A
This contribution is part of Focused Symposium “BREAST CANCER
AND EXERCISE” number 243
EXERCISE INTERVENTIONS FOR UPPER LIMB DYSFUNCTION
DUE TO BREAST CANCER
McNeely M; University of Alberta
LEARNING OBJECTIVES: To review recent research on upper ex-
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
range of motion (ROM), pain and numbness in the surgical area,
nerve injury, loss of strength in the upper extremity, and swelling
of the upper extremity and chest wall. The two most frequent
impairments from breast cancer treatment are shoulder dysfunction
and arm swelling, complications related to axillary lymph node
dissection and axillary radiation therapy. Although the prevalence
of impairments varies from study to study, the literature is clear
that a significant number of women have limitations in shoulder
ROM and strength, as well as difficulties with functional activities.
While rehabilitative interventions after breast cancer surgery have
been noted to improve recovery of shoulder ROM and function,
some controversy remains over the intensity and timing of the
post-operative intervention, mainly surrounding issues of wound
drainage and seroma formation. The purpose of this systematic
review is to examine the evidence from randomised controlled trials
on the benefit of therapeutic exercise interventions in preventing
and/or minimising upper limb morbidity due to breast cancer
treatment. IMPLICATIONS/CONCLUSIONS: Results of the review
S13
will be presented and the clinical implications of findings discussed.
KEYWORDS: breast cancer; exercise; upper limb; physical therapy.
FUNDING ACKNOWLEDGEMENTS: Margaret McNeely is funded
by a studentship from the Alberta Heritage Foundation for Medical
Research.
Focused Symposium Contribution
464 Monday 4 June 10:45
VCEC Ballroom A
This contribution is part of Focused Symposium “BREAST CANCER
AND EXERCISE” number 243
EXERCISE INTERVENTIONS IN BREAST CANCER PATIENTS:
A META-ANALYSIS
Campbell K; University of Alberta
LEARNING OBJECTIVES: The primary purpose of this systematic
review is: 1) to examine the available evidence concerning the effect
of exercise in women with breast cancer and 2) to understand the
implications for clinical practice. SUMMARY: Margaret L. McNeely,
Kristin L. Campbell, Brian H. Rowe, Terry P. Klassen, John R.
Mackey, Kerry S. Courneya. A systematic review of randomized
controlled trials of exercise interventions in women with breast
cancer was completed. The literature search included: Cochrane
Registry of Clinical Trials, MEDLINE, EMBASE, CINAHL, PsychInfo
and Cancerlit in addition to conference proceedings, clinical practice
guidelines, and other grey literature resources. Studies were required
to be randomized controlled trials that examined exercise in women
with breast cancer. A comprehensive search identified 140 papers,
of which 14 were considered potentially relevant. Despite significant
heterogeneity and relatively small sample sizes, the point estimates
in terms of exercise benefits for all outcomes were positive even when
statistical significance was not achieved. Exercise led to significant
improvements in quality of life as assessed by the Functional
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
fatigue. IMPLICATIONS/CONCLUSIONS: This preliminary evidence
suggests that exercise is an effective intervention to improve
quality of life, cardiorespiratory fitness, physical functioning, and
fatigue. Physical therapists could be playing a major role in the
rehabilitation of women living with breast cancer, not only in providing
treatment but also by contributing to the knowledge base underlying
those treatments through rigorous and carefully conducted clinical
research. KEYWORDS: cancer, physical activity, aerobic fitness,
exercise, quality of life. FUNDING ACKNOWLEDGEMENTS: KL
Campbell and ML McNeely are supported by Studentships from the
Alberta Heritage Foundation for Medical Research
Focused Symposium Contribution
266 Monday 4 June 10:45
VCEC Ballroom B & C
This contribution is part of Focused Symposium “MOVING ELEC-
TROPHYSICAL AGENTS FORWARD IN AN EVIDENCE-BASED
PRACTICE ENVIRONMENT” number 246
RESEARCH EVIDENCE FOR WOUND HEALING WITH LOW
FREQUENCY ULTRASOUND
Kloth L; Marquette University, Milwaukee, USA
LEARNING OBJECTIVES: 1. Base on research evidence, compare
and contrast similarities and differences between traditional high
frequency and low frequency ultrasound (US). 2. Discuss indications,
advantages and mechanisms of 25 kHz and 40 kHz US in promoting
chronic wound healing and the need for additional research. 3.
Illustrate wounds of patients for which low frequency US was used
to facilitate tissue repair. SUMMARY: Traditional or high frequency (1
and 3 MHz) US has a long history of use by physical therapists
S14
for the treatment of a variety of musculo-skeletal afflictions. The
evidence supporting the use of high frequency US to promote
healing of recalcitrant wounds is inconclusive. It seems reasonable
to assume that through the properties of cavitation and acoustic
streaming, low frequency US has been shown to promote healing
of intractable chronic wounds by speeding debridement of necrotic
tissue, enhance enzymatic fibrinolysis, remove bacteria, reduce
bacterial viability in biofilms and improve perfusion. Using saline
coupling, US at kHz frequencies may be delivered in contact
or non-contact with wound tissues. Indications, contraindications,
advantages and mechanisms for the use of low frequency US
to augment wound healing will be presented as an example of
an EPA intervention that has had a delayed impact on clinical
practice. IMPLICATIONS/CONCLUSIONS: The use of US at kHz
frequencies has been shown in vitro to enhance cellular processes
involved in soft tissue repair and to promote wound healing
in a limited number of clinical trials. Additional basic science
research is needed to clearly identify mechanisms by which low
frequency US promotes wound healing. More clinical research is also
needed to determine how chronic wound healing is affected by US
treatments with different low frequencies. Are clinical observation and
positive treatment outcomes alone, adequate justification for treating
patients with existing and new EPA technologies? KEYWORDS:
Low frequency ultrasound, wound debridement, wound healing.
FUNDING ACKNOWLEDGEMENTS: Funding not available
Focused Symposium Contribution
305 Monday 4 June 10:45
VCEC Ballroom B & C
This contribution is part of Focused Symposium “MOVING ELEC-
TROPHYSICAL AGENTS FORWARD IN AN EVIDENCE-BASED
PRACTICE ENVIRONMENT” number 246
RESEARCH-BASED EVIDENCE AND ELECTROPHYSICAL
AGENTS
Robertson V; University of Newcastle, Newcastle, New South
Wales, Australia
LEARNING OBJECTIVES: 1. To explore the types of evidence
relevant to justifying using EPAs. 2. To investigate how evidence
can support using EPAs. 3. To investigate the requirements of
users evaluating EPAs. SUMMARY: Evidence of the effectiveness
of clinical interventions is integral to ethical practice. Dismissals of
some uses of electrophysical agents (EPAs) as not supported by
evidence from randomized controlled trials indicates an overly narrow
interpretation of ‘evidence’. This abstract will outline two dimensions
of evidence and other requirements necessary for users of EPAs
in an evidence-based environment. Energy forms commonly applied
clinically have well described physical properties. For example, many
effects of electrical currents depend upon the pulse duration and
frequency. Similarly, if a type of energy cannot pass through the
skin barrier in sufficient quantities and to a sufficient depth its
bioeffects may be very limited. Scientific knowledge like this is the
first type of evidence adduced when evaluating EPAs. Contributing
sciences include chemistry, biophysics, microbiology and physiology.
Future contributions will come as newer sciences develop alternative
methods of investigation. Clinical evidence is the second type of
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
WCPT 2007, Focused Symposium Contributions
mobilising or stretching requires little more than anecdotal evidence
for support. It is a very minor component of a treatment, has
few opportunity costs, is cheap, requires minimal user skills and
introduces few risks. By contrast, requiring a child to wear a visible
electrical stimulator for hours per day may have a considerable impact
on their life. The evidence required to justify this has clearly to
be considerably more convincing. IMPLICATIONS/CONCLUSIONS:
This abstract has outlined 2 of the dimensions of evidence:
scientific/clinical and strength of evidence. Moving the use of EPAs
forwards in an evidence-based practice environment requires more.
Clinicians must use science and clinical research critically and
effectively. They need a sufficient depth of scientific knowledge and
of the contributions of different clinical research methods. They must
also be able to balance different types of evidence when insufficient
is available or it’s contradictory. For example, contraindications to
using therapeutic ultrasound over epiphyses or electrical current over
a pregnant uterus are typically based on historical evidence of a
questionnable clinical relevance. Above all moving forwards requires
being able to change practice in response to new evidence. This
is possibly the greatest barrier most of us face in an evidence-
based environment. KEYWORDS: Electrophysical agents, evidence,
research. FUNDING ACKNOWLEDGEMENTS: None.
Focused Symposium Contribution
327 Monday 4 June 10:45
VCEC Ballroom B & C
This contribution is part of Focused Symposium “MOVING ELEC-
TROPHYSICAL AGENTS FORWARD IN AN EVIDENCE-BASED
PRACTICE ENVIRONMENT” number 246
ELECTROPHYSICAL AGENTS: THE CHALLENGE FOR
EDUCATION
Baxter D; School of Physiotherapy, University of Otago, New Zealand
LEARNING OBJECTIVES: 1.to explore the salient issues in teaching
electrophysical agents (EPA) 2.to investigate how evidence can be
incorporated to support teaching of EPAs; 3.to propose models for
effective teaching of EPAs. SUMMARY: Teaching of electrophysical
agents presented specific challenges for educators, including the
need to integrate knowledge from diverse fields (biophysics), variable
levels of evidence to support applications, and changing clinical
practice. In providing students with the requisite skills to be competent
as ‘research-enabled’ practitioner, it is important that evidence
is seen in the widest sense to underpin teaching in the EPAs:
i.e. at every level appropriate evidence should be provided to
inform the biophysical basis of specific modalities, principles of
application, and contraindications, as well as the indications for
treatment based on evidence of effectiveness. In the latter case,
learning should provide students with the basis to appreciate the
difference between internal and external validity in published studies.
IMPLICATIONS/CONCLUSIONS: Students need to be research-
enabled practitioners if they are to practise autonomously. For this,
they need to develop a knowledge of the scientific basis of treatment
with EPAs, and of the relative contributions of different types and
levels of evidence. KEYWORDS: Electrophysical agents, Evidence,
Teaching. FUNDING ACKNOWLEDGEMENTS: New Zealand Centre
for Physiotherapy Research
Focused Symposium Contributions
Focused Symposium Contribution
326 Monday 4 June 14:00
VCEC Ballroom B & C
This contribution is part of Focused Symposium “ADVANCES IN PUL-
MONARY REHABILITATION: PERIPHERAL AND RESPIRATORY
MUSCLE ADAPTATIONS” number 298
FATIGUE, INJURY AND TRAINING OF THE INSPIRATORY
MUSCLES IN COPD
Reid W; Associate Professor and Co-ordinator of Research
Graduate Programs, School of Rehabilitation Sciences, University
of British Columbia
LEARNING OBJECTIVES: Following this session, the participant
will be able to: 1. describe evidence supporting the benefit of
inspiratory muscles training in COPD; 2. describe evidence of
fatigue and injury of the inspiratory muscles in COPD; 3. outline
training precautions and guidelines for inspiratory muscle training for
people with COPD. SUMMARY: Because many generic and disease
specific factors contribute to skeletal muscle dysfunction in COPD,
physiotherapists need to consider these injury promoting factors in
order to prescribe exercise that has an effective training stimulus
but minimizes injury. Inspiratory muscle training can reduce dyspnea
and improve exercise tolerance but the literature has provided
conflicting results. The first part of the presentation will provide
evidence from recent systematic reviews that support the benefit
of inspiratory muscle training on inspiratory muscle strength and
endurance, exercise capacity, dyspnea and quality of life for adults
with chronic obstructive pulmonary disease (COPD). We performed
a systematic review of the literature according to the Cochrane
Collaboration protocol using Medline and CINAHL databases. We
compared inspiratory muscle training versus sham or no intervention;
low versus high intensity inspiratory muscle training; and two different
types of training devices. Meta-analyses revealed that targeted
resistive or threshold inspiratory muscle training improved inspiratory
muscle strength and endurance, exercise capacity, and dyspnea
compared to sham training whereas inspiratory muscle training
without a target or threshold trainer did not show improvement in
these variables. There was no conclusive evidence supporting the
benefit of inspiratory muscle training on quality of life measures. The
second part of the presentation will present evidence of diaphragm
injury in people with airflow obstruction and those who died with a
diagnosis of COPD. Morphometric analysis of hematoxylin and eosin
stained diaphragm cross-sections showed that the percent cross-
sectional area (CSA) of abnormal muscle was 17.6% in patients
going for thoracotomy and this CSA was significantly correlated to
airflow limitation. Post-mortem analysis of diaphragm cross-sections
revealed a CSA of connective tissue to be increased in people with
a diagnosis of COPD (24.2% versus 18.6%, respectively, in those
with and without a diagnosis of COPD). The percentage of abnormal
or injured diaphragm fibres was 28.4% versus 12.0%, respectively,
in those with and without a diagnosis of COPD. These structural
changes have significant clinical implications because animal models
have demonstrated that structural changes of a lesser magnitude
result in force losses that can be 5 to 7-fold greater than the
CSA of abnormal muscle. The last part of the presentation will
outline an integrative approach to exercise prescription that outlines
guidelines and precautions to optimize outcomes of inspiratory
muscle training while minimizing the potential for undue fatigue
and muscle injury. IMPLICATIONS/CONCLUSIONS: Inspiratory
muscle training is effective but underutilized by physiotherapists
who prescribe exercise to people with stable COPD. Utilizing the
appropriate training device, careful monitoring and progression of
training intensity will ensure effective training while minimizing
untoward responses. KEYWORDS: Respiratory, Muscles, Exercise.
FUNDING ACKNOWLEDGEMENTS: British Columbia Lung Associ-
ation, Ontario Respiratory Care Society
S15
Focused Symposium Contribution
431 Monday 4 June 14:00
VCEC Ballroom B & C
This contribution is part of Focused Symposium “ADVANCES IN PUL-
MONARY REHABILITATION: PERIPHERAL AND RESPIRATORY
MUSCLE ADAPTATIONS” number 298
REHABILITATION OF COPD PATIENTS: THE CHALLENGE OF
ADJUSTING THE SAILS
Gosselink R; Respiratory Rehabilitation and Respiratory Division,
University Hospitals, and Department of Rehabilitation Sciences,
Faculty of Kinesiology and Rehabilitation Sciences, Katholieke
Universiteit Leuven, Leuven, Belgium
LEARNING OBJECTIVES: Give insights and tools in the assessment
of COPD patients. SUMMARY: Rehabilitation programs should be
part of a larger decision tree including optimal medical therapy,
and non-pharmacological treatment options. The current programs
improve health related quality of life and exercise tolerance to
a greater extent than any other intervention currently available
for COPD patients. Pulmonary rehabilitation reduces health care
utilization in patients with excessive utilization of health care
resources. It has become clearer that patients at both ends of the
disease spectrum can be good candidates for properly designed
rehabilitation programs. The presence of muscle weakness is an
indicator of favourable outcome. Psychosocial factors and disease
severity seem less important factors in the prognosis of outcome
of (multidisciplinary) pulmonary rehabilitation. Future research in
rehabilitation should focus on further fine-tuning the rehabilitation
programs for individual patients. However the overwhelming evidence
currently available is clearly sufficient for regulatory authorities to
conclude that there is an evidence base for reimbursement for pul-
monary rehabilitation. IMPLICATIONS/CONCLUSIONS: Pulmonary
rehabilitation programs improve health related quality of life and
exercise tolerance to a greater extent than any other intervention
currently available for COPD patients. Patent selection and tailoring
programs to make these benefits as large and as long-lasting
as possible remains a major challenge. KEYWORDS: Pulmonary
rehabilitation, prognosis, muscle weakness, psychosocial factors,
COPD. FUNDING ACKNOWLEDGEMENTS: None.
Focused Symposium Contribution
469 Monday 4 June 14:00
VCEC Ballroom B & C
This contribution is part of Focused Symposium “ADVANCES IN PUL-
MONARY REHABILITATION: PERIPHERAL AND RESPIRATORY
MUSCLE ADAPTATIONS” number 298
PERIPHERAL MUSCLE ATROPHY DEVELOPMENT IN CHRONIC
OBSTRUCTIVE PULMONARY DISEASE
Debigare R; Université Laval, Faculté de Médecine, Département
de Réadaptation, Québec, Canada
LEARNING OBJECTIVES: This presentation should demonstrate
the significant clinical consequences of peripheral muscle atrophy in
COPD patients and describe some biochemical mechanisms related
to its initiation and development. In addition, exercise will presented
as a potential tool to stop or slow down muscle atrophy development.
SUMMARY: Among the clinical consequences of chronic obstructive
pulmonary disease (COPD), peripheral muscle atrophy is definitely
an important issue. As the pulmonary disease progresses, afflicted
patients will loose as much as 30% of their muscle mass impairing
their functional status as well as their quality of life. More importantly
peripheral muscle atrophy is responsible for an increased risk of
mortality independently of the lung disease. Muscle mass is a
tight balance between protein synthesis and degradation. Hints
regarding hypertrophying and atrophying signalling are accumulating
in different catabolic models but are still obscure in COPD. In
general, protein catabolism is predominant and muscle atrophy will
S16
develop progressively. The Ubiquitin-Proteasome system, an ATP-
dependant proteolytic system, is degrading contractile proteins in
muscle tissue. Its proteolytic activity thoroughly increases during
catabolic conditions. There are evidences that it would be also
the case in peripheral muscle of patients with COPD. Precise
factors initiating muscle wasting in COPD are still unknown. Using
different models such as cell culture, animal models and human
muscle biopsies, we are currently exploring plausible causes in our
laboratories including hypoxia, inflammation and oxidative stress.
IMPLICATIONS/CONCLUSIONS: Because of its clinical implication
(morbidity and mortality) in several chronic diseases, peripheral
muscle wasting is an important problem to study. It is based on
accurate knowledge of the biochemical mechanisms underlying
peripheral muscle atrophy initiation and development that the medical
community will be in an advantageous position to design and
implement efficient therapies aimed at stopping or slowing down the
progression of muscle wasting in patients with COPD. KEYWORDS:
Muscle atrophy, COPD, proteolysis, proteasome, inflammation, hy-
poxia, oxidative stress. FUNDING ACKNOWLEDGEMENTS: None.
Focused Symposium Contribution
459 Tuesday 5 June 09:00
VCEC Ballroom B & C
This contribution is part of Focused Symposium “FES THERAPY
AFTER SCI: FUNCTIONAL, PHYSIOLOGICAL, PSYCHOSOCIAL,
BIOENGINEERING OUTCOMES” number 417
FES APPLICATIONS IN PEDIATRIC SCI AND PSYCHOSOCIAL
ASPECTS OF FES
Johnston T; Shriners Hospitals for Children, Philadelphia, PA
LEARNING OBJECTIVES: 1) Describe the unique aspects of
children in relation to FES use. 2) Discuss past and current research
with FES for children with SCI. 3) Discuss the psychosocial aspects of
FES use for children and adults. SUMMARY: The majority of the work
with functional electrical stimulation (FES) for individuals with spinal
cord injury (SCI) has focused on adults. However, children with SCI
can also benefit from these applications and perhaps have greater
potential to succeed with FES due to their desire to move, explore,
and learn. In addition as children’s systems are still developing, there
is potentially greater neuroplasticity of the nervous system, providing
unique opportunities for children. Research on FES for children with
SCI has examined percutaneous and implanted FES systems for
standing and walking, hand function, and bladder and bowel function.
Implanted systems require accommodation for growth as children as
young as 7 years old have participated in these studies. Growth and
electrode responses are continuing to be monitored until maturity
is reached. More recently, surface stimulation has been applied
for FES cycling for children with SCI, as a cycle is now available
to accommodate the size of children. Research in this area is
ongoing to examine the potential for cardiovascular, musculoskeletal,
and neurological changes to determine if improvements occur in
children. Literature reports success in these areas with adults, but
children have been excluded. An additional aspect of FES is its
psychosocial benefits for children and adults with SCI. Studies have
reported improvements in the ability to interact with others and
the environment. Increased independence seen with FES can lead
to increased self-esteem and an overall sense of feeling good.
Users of FES systems for standing have reported that they enjoy
looking eye to eye with people and those with FES systems for
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
WCPT 2007, Focused Symposium Contributions
are important to understand to ensure that we are meeting the
functional and psychosocial needs of the users of FES. KEYWORDS:
pediatrics, FES, psychosocial. FUNDING ACKNOWLEDGEMENTS:
These studies have been funded by Shriners Hospitals for Children,
Grants 8530 and 8540.
Focused Symposium Contribution
511 Tuesday 5 June 09:00
VCEC Ballroom B & C
This contribution is part of Focused Symposium “FES THERAPY
AFTER SCI: FUNCTIONAL, PHYSIOLOGICAL, PSYCHOSOCIAL,
BIOENGINEERING OUTCOMES” number 417
FUNCTIONAL RESPONSE TO FES GAIT TRAINING AND
NEUROPROSTHESIS AFTER SCI
Daly J; Case Western Reserve Un and DVA Cleveland Medical
Center
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
the limitations of these system. 3) Appreciate how differences in
patient characteristics help determine the most suitable form of FES
SUMMARY: Loss of mobility and walking after spinal cord injury (SCI)
is debilitating from a physical and emotional standpoint. Functional
electrical stimulation (FES) has shown promise for restoration of
mobility for both motor incomplete and complete SCI. Several
research groups have studied the feasibility of using FES for gait
training, finding that FES with surface stimulation can be a practical
approach for training sessions and when few channels of stimulation
are required. Response to surface FES gait training has shown
promise for those with motor incomplete SCI. According to measures
of spasticity (pendulum test), and walking speed, FES + treadmill
showed greater absolute gains versus other gait training methods.
For those with complete SCI, one promising approach is the use
implanted FES technology as a prosthetic device. In the 1980’s,
one research team demonstrated that a multi-channel system (up to
12 channels per limb) could be coordinated in correct sequencing
and timing to provide stance and swing phase gait components,
for those with complete SCI, that closely resembled normal gait.
More recently, a more compact system of 8 or more channels per
limb showed the capability of providing mobility functions such as
transfers; standing; one-handed reaching; forward, side, and back
stepping; and stair ascent and descent. The implanted components
of this system include the intramuscular electrodes and a multi-
channel receiver-stimulator, a passive pacemaker-like device that
receives power and command signals from a wearable external
control unit. In an effort to reduce the energy cost of FES-driven
gait, researchers have investigated the hybrid system of FES and
bracing. At slow speeds, the hybrid system requires less energy
cost than does bracing alone or FES alone. For long-distance
walking this is a promising finding. IMPLICATIONS/CONCLUSIONS:
For long-term clinical applications in complete SCI, implanted
systems provide advantages over surface FES systems, including
reliability, repeatability, convenience, cosmesis, and maintenance.
For individuals with incomplete SCI, surface systems my provide
improved mobility without the invasiveness of the implanted systems.
KEYWORDS: Spinal Cord Injury, Gait, Mobility, Functional Electrical
Stimulation. FUNDING ACKNOWLEDGEMENTS: Department of
Veterans Affairs, Rehabilitation Research and Development Service;
National Institutes of Health; Department of Defense
Focused Symposium Contributions
Focused Symposium Contribution
521 Tuesday 5 June 09:00
VCEC Ballroom B & C
This contribution is part of Focused Symposium “FES THERAPY
AFTER SCI: FUNCTIONAL, PHYSIOLOGICAL, PSYCHOSOCIAL,
BIOENGINEERING OUTCOMES” number 417
NEW DEVELOPMENTS IN FES TECHNOLOGY FOR SCI
REHABILITATION
Prochazka A; Centre for Neuroscience, University of Alberta,
Edmonton, AB, Canada
LEARNING OBJECTIVES: Following this presentation, participants
will be able to: 1) Discuss the applications of FES for upper extremity,
lower extremity, respiratory and bladder function. 2) Appreciate the
possible role of implanted spinal cord stimulators in the restoration
of movement after SCI 3) Discuss the role of BIONS and other
neural prostheses in restoration of functional movement. 4) Discuss
the role of automated, FES-assisted exercise therapy. SUMMARY:
While neural regeneration after spinal cord injury (SCI) will likely
be possible at some time in the future, it is also likely that
some functions will not be fully restored. Neural prostheses may
be used to restore functions lost due to damage of the spinal
cord. In addition to providing or augmenting limb movement, neural
prostheses can be used to restore high priority functions such
as bladder control and respiration. Epidural spinal cord stimulators
have been shown to improve walking function in individuals with
SCI, and in animal models of SCI, stimulators implanted directly
into the spinal cord can control the activation of lower extremity
muscles. Improvement in bladder and bowel function is a high
priority for many SCI people. In the last five years a number of
biomedical engineering developments have occurred that will likely
lead to significant advances in the rehabilitation and evaluation of
quadriplegia and hemiplegia. Three new surface stimulators have
recently entered the North American marketplace: the H200 hand
stimulator and the Odstock and WalkAide footdrop stimulators.
Several groups are studying the efficacy of FES-assisted intensive
exercise therapy for hand function. A variety of instrumented exercise
workstations and robotically-assisted devices are in clinical trials. At
least three new types of implantable neural prostheses are at various
stages of testing: the Bion microstimulator, the Neurodan footdrop
stimulator and a new passive neural prosthesis, the “Stimulus
Router.” The applications include shoulder subluxation, hand function,
incontinence and footdrop. Biomechanical evaluation devices are
gradually replacing qualitative evaluation of spasticity and motor
function in ADL. IMPLICATIONS/CONCLUSIONS: It seems that
the long-awaited emergence and availability of new technologies
in rehabilitation is now fully underway, most significantly in the
commercial arena. New FES garments, and the emergence of
automated exercise workstations and devices that quantify outcomes
is changing the way motor rehabilitation is performed and assessed.
More must be known about how implanted neural prostheses interact
with the nervous system over the long term. KEYWORDS: Functional
electrical stimulation, neural prostheses, FES-assisted exercise ther-
apy, bladder control. FUNDING ACKNOWLEDGEMENTS: Funded
by ISRT, NIH, CIHR and AHFMR
S17
Focused Symposium Contribution
451 Tuesday 5 June 14:00
VCEC Ballroom B & C
This contribution is part of Focused Symposium “PROMOTING EF-
FECTIVE INTERVENTIONS FOR UPPER EXTREMITY RECOVERY
IN NEUROLOGICAL CONDITIONS.” number 287
RETHINKING REHABILITATION AND RECOVERY – THE
BRAIN-BEHAVIOR CONNECTION
Winstein C; University of Southern California, Los Angeles, United
States
LEARNING OBJECTIVES: 1. Critique current treatment protocols in
neurologic rehabilitation for scientific rationale pertaining to intensity,
duration, and contents. 2. Evaluate a new conceptualization of the
problem of stroke-hemiparesis that incorporates the important con-
structs of skill, capacity, and motivation. 3. Assess the Accelerated
Skill Acquisition Protocol (ASAP) which incorporates principles of skill
development derived from the fields of psychological science, social-
cognitive neuroscience, and exercise/movement science. 4. Review
real case examples that capture, patient-therapist collaboration, self-
management and problem-solving, and the promotion of self-efficacy
for persistent and sustainable outcomes. SUMMARY: What critical
ingredient binds together, brain plasticity, recovery, and function?
Significant growth and interest in the field of rehabilitation medicine
has been fueled in part by advances in rehabilitation science within
an interdisciplinary research model. More importantly, research in
rehabilitation has witnessed the application of the scientific method to
specific functional problems such as recovery of upper extremity (UE)
use after stroke hemiparesis. Recently, this translational research
has spawned various protocol based treatments, for example, to
enable use of the hemiparetic UE in adults with sub-acute stroke.
However, if rehabilitation medicine is to join the ranks of other
evidence-based medical and pharmaceutical practices, objective
treatment protocols will become a necessary component of valid
efficacy and effectiveness research. The development of specific and
objective rehabilitation treatment protocols will be a clear signal of
progress in the field of rehabilitation medicine. At present, the majority
of published protocols in neurologic rehabilitation lack an explicit
scientific rationale for the intensity, duration, and most importantly,
the contents (e.g., task-specific versus muscle-specific) of training
within the rehabilitation treatments. Without an explicit rationale (or
even hypothesis), the precise parameters of training for a given
rehabilitation treatment can take on a mythical quality with hidden
meaning at worst, and lead to “blind” following at best. This process
undermines scientific enquiry and in some cases tends to hinder the
development of alternative and innovative approaches. For example,
why is the signature constraint-induced therapy (CIT) protocol of 6
h/day (60 h total) with one-on one supervised training for no less
than a 2-week period “optimal” for reversing learned non-use? How
important is the “constraint” within a CIT training protocol? These
rhetorical questions provide the starting point for the development
of a new conceptualization of the problem of stroke-hemiparesis
that incorporates the important constructs of skill, capacity, and
motivation. My presentation will describe this new conceptual model
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)
S18
Focused Symposium Contribution
460 Tuesday 5 June 14:00
VCEC Ballroom B & C
This contribution is part of Focused Symposium “PROMOTING EF-
FECTIVE INTERVENTIONS FOR UPPER EXTREMITY RECOVERY
IN NEUROLOGICAL CONDITIONS.” number 287
EVIDENCE SUPPORTING FOCUSED UPPER LIMB TREATMENT
TECHNIQUES IN STROKE REHABILITATION
Wolf S; Emory University School of Medicine, Atlanta, Georgia,
United States
LEARNING OBJECTIVES: 1. To understand how findings from
animal studies contribute to the evidence for effective upper
limb rehabilitation among patients with stroke. 2. To differentiate
between training approaches based upon repetitive use of the more
affected upper limb of patients with stroke and determine their
applicability. 3. To familiarize participants with use of contemporary
technologies such as TMS and neuroimaging as vehicles that provide
evidence to expose mechanisms contributing to improvement in
clinical outcomes from focused upper limb treatment in patients
with stroke. SUMMARY: Investigations in animal models of stroke
have demonstrated that repetitive use that challenges problem
solving can lead to anatomical and physiological evidence of cortical
reorganization. Findings suggestng these types of improvement have
been observed among patients with acute, sub-acute and chronic
stroke who have undergone constraint induced movement therapy,
functional training or strengthening programs. This presentation
provides evidence from the EXCITE Trial and other studies to
demonstrate the clinical effectiveness of these forms of training
and to relate these improvements to measures of cortical plas-
ticity obtained through transcranial magnetic stimulation and fMRI
studies. IMPLICATIONS/CONCLUSIONS: Efforts to define patient
criteria that predict persistent improvement in upper limb function
following stroke is a critical issue in neurorehabilitation.Identifying
clinical approaches, such as constraint induced movement therapy,
functional training and strengthening exercises, and defining the
attributes of those patients who best benefit from these interventions
afford physical therapists the opportunity to optimally target treatment
approaches. The interface between tools to assess elements of
neuroplasticity and interventions yielding clinical improvement forms
the cornerstone of linking the art and science underlying stroke
neurorehabilitation. KEYWORDS: cerebrovascular accident, hemi-
plegia, upper limb, constraint induced movement therapy, forced use,
strengthening exercise, transcranial magnetic stimulation, functional
magnetic resonance imaging. FUNDING ACKNOWLEDGEMENTS:
Work described in this presentation was supported in part from NIH
Grants R01 HD37606 and HD 40984, National Center for Medical
Rehabilitation Research of the National Institute of Child Health and
Human Development.
Focused Symposium Contribution
485 Tuesday 5 June 14:00
VCEC Ballroom B & C
This contribution is part of Focused Symposium “PROMOTING EF-
FECTIVE INTERVENTIONS FOR UPPER EXTREMITY RECOVERY
IN NEUROLOGICAL CONDITIONS.” number 287
COMPENSATION AND RECOVERY OF REACHING IN PATIENTS
WITH STROKE
Levin M; School of Physical and Occupational Therapy, McGill
University, Montreal, Canada
LEARNING OBJECTIVES: 1) to understand how compensatory
movements of the trunk are used to assist in the accomplishment
of reaching and grasping in patients with stroke; 2) to evaluate
the effectiveness of a treatment intervention aimed at diminishing
motor compensations of the trunk on reaching and grasping in
patients with stroke. SUMMARY: Trunk anterior displacement is a
compensatory movement used by patients with hemiparesis for arm
WCPT 2007, Focused Symposium Contributions
transport during arm swinging, reaching and for hand orientation
during grasping. Despite widespread use of motor compensations,
studies of therapeutic effectiveness focus on task accomplishments
as outcome measures with less consideration of how functional
gains are achieved: by recovery of lost movement elements or by
increased use of compensations. Since increased compensation may
potentially limit recovery of lost movement elements, it is essential
to describe effective training paradigms that reduce compensations.
This presentation will review how the trunk is used to compensate for
distal motor control deficits. A model of disordered motor control for
reaching will be presented. Results will be also presented of a double-
blind randomized control trial of a therapist-supervised home program
(3x/wk, 5 weeks) in 30 patients with chronic hemiparesis stratified
by arm impairment level (Fugl-Meyer). The intervention group
(TR) received progressive object-related reach-to-grasp training with
prevention of trunk movements. The control group (C) practised
tasks without trunk restraint. Main outcome measures were upper
limb impairment (Fugl-Meyer Arm Section) and function (TEMPA)
and movement kinematics (trunk displacement, elbow extension;
Optotrak, 10 trials) of a reach-to-grasp movement. Evaluations were
repeated before, immediately and 1 month post-intervention by blind
evaluators. TR training led to greater improvements in impairment
and function compared to C. Improvements were accompanied
by increased active joint range and were greater in initially more
severe patients. In these patients, TR decreased trunk movement
and increased elbow extension while C had opposite effects
(increased compensatory movements). In TR, changes in arm
function were correlated with changes in arm and trunk kinematics.
IMPLICATIONS/CONCLUSIONS: Basic motor control research has
described mechanisms by which deficits in arm motor function
may be compensated by trunk movements. Evidence suggests that
interventions aimed at arm motor recovery should be tailored to arm
impairment severity with particular attention to controlling excessive
trunk movements if the goal is to improve arm movement quality.
KEYWORDS: Knowledge translation, motor control, motor learning,
upper limb rehabilitation, treatment effectiveness, evidence-based
practice. FUNDING ACKNOWLEDGEMENTS: Canadian Institutes of
Health Research (CIHR), National Science and Engineering Council
of Canada (NSERC)
Focused Symposium Contribution
361 Tuesday 5 June 16:15
VCEC Ballroom B & C
This contribution is part of Focused Symposium “CONSERVATIVE
TREATMENT OF PATELLOFEMORAL PAIN SYNDROME” num-
ber 209
ABNORMAL LOWER EXTREMITY MECHANICS AND
PATELLOFEMORAL DYSFUNCTION: IMPLICATIONS FOR
TREATMENT
Powers C; University of Southern California
LEARNING OBJECTIVES: 1) Describe the influence of abnormal
lower extremity mechanics on patellofemoral joint dysfunction. 2)
Plan appropriate treatment interventions for the patellofemoral joint
based on a dynamic assessment of the lower extremity. SUMMARY:
Patellofemoral pain (PFP) is recognized as being one of the most
common disorders of the lower extremity. Despite its high prevalence
however, the clinical diagnosis and treatment of this condition
remains vague and highly controversial. The premise behind most
treatment approaches is that PFP is the result of abnormal patellar
tracking and/or patella malalignment. Given as such, interventions
typically focus on the joint itself and have traditionally included
vastus medialis oblique (VMO) strengthening, taping, bracing, soft
tissue mobilization, and patellar mobilization. More recently, it has
been recognized that the patellofemoral joint and therefore PFP
can be influenced by the interaction of the segments of the lower
extremity. For example, abnormal motions of the tibia and femur
Focused Symposium Contributions
in the transverse and frontal planes can have a substantial effect
on patellofemoral joint mechanics. In particular, internal rotation
of the femur and valgus at the knee (achieved through thigh
adduction and/or tibial adduction) can increase the lateral forces
acting on the patella. Although structural deformities can lead to
alignment abnormalities (i.e. femoral anteversion), in many cases,
abnormal lower extremity kinematics can be observed through a
dynamic functional assessment. IMPLICATIONS/CONCLUSIONS:
There is growing research and clinical support for the concept
that dynamic lower limb alignment can be achieved through
strengthening and improving neuromuscular control. With this in
mind, interventions aimed at controlling hip and pelvis motion
(proximal stability) and ankle/foot motion (distal stability) may be
warranted and should be considered in this population. However,
the necessity for such interventions should be determined by a
thorough biomechanical/functional evaluation as not all patients with
PFP demonstrate lower limb abnormalities and/or lack of dynamic
control. By addressing all factors that may influence patellofemoral
joint mechanics, better long term treatment success and prevention
of PFP can likely be achieved. KEYWORDS: Patellofemoral joint;
Biomechanics; Intervention; Lower extremity kinematics. FUNDING
ACKNOWLEDGEMENTS: None.
Focused Symposium Contribution
522 Tuesday 5 June 16:15
VCEC Ballroom B & C
This contribution is part of Focused Symposium “CONSERVATIVE
TREATMENT OF PATELLOFEMORAL PAIN SYNDROME” num-
ber 209
HIP AND VASTI ACTIVATION IN THE MANAGEMENT OF PFPS
Crossley K; University of Melbourne, Australia
LEARNING OBJECTIVES: After attending the presentation, the
participant will: (a) Be aware of the scientific and clinical rationale
for hip and vasti activation in the development and treatment of
patellofemoral pain. (b) Understand the scientific evidence related to
hip and vasti retraining in the management of patellofemoral pain.
SUMMARY: The vastus medialis obliquus (VMO) has long been
considered to be implicated in patellofemoral joint dysfunction and
pain. This is mostly due to its anatomy and function as a medial
stabilizer of the patellofemoral joint and the clinical observation
of its wasting in individuals with anterior knee pain. Therefore,
many physical therapy interventions have focused on training the
VMO as part of the rehabilitation. Current research has identified
a relationship between vasti dysfunction and patellofemoral pain,
particularly the imbalance in the activation patterns of the VMO
and the vastus lateralis (VL). However, conjecture remains over the
relationship between vasti dysfunction and patellofemoral pain. The
disparity in the evidence may be attributed to a number of factors,
but the most likely explanation is that the aetiology of patellofemoral
pain is multifactorial. Individuals with vasti dysfunction comprise
a subgroup in the entire cohort of individuals with patellofemoral
pain. While generalized quadriceps strengthening can be effective
in reducing patellofemoral pain, the subset on individuals with
vasti dysfunction may require specific training or retraining of the
vasti. This is especially the scenario for those with recalcitrant
or recurrent symptoms. Vasti re-training has been shown to be
efficacious in the management of patellofemoral joint dysfunction
when combined with other therapies (patellar taping, hip muscle
training and mobilisation). Furthermore, this combined intervention
can improve the onset of VMO activity. While traditionally, the major
clinical and research interest has been targeted to the local knee
muscles of the tibiofemoral and patellofemoral joints, it has long
been recognized by clinicians that hip muscle function (strength or
co-ordination) may be impaired in individuals with patellofemoral
pain. This clinical observation has sparked more recent research
interest in pelvis and hip muscle contributions to patellofemoral
pain. Hip muscles (particularly the abductors and external rotators)
S19
play a considerable role in maintaining an optimal lower limb
alignment during weight bearing activities. Reduced strength or
neuromotor control of these muscles may be associated with an
increase in hip internal rotation and adduction, with deleterious
consequences at the tibiofemoral and patellofemoral joints. Current
research has indicated that the activity of the hip muscles may
be compromised in individuals with patellofemoral pain. Similar to
vasti muscle dysfunction, individuals with hip muscle dysfunction
form a subgroup on those with patellofemoral pain. Further research
has aimed at identifying individuals with hip muscle dysfunction.
Combined interventions that have incorporated hip muscle retraining
have been shown to be effective and efficacious for patellofemoral
pain. However, as this is an emerging area of research, further
scientific evidence is required to confirm the role of hip muscle
dysfunction in the development and management of patellofemoral
pain. IMPLICATIONS/CONCLUSIONS: Dysfunction of the vasti
and/or the hip muscles may result from or contribute to PFPS and
should be evaluated and addressed as part of a comprehensive
rehabilitation. KEYWORDS: quadriceps, vasti, hip, patellofemoral
pain. FUNDING ACKNOWLEDGEMENTS: National Health and
Medical Research Council (Australia)
Focused Symposium Contribution
527 Tuesday 5 June 16:15
VCEC Ballroom B & C
This contribution is part of Focused Symposium “CONSERVATIVE
TREATMENT OF PATELLOFEMORAL PAIN SYNDROME” num-
ber 209
MUSCLE STRENGTH IN PATELLOFEMORAL PAIN SYNDROME:
TESTING AND TRAINING
Werner S; Section of Sports Medicine, Karolinska Institute,
Stockholm, Sweden
LEARNING OBJECTIVES: The objectives are: 1. To present
the optimal way of measuring thigh muscle strength in patients
with patellofemoral pain syndrome (PFPS). 2. To explain how to
improve imbalance between vastus medialis and vastus lateralis in
patients with PFPS.3. To describe different ways of strengthening
the quadriceps muscle in patients with PFPS. SUMMARY: The
quadriceps muscle is often weakened in patients with patellofemoral
pain syndrome (PFPS). In particular, hypotrophy of vastus medialis
(VM) is common and it is the weakest and most vulnerable muscle
of the extensor mechanism. Manual muscle testing comparing each
side gives a rough awareness of quadriceps strength. If possible,
isokinetic measurement of quadriceps torque is recommended.
During isokinetic measurement it is preferable to evaluate whether
pain inhibition might interfere with the “true” result of muscle torques.
This could be done with twitch interpolation technique and also to
some extent with Borg’s pain scale or the visual analogue scale.
Several authors have emphasized the importance of quadriceps
training in patients with PFPS to improve the extensor mechanism.
Functional ability has been reported to be associated with increased
ability to generate quadriceps torque. The main objective is to
strengthen VM, since appropriate timing and intensity of VM obliquus
activation relative to vastus lateralis (VL) has been promoted as a key
aspect in patients with PFPS. The balance between VM obliquus and
VL should be restored before starting to train the entire quadriceps
muscle group. The literature provides many suggestions to improve
VM by different exercises. However, transcutaneous electrical muscle
stimulation is the optimal way proven to selectively contract and
improve the function of VM. Earlier authors have recommended
isometric quadriceps training in order to decrease knee pain by
reduced patellofemoral compression. However, isometric exercises
are time consuming, since strength is mostly gained at the fixed
position. Isometric training doesn’t improve functional performance
and could therefore be questioned in patients with PFPS. Isokinetic
quadriceps training has been suggested as a possible treatment
for strengthening the quadriceps muscle, especially eccentrically, in
S20
patients with PFPS. Quadriceps can be strengthened during closed
as well as open kinetic chain exercises. In order to reduce the
patellofemoral joint reaction forces closed kinetic chain exercises
have been reported to be trained during the last 30–40º of knee
extension and open kinetic chain exercises between 90º and 40º
of knee flexion. When the quadriceps muscle has improved and
a good balance exists within the extensor mechanism, functional
training with gradual increase of knee loading exercises could begin.
There is a wide variation of functional knee loading exercises with
different heavy demands upon both the quadriceps muscle and the
knee joint. IMPLICATIONS/CONCLUSIONS: The isokinetic method
is the most objective way of measuring thigh muscle torques.
Twitch interpolation technique used simultaneously with muscle
strength measurements is an objective way of evaluating whether
pain inhibition interferes with “true” muscle torques. Transcutaneous
electrical muscle stimulation is the optimal way of improving the
activity and function of VM. Isokinetic training is a good way of
quadriceps strengthening, in particular during eccentric actions in
patients with PFPS. KEYWORDS: Anterior knee pain; Extensor
mechanism; Muscle activity. FUNDING ACKNOWLEDGEMENTS:
The studies were supported by grants from the Swedish National
Center for Research in Sports, Stockholm, Sweden.
Focused Symposium Contribution
347 Wednesday 6 June 10:45
VCEC Ballroom B & C
This contribution is part of Focused Symposium “RANDOMIZED
TRIALS IN COMMON MUSCULOSKELETAL PROBLEMS: CHAL-
LENGES AND FUTURE DIRECTIONS” number 291
OVERCOMING THE CHALLENGES OF RANDOMIZED TRIALS
OF MUSCULOSKELETAL PAIN
Van der Windt D; EMGO Institute and Department of General
Practice, VU Universiy medical center, Amsterdam, The Netherlands
LEARNING OBJECTIVES: − Participants understand the advan-
tages and disadvantages of cluster-randomization. − Participants
are aware of the potential influence of patient expectations and
preferences on the outcome of intervention studies. − Participants
understand the use and disuse of subgroup-analyses in randomised
controlled trials. SUMMARY: The randomised controlled trial (RCT)
is considered to be the tool providing the strongest evidence on
the effectiveness of physiotherapy interventions. However, designing
RCTs that evaluate the effectiveness of complex physiotherapy
interventions is not without challenges. In this presentation three
methodological problems encountered in RCTs will be discussed,
along with the measures that can be taken to solve these
issues. Specific examples will be given using published RCTs
evaluating primary care interventions for shoulder pain or back
pain. 1) Randomization of individual patients within a physiotherapy
practice may not always be possible, especially when specific skills
are required to carry out a complex intervention. Newly learnt
skills may be (partly) transferred to patients in the control group
leading to contamination and a reduction of contrast between
interventions. Cluster-randomization (randomization of therapists
rather than individual patients) may solve this problem, but has
several disadvantages. Some of the pro’s and con’s of cluster-
randomization will be discussed. 2) In RCTs evaluating complex
physiotherapy interventions it is often not possible to blind patients or
therapists to the allocated treatment. Patients may have preferences
or expectations regarding the interventions under study, which may
influence their response to therapy. Similarly, therapists may prefer
certain treatments or expect a better outcome of specific interventions
in individual patients. We assessed the influence of patient and
therapist preferences on treatment outcomes in RCTs evaluating
primary care interventions for shoulder pain and knee pain. 3) Some
patients may respond better to specific physiotherapy interventions
than others. RCTs usually present an ‘average’ treatment effect,
which may obscure this variation in treatment response across
WCPT 2007, Focused Symposium Contributions
patients. Subgroup analyses can be used to identify subgroups
who respond better than others. Examples will be given based on
research in low back pain or shoulder pain. Subgroup analyses
can generate interesting hypotheses to be tested in subsequent
trials, but rarely provide conclusive results and may even lead to
‘data dredging’. The use and disuse of subgroup analyses will
be discussed. IMPLICATIONS/CONCLUSIONS: Although several
obstacles need to be overcome when designing RCTs, high
quality studies can be successfully undertaken, and can provide
relevant evidence on the effectiveness of complex physiotherapy
interventions in patients with musculoskeletal pain. KEYWORDS:
Cluster-randomization, patients preferences and expectations, sub-
group analyses. FUNDING ACKNOWLEDGEMENTS: The research
presented was sponsored by The Netherlands Organization for
Health Research and Development and the Dutch Health Insurance
Council.
Focused Symposium Contribution
410 Wednesday 6 June 10:45
VCEC Ballroom B & C
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?
Dziedzic K; Primary Care Sciences Research Centre, Keele
University, UK
LEARNING OBJECTIVES: This session will provide an opportunity
for participants to Review the evidence from examples of high
quality, randomized controlled trials of physical therapy in the area
of low back and neck pain. Consider the studies in terms of patient
selection, interventions delivered and outcomes measured. Reflect
on the implications of the findings of such studies SUMMARY: The
findings of large, well-conducted randomized controlled trials (RCTs)
are widely considered the gold standard source of evidence for
the effectiveness of different treatment approaches. The RCT can
address clinically important questions relevant to both patients and
physical therapists by asking ‘is this treatment helpful on average for
a wide range of patients?’. In line with findings of systematic reviews
in the area of musculoskeletal pain disorders, there is a clear trend
towards large, high quality RCTs showing either no differences or
very small differences between different physical therapy approaches
to the management of a range of musculoskeletal pain disorders.
Where differences are seen, although statistically significant their
clinical importance remains unclear. Key decisions are made when
designing RCTs in physical therapy. Identifying the patient population,
choosing interventions for the trial protocol and selecting outcome
measures are all critical in designing a high quality study. A study
population needs defining according to eligibility criteria. The trial
requirements are that large numbers of participants are recruited
as quickly as possible. In order to do this, eligibility criteria need
to be very broad. Patients in the study should reflect the people
who present with the condition in routine practice. The problem in
musculoskeletal pain is that diagnostic classification is still somewhat
limited and its reliability in practice is not fully established. Therefore
an approach adopted in primary care is to define cases quite broadly,
excluding only people with red flags. With all these issues in mind
one approach is to be pragmatic e.g. a trial of physical therapy for
neck pain in primary care (1). The implications of this approach will
be examined. 1. Dziedzic K, Hill J, Lewis M, Sim J, Daniels J, Hay
EM. Effectiveness of manual therapy or pulsed shortwave diathermy
in addition to advice and exercise for neck disorders: A prag-
matic randomized controlled trial in physiotherapy clinics. Arthritis
Rheum. 2005;53(2):214-22. IMPLICATIONS/CONCLUSIONS: The
session will enable experienced clinical trialists, experienced clinical
practitioners and others, interested in improving the quality of
the evidence from randomized controlled trials (RCTs) in physical
Focused Symposium Contributions S21

therapy, to examine what influences the findings of RCTs of
musculoskeletal pain problems. An example of a pragmatic RCT
of physical therapy approaches for common neck disorders will be
used to highlight issues of case definition, treatment selection and
outcome measurement. KEYWORDS: Randomized controlled trial
design, musculoskeletal pain, evidence based practice. FUNDING
ACKNOWLEDGEMENTS: The Arthritis Research Campaign, UK;
The National Lottery Charities Board, UK; The North Staffordshire
Medical Institute, UK; The Physiotherapy Research Foundation,
UK; The Welsh Office, UK; The National Coordinating Centre for
Research Capacity Development, Department of Health, England.
not only advances that will impact clinical care, but also represent
important advances in research methodology that can enhance
the power of future research. Considering the economic as well
as clinical outcomes of physical therapy interventions will also
be an important consideration in future research. KEYWORDS:
patient sub-groups, clinical classification, clinical prediction rules,
economic analysis. FUNDING ACKNOWLEDGEMENTS: Foundation
for Physical Therapy

Focused Symposium Contribution

489 Wednesday 6 June 10:45
VCEC Ballroom B & C
This contribution is part of Focused Symposium “RANDOMIZED
TRIALS IN COMMON MUSCULOSKELETAL PROBLEMS: CHAL-
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
Physiotherapy Volume 93 Supplement 1
Workshops
Workshop
356 Sunday 3 June 08:30
VCEC Meeting Rooms 1-3
CROSS CULTURAL E-LEARNING IN ENTRY-LEVEL PHYSICAL
THERAPY EDUCATION: MAXIMIZING EXPERTISE AND
RESOURCES GLOBALLY
Redenbach D1 , Dean E1 , Jones A2 , McIntrye L3 , Bainbridge L4 ;
1 School of Rehabilitation Sciences, University of British Columbia,
Vancouver, BC, Canada; 2 Department of Rehabilitation Sciences,
Hong Kong Polytechnic University, Hong Kong; 3 Telestudios,
University of British Columbia, Vancouver, BC, Canada; 4 College
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-
technologies, including interactive Web and video-linked technolo-
gies, and discuss their potential for diverse physical therapy
programs. 2.Observe and experience new e-technology tools for
clinical education, in the capacity of learners. 3.Discuss and
consider the resources required and barriers to implementing
these technologies in relation to the needs of physical therapy
education programs in middle- and low-income, as well as high-
income countries. SUMMARY: Changing global health indicators
such as increased life expectancy, and the growing prevalence of
chronic degenerative conditions that contribute to prolonged end-of-
life morbidity and health care cost, support the need for an increasing
number of physical therapists worldwide. Commensurate with the
demand for the expansion of physical therapy programs however,
is a critical shortage of qualified educators. New technologies
harnessing interactive e-learning opportunities are one means of
addressing this critical shortage. Workshop participants from across
the international community will have an opportunity to identify
barriers to their unique e-learning needs. They will experience two
e-learning technologies, namely, interactive web-based instruction,
and an international video-linked learning experience. International
educators and education researchers will provide insights into
these two technologies and discuss the strengths and limitations
of these learning modes for physical therapy programs. They will
discuss the implications for educational institutions and programs
globally, specifically, those in low- and middle-, as well as high-
income countries. Experts in the development of e-learning tools
will demonstrate emerging tools designed to enhance interactive
distributed learning. The practicalities of setting up Web-based
learning opportunities through linkages with international programs,
and video-linked learning opportunities will be presented. Physical
Therapy educators will learn how they can share learning resources
and implement e-learning methodologies. The session will end with
a review of the unique barriers identified by participants at the
outset of the workshop and input from experts for solutions or
resources to address these needs. Participants will be invited to
submit questions prior to the session to ensure their questions
are included. IMPLICATIONS/CONCLUSIONS: Exploiting e-learning
technologies has several major implications for entry-level physical
therapy education globally. First, these technologies can help to
address the critical shortage of physical therapy educators worldwide.
Second, these technologies promote the sharing of expertise across
geopolitical borders and boundaries, and facilitate worldwide access
to quality physiotherapy education. Third, sharing expertise in this
manner can be cost-effective in that internationally recognized
experts in the field do not have to travel, be accommodated, or
take significant time away from their primary education affiliation.
S23
Funding ear-marked for invited and international educators can
be invested into an institution’s e-learning programs. With its
world-wide reach, our profession is in a unique position to take
advantage of emerging e-technologies to foster universal access
to quality education of physiotherapists and contribute to cost-
effective improvement in global health. KEYWORDS: Physical
therapy entry-level education; Web based e-learning; Video-linked e-
technology. FUNDING ACKNOWLEDGEMENTS: East-Meets-West
Strategic Initiative Grant, Hong Kong Polytechnic University; Teaching
and Learning Enhancement Fund Grants, University of British
Columbia
Workshop
120 Sunday 3 June 10:45
VCEC Meeting Rooms 1-3
CLINICAL DATABASES IN PHYSICAL THERAPY: CREATING AN
INTERNATIONAL NETWORK
Van der Wees P1 , Swinkels I2 , Hart D3 , Deutscher D4 ; 1 KNGF,
Royal Dutch Society for Physical Therapy, Netherlands, Center for
Evidence Based Physiotherapy, Maastricht University, Netherlands;
2 NIVEL, Netherlands Institute for Health Services Research, Utrecht,
The Netherlands; 3 Focus On Therapeutic Outcomes, Inc, Knoxville,
Tennessee, USA; 4 Maccabi Healthcare Services, Tel Aviv, Israel
LEARNING OBJECTIVES: 1. To discuss relevance and char-
acteristics of clinical databases for transparency of outcome of
care. 2. To exchange experiences and knowledge in setting-up
and running clinical databases. 3. To investigate the feasibility
of creating an international network of investigators in clinical
databases. SUMMARY: Clinical databases on physical therapy
related information include useful data for health services research.
An international investigation (Swinkels et al, submitted) resulted
in seven identified clinical databases around the world. We speak
of clinical databases when information from (electronic) medical
records of multiple providers is stored in a database for research
purposes. These databases are a valuable source of information for
research and quality assurance. To a growing extent, information
technology is an important tool for improving clinical management
and assessing clinical outcomes. Therefore, and due to advancement
in electronic data management capabilities, it is likely that the number
of clinical databases will grow in the near future. Content and
purposes of the existing databases, and possibilities of promoting
an international database will be discussed in the workshop.
By discussing procedures, opportunities and pitfalls of existing
databases, investigators can learn from each other. Experiences of
others can be applied in their own (future) databases. Consequently,
this will result in improved quality, validity and comparability of
databases, promoting an international use of data from clinical
databases in physical therapy. IMPLICATIONS/CONCLUSIONS: The
workshop will contribute in creating a common body of knowledge
concerning clinical databases. The desired result of the workshop is
the start of an international network of investigators. This network
will contribute to mutual learning and a body of knowledge. Future
goals are to compare physical therapy processes and patient
outcomes internationally. KEYWORDS: Clinical databases; Outcome
measures; Record keeping. FUNDING ACKNOWLEDGEMENTS:
None.
S24
Workshop
345 Sunday 3 June 02:00
VCEC Meeting Rooms 8&15
EDUCATING FOR MORAL ACTION: CREATING A GLOBAL
DIALOGUE
Purtilo R1 , Jensen G2 , Swisher L3 , Mostrom E4 , Edwards I5 ,
Delany C6 ; 1 Ethics Initiative, MGH Institute of Health Professions,
Boston, MA, USA; 2 Dept Physical Therapy and Center for Health
Policy/Ethics, Creighton University, Omaha, NE, USA; 3 School
of Physical Therapy, University of South Florida, Tampa, FL, USA;
4 School of Rehabilitation and Medical Sciences, Central Michigan
University, Mount Pleasant, Michigan, USA; 5 School of Health
Sciences, University of South Australia, Adelaide, Australia; 6 School
of Physiotherapy, University of Melbourne, Melbourne, Australia
LEARNING OBJECTIVES: Through active participation and dia-
logue, participants will engage in a process to: 1) Synthesize relevant
insights regarding the state of ethics education for physiotherapy
in academic and practice settings. 2) Propose a framework for
analysis and discussion of ethics education for physiotherapists
as moral agents. 3) Generate practical educational strategies for
educators and practitioners that will support moral action and
moral leadership in clinical and education settings. SUMMARY: This
workshop is designed to create an international dialogue about
current and future needs for ethics education in both classroom
and clinic. There is renewed interest in enhancing and expanding
ethics education for physiotherapists around the world fueled by
rapidly changing health care environments. Health care practitioners
experience ethical distress as health care delivery is seen more often
as a commodity driven by economic forces than a human service.
Still, ethics education in physiotherapy often is more focused on
the selection of topics to be covered in courses or on the Code of
ethics, than on dialogue about the models, concepts and leadership
initiatives necessary to meet current challenges locally and globally.
Although details of ethical situations may vary in different national
contexts, educators and clinicians can benefit greatly by learning
from each other through dialogue about educational strategies and
authentic learning tools designed to promote moral reasoning, moral
leadership and moral action. This workshop includes examination of
evidence for educational effectiveness, facilitated group discussion,
lecture, and case examples to address ethics curriculum, moral
reasoning, and moral development in clinical education. The goal
of the session is to generate practical strategies for promoting
moral reasoning, moral action and moral leadership in physiotherapy
practice and educational settings. IMPLICATIONS/CONCLUSIONS:
Although physiotherapy ethics to date has primarily focused on
situations facing discrete national environments, the professional
preparation of physiotherapists for successful participation in fu-
ture local and global challenges facing our profession requires
education based on dialogue that transcends national boundaries.
Ethics education for physiotherapists needs to prepare physio-
therapists worldwide for effective reflection, moral reasoning and
moral action. KEYWORDS: Ethics education, Ethical reasoning,
Moral action/leadership. FUNDING ACKNOWLEDGEMENTS: We
acknowledge the Center for Health Policy and Ethics at Creighton
University and federal grant support of HRSA Grant #D37 HP 00824
(Dreamcatchers and the Common Good:Allied Health Leadership
in Generational Health and Ethics) for the Leadership in Ethics
Education For Physical Therapy and Occupational Therapy working
institute. The institute project was published by FA Davis, 2005:
Purtilo R, Jensen G, Royeen C(Eds): Educating For Moral Action:
A Sourcebook in Health and Rehabilitation Ethics.
WCPT 2007, Workshops
Workshop
442 Sunday 3 June 04:15
VCEC Meeting Rooms 1-3
CARDIORESPIRATORY PHYSIOTHERAPY EDUCATION: IS IT
COMMENSURATE WITH THE HEALTH CARE NEEDS OF THE
WORLD?
Cahalin L1 , Cruz Velandia I2 , Matsuo Y3 , Roskell C4 ; 1 Northeastern
University, Department of Physical Therapy, Boston, Massachusetts,
USA; 2 Universidad del Rosario, Facultad de Rehabilitación y
Desarrollo Humano, Bogota, Colombia; 3 Kobegakuin University,
Faculty of Rehabilitation, Kobe, Japan; 4 University of Birmingham,
School of Health Sciences, Birmingham, United Kingdom
LEARNING OBJECTIVES: 1. Discover the results of an internet sur-
vey examining cardiorespiratory physical therapy (PT) education and
practice in a number of countries around the globe. 2. Understand the
cardiorespiratory PT education and practice opportunities provided to
students in several specific countries (South America, Japan, United
States, and the United Kingdom). 3. Dialogue with others in the
audience about cardiorespiratory PT education and practice around
the globe. SUMMARY: Cardiovascular and pulmonary diseases
are common among many PT patients as primary, secondary, or
even combined diagnoses. Despite the fact, that the incidence of
cardiovascular disease has decreased slightly, the incidence and
prevalence of pulmonary disease and chronic cardiovascular disease
is increasing. Both disorders are responsible for a substantial degree
of morbidity, mortality, and disability. Physical therapists are in
a pivotal position to favorably affect the morbidity, disability, and
possibly mortality of patients suffering with these disorders via
secondary and primary prevention. However, few North American
physical therapists specialize in this area and few routinely assess
the cardiorespiratory systems during PT. This is concerning since
cardiovascular and pulmonary diseases are the leading causes of
morbidity, mortality, and disability worldwide and often co-exist with
many other conditions routinely seen by physical therapists. The
results of a questionnaire survey of cardiorespiratory PT education
in the USA, Canada, United Kingdom, Australia, and New Zealand
revealed that cardiorespiratory education in the USA appears to lag
behind that in other countries. It appears that PT education in the
USA is not commensurate with the health care needs of the USA or
the world. We are currently examining cardiorespiratory PT education
and practice in over 25 countries around the globe using an internet
survey. The results of this survey will be presented which will enable
a comparison among countries to be made and discussion among
workshop participants. IMPLICATIONS/CONCLUSIONS: The World
Health Organization has identified cardiovascular and pulmonary
disease as two of the major preventable causes of death and disability
throughout the world. Therefore, greater focus on the health care
needs of each country and the world is needed in the PT educational
programs throughout the world. Providing optimal academic and
clinical experiences in cardiovascular and pulmonary areas are likely
to ensure that PT is commensurate with the health care needs of the
world. Not providing optimal PT academic and clinical experience in
cardiovascular and pulmonary areas may allow others less qualified
to fulfill the need to care for the increasing numbers of individuals
throughout the world diagnosed with cardiovascular and pulmonary
disorders resulting in lower standards of care. KEYWORDS: 1.
Physiotherapy education. 2. Cardiorespiratory physiotherapy. 3.
Global health. FUNDING ACKNOWLEDGEMENTS: Japanese Pfizer
Health Research Foundation.
Workshops
Workshop
245 Monday 4 June 08:30
VCEC Meeting Rooms 8&15
“WALKING” – AN EVIDENCE-BASED APPROACH TO WEANING
PATIENTS FROM MECHANICAL VENTILATION IN ICU
Perme C1 , Dean E2 ; 1 The Methodist Hospital, Houston, Texas,
United States of America; 2 University of British Columbia, School
of Rehabilitation Sciences, Vancouver, Canada
LEARNING OBJECTIVES: During the workshop, with respect to
the patient who is mechanically ventilated, and through a series
of case studies, participants will learn to: 1. Apply state of the art
evidence for integrating exercises physiology, specifically walking as
an intervention in patients in the ICU. 2. Identify key elements of
the assessment including a “mobilization test” and its intrepretation.
3. Progress the mobilization stimulus consistent with long term
patient goals. SUMMARY: Physical therapists, who practice in high
dependency, critical care or ICU settings, face a complex challenge.
ICU patients are surviving in greater numbers contributing to the
physical therapist’s challenge both respect to the severity of the
patients treated these days, and the duration of their ICU stay.
These patients have limited mobility due to life support, monitoring
equipment, multiple medical problems, aerobic deconditioning, and
muscle weakness. Early mobilization can facilitate weaning from
mechanical ventilation as well as enhance functional outcomes by
optimizing cardiopulmonary and neuromuscular status. This work-
shop describes the evidence-base and decision making strategies
to guide clinicians through the process of managing ICU patients,
particularly with respect to walking patients on mechanical ventilation,
therapeutically and safely. Case reports are used to illustrate how
early mobilization and ambulation positively impact the recovery and
discharge of these patients. Practical clinical guidelines regarding
clinical decision making and judgment are highlighted with respect to:
1. the assessment to determine the indications and contraindications
for mobilizing critically ill patients, 2. the mobilization prescription,
i.e., the type of mobilization, its intensity, and duration, and 3.
the progression of the mobilization stimulus including walking. The
role of monitoring is emphasized as a basis for clinical decision
making and includes vital signs, hemodynamic monitoring, ECG,
muscle strength and endurance in addition to routine blood work,
arterial blood gases, and signs of infection. Finally, the role of
team work is discussed, in that mobilizing patients requires a high
degree of clinical judgment and cooperation among team members.
Audience participation through questions and answers, and small
group interaction, will be used to foster an interactive learning
experience. IMPLICATIONS/CONCLUSIONS: Early mobilization of
ventilator dependent patients in the ICU may facilitate outcomes such
as weaning, functional return, discharge from the hospital, as well as
reduced ICU complications, which collectively, have implications for
improving quality of life and reducing health care costs. In addition,
ICU physical therapy particularly related to mobilizing critically ill
patients, requires collaborative team work and respect for each team
member’s role. KEYWORDS: Oxygen transport; Intensive care; Early
mobilization; Weaning. FUNDING ACKNOWLEDGEMENTS: None
S25
Workshop
292 Monday 4 June 08:30
VCEC Meeting Rooms 1-3
SYNERGY BETWEEN NEUROSCIENCE RESEARCH
AND NEUROREHABILITATION: PUTTING KNOWLEDGE
TRANSLATION INTO PRACTICE
MacKay-Lyons M1 , Corbett D2 , Ploughman M3 , Nudo R4 ; 1 School
of Physiotherapy, Dalhousie University, Halifax, Nova Scotia,
Canada; 2 Memorial University, St. John’s, Newfoundland, Canada;
3 Physiotherapy, Rehabilitation Program, L.A. Miller Centre, St.
John’s, Newfoundland, Canada; 4 Landon Center on Aging, Kansas
University Medical Center, Kansas City, KS 66160
LEARNING OBJECTIVES: By the end of this interactive work-
shop, participants will: 1. Demonstrate enhanced understanding of
the importance for researcher-clinician collaboration in advancing
knowledge translation in neurorehabilitation. 2. Identify mechanisms
of neuroplasticity that contribute to functional recovery following
damage to the nervous system. 3. Describe how certain intervention
protocols have evolved from animal research and how future research
initiatives could be informed by these protocols. SUMMARY: Knowl-
edge translation goes beyond the mere diffusion and dissemination
of knowledge. It is about not only ensuring that clinicians are aware
of and use research evidence to inform their clinical decision-
making but also ensuring that researchers are informed by the
experiences and information needs of clinicians. In other words,
knowledge translation is a two-way street between clinicians and
researchers. In the area of neuroscience, basic researchers, clinical
researchers, and neurorehabilitation clinicians often function as
three distinct communities. The traditional unidirectional nature of
knowledge transfer has not been effective in encouraging clinicians
to adopt new research findings. Rather, early engagement and
interactive exchange among these ‘communities’ are key to building
researcher-user relationships that remove barriers to research
utilization and tailor information so that effective interventions can
be more widely applied. This workshop will emphasize researcher-
clinician exchanges in the analysis of animal and human case
studies that are linked by the neurorehabilitation interventions and
mechanisms of neuroplasticity under investigation. The approach
is novel – the presenters have the breadth of experience in basic
and applied research and clinical neurorehabilitation needed to
reinforce the notion of synergy in this exciting field. Stroke, spinal
cord injury and cerebral palsy comprise the main diagnostic groups
discussed. Animal research has precipitated or supported a number
of neurorehabilitation interventions (e.g., environmental enrichment,
endurance exercise, skilled movement training, repetition of alternat-
ing, repetitive movements). Studies using animal models have shown
that such interventions result in alterations in neuronal structure and
brain chemistry that enhance plasticity processes in the damaged
nervous system that, in turn, promote functional recovery. The case
studies will underline the importance of effective researcher-clinician
collaborations in developing intervention protocols that can be applied
clinically. Emphasis on the practical implications of findings and the
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
S26
to accelerated translation of meaningful research findings into
clinical practice. KEYWORDS: Neurorehabilitation; Neuroplasticity;
Recovery. FUNDING ACKNOWLEDGEMENTS: Canadian Institutes
for Health Research, Heart and Stroke Foundation of Canada,
Canadian Stroke Network, Canada Research Chairs Program.
Workshop
448 Monday 4 June 08:30
VCEC Ballroom A
BRIDGING THE GAP: THE ROLE OF THE PELVIC FLOOR IN
MUSCULOSKELETAL AND UROGYNECOLOGICAL FUNCTION
Lee D1 ,
Lee L2,3 ; 1 Diane
Lee & Associates – Consultants in
Physiotherapy, White Rock, BC, Canada; 2 Synergy Physiotherapy
& LJPT Consulting, North Vancouver, BC, Canada; 3 University
of Queensland, Brisbane, Queensland, Australia
LEARNING OBJECTIVES: 1) Review the evidence for clinical
tests for pelvic girdle musculoskeletal function and relationships
between the pelvic floor and other muscles linking low back/pelvic
girdle pain and urogynecological dysfunction. 2) Combine evidence
with clinical reasoning to assess and treat lumbopelvic and pelvic
organ impairments with multi-modal programs, including using real-
time ultrasound imaging; highlight areas needing further research
to create clinical trials. 3) Integrate knowledge from different
physical therapy specialization subgroups to facilitate optimal care
for patients by exposing therapists to new techniques and treatment
approaches and emphasizing the importance of communication and
efficient cross-referral between therapists of different subgroups.
SUMMARY: In recent years, there has been an explosion of scientific
and clinical knowledge pertaining to musculoskeletal and urogy-
necological function relevant to physical therapists. Consequently,
specialization within physical therapy has evolved to meet the
challenge of evidence-based clinical practice. While focusing on one
area of evidence facilitates expertise in an area (back/pelvic girdle
pain, incontinence/pelvic floor dysfunction), it can limit the holistic
view of the patient and the presenting problem. Recent studies
highlight epidemiological links between low back/pelvic girdle pain,
incontinence and respiratory disorders. Neurophysiological studies
identify biomechanical and neurological connections between the
musculoskeletal system and the internal organs. It is increasingly
apparent that patients with low back and pelvic ‘girdle’ pain share
common neuromuscular impairments with patients presenting with
stress urinary incontinence and pelvic ‘floor’ pain syndromes. It is
time to bridge the gap that has evolved with specialization and
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
required. This workshop will discuss scientific and clinical evidence
that led to an integrated approach for assessment and treatment
of the lumbopelvic-hip region for low back/pelvic girdle pain and
urinary incontinence/pelvic floor syndromes. Case studies will be
presented to reflect variances in clinical presentation and illustrate
how education, manual therapy, real-time ultrasound imaging, and
exercise are integrated. Validated tests for load transfer through
the joints and organs of the pelvis as well as for deciding which
muscles to target for rehabilitation will be demonstrated through
video clips. The goal of this workshop is to demonstrate that
optimal musculoskeletal function and urogynecological function share
common components; therapists in previously separate fields need
to bridge a gap in order to build an integrated and effective approach
to rehabilitation. The mergence of this information will facilitate
networking within the profession with the ultimate goal of providing
optimal rehabilitative care. IMPLICATIONS/CONCLUSIONS: The
multi-modal, evidence-based rehabilitation program presented draws
on clinical experience of the presenters to bridge the narrowing, yet
still present, gap between what we know (the evidence) and what
we still need to know (clinical tools to be validated) to effectively
restore optimal function for the lumbopelvic region, both in the
WCPT 2007, Workshops
musculoskeletal and internal urogenital/gynecological systems. This
workshop will facilitate information sharing for further development of
multi-modal programs and stimulate research to validate and improve
treatment for people with impairments of the musculoskeletal and
urogynecological systems. KEYWORDS: Low back pain, pelvic girdle
pain, incontinence. FUNDING ACKNOWLEDGEMENTS: This work
is funded privately by Diane G. Lee Physiotherapist Corporation and
LJPT Consulting
Workshop
188 Monday 4 June 10:45
VCEC Meeting Rooms 1-3
WCPT: INTERNATIONAL COLLABORATION IN CLINICAL
GUIDELINE DEVELOPMENT AND IMPLEMENTATION
Van der Wees P1 , Hendriks E2 , Mead J3 , Rebbeck T4 ; 1 KNGF,
Royal Dutch Society for Physical Therapy, Amersfoort, Center for
Evidence Based Physiotherapy, Maastricht University, Netherlands;
2 Center for Evidence Based Physiotherapy, Maastricht University,
Netherlands, Dutch Institute of Allied Health Care (NPi), Amersfoort,
Netherlands; 3 Chartered Society for Physiotherapy (CSP), London,
United Kingdom; 4 University of Sydney, Australia
LEARNING OBJECTIVES: 1. To strengthen the existing network
of clinical guideline developers in Physical Therapy. 2. To promote
adaptation of existing (international) clinical guidelines for national
and local use. 3. To facilitate involvement of member organisations
of WCPT in multi-disciplinary guideline development. SUMMARY:
Clinical guidelines provide recommendations for practice, drawn
from the available evidence. To create an international standard for
Physical Therapy treatment and to enhance efficiency in development
of clinical guidelines, further international collaboration in guideline
development is required. For example, existing (international)
guidelines can be adapted for specific national or local use. We also
observe a lack of involvement of Physical Therapy in multi-disciplinary
guideline development. In this workshop we we will present and dis-
cuss possibilities for (a) further collaboration in developing guidelines,
(b) adaptation of existing guidelines for national or local use and
(c) involvement of Physical Therapy in multi-disciplinary guideline
development. IMPLICATIONS/CONCLUSIONS: This workshop will
help to enhance international collaboration in guideline development
within physical therapy and will provide tools for adaptation of existing
guidelines and involvement in multi-disciplinary guideline develop-
ment. KEYWORDS: Clinical Guidelines; Collaboration; Evidence
Based Practice. FUNDING ACKNOWLEDGEMENTS: None.
Workshop
210 Monday 4 June 02:00
VCEC Meeting Rooms 11-12
EXERCISE BASED CARDIAC REHABILITATION FOR HEART
FAILURE
Thow M1 , Taylor A2 , Lough F3 , Cowie A4 ; 1 Division of
Physiotherapy, Glasgow Caledonian University, Glasgow G4 0BA,
Scotland, UK; 2 Department of Physiotherapy,University of Limerick,
Limerick, Ireland; 3 Hatter Cardiovascular Health Institute, University
College Hospital London; 4 Glasgow Caledonian University (School
of Health and Social Care) Glasgow, Scotland
LEARNING OBJECTIVES: The key learning objectives for this
session will be: 1. Understand and appraise the evidence base
for exercise in people with heart failure; 2. Comprehend and apply
contemporary principles of prescription and monitoring of exercise for
people with heart failure. 3. Critique the outcome measures for the
training effect of exercise in people with heart failure. SUMMARY:
Chronic heart failure is fast becomming one of the most common
cardiac conditions. As a result of improved medical management
and the ageing population, there are many more people living with
the limiting symptoms of heart failure. People with chronic heart
Workshops
failure are characterised by severe exercise intolerance, including
fatigue and dyspnoea. Furthermore, people with heart failure often
have poorer quality of life and psychosocial outcomes. Historically,
people with heart failure were advised to restrict their physical activity.
Not only was this deleterious to their physiological function, also
contributed to poorer mental health. There has been a growing
body of evidence over the 1990’s and 2000’s of the positive
effects of exercise on physiological and pshchosocial outcomes for
these patients, and they are now more often refered to exercise
based cardiac rehabilitation. IMPLICATIONS/CONCLUSIONS: The
potential for exercise both to improve symptoms and functional
capacity and to enhance quality of life is now recognised within
the literature. Supervised, individualised, structured exercise can
therefore be of great benefit to people with chronic heart failure.
For the cardiac rehabilitation specialist physiotherapist this group of
patients are now routinely refered for exercise based rehabilitation.
For the cardiac rehabilitation specialist physiotherapist, people with
heart failure, compared with other cardiac groups, present a greater
challenge, due to their lower functional status and limiting symptoms.
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,
cardiac rehabilitation. FUNDING ACKNOWLEDGEMENTS: Ayrshire
and Arran Health Board managed clinical network for cardiology
is funding Aynsley Cowie’s research project on exercise outcome
measures for heart failure.
Workshop
163 Tuesday 5 June 08:30
VCEC Meeting Rooms 1-3
BONE HEALTH IN CHRONIC CONDITIONS: IMPLICATIONS FOR
PHYSIOTHERAPISTS
Pang M1 , Eng J2 , Jones A1 ; 1 Hong Kong Polytechnic University,
Hong Kong, China; 2 University of British Columbia, Vancouver,
British Columbia, Canada
LEARNING OBJECTIVES: After completion of the workshop, the
participants will be able to: 1. describe the common imaging
techniques used to measure bone mineral density. 2. explain how
chronic conditions, such as spinal cord injury, stroke or COPD
may negatively impact on bone health. 3. describe the current
scientific evidence concerning exercise intervention on bone health
in people with chronic conditions and explain how physiotherapists
can play a key role in prevention and treatment of secondary
osteoporosis in people with chronic conditions. SUMMARY: In
Canada, approximately 1.4 million people are suffering from osteo-
porosis. The Canadian health care cost associated with osteoporosis
currently stands at 1.3 billion per year and is predicted to reach
32.5 billion by 2018 due to the aging population. Individuals living
with a chronic condition (e.g. spinal cord injury, stroke, COPD)
are particularly at risk for osteoporosis. These individuals often
have a number of physical impairments (e.g. muscle weakness,
low cardiopulmonary fitness, poor balance, sensory deficits), which
contribute to various functional limitations, resulting in a sedentary
lifestyle. The lack of mechanical loading to the skeleton due to
physical inactivity may increase the rate of bone loss. The same
physcial impairments are also contributing factors to an increased
risk of falls. Compormised bone mineral density coupled with
falls is the primary cause of fragility fractures and becomes a
major health concern in people with chronic conditions. Knowing
that skeletal loading is an important factor for promoting bone
formation, exercise may be an effective method for the prevention
and treatment of osteoporosis. Exercise interventions have been
shown to be effective in promoting bone health in older adults.
Concerning individuals with chronic conditions, literature review
suggests that there is some evidence that exercise is beneficial in
promoting bone health but further study is required. This workshop
S27
will discuss the principles of exercise prescription for promoting
bone health and review the scientific evidence on the effects of
exercise therapy on bone health in selected chronic conditions.
Physiotherapists can play an important role in the prevention and
treatment of secondary osteoporosis in people with chronic condi-
tions, including the assessment of risk factors for falls (e.g. balance,
muscle strength, vision) and secondary osteoporosis (e.g. muscle
atrophy, corticosteroid therapy), prescription of appropriate exercise
interventions to reduce falls and improve bone health, and patient
education. IMPLICATIONS/CONCLUSIONS: Increasing emphasis
has been placed on health promotion and prevention of secondary
conditions for people with disability. With the aging population and
the increasing number of chronic disease survivors, osteoporosis
and bone fractures will be major health concerns. The prevention
of secondary osteoporosis and resulting fractures in people with
chronic conditions is an important area where physiotherapists can
play a key role. KEYWORDS: osteoporosis, bone health, chronic
conditions. FUNDING ACKNOWLEDGEMENTS: Natural Sciences
and Engineering Research Council of Canada (Marco Pang).
Workshop
145 Tuesday 5 June 10:45
VCEC Ballroom B & C
STRUCTURAL DIFFERENTIATION DIAGNOSIS OF THE UPPER
AND LOWER QUARTER
Cook C1 , Cleland J2 ; 1 Assistant Professor, Duke University Medical
Center, Department of Community and Family Medicine, Division
of Physical Therapy, Duke University, Durham, North Carolina,
United States of America; 2 Assistant Professor Franklin Pierce
College, and Research Coordinator, Rehabilitation Services of
Concord Hospital, Concord, NH, United States of America
LEARNING OBJECTIVES: 1) Categorize and synthesize the chief
identifying features of the upper (cervical-spine, thoracic spine
and shoulder)and lower (lumbar-spine, hip and pelvis) quarter
pain generating structures; specifically the overlap in symptom
manifestation, and identify red flags that masquerade of muscu-
loskeletal disorders. 2) Evaluate the use of highly sensitive tests and
measures versus highly specific tests and measures during structural
differential diagnosis. 3) Apply the newly outlined tests and measures
toward the presented case studies of multidimensional pain patients
and organize an effective examination based on the structural
differentiation findings. SUMMARY: The purpose of a clinical
examination is to outline the movements, positions, or activities
that produce, reduce, or selectively modify the patient’s ‘familiar
sign and symptoms’ and to isolate the causal structure behind the
impairment. Additionally, an effective clinical evaluation reduces the
risk of missing “red flags” that may undermine the progression of
a patient’s condition. To accomplish this task, physiotherapists must
focus their examination tests and measures toward the appropriate
structural region. Musculoskeletal regions such as the upper quarter
(cervical, thoracic and shoulder) and lower quarter (lumbar spine, hip
and pelvis) often display overlapping symptoms that require structural
differentiation. The appropriate use of structural differentiation tests
that are highly sensitive and yield beneficial diagnostic value can
assist the clinician in ruling out inappropriate non-causal structures.
IMPLICATIONS/CONCLUSIONS: Physiotherapists function as entry
point providers for many musculoskeletal disorders. Proper structural
differentiation is necessary for effective treatment. Many upper
and lower quarter impairments yield similar findings and require
structural differentiation. The correct use and understanding of
appropriate diagnostic tests can improve the physiotherapists’
capability as a diagnostic clinician. KEYWORDS: Sensitivity, Speci-
ficity, Diagnosis, Differentiation, Tests and Measures. FUNDING
ACKNOWLEDGEMENTS: None
S28
Workshop
3334 Tuesday 5 June 02:00
VCEC Meeting Rooms 1-3
WRITING FOR PUBLICATION
Herbert R1 , Moore A2 , Baxter D3 , Hasson S4 , Simoneau G5 ,
Hudson Z6 , Kolt G6 , Abbott H7 , Ada L1 , Harms M8 , Sundelin G9 ,
Deutsch J10 ; 1 Australian Journal of Physiotherapy; 2 Manual
Therapy; 3 Physical Therapy Reviews; 4 Physiotherapy Theory
& Practice; 5 Journal of Orthopedic and Sports Physical
Therapy; 6 Physical Therapy in Sport; 7 New Zealand Journal
of Physiotherapy; 8 Physiotherapy; 9 Advances in Physiotherapy;
10 Journal of Neurologic Physical Therapy
LEARNING OBJECTIVES: By the end of the workshop participants
should understand editorial processes and be better able to prepare
manuscripts for submission to a scientific journal. SUMMARY: Editors
from seven leading physical therapy journals will offer advice and
guidance on preparing and submitting manuscripts for publication.
The workshop will include presentations about editorial processes
and tips for aspiring authors, as well as critique of manuscripts in
small groups. Elsevier publishers are working in partnership with
WCPT to publish Congress proceedings and will provide delegates
in the workshop with handouts on manuscript preparation. There will
also be guidelines for submittign to a range of journals availabel
to take away. IMPLICATIONS/CONCLUSIONS: A large volume of
research and service developments presented at both national
and international congresses is never written up or published in
peer-reviewed journals. Many factors may affect this including the
authors’ abilities to prepare full manuscripts that withstand the rigours
of the editorial process and a lack of understanding of journal
editorial processes. By understanding more about scientific writing
and editorial processes it is hoped that workshop participants will
aspire to have their work published and feel inspired and able to
prepare manuscripts for publication. KEYWORDS: Journals, writing,
publications. FUNDING ACKNOWLEDGEMENTS: Elsevier
Workshop
249 Wednesday 6 June 01:45
VCEC Meeting Rooms 11-12
GUIDED ACTIVITY AND EXERCISE THERAPY FOR CHRONIC
FATIGUE SYNDROME AND OTHER CHRONIC PAIN/FATIGUED
STATES
Nijs J1 , Paul L2 , Wallman K3 ; 1 Department of Human Physiology,
Faculty of Physical Education and Physiotherapy, Vrije Universiteit
Brussel, Belgium and Division of Musculoskeletal Physiotherapy,
Higher Institute of Physiotherapy, Hogeschool Antwerpen, Belgium;
2 Glasgow Caledonian University, Glasgow, Scotland, UK; 3 Human
Movement & Exercise Science, University of Western Australia
LEARNING OBJECTIVES: By the end of the workshop dele-
gates will be able to: a. Demonstrate an understanding of the
pathophysiology, exercise physiology, and psychopathology of CFS;
b. apply an evidence based approach to the management of
people with CFS; c. formulate possible referral criteria for people
with CFS embarking on a physical therapy program; d. design
and implement a graded/guided exercise programme in patients
with CFS; e. critically evaluate possible assessment strategies for
patients with CFS; f. apply the clinical reasoning process to the
holistic management of patients with CFS; g. appraise methods of
engaging patients with CFS into an exercise/activity programme.
SUMMARY: Controversy regarding the aetiology and treatment of
patients with Chronic Fatigue Syndrome (CFS) continues to affect
the physical therapy profession. From the clinical research physical
therapists and researchers in the field of CFS are now able to
use both general and disease specific measures for a reliable and
valid assessment of a variety of constructs in patients with CFS.
Research data from both the fundamental and clinical sciences can
be incorporated in the clinical reasoning process and treatment of
WCPT 2007, Workshops
patients with CFS. When graded exercise therapy is implemented by
means of the cognitive behavioural principles, it does not comply
with our current understanding of CFS exercise physiology and
pathophysiology. Indeed, recent experimental research shows further
deregulation of the immune system in response to submaximal
exercise and subsequent increased fatigue and musculoskeletal
pain (postexertional malaise). Therefore, patients are encouraged to
achieve an appropriate balance between activity and rest in order
to avoid exacerbation of symptoms and to set realistic goals for
increasing activity (pacing self-management techniques). Contrary
to the cognitive behavioural approach, pacing takes into account the
considerable fluctuations in symptom severity and delayed recovery
from exercise that typically occurs in patients with CFS. When a
person with CFS is able to manage their daily activity (i.e. when
they no longer experience fluctuations in symptoms) (stabilisation
phase), then the physical therapist can start to grade activity and
exercise levels (grading phase). During the grading phase, the
same pacing techniques are applied to grade both activity level
and exercise level. This type of graded exercise has been found
to be superior over relaxation and flexibility training in patients with
CFS. Various validated methods of monitoring and assessing the
effectiveness of this approach are available. The workshop aims at
incorporating the available research evidence into physical therapy
practice, addressing both the fundamental (exercise physiology,
pathophysiology, and psychopathology) and the clinical sciences
(clinical trials, assessment tools). IMPLICATIONS/CONCLUSIONS:
The workshop will allow participants to apply the research evidence
to support/guide the assessment, clinical reasoning process, and
treatment employed by physical therapists to persons with CFS.
The overall aim of the session is to improve the effectiveness of
physical therapy management of those with CFS and consequently
reduce the impact of the condition on the lives of those who suffer
from CFS. KEYWORDS: chronic fatigue syndrome, exercise therapy,
activity management. FUNDING ACKNOWLEDGEMENTS: Jo Nijs
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
support of the research.
Workshop
377 Wednesday 6 June 01:45
VCEC Meeting Rooms 1-3
CONSERVATIVE MANAGEMENT OF NECK DISORDERS: THE
CURRENT EVIDENCE, BIOLOGICAL FOUNDATIONS AND
IMPLICATIONS FOR FUTURE RESEARCH
Gross A, Mac Dermid J, Galea V, Goldsmith C, McLaughlin L;
McMaster University, Hamilton, Canada
LEARNING OBJECTIVES: 1. Learn about, apply, and identify
gaps in the best current evidence on conservative management
of mechanical neck disorders (MND)to resolve a patient case. 2.
Describe new innovative technology utilizing neuro-sensory, motor
control, serum, capnography and biomechanical methods that will
address knowledge deficits in MND disability. 3. Describe key
research design issues for future RCTs. 4. Provide input into
HaNSA’s future clinical and applied research. SUMMARY: Neck
pain is still a major contributor to disability worldwide with about
70% of the people experiencing an episode of neck pain at some
point in their lives and 15% experiencing chronic pain. Chronic pain
accounts for about $150 to $215 billion USD each year in economic
loss (ie. lost work days, therapy, disability), and yet very little is
known about the effectiveness of many of the available treatments.
Since first publishing our overview in 1996 (Aker et al 1996), our
cervical overview group (COG) has completed and updated 11
systematic reviews on conservative management of mechanical neck
disorders. In the course of the last ten years, we have come to
learn many things – not only about the effectiveness of certain
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
Physiotherapy Volume 93 Supplement 1
Research Reports
Platform Presentations, Sunday 3 June
Research Report Platform Presentation
990 Sunday 3 June 08:30
PP Crystal Pavilion B & C
EFFECT OF TRUNK ROTATION ON SOLEUS H-REFLEX AND
RADICULAR SYMPTOMS IN SUBJECTS WITH SCIATICA
Ali M1 , Elhafez S1 , Balbaa A2 , Elhafez H3 ; 1 Department of
Biomechanics, Faculty of Physical Therapy, Cairo University, Egypt;
2 Department of Physical Therapy for Musculoskeletal Disorders,
Faculty of Physical Therapy, Cairo University, Egypt; 3 Department of
Basic Science, Faculty of Physical Therapy, Cairo University, Egypt
PURPOSE: The first aim of this study was to test the effect of
trunk rotation from side lying (on the pain free side) on soleus H-
reflex and radicular symptoms in case of discogenic sciatica. The
second aim was to test whether a prolonged use of this position as
a home program can reduce the radicular symptoms. RELEVANCE:
Controlling or reducing radicular pain without drug intake is the main
purpose of effective treatment. This study identifies how this pain
could be reduced using positional technique of the trunk in subjects
with discogenic sciatica. PARTICIPANTS: Thirty subjects with L5-S1
sciatica were randomly selected and examined. Their age ranged
from 25-45 years. They were all suffering from unilateral sciatica with
radicular symptoms (pain, numbness, and/or weakness) matching
the dermatomal distribution of S1 nerve root. METHODS: H-reflex
of the soleus muscle was recorded by stimulating the posterior
tibial nerve using 1 ms pulse at 0.2 pps and recording the reflex
using surface electrodes. For each subject, H reflex was tested in
two positions (the unloading prone lying and the loading standing
positions). The H-reflex was tested for three times. The first time
was before any treatment. The second time was immediately after
the subject had assumed the position (trunk rotation from side
lying) for 15 minutes. Then each subject was instructed to assume
this position three times per day for 2 weeks as a home program
and after that the H reflex was recorded for the third time. The
pain intensity was tested using Visual Analogue Scale (VAS) in
the three tested conditions and Stanford score was measured in
the first session and after the 2 weeks of home program to test
how effective the treatment has been. ANALYSIS: The Stanford
score was tested using t-test. Two ways ANOVA was carried out
by using StatGraphics software with multiple range test to examine
the significant difference between the three studied conditions.
RESULTS: The results of the study indicated that trunk rotation
from side lying position on the pain free side significantly increases
(p < 0.05) the amplitude of the soleus H reflex whether tested
in loading or unloading position. Similarly the statistical analysis
revealed that the level of pain reduced significantly (p < 0.05) after
positioning. On the other hand the results indicated that the prolonged
use of this position as a home program (for 2 weeks) maintained the
improvement of the H reflex of the soleus muscle. The functional
performance of the subjects improved significantly (p < 0.05) after
two weeks of positioning. CONCLUSIONS: Trunk rotation from side
lying position (on the pain free side) improves the H reflex of the
soleus muscle and significantly reduces the pain of the affected
lower limb. IMPLICATIONS: Using trunk rotation as a treatment
program for subjects with sciatica was reported to be effective in
reducing the radicular pain in the affected extremity. In addition
this position improves the functional performance of the subjects
when used as a home program. KEYWORDS: Sciatica, Rotation, H-
S31
reflex. FUNDING ACKNOWLEDGEMENTS: This research study was
not funded. CONTACT: dr3mpt@yahoo.com, balbaaaa@yahoo.com,
egyptsalam@yahoo.co.uk
ETHICS COMMITTEE: Egyptian physical therapy syndicate
Research Report Platform Presentation
2978 Sunday 3 June 08:30
VCEC Ballroom A
CRYOTHERAPY FOR ACUTE ANKLE SPRAINS: A RANDOMIZED
CONTROLLED STUDY OF TWO DIFFERENT ICING PROTOCOLS
Bleakley C1 , McDonough S1 , MacAuley D2 ; 1 Health and
Rehabilitation Sciences Research Institute, University of Ulster,
Northern Ireland; 2 Hillhead Family Practice, Belfast, Northern Ireland
PURPOSE: This study aimed to compare the efficacy of an inter-
mittent cryotherapy treatment protocol with a standard cryotherapy
treatment protocol in the management of acute ankle sprains.
RELEVANCE: The application of ice after ankle sprain is a time-
honored treatment. However no study has rigorously compared the
effectiveness of two different icing protocols; and there is no evidence
to suggest an optimal mode, duration or frequency of ice application.
PARTICIPANTS: Sportsmen (n=44) and members of the general
public (n=45) with mild / moderate acute ankle sprains METHODS:
Subjects were randomly allocated, under strictly controlled double
blind conditions, to one of two treatment groups: standard ice
application (n=46), or intermittent ice application (n=43). The mode
of cryotherapy was standardised across groups and consisted of
melting iced water (0 degrees C) in a standardised pack. Function,
pain and swelling were recorded at baseline, one, two, three, four and
six weeks post injury. ANALYSIS: Data was analysed using SPSS 9.0
for Windows. For all outcome measures, a within subjects repeated
measures of analysis of variance (ANOVA) was performed to
determine the significant change over time between groups. The raw
scores recorded at baseline, week 1, 2, 3, 4 and 6 were the six levels
on the within subjects factor. The two treatment groups (intermittent
and standard) were the two levels on the between subject factor. In
addition a within subjects repeated measures analysis of covariance
(ANCOVA) was undertaken to control for the subjects baseline
levels before looking at their change in subsequent time points.
RESULTS: Subjects treated with an intermittent treatment protocol
had significantly less ankle pain on activity, than those using a
standard twenty-minute treatment protocol; one week (p < 0.05) after
ankle injury, however there were no significant differences between
groups in terms of function, swelling, or pain at rest. CONCLUSIONS:
It appears that intermittent applications may enhance the therapeutic
effect of ice after acute soft tissue injury, however the benefits
of intermittent treatment are currently restricted to pain relief, and
many more high quality studies are required. IMPLICATIONS:
Cryotherapy is largely accepted as the treatment of choice for
acute soft tissue injury, but current recommendations have many
shortcomings and selection of parameters in a clinical environment
continues to be made pragmatically. This is the first randomised
controlled study to stringently compare two different cryotherapy
protocols using subjects with closed soft tissue injury and in
accordance with basic science research, the results highlight that
shorter, intermittent applications may enhance the analgesic effect
of ice after acute ankle injury. KEYWORDS: cryotherapy, ankle
sprain, soft tissue injury. FUNDING ACKNOWLEDGEMENTS: None.
CONTACT: chrisbleakley@hotmail.com
ETHICS COMMITTEE: University of Ulster Research Ethics
Committee
S32
Research Report Platform Presentation
797 Sunday 3 June 08:30
VCEC Meeting Rooms 11-12
VARIABILITY IN MOVEMENT: THE EXAMPLE OF GROUND
REACTION FORCES ON STAIR
Luder G, Rocourt M, Deschner G, Radlinger L; Physiotherapy
Research, University Hospital Berne, Switzerland
PURPOSE: Variability is common in all movements. The important
question is how much variability is advantageous or not. We propose
as a hypothesis that there is an optimal variability for every movement
measurement. Lower or higher variability will lead to problems and
could be related to difficulties in movement control or conditional
deficits. This hypothesis has been investigated by the example of
ground reaction forces (GRF) on stairs in people that underwent
specific hip surgery and thus had to walk with reduced weight-
bearing for 8 weeks. RELEVANCE: Stair climbing is a demanding
task of daily-life and leads to a higher risk of falls than level gait.
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
variability of GRF on stairs may also serve as a predictor for the
risk of falling and could be an indicator for movement control and
quality. PARTICIPANTS: A cross-sectional survey with three groups
was performed: persons three months after surgical hip dislocation
(G3, n=29, 28.1±5.8 years, 76.7±17.1 kg), persons 12 months
after surgery (G12, n=28, 30.1±5.1 years, 80.4±15.7 kg) and a
healthy control group (G0, n=34, 28.0±4.9 years, 67.4±11.0 kg).
METHODS: GRF in stair ascent and descent were measured on a
6-step staircase with two embedded force plates on the 3rd and 4th
step. The inclination of the stair was 30.4º with a riser height of 17.9
cm and a tread of 29 cm. All persons walked barefoot and without
using the handrail. ANALYSIS: Several force and time parameters of
the GRF-curves were detected and the coefficient of variation (CV)
was calculated over 5 trials per subject. Descriptive statistics and
group differences (nonparametric: Kruskal-Wallis-H, post-hoc: Mann-
Whitney-U) were computed using SPSS. RESULTS: The CV of the
force parameters were all below 7%, with a slight decrease for both
experimental groups, which was only significant for G12 in ascent.
Loading rates showed CV up to 12% and mostly increased for G3
and G12 compared to G0. The highest changes between groups were
found for time parameters CV’s, which reached 14%. The differences
between groups were not systematic and only several differences
were significant. CONCLUSIONS: Optimal variability seems to differ
for different types of parameters and the changes between the groups
were not consistent. The different variability of the time parameters
may partly be explained by differences in leg strength, which was also
measured in the participants. Maybe the differences were small since
persons in our study did not have any falls or even severe difficulties
in climbing stairs. IMPLICATIONS: Variability is an important and
interesting topic related to movement control. Further investigations
have to be done to show the CV of GRF for other groups, such
as elderly people, people with history of falls or with pain or
difficulties while stair climbing. KEYWORDS: Variability, Stair, Ground
reaction force. FUNDING ACKNOWLEDGEMENTS: Swiss Asso-
ciation of Physiotherapy, Switzerland. CONTACT: gere.luder@fisio-
burgernziel.ch
ETHICS COMMITTEE: The study was approved by the Ethics
committee of Canton Berne, Switzerland.
WCPT 2007, Research Reports
Research Report Platform Presentation
2984 Sunday 3 June 08:30
VCEC Meeting Rooms 8&15
LONGITUDINAL AND CONSTRUCT VALIDITY OF A
COMPUTERIZED ADAPTIVE TESTING FUNCTIONAL STATUS
OUTCOME MEASURE
Deutscher D1 , Hart D2 ; 1 Maccabi Healthcare Services – HMO,
Tel-Aviv, Israel; 2 Focus On Therapeutic Outcomes, Inc., White
Stone, VA, USA
PURPOSE: The purpose of this study was to assess performance
of a Hebrew translation of a computerized adaptive testing (CAT)
functional status (FS) measure. Objectives were to assess longitu-
dinal and known groups construct validity in an Israeli population of
patients receiving physical therapy in community based outpatient
clinics due to neuro-musculoskeletal conditions. RELEVANCE: An
FS measure estimated using a CAT application was developed in the
United States. The FS items were translated into Hebrew, and the
outcomes system was implemented in Israel. Validity of the translated
FS measure was unknown. PARTICIPANTS: Data were examined
from 4,423 consecutive Hebrew speaking adult patients (mean
age=49, SD=16, range=18-95, 56% women) referred to physical
therapy for treatment of functional deficits secondary to a variety of
neuro-musculoskeletal disorders. METHODS: Outcomes data were
collected in 11 outpatient clinics. Measures of FS generated using
item response theory mathematics and applied using CAT methods
were transformed to a range from 0-100 (low to high functioning)
on a linear metric. Outcomes data were integrated into an electronic
health record system to produce a comprehensive database. Ability
of the translated FS measure to detect FS change (longitudinal
construct validity) was assessed by measuring the effect sizes and
standardized response means. Known-groups construct validity was
assessed by determining if FS measures discriminated between
patients known to vary in clinically logical ways. We examined the
overall sample as well as the 4 largest groups of patients by body part
treated (lumbar, cervical, knee, shoulder). ANALYSIS: Descriptive
statistics were used to calculate the effect sizes and standardized
response means. Known groups construct validity was assessed
using one-way ANCOVAs. FS change was the dependent variable.
Intake FS measure was the covariate. Independent variables were
symptom acuity, age, gender and surgical history related to the
treated disorder. RESULTS: Effect sizes were 0.90 overall, and 1.07,
0.91, 0.86, and 0.79 for patients with shoulder, lumbar, knee or
cervical impairments, respectively. Standardized response means
were similar, but magnitudes were less (range 0.77 to 0.91). For
the overall sample, FS measures discriminated patients in clinically
logical ways by symptom acuity, age group and gender (P < 0.01), but
not for surgical history (P = 0.09). For the body part specific samples,
FS measures discriminated patients consistently by symptom acuity,
but there were mixed results for age group, gender and surgical
history, especially for patients treated due to cervical impairments.
CONCLUSIONS: FS change measures were responsive to change
supporting longitudinal construct validity and discriminated most
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: dandeuts@netvision.net.il
ETHICS COMMITTEE: IRB, Maccabi Health Care Services – HMO,
Tel-Aviv, Israel
Platform Presentations, Sunday 3 June
Research Report Platform Presentation
805 Sunday 3 June 08:30
VCEC Meeting Room 16
RECOVERY AND HEALTH-RELATED QUALITY OF LIFE (HRQL)
OVER THE FIRST POST-STROKE YEAR: DOES AGE MATTER?
Wood Dauphinee S1−3 , Mayo N1−3 , Scott S3 ; 1 School of Physical &
Occupational Therapy, McGill University, Montreal, Canada;
2 Department of Medicine, McGill University, Montreal, Canada;
3 Clinical Epidemiology, McGill University Health Centre, Montreal,
Canada
PURPOSE: The goals of this study were to examine the impact
of age and its common health and social problems on recovery
and HRQL during the first year after stroke. RELEVANCE: People
with stroke, many of whom are elderly with comorbid conditions, are
commonly treated by physical therapists. Treatment generally focuses
on facilitating neurological recovery and resuming usual activities.
Treatable complications, such as depression, and less than optimal
social resources may impact the outcome. PARTICIPANTS: In
Montreal, 267 people with a confirmed ischemic or hemorrhagic first
stroke, who spoke English or French, were admitted to five involved
acute care hospitals, and consented to participate were enrolled.
METHODS: Members of this inception cohort were interviewed by
trained interviewers over the telephone at 1, 3, 6, and 12 months post-
stroke using multiple measures including the Stroke Impact Scale
(SIS) and the Short Form (SF)-36. Clinical data were abstracted
from the patients’ charts. ANALYSIS: Cross-sectional descriptive
statistics (radar plots) and longitudinal growth curve analyses were
used to portray the results. Outcomes include the physical and mental
composite summaries (PCS & MCS) of the SF-36 and a ‘recovery’
visual analogue scale (VAS) from the SIS. RESULTS: Mean
trajectories of PCS and MCS remained 5-7 points below population
norms 1 year post-stroke. Most improvement in PCS occurred
during the first 6 months. On average, women scored 3 points
lower than men, and trajectories lowered with increased comorbidity;
these differences remained over time. Stroke severity had a strong
impact at 1 month, though it was somewhat reduced over time,
as those with more severe strokes demonstrated a higher rate of
recovery. Their level of recovery, however, remained substantially
below those with milder strokes. Age, beyond comorbidity, impacted
both the initial score and rate of recovery of PCS. While initial scores
varied by 2 points for a 15-year age change from the average (70
years), by 1 year that 2-point difference had increased to 3 12 points
due to continued (though reduced) recovery in younger patients
6 to 12 months post stroke. Both PCS and MCS varied by level
of social resources. MCS trajectories of persons with the fewest
resources (8%) were 8 points lower than those at the highest
level (27%). An inverse association was found between MCS and
stroke severity, with slightly lower trajectories found for those with
milder strokes. MCS also varied by cognitive status and physical
ability. No association with sex remained once other factors were
considered. Perceived stroke recovery, measured by the SIS VAS,
was associated with physical ability, depression, social resources
and cognitive status. CONCLUSIONS: Age, severity, comorbidity,
social resources, and mental and physical abilities influence both
perceived recovery and HRQL the year after stroke. IMPLICATIONS:
When the person with stroke is elderly, attention to modifiable factors,
physical ability, co-morbidity and social situation, should be a focus
of therapeutic management to achieve best results. Therapists and
other providers need to identify and deal with such problems during
rehabilitation. KEYWORDS: Stroke, Co-morbidity, Social support.
FUNDING ACKNOWLEDGEMENTS: The Canadian Stroke Network.
CONTACT: sharon.wood.dauphinee@mcgill.ca
ETHICS COMMITTEE: Institutional Review Board of McGill Univer-
sity and the Ethics Review Boards of the participating hospitals: RVH,
MGH, JGH, HSL, HMR
S33
Research Report Platform Presentation
1231 Sunday 3 June 08:30
VCEC Meeting Room 17
IMPAIRMENT, ACTIVITY, PARTICIPATION: EFFECTIVE GOAL
SETTING – CHILDREN WITH CEREBRAL PALSY AND
LOWER LIMB BOTULINUM TOXIN (TYPE A) INJECTIONS
Kealey L1 , Megens A1 , McCormick A1 , Sveistrup H2 ; 1 Ottawa
Children’s Treatment Centre, Ottawa, Ont,Canada; 2 University
of Ottawa,Ottawa,Ont.,Canada
PURPOSE: Understanding the difference between clinicians’ and
parental observations is crucial for a multidisciplinary spasticity
management team. The purpose of the retrospective study was to
collect information about pre-injection goal setting, post injection
observations and parent reports of children with cerebral palsy who
had injections with botulinum toxin(type A) in lower limb muscles.
RELEVANCE: Based on the use of the Gross Motor Function Clas-
sification System (GMFCS), children with cerebral palsy in different
age bands demonstrate varying functional movement abilities. The
types of goals and patterns of outcomes may differ between the
GMFCS levels. The International Classification of Functioning and
Disability (ICF) allows the clinician to conceptualize and categorize
observations. PARTICIPANTS: The health records of 57 children,with
cerebral palsy, who had lower limb injections with botulinum toxin
(type a) between the years of 2003 and 2005 were included.
METHODS: Ethics approval was granted from the University of
Ottawa Research Ethics Board. A retrospective chart review was
performed collecting the pertinent information relating to pre-injection
goals, post-injection outcomes and family observations. ANALYSIS:
The data forms were sorted according to the child’s GMFCS level
from 1 to 5. The pre-injection goal areas, post injection outcomes
and post-injection family observation were listed. The items were
counted and categorized into impairment, activity and participation
groupings. The frequency of items was calculated and compared in
each group and GMFCS level, to delineate the different patterns of
goal setting and outcome observation according to age band and
functional level. Means were calculated across the five GMFCS levels
to compare impairment, activity and participation trends. RESULTS:
Pre-injection, the mean percentage of goals based on impairment
items was 48.48%, activity items was 48.56%, and participation
items was 2.96%. Post-injection, the mean percentage of impairment
observations was 38.8%, activity was 57.66%, and participation was
3.54%. Post-injection, parents reported on impairment observations
17% of the time, activity 69.54% of the time, and participation
13.42% of the time. Pre-injection, participation based goals were only
reported in the GMFCS 1 group at 6%. There were no participation
based goals documented for children in GMFCS levels 2-5. Post-
injection participation observations were reported in GMFCS 1 at
8.3%, GMFCS 2 at 4.2%, and GMFCS 3 at 4.2%. The families
of children in GMFCS 1 did not report on impairment. Families
of children in GMFCS 4 and 5 did not report on participation but
families in the GMFCS 4 reported on activity post injection at 85.7%.
CONCLUSIONS: Trends are observed within the individual GMFCS
levels for pre-injection goal setting, post injection observations
and parent reporting. Collectively, impairment goal items decrease
post injection. Families did not report on impairment to the same
degree as activity and participation. The evidence demonstrates
that potential functional change needs to be evaluated in the
child’s routine, environment and family lifestyle. IMPLICATIONS:
The physical therapist is challenged to partner with the family to
set realistic goals building on activity and participation outcomes.
Future research is required to investigate the impact of spasticity
management on activity and participation, particularly in relation to
family/child quality of life. KEYWORDS: Botulinum Toxin Type-A,
cerebral palsy, goal setting. FUNDING ACKNOWLEDGEMENTS:
Unfunded but supported by global budget of Ottawa Children’s
Treatment Centre. CONTACT: lkealey@octc.ca
ETHICS COMMITTEE: University of Ottawa Research Ethics Board
S34
Research Report Platform Presentation
763 Sunday 3 June 08:30
VCEC Meeting Room 18
IS LEG LENGTH INEQUALITY IMPORTANT AFTER TOTAL HIP
REPLACEMENT?
Beard D1 , Gill R1 , Andrew G2 , Nolan J3 , Barker K4 , Murray D1 ;
1 Nuffield Dept Orthopaedic Surgery, University of Oxford, UK;
2 Bangor Hospital, North Wales, UK; 3 Norfolk & Norwich Hospitals
Trust, Norwich, UK; 4 Nuffield Orthopaedic Centre NHS Trust,
Oxford, UK
PURPOSE: To document the incidence and influence on outcome of
length leg discrepancy (LLD) after cemented total hip replacement
(THR). In addition, contributory factors to the aetiology of this com-
mon post operative complication were investigated. RELEVANCE:
Leg length discrepancy is a well known complication following THR.
The true magnitude, and the cause, of LLD remains unknown as there
are few studies documenting the incidence and potential mechanisms
of undesirable limb shortening after THR. To what extent this problem
influences functional outcome is also unknown. Physiotherapists are
often required to treat the sequelae of this condition because of
the effect on gait and functional activity. Increased understanding of
the problem will help therapists in the management of this common
complication. PARTICIPANTS: 1583 patients undergoing elective
cemented THR were recruited to the Exeter Primary Outcomes
Study (EPOS). All patients had all undergone cemented primary
THR using the Exeter stem in seven different UK centres. Either an
anterolateral (n=1143) or posterior (n=426) was used. METHODS:
Data were collected prospectively by a research assistant in each
centre. Various demographic data were assimilated including age,
gender, BMI, grade of surgeon, type of anaesthetic. Standard
validated outcome instruments were used including the Oxford Hip
Questionnaire and Activity scores at one and two years. True leg
length discrepancy was measured using the standard linear tape
method from anterior superior iliac spine (ASIS) to medial malleolus.
ANALYSIS: Descriptive methods were used for the frequency data.
Outcome data were examined in two ways; 1) by comparing those
with and without LLD (Mann Whitney) and 2) assessing the influence
of LLD on specific activities (ANOVA with post hoc Tukey). A Chi
square was used to examine the influence of anaesthetic type.
RESULTS: 318 patients (20%) had a LLD  1cm whilst 74 of
these (5%) had LLD of  2cm. There was a significant difference
in Oxford Hip Score between patients with and without LLD. In terms
of specific activities, patients with LLD found it more difficult to put
on socks, ascend stairs and had more pain than those without. It
was found that patients who underwent an epidural anaesthetic were
more likely to have resultant and significant LLD after the operation
than those who had a general anaesthetic. CONCLUSIONS: The
incidence of LLD after cemented THR is higher than expected. This
complication has a major influence on outcome and specific function
of THR patients. Excessive muscle relaxation during an epidural
anaesthetic may contribute to the generation of LLD. IMPLICATIONS:
These results, from a large multi-centre cohort, indicate the need
for increased vigilance by the rehabilitation team regarding leg
length discrepancy after THR. Physiotherapy management after THR
should include careful screening and the initiation of appropriate
treatment for LLD. Intervention should include prosthetic referral and
gait assessment/education as necessary. KEYWORDS: Hip, Leg,
Length. FUNDING ACKNOWLEDGEMENTS: Stryker Howmedica
Osteonics have provided funding for the EPOS study. The Oxford
database group are thanked for their assistance. CONTACT:
david.beard@ndos.ox.ac.uk
ETHICS COMMITTEE: COREC (Oxford) UK
WCPT 2007, Research Reports
Research Report Platform Presentation
597 Sunday 3 June 08:30
VCEC Meeting Rooms 19-20
MORAL JUDGMENT OF PHYSICAL THERAPY STUDENTS: A
COMPARATIVE STUDY
Larin H1−3 , Geddes E2 , Eva K2 ; 1 University of Sharjah, Sharjah,
United Arab Emirates; 2 McMaster University, Hamilton, Ontario,
Canada; 3 Ithaca College, Ithaca, NY, USA
PURPOSE: This collaborative study investigated and compared the
moral judgment of two cohorts of physical therapy students – one
in Canada and one in the United Arab Emirates. RELEVANCE: Age
and formal education are important variables for promoting change in
moral judgment, i.e., the ability to judge what is morally right or wrong.
During their professional program, physical therapy students need to
become reflective practitioners and develop their moral judgment.
Since curricular improvements are based on student outcomes, it
is imperative to measure students’ characteristics and change over
time. However, the instruments chosen to measure outcomes must
be suitable. PARTICIPANTS: Two cohorts of students volunteered
to participate: (1) Ten females from the 3-year BScPT program,
University of Sharjah (UOS), who were Arabic and English speaking
(mean age 18.5 years); and, (2) 35 females from the 2-year BHScPT
program, McMaster University (MAC) who were English speaking
(mean age 24.9 years). Written consents were obtained. METHODS:
The study design was longitudinal and comparative. The Defining
Issues Test (DIT,) designed in English to measure moral judgment,
was administered on entry into and exit from the students’ respective
professional programs. The DIT was translated into Arabic for the
UOS students. The primary investigators were blind to the study
results until after the students’ graduation. ANALYSIS: Within each
cohort and between the two cohorts, the entry and exit DIT mean
scores were compared using an ANCOVA. Change over time was
determined using matched entry and exit tests from both cohorts
with age and grade point average (GPA) controlled as covariates.
RESULTS: DIT mean scores at entry were: MAC 48.8 (SD 11.1) and
UOS 30.8 (SD 5.7), p < 0.05. At exit, the scores were: MAC 53.9
(SD10.6) and UOS 29.0 (SD12.6), p < 0.05. Because of attrition and
incomplete score sheets, DIT change scores could be matched for
24/35 MAC and 8/10 UOS students. The mean change was: 47.5 to
54.9 for MAC students (p < 0.05) and 29.1 to 27.4 for UOS students
(n.s.). Adjusting for differences in age and GPA had no effect.
The large differences in scores between cohorts enable statistical
significance despite the small sample size. CONCLUSIONS: There
was a significant difference in the moral judgement scores between
physical therapy students at MAC and those at UOS regardless
of age and GPA. DIT scores of MAC students were higher than
UOS students at both entry and exit from their programs. Only MAC
students demonstrated significant change in their DIT scores over
time. IMPLICATIONS: In all cultures, professional programs have a
role in furthering the development of moral judgment in students.
However, these preliminary results have not been able to detect
change in the UOS students. These results should be interpreted
cautiously. This first Arabic version of the DIT requires further analysis
with regard to its cultural sensitivity and logistical administration.
Ethics educators need to be aware of the process related to the
development of moral judgment from within the particular perspective
of the students’ culture in order to effectively develop and adapt their
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:
hlarin@ithaca.edu
ETHICS COMMITTEE: University of Sharjah, College of Health
Sciences, Research Committee
Platform Presentations, Sunday 3 June
Research Report Platform Presentation
1280 Sunday 3 June 08:50
PP Crystal Pavilion B & C
CERVICAL PROPRIOCEPTION – HEAD REPOSITIONING
ACCURACY IN NORMAL SUBJECTS MEASURED WITH THE
VICON MOTION ANALYSIS EQUIPMENT
Ross L, Green A, Blundell M; Coventry University, Coventry, England
PURPOSE: To investigate, using the 6-camera Vicon 512 video
motion analysis system to measure in degrees, joint position error
(JPE) via the error of head repositioning accuracy (HRA) in a
population of healthy subjects, in the three cardinal planes –
sagittal, coronal and horizontal, following three different movements
performed: flexion/extension, lateral flexion and rotation in the
cervical spine. RELEVANCE: The evidence for inclusion of the
proprioception aspect of a body region into assessment and
rehabilitation programmes is compelling. Clinically only strength and
mobility are currently evaluated in the cervical spine and it has been
suggested that it is time to move away from these gross and non-
specific measures of musculoskeletal function as the underpinning
for diagnosis and towards more specific measurements such as
cervicocephalic kinaesthetic awareness. However, there are very
few studies, to date, into the proprioceptive ability of the normal,
healthy cervical spine PARTICIPANTS: A convenience sample of
twenty four healthy adults (age 19-55) were chosen. Twelve males
and twelve females. An ICC to give “good reliability” with 80%
power at a 5% significance level required at least thirteen subjects
if each was measured three times. The number needed to be a
multiple of six to allow for counterbalancing of the sequence of
three movements to be performed. METHODS: All subjects were
measured on three separate occasions; performing flexion/extension,
lateral flexion and rotation of their cervical spine in a counterbalanced
order of performance. Measurements were taken with the Vicon
512 video motion analysis system which gave degrees of error of
HRA to subjective neutral in the three cardinal planes following
each movement performed. ANALYSIS: The raw data was entered
into SPSS version 11.5 and an intraclass correlation coefficient
(ICC) was calculated in a two way random effects model looking
for absolute agreement, against a test value of 0.7, for the
reliability of the three repeats. RESULTS: There was statistically no
significant difference between the three repeats in any movement
plane following any movement direction. Sagittal plane following
flexion/extension mean error HRA −4.81 degrees (undershoot), ICC
0.44, 95% CI 0.17-0.69; coronal plane following lateral flexion mean
error HRA −0.39 degrees (undershoot), ICC 0.61, 95% CI 0.38-
0.80; horizontal plane following rotation mean error HRA −0.33
degrees (undershoot), ICC 0.76, 95% CI 0.57-0.88. CONCLUSIONS:
The normal healthy population can accurately and reliably relocate
their head to a subjective neutral position following displacement
in all directions. However, the greatest error in this relocation
was recorded in the sagittal plane following the movement of
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.
patients suffering from whiplash associated disorder, sports specific
population where injury/stresses to cervical spine are common.
Further studies should be performed to evaluate the effectiveness
of proprioceptive rehabilitation programmes. KEYWORDS: Cervical
spine, Proprioception, VICON. FUNDING ACKNOWLEDGEMENTS:
Not funded. CONTACT: l.ross@coventry.ac.uk
ETHICS COMMITTEE: Coventry University Ethics Committee
S35
Research Report Platform Presentation
757 Sunday 3 June 08:50
VCEC Ballroom A
EFFECT OF LOCAL COOLING ON THE CORTICO-MOTOR
EXCITABILITY OF ANKLE MUSCLES
Tremblay F1 , Dubé J, Adam P, Poirier M, Marcoux J; 1 Physiotherapy
Program, School of Rehabilitation Sciences, University of Ottawa
PURPOSE: To determine the effect of local cooling on the corticomo-
tor excitability of ankle muscles by means of transcranial magnetic
stimulation (TMS). RELEVANCE: Local cooling is commonly used by
physiotherapists as a hands-on modality to treat acute tissue injuries
in the context of competitive sports or recreational activities. While the
local effects of cooling are relatively well known, its influence at the
central level are less known. PARTICIPANTS: Twelve young healthy
adults (20-30 years, 6 males) participated in this study. METHODS:
Cortico-motor excitability was assessed by monitoring the amplitude
and latency of motor evoked potentials (MEPs) elicited in the right
Tibialis Anterior (TA) and Soleous (SOL) muscles in response to
TMS of the left motor cortex. TMS pulses were produced using a
double cone coil connected to a Magstim 200 stimulator (MagStim
Co. Dyfed, UK). Variations in the amplitude and latency of MEPs
were measured before (i.e., baseline), during (5-min interval) and
after local cooling (5 & 10-min post) of the ankle. The cooling
was produced by covering the anterior and lateral aspects of the
right ankle with a cold wrap (ice pack) for 20-min. Variations in
the skin surface temperature were also monitored by means of an
infra-red temperature gun. ANALYSIS: Paired t-tests were used to
assess differences between baseline MEP values (pre-cooling) and
variations measured during and after cooling. RESULTS: During
cooling, the amplitude of MEPs in TA gradually decreased in parallel
with the drop in skin temperature, reaching its maximum at 15 min
(20% diminution on average, p < 0.05). MEP latency values in TA were
correspondingly increased during cooling with significant differences
being detected at 10 (p < 0.01) and 15-min (p < 0.05) cooling. After
removal of the cold wrap, both MEP values and skin temperature
returned to baseline by the 10th min post-application. In the SOL,
similar changes were observed though the overall effect was far less
important than in the TA, with large variations being noticed between
individuals. No statistical differences could be detected in the SOL.
CONCLUSIONS: Local cooling at the ankle selectively depresses
the corticomotor excitability of the TA in parallel with the decrease
in skin temperature. This depression is transitory, however, and
gradually vanishes as the cooling agent is removed from the treated
area. IMPLICATIONS: A period of 10-15-min should be allowed
after a cold application for excitability to recover before a return to
activity or engaging in exercises. KEYWORDS: motor cortex, ankle,
neurophysiology. FUNDING ACKNOWLEDGEMENTS: F. Tremblay
is supported by NSERC. CONTACT: francois.tremblay@uottawa.ca
ETHICS COMMITTEE: Research Ethics Committee, University of
Ottawa
Research Report Platform Presentation
1117 Sunday 3 June 08:50
VCEC Ballroom B & C
THE ROLE OF EXPERIENCES IN FOSTERING DEVELOPMENT
OF CULTURAL COMPETENCE IN EARLY-CAREER PHYSICAL
THERAPISTS
Salzman A, Canty T, Eaton K, Mosaddeghi P, Terada P, Sander A,
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
S36
therapists (PTs) develop cultural competence. This research, part
of a larger study exploring the development of cultural competence
in early-career PTs, primarily examined the role of experiences in
developing cultural competence. A secondary focus was to explore
how learning from experience becomes meaningful and leads to
changes in attitudes, skills, knowledge, and behaviors. RELEVANCE:
Culturally competent care is recognized as a matter of social
justice and considered critical for improving the health of those
in ethnoculturally and socially diverse societies. Although there is
a growing body of literature addressing the need for PTs to be
culturally competent, there is a lack of understanding regarding what
types of educational and life experiences foster the development of
cultural competence. PARTICIPANTS: Fifteen PTs (14 females, 1
male) with no more than 3 years of experience, practicing in various
clinical settings throughout a large, metropolitan area participated in
the study. Twelve participants identified themselves as white non-
Hispanic, two identified as Asian or Pacific Islander, and one as
Hispanic/Latino. Volunteers were recruited through letters, E-mails,
and flyers sent to physical therapy clinics. METHODS: Data were
gathered through audiotaped, individual, semi-structured interviews.
Interviews were conducted until theoretical saturation occurred.
ANALYSIS: Tapes were transcribed; transcripts were individually
coded by the research team after establishing trustworthiness of
the coding schema. Constant comparative methods were used
to develop themes using concept mapping. Strategies used to
strengthen the quality of the findings included negative case analysis,
peer review, an audit trail, and thick description. RESULTS: Four
main themes emerged regarding transforming experiences that
assisted in developing cultural competence: 1) value of local or
international service learning experiences; 2) value of patient-
centered learning experiences; 3) importance of “out of comfort
zone” experiences, including feeling different than Others; and 4)
signficance of reflection in learning and leading to conviction to
change. CONCLUSIONS: Local and international immersion service
experiences and interactions with diverse patients contribute in the
ongoing process of developing cultural competence; experiences
which cause cognitive and emotional discomfort are most likely
to develop cultural competence. Reflection on the experiences is
required for learning to occur. Depth and breadth of reflection is
enhanced during interactions with influential people, including par-
ents and friends. Future planned studies will examine longitudinally
all aspects of professional development and patients’ perspectives
on PTs’ cultural competence. IMPLICATIONS: Cross-cultural clinical
interactions can be expected because of changing population
demographics. Educators and mentors can assist early-career PTs
to develop cultural competence by encouraging participation in
and reflection on cross-cultural experiences, both in the clinic
and in the community, and fostering conviction to assist them to
take action to change attitudes, skills, knowledge, and behaviors.
KEYWORDS: cultural competence, professional development, qual-
itative inquiry. FUNDING ACKNOWLEDGEMENTS: Chicago Area
Clinical Educators’ Forum and Northwestern University Department
of Physical Therapy and Human Movement Sciences. CONTACT:
a-salzman@northwestern.edu
ETHICS COMMITTEE: Northwestern University Institutional Review
Board
WCPT 2007, Research Reports
Research Report Platform Presentation
924 Sunday 3 June 08:50
VCEC Meeting Rooms 8&15
A SYSTEMATIC REVIEW OF MEASUREMENT TOOLS TO
ASSESS ATAXIA
Watson A1 , Tyson S1,2 , Moss S1,3 , Troop H4 , Dean-Lofthouse G5 ,
Jorritsma S6 , Shannon M7 ; 1 Physiotherapy Directorate, University
of Salford, UK; 2 Centre for Rehabilitation and Human Performance
Research, University of Salford, UK; 3 Salford Primary Care Trust,
UK; 4 Tameside National Health Service Trust, UK; 5 Physiotherapy
Private Practice, UK; 6 Trafford National Health Service Trust, UK;
7 Salford Royal Hospital Trust, UK
PURPOSE: A systematic review of measurement tools for ataxia was
carried out to assess their psychometric properties and suitability
for clinical use and to make recommendations for best practice.
RELEVANCE: Ataxia is a disabling aspect of many conditions
and its management forms an important part of neurological
physiotherapy. There is little research to inform practice, particularly
regarding measurement and assessment. DESCRIPTION: CINAHL,
Medline, AMED, Psychoinfo, Sportsdiscuss and Embase databases
were searched using combinations of the following keywords:
ataxia / tremor / co-ordination and measurement / assessment
/ outcome / outcome measure / measurement tool. Searches
were limited to English publications and those involving adult
humans. The identified articles were assessed for psychometric
properties (inter and intra rater-reliability, validity and sensitivity
to change) and clinical utility (cost, portability, time taken to
perform and need for specialist equipment). Article quality was
independently reviewed by clinicians using criteria based on the
Scottish Inter-Collegiate Guidelines Network and methods described
by Jorstad et al1 . Minimum standards for weak, adequate and
good quality evidence for psychometric properties and clinical utility
were defined. EVALUATION: Five ordinal scale tools were identified;
four measured the severity of ataxic tremor (Fahrs Tremor Rating
Scale [FTRS]2,3 , Graded Finger-Nose Test [GFNT]4,5 , Clinical Tremor
Rating Scale [CTRS]6,7 and International Cooperative Ataxia Rating
Scale [ICARS]8,9 ) and one measured disability caused by ataxia
(Tremor Disability Questionnaire [TDQ]10 ). Only ICARS was ataxia-
specific; all others had been tested on people with conditions causing
multiple impairments (including ataxia, weakness and spasticity).
Reliability, validity and clinical utility had been examined for all tools
but sensitivity to change was unaddressed for all. Reliability of the
FTRS, ICARS and upper limb and head sections of the TDQ were
adequate or good. Reliability of the GFNT, CTRS and lower limb
section of the TDQ were weak. Compared with measures of disability
and clinical assessment, the validity of the tools were adequate or
good. Compared with instrumented measures of impairment, the
validity ranged from weak to good. Clinical utility was good for all
measures. Most tools were quick to perform, cheap, portable and
required little specialist equipment. CONCLUSIONS: The FTRS has
the best overall score and is reliable and valid for people with ataxia
caused by multiple sclerosis. It can be time consuming to complete
and sensitivity to change is untested. IMPLICATIONS: None of the
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
Platform Presentations, Sunday 3 June
NHS Trust, Bolton PCT, and Wigan, Ashton and Leigh PCT, UK.
CONTACT: a.watson@salford.ac.uk
Research Report Platform Presentation
1382 Sunday 3 June 08:50
VCEC Meeting Rooms 11-12
SPINNING® GROUP STATIONARY CYCLING IMPROVES
TEMPORAL AND SPATIAL QUALITY OF GAIT IN PERSONS
WITH MILD TO MODERATE KNEE OSTEOARTHRITIS
Marchetti G1 , Salicinski A2 , Krohn K3 ; 1 Duquense University,
Pittsburgh, PA, USA; 2 University of Pittsburgh, Pittsburgh, PA,
USA; 3 Mercy Hospital, Pittsburgh, PA, USA
PURPOSE: To examine the effect of a group cycling intervention
on the gait characteristics of persons with mild to moderate knee
osteoarthritis (OA). RELEVANCE: Persons with knee OA have
demonstrated gait- pattern alterations. The effects of exercise
interventions on gait patterns have not been previously investigated.
PARTICIPANTS: Forty-one volunteers (29 females, 12 males) with
confirmed knee OA (Kellgren-Lawrence grades K-L 1-3) were
recruited from physician practices and by general media notices.
Mean age of subjects was 57 years (range 37-74). METHODS:
Subjects were randomly assigned to cycling and control groups and
were evaluated for baseline fitness on cycle ergometer (VO2max ,
target heart rate zones) and gait pattern on a 12 foot walkway
with GAITRite® analysis system. Cycling subjects participated in
a community-based 12-week program of supervised stationary
cycling classes at least twice weekly designed to maximize
aerobic fitness while limiting direct knee joint stress. Classes
progressively increased from 40 to 60 minutes and included light
intensity warm-up/cool-down, stretching and alternating efforts of
fast-cadence pedaling efforts and simulated hills-climbs. Subjects
were instructed to maintain an average of 70-75% of predicted
maximum heart rate throughout cycling classes with heart rate
monitors. Control subjects continued current fitness activities but did
not participate in supervised cycling. Gait parameter changes (3 trial
average, preferred/maximal velocity/cadence, step/stance times and
symmetry) were measured in groups after 12 weeks. ANALYSIS:
Cycling/control group demographics, gait parameters at baseline
and gait parameter change differences from baseline and 12 weeks
were compared using independent sample t-test (type I error rate
= 0.05). Proportion of subjects in each group showing velocity
improvement and number needed-to-treat (NNT) was estimated.
Intent-to-treat analysis was conducted to describe study dropout
subjects. RESULTS: There was no age or self-reported weight
differences between groups at baseline. Cycling group demonstrated
greater baseline mean gait velocity (preferred, maximum) and step
length differential at maximum velocity than controls. Eight cycling
and five control subjects withdrew or were lost to follow-up by
12 weeks. Cycling group subjects demonstrated greater mean
increase in preferred velocity (p = .01), preferred cadence (p < 0.01)
and reduction in step length asymmetry at maximum velocity
(p = 0.01) than control subjects. Analysis of improvement in preferred
velocity demonstrated NNT = 2. There were no significant age or
baseline gait parameter differences between 12 week completing
and dropout subjects. Dropout subjects demonstrated significantly
greater mean self-reported weight (p < 0.05). Two cycling (10%)
dropout subjects reported increased knee pain as the reason
for withdrawal. CONCLUSIONS: Subjects with mild-moderate knee
OA who completed a 12 week community-based Spinning® group
cycling class demonstrated a significant improvement in preferred
gait velocity and a reduction gait asymmetry at maximum velocity
over non-cycling controls. One in two cycling subjects demonstrated
preferred gait velocity improvement. Future research will examine the
effects of group cycling intervention on pain, functional abilities, and
quality-of-life in persons with knee OA. IMPLICATIONS: This study
provides evidence for Spinning® as a viable long-term intervention
for persons with mild-moderate knee OA may who have limited
S37
fitness choices. KEYWORDS: Knee osteoarthritis, gait, exercise
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.
CONTACT: marchetti@duq.edu
ETHICS COMMITTEE: Internal Review Boards of Duquesne
University and Mercy Hospital, Pittsburgh PA, USA
Research Report Platform Presentation
1060 Sunday 3 June 08:50
VCEC Meeting Room 16
DEVELOPMENT OF A MEASURE OF FUNCTIONING
POST-STROKE
Finch L1 , Higgins J1 , Wood-Dauphinee S1,2 , Mayo N1,3 ; 1 School of
Physical and Occupational Therapy, McGill University; 2 Department
of Epidemiology and Biostatistics McGill University; 3 Faculty of
Medicine, McGill University
PURPOSE: To develop a measure of functioning after a stroke that
could be used to quantify recovery. RELEVANCE: Stroke survivors
measure functioning compared to what they did in their pre-stroke
life, hence equating functioning and recovery. Quantifying recovery
requires a mathematical comparison of a stroke survivor’s current and
pre-stroke functional state: without a measure of functioning, recovery
cannot be quantified. Measuring a person’s ability to function is
part of a standard rehabilitation evaluation for stroke. Existing tests
and indices assess various aspects of functioning post-stroke, but
few capture the full spectrum from basic activities to participation.
Measuring function using multiple indices is methodologically difficult,
but a single index does not exist. Rasch analysis, a method of
quantifying behaviours, has helped develop, refine, and combine
items from different indices into a single measure. Rasch analysis
transforms ordinal observations from items onto an interval scale
and produces a unidimensional measure on which items and people
are organized hierarchically, by difficulty and ability, respectively,
on the same measurement scale in natural logarithm linear units
or logits. Items that fit a Rasch model could form a measure of
functioning to determine a person’s functioning and recovery post-
stroke. PARTICIPANTS: The subjects are a subset of 202 community
dwelling first stroke survivors from a cohort of 612 persons. The
survivors, aged 68, were predominately men with an ischemic stroke
(86%). Despite high activity of daily living scores (Barthel Index
mean: 92 out of 100; SD: 16), 12% of the sample were limited in
eating, and grooming, and 20% could not bathe, walk fifty yards
or climb stairs independently. Major participation restrictions were
related to the ability to travel (40%) and do recreational activities.
METHODS: A prospective longitudinal study was carried out. All 202
subjects responded over the telephone, within 9-months of stroke,
to 39 questions from five indices. Data on influencing variables:
age, stroke type and severity, and previous health, were also
collected. ANALYSIS: Two statistical methods, exploratory factor
analysis and Rasch analysis, confirmed the item factor structure,
hierarchy and dimensionality of the measure. The poorest fitting items
were removed iteratively until the best fit of the data was achieved.
Fit statistics confirmed fit to the model and internal consistency
was also assessed. A consensus exercise involving health care
professionals with expertise in stroke helped validate the measure’s
content. RESULTS: Twelve of the 39 items best fit the hierarchical
nature of the Rasch model with reliability indices of 0.91 and
0.98 for persons and items, respectively. The item difficulty levels
extended from −7.36 to +5.35 logits with item precision (standard
error) ranging from 0.14 to 0.37 logits. Gaps in measurement
occurred only at the extremes of the measure. CONCLUSIONS:
A 12-item prototype measure of functioning that combined activity
and participation indices was developed. Before using this measure
to quantify recovery test-retest reliability and responsiveness to
change needs to be tested IMPLICATIONS: The measure of
S38
functioning outlines what is necessary and important for community
functioning and its parsimony greatly reduces the response burden
in capturing this important concept. KEYWORDS: Functioning, post-
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.finch@mail.mcgill.ca
ETHICS COMMITTEE: Faculty of Medicine McGill University
Institutional Review Board.
Research Report Platform Presentation
1400 Sunday 3 June 08:50
VCEC Meeting Room 17
A SYSTEMATIC REVIEW OF CONTROLLED TRIALS OF
STRENGTH TRAINING FOR PEOPLE WITH CEREBRAL PALSY
Taylor N, Dodd K, Zoghi M; School of Physiotherapy, La Trobe
University, Melbourne, Australia
PURPOSE: To evaluate the evidence from controlled trials about
the positive and negative effects of strength training for people
with cerebral palsy. RELEVANCE: The movement disorders that
are typical of people with cerebral palsy are often characterised by
muscle weakness providing a rationale for the intervention of strength
training. However, the intervention of strength training has not been
applied widely in neurological clinical practice due to concerns that
strength training might exacerbate spasticity. A systematic review
of controlled trials will provide clinicians with the best available
evidence about the positive and negative effects of this intervention.
PARTICIPANTS: The ‘participants’ in this study were seven papers
reporting the results of five controlled trials on strength training
for people with cerebral palsy. Trials were selected by searching
electronic databases for randomised controlled trials or controlled
trials that evaluated the positive and or the negative effects of
strength training on adults or children with cerebral palsy. METHODS:
Quality assessment was completed using the PEDro scale and
data were extracted using a standardised form. ANALYSIS: Data
were extracted on environmental and personal contextual factors,
and standardised mean differences (effect sizes) were calculated for
measures of muscle strength, functional activities, and psychological
functioning. Due to heterogeneity in program details a meta-analysis
was not conducted. RESULTS: Quality assessment on the PEDro
scale ranged from 3 to 8 (M 5.6, SD 1.9) and sample sizes were
small to moderate with a total of 138 participants in this review.
Most participants had cerebral palsy of the spastic diplegic type,
were aged from 8 to 18 years, and were independent walkers with
or without assistive devices. Strength training programs were varied,
but typically included lower limb exercises. Detailed description of
exercise intensity and progression was often lacking. There was
no consistent trend in the effect of strength training on increasing
strength with effects ranging from d = −0.71 to +1.92. There
was also no consistent effect on functional activity with effects
ranging from d = −1.74 to +1.85, or on changes in self-perception
with effects ranging from d = −1.33 to +0.99. The two trials that
assessed spasticity did not find any significant differences between
the training and control groups and no other adverse effects were
reported. CONCLUSIONS: A systematic review of controlled trials
finds insufficient evidence from five controlled trials to conclude that
strength training can increase muscle strength, improve functional
activity or improve psychological functioning in people with cerebral
palsy. There is no evidence that strength training leads to any
negative effects on spasticity. Further randomised controlled trials
with larger sample sizes with well documented exercise programs of
sufficient intensity to provide a strengthening stimulus are required
to provide clinicians with the evidence to support the routine
intervention of strength training for people with cerebral palsy.
IMPLICATIONS: Strength training appears to be a safe intervention
for people with cerebral palsy but there is as yet insufficient evidence
to determine if it helps increase muscle strength, activity and
WCPT 2007, Research Reports
psychological functioning. KEYWORDS: Cerebral Palsy, Strength
Training, Systematic Review. FUNDING ACKNOWLEDGEMENTS:
No funding. CONTACT: N.Taylor@latrobe.edu.au
Research Report Platform Presentation
885 Sunday 3 June 08:50
VCEC Meeting Room 18
EFFECT OF PHYSIOTHERAPY INTENSITY ON ACHIEVEMENT
OF INPATIENT PHYSIOTHERAPY KEY FUNCTIONAL
MILESTONES POST-TOTAL HIP REPLACEMENT IN PATIENTS
WITH OSTEOARTHRITIS
Gibson C1 , Mawson S2 , Enderby P1 , Hamer A3 , Norman P4 ;
1 School of Health & Related Research, University of Sheffield,
Sheffield, UK; 2 Centre for Health & Social Care Research, Sheffield
Hallam University, Sheffield, UK; 3 Department of Orthopaedics,
Northern General Hospital, Sheffield Teaching Hospitals NHS
Foundation Trust, Sheffield, UK; 4 Department of Psychology,
University of Sheffield, Sheffield, UK
PURPOSE: To assess factors (psychological, demographic, medical
and physiotherapy) which affect recovery following total hip replace-
ment (THR) in patients with osteoarthritis (OA). RELEVANCE: OA is
a major cause of disability in the elderly. THR is routinely conducted
to relieve pain and loss of function associated with OA. Around
50,000 THR are performed annually in England, approximately 82%
of these resulted from OA. This is a major burden on the NHS
that will increase with the aging population. Increased demand
for THR could be tackled by optimising the rehabilitation process
following surgery and thus reducing the length of stay (LOS).
Recovery time and LOS following THR is hugely variable. Medical
and demographic factors account for some, but not all, of this
variability. It was hypothesised that patients’ personality and coping
strategies would affect the success of rehabilitation following THR.
A second hypothesis stated that intensity of treatment may affect
the achievement of these milestones. PARTICIPANTS: Consecutive
patients attending pre-admission assessment clinic (under the care
of one of five clinicians conducting surgery at three hospitals) for
unilateral THR as a result of OA were invited to take part in the
study. 159 patients consented of which 99 successfully completed
the pre-operative questionnaires and had their surgery within the
study time frame. METHODS: Participants completed psychological
and demographic questionnaires prior to surgery. Data regarding
time in days to achieve key physiotherapy milestones (bed transfer,
chair transfer, independence with frame, independence with crutches,
physiotherapy discharge, post-operative LOS) were recorded from
the patients’ notes. The physiotherapists treating the patients were
blinded to the purpose of the study. Physiotherapy intensity was
calculated by dividing the number of physiotherapy sessions a patient
received by the number of days until discharged from the inpatient
physiotherapy team. ANALYSIS: Pearson correlations were recorded
between the independent and dependent variables (key milestones).
Independent variables which significantly correlated (p < 0.05) with
the dependent variable where included in a forward stepwise multiple
regression analysis. RESULTS: Physiotherapy intensity significantly
correlated with all key functional milestones. Few psychological
variables have significant associations with the milestones. Multiple
regression analysis revealed physiotherapy intensity to be linked
to only bed transfer and chair transfer. However, hospital in which
the patient was treated was a predictor of the other milestones.
A statistically significant relationship existed between hospital and
physiotherapy intensity. The regression analyses were repeated with
hospital excluded as a predictor. The repeat analyses revealed
physiotherapy intensity a predictor of bed transfer, chair transfer,
independence with frame, independence with crutches and LOS.
The proportion of the variance predicted solely by this factor ranged
from 3-12%. CONCLUSIONS: Intensity of treatment predicts time
taken to achieve key physiotherapy milestones post-THR. As the
sample size was small, repeating with a larger population size
Platform Presentations, Sunday 3 June
would be beneficial. IMPLICATIONS: Providing more physiotherapy
sessions per day post-THR is associated with earlier independence
and reduced LOS. Increasing physiotherapy input will allow a greater
throughput of patients freeing vital bed space and contributing
to reduction in waiting list times. KEYWORDS: physiotherapy in-
tensity. FUNDING ACKNOWLEDGEMENTS: unfunded. CONTACT:
C.N.Gibson@sheffield.ac.uk
ETHICS COMMITTEE: North Sheffield Ethics Committee, Sheffield,
UK
Research Report Platform Presentation
1542 Sunday 3 June 09:10
PP Crystal Pavilion B & C
THE INFLUENCE OF A BACK-SUPPORT HARNESS
ON THE THREE DIMENSIONAL KINEMATICS AND
ELECTROMYOGRAPHY OF THE TRUNK IN SHEEP SHEARERS
Schneiders A1 , Milosavljevic S1 , Milburn P1 , Wilson B2 ; 1 School of
Physiotherapy, University of Otago; 2 School of Physical Education,
University of Otago
PURPOSE: The purpose of this study was to investigate the
effect of a back-support harness on three-dimensional kinematics
and electromyography of the trunk during the occupational task of
sheep-shearing. RELEVANCE: The occupation of sheep-shearing
is classified as heavy to very-heavy physical work requiring a
high level of energy expenditure while performing a repetitive task
in a predominantly sustained trunk flexion posture. The task is
further complicated by unpredictable animal behaviour. Shearing
is considered to carry a high risk of injury particularly to the
lumbar spine and epidemiological studies have demonstrated that the
prevalence of low back pain (LBP) in shearers is high relative to other
occupations. The emergence of a commercial shearing-aid (Warrie
Back-Aid™) that is purported to decrease loading on the spine,
reduce injury rate and alleviate symptoms of spinal origin has been
welcomed by many sectors of the wool-harvesting industry. However,
the precise biomechanical influence of the Warrie Back-Aid™ (WBA)
on the entire sheep-shearing task has not previously been quantified.
PARTICIPANTS: Subjects were twelve (12) voluntary participants
from the New Zealand geographical regions of Otago and Canterbury
who were classified as professional sheep shearers and could
machine shear between 200 and 300 sheep over an average eight-
hour day. METHODS: Nine distinct phases of the shearing-task
where the harness was worn during the removal of the sheep’s
fleece were investigated. The study used an opto-electronic motion
analysis system and rigid body dynamic modelling. The shearer’s
trunk and pelvis were considered as a series of three coupled
rigid segments; pelvis, lumbar, and thorax, with four passive retro-
reflective markers defining each segment. An eight channel sEMG
telemetry system simultaneously recorded activity in four pairs
of trunk muscles. ANALYSIS: The kinematic variables of angular
displacement, velocity and acceleration at the thoraco-lumbar and
lumbo-pelvic joint centres were calculated for each shearer while
shearing with and without the WBA. Temporal analysis of the sEMG
signal gave information on the duration and relative intensity of trunk
muscle activity. RESULTS: The introduction of the WBA had no effect
on the time taken to shear or trunk kinematics however it resulted in
reductions in muscular activity of the trunk extensors. A statistically
significant reduction in mean intensity of muscle activity for the
left multifidus (p = 0.010), right multifidus (p = 0.001), right iliocostalis
(p = 0.004) and right longissimus (p = 0.002) occurred when the WBA
was used. A reduction in muscular activity of the trunk extensors
during the sheep-shearing task may result in a decrease in spinal
loading, energy expenditure and muscular fatigue. CONCLUSIONS:
The results demonstrated that the task of sheep-shearing required
endurance-based muscle activity and the adoption of quasi-static
posturing combined with complex asymmetrical trunk motion for
extensive periods of the task time. There was considerable variability
S39
in the trunk motion of individual shearers despite the pattern-
taught and repeatable nature of the shearing task. IMPLICATIONS:
The clinical recommendation based on the biomechanical results
of this study is that the WBA should be incorporated into the
practice of sheep-shearing to assist in the reduction of inherent
risks associated with the shearing task. KEYWORDS: Low-back
Pain; Occupational Health; Biomechanics; Motion Analysis; Elec-
tromyography. FUNDING ACKNOWLEDGEMENTS: The authors
wish to thank The Health Research Council of New Zealand
who supported this study through a contestable grant. CONTACT:
tony.schneiders@otago.ac.nz
ETHICS COMMITTEE: National Ethics Committee of the New
Zealand Health Research Council and the University of Otago Human
Ethics Committee.
Research Report Platform Presentation
2596 Sunday 3 June 09:10
VCEC Ballroom A
SKIN SURFACE TEMPERATURE ASSOCIATED WITH
EVAPORATIVE CRYOTHERAPY
Dale R; Department of Physical Therapy, University of South
Alabama, Mobile, AL, USA
PURPOSE: Evaporative cryotherapeutic modalities often purport to
decrease skin temperature by 15 degrees Celsius (C) within 15
minutes of application. These modalities are portable and could
be applied outdoors. However, environmental factors, such as
ambient air temperature, may influence skin temperature achieved by
evaporation. RELEVANCE: No studies exist supporting the efficacy
of evaporative cryotherapy modalities in controlled environmental
conditions. Therefore, this experiment sought to determine skin
temperature (Tsk) and perceived skin cooling (Pcool) in neutral (25
C) and hot (32 C) ambient temperatures with ~50% relative humid-
ity. PARTICIPANTS: Eight volunteer female subjects. METHODS:
Data collection occurred in a temperature-controlled environmental
chamber. The evaporative modality was applied for 30 minutes to the
mid-thigh region of one extremity while the contralateral thigh served
as control during two separate trials spaced 72 hours apart. The
subsequent trial was a repeat of the first, except it occurred in the
opposite room temperature. Pcool was measured with a visual analog
scale and Tsk with thermocouples connected to a data processor
(Columbus Instruments, Columbus, OH). ANALYSIS: Data were
analyzed by a repeated measures analysis of variance using within-
subject factors of condition (hot vs. neutral), treatment (modality vs.
control), and time (pre to post-treatment) using SPSS 14.0 software
(Chicago, IL). The apriori alpha level was 0.05. Post-hoc analyses
were performed with paired t-tests corrected for alpha inflation by
Bonferonni’s procedure. RESULTS: The evaporation rate of the
modality did not differ (p > 0.05) between the neutral (22.8 + 2.1 ml
per hour) and hot room temperatures (19.4 + 2.0 ml per hour) (means
+ SEM). Baseline Tsk for the modality limb was 32.2 + 0.2C and 32.5
+ 0.3C at time 0 in the neutral and hot room condition, respectively
(p > 0.05). Also, there were no Tsk differences within the modality limb
between room temperatures at 5 and 10 minutes; however, significant
differences emerged at 15 minutes and beyond (p < 0.01). Absolute
Tsk of the modality limb after 30 minutes was 29.5 + 0.3C and 31.3 +
0.3C for the neutral and hot room conditions, respectively (p < 0.01).
Pcool of the modality limb, however, was not different between room
conditions (p > 0.05), but differed between the modality and control
limbs by 42 and 43% during the neutral and hot room conditions,
respectively (p < 0.01). CONCLUSIONS: Ambient air temperature
influenced Tsk achieved by this evaporative cryotherapeutic modality.
Skin temperature decrease was minimal even in the neutral room
temperature, and thus, any therapeutic effect is likely due to a
counterirritation-induced cooling sensation (Pcool). Further research
needs to substantiate these findings in clinical populations and
to determine the influence of other environmental factors such as
relative humidity. IMPLICATIONS: These data indicate that ambient
S40
temperature influences Tsk but not Pcool with the application of this
evaporative cooling modality. KEYWORDS: evaporation, cryotherapy,
skin temperature. FUNDING ACKNOWLEDGEMENTS: None.
ETHICS COMMITTEE: University of South Alabama Institutional
Review Board
Research Report Platform Presentation
1662 Sunday 3 June 09:10
VCEC Ballroom B & C
PATIENT EDUCATION GEARED TOWARDS CHRONIC DISEASE
SELF MANAGEMENT:THE ROLE OF LITERACY
King J; University of Ottawa, Ottawa, Canada
PURPOSE: The purpose of this study was to identify the barriers that
adults with limited literacy and chronic diseases encounter in patient
education experiences. RELEVANCE: There is a direct link between
literacy skill level and health. Low literacy skills affect a person’s ability
to effectively use health services, take medications, and understand
other information provided to them regarding their health (Health
Canada, 2001). The Adult Literacy and Life Skills Survey estimates
that 22% of adults in Canada cannot determine the maximum number
of days they should take a medication by simply looking at the label
(Statistics Canada & Organisation for Economic Co-operation and
Development, 2005). Everyday, physiotherapists therefore assess,
treat, and provide patient education to patients that have limited
literacy.Patient education includes advice regarding self-management
techniques. For patients with chronic diseases this information is
seen as essential to maintain their health and quality of life. Previous
research has demonstrated that self-management skills are poorest
among patients with limited literacy skills (Williams, Baker, Honig,
Lee, & Nowlan, 1998). PARTICIPANTS: A purposeful selection of
14 adults who were attending a community based literacy program
and have a chronic disease were selected. The participants were
living with a number of chronic diseases including asthma, arthritis
and diabetes. METHODS: An inductive, interpretive, hermeneutic
phenomenological method was used (van Manen, 1997). The
data sources were interviews,field notes, document analysis and
researcher’s journal. ANALYSIS: The data sources were analyzed by
reading, organizing and coding, identifying the meaning statements,
and grouping the aggregrate formulated meanings into clusters of
themes. RESULTS: Five themes emerged from the data representing
the barriers that participants encountered in patient education
experiences they were; different roles and relationships, living
between worlds, language and health care interactions, mismatched
expectations, and powerlessness. CONCLUSIONS: Pressure on
patients to manage their own health is particularly detrimental to
individuals with limited literacy due to the barriers they encounter
during patient education experiences. Participants suggested to
overcome these barriers physiotherapists could use plain language;
decrease reliance on written pamphlets and provide specific details
on how to integrate patient education advice into their daily lives.
Further research is needed to test these specific patient education
strategies. But it is hoped that incorporating appropriate patient
education interventions into physiotherapists’ practice will help to
optimise the care of patients living with chronic diseases and
limited literacy leading to reduction in health care spending and
an improved quality of life. IMPLICATIONS: WCPT’s Declaration
of Principles expects that all physical therapists provide accurate
treatment information and a clear explanation of the risks associated
with treatment. The findings from this study indicate that this
may not always occur.The Adult Literacy and Life Skills Survey
findings estimates that 20-40% of adults in over 30 countries
have low literacy skills (Organisation for Economic Co-operation
and Development, 2005). Therefore many physiotherapists in the
world will provide patient education for patients living with limited
literacy, it is hoped that the findings of this study will help increase
the awareness of physiotherapists of the impact of limited literacy
on patient education experiences. KEYWORDS: Literacy, patient
WCPT 2007, Research Reports
education, chronic diseases. FUNDING ACKNOWLEDGEMENTS:
Social Sciences and Humanities Research Council of Canada
(SSHRC), Canadian Lung Association-Canadian Physiotherapy Car-
diorespiratory Society, Ontario Lung Association- Ontario Respiratory
Care Society, University of Ottawa,Ontario Graduate Scholarship.
CONTACT: jking@uottawa.ca
ETHICS COMMITTEE: University of Ottawa’s Ethics committee
Research Report Platform Presentation
1423 Sunday 3 June 09:10
VCEC Meeting Rooms 8&15
THE RELATIVE MERITS OF STANDARD TURN TESTS:
DISPARITIES IN DEGREE OF DIFFICULTY, MEASUREMENT
PROPERTIES AND ECOLOGICAL VALIDITY
Kampshoff C1,2 , Burnett M1 , Stack E1 , Ashburn A1 , Fitton C1 ;
1 University of Southampton, Southampton, UK; 2 Radboud
University, Nijmegen, The Netherlands
PURPOSE: Mobility assessment is not limited to whether people walk
safely and efficiantly in straight lines; the ability to turn is equally
fundamental. To inform the clinician’s choice between established
turn tests, we compared four and identified the relative merits of
each. RELEVANCE: Turn tests have joined the plethora of mobility
measures: some may be more challenging than others (e.g. in the
magnitude of turning steps) but no direct comparisons have been
made between them, whereby one group perform multiple tests on
one occasion. PARTICIPANTS: Fourteen healthy adults, median age
32 (range 24-56). METHODS: Ethical approval was granted by the
School of Health Professions and Rehabilitation Sciences Ethics
Committee at the University of Southampton. Participants performed
four tests following the standard protocol for each, in random order,
in our laboratory: 360 and 180 degree turns ‘on-the-spot’ (360-Spot
and 180-Spot); the Standing Start 180 degree Turn Test (SS-180);
and the Timed Up and Go (TUG). Using video and three-dimensional
movement analysis, we evaluated the steps (n) and time (sec) taken,
floor space covered (m) and delay between onset of head rotation
and the first step (sec) during turning. ANALYSIS: We described
group performance for each test and examined ranked correlations
between tests. For the clinically measurable variables (step count
and turn time) we examined inter-rater and test-retest reliability,
using the Bland-Altman method of comparison to determine the 95%
limits of agreement. RESULTS: The 360-Spot was completed in a
median 6 steps over 3.3sec, covering an area 0.5m by 0.5m; the
180-Spot in 4 steps, 2.3sec, covering 0.4m by 0.4m; the SS-180 in
2 steps, 1.6sec, covering 1.3m by 0.5m; and the TUG in 4 steps,
2.4sec, covering 1.9m by 0.5m. Thus, median step time was 0.8sec
in the SS-180 and 0.6sec otherwise and median step length was
0.7m in the SS-180, 0.5m in the TUG and 0.1m otherwise. The
delay between head rotation and stepping was 0.2sec in the 360-
Spot and 0.3sec otherwise. ‘On-the-spot’ tests correlated on steps,
time and space covered; walking tests did not. Inter-rater reliability
was best (i.e. limits of agreement narrowest) for ‘on-the-spot’ turns
and the SS-180; test-retest reliability was best for the SS-180
and the TUG. CONCLUSIONS: Walking turn tests are challenging
(the SS-180 necessitated the longest turning steps both spatially
and temporally) and show good test-retest reliability. ‘On-the-spot’
turn tests provide little challenge (the Spot-360, necessitated least
dissociation between head rotation and stepping), require little space
and show good inter-rater reliability. IMPLICATIONS: Not all turn
tests are the same. These differences (plus the dearth of correlation
between tests) suggest the tests measure different aspects of
performance. Clinicians can choose a suitable turn test based on
client ability, the assessment environment (available space and
equipment) and the need for measurement precision. KEYWORDS:
Outcome Measures; Evidence Based Practice (EBP). FUNDING
Platform Presentations, Sunday 3 June
ACKNOWLEDGEMENTS: This work was unfunded. CONTACT:
els1@soton.ac.uk
ETHICS COMMITTEE: School of Health Professions and Rehabili-
tation Sciences Ethics Committee
Research Report Platform Presentation
1938 Sunday 3 June 09:10
VCEC Meeting Rooms 11-12
RELATIONSHIP BETWEEN MAXIMAL STEP LENGTH AND
CHARACTERISTICS OF STEPPING OVER AN OBSTACLE
UNDER DUAL-TASK CONDITIONS IN OLDER ADULTS
Goto M1 , Kanemura N2 , Shinkoda K2 ; 1 Department of PT, Faculty
of Nursing and Rehabilitation, Aino University, Osaka, Japan;
2 Department of PT and OT Sciences, Hiroshima University
Graduate School of Health Sciences, Hiroshima, Japan
PURPOSE: Previous research suggests that maximal step length
(MSL) can be a good predictor of mobility performance and is closely
related to fall risk. This study was conducted to better understand
the relationship between maximal step length and characteristics of
stepping over an obstacle while performing a secondary cognitive
task. RELEVANCE: This study is undertaken as a first step in
developing an effective stepping exercise using a dual task to prevent
falls. PARTICIPANTS: Thirty-four individuals (15 men and 19 women)
with a mean age of 71.2 years who use day care services more than
once a week participated in this study. METHODS: Each subject
was tested for MSL in the front, side, and back directions in each
lower extremity. Additionally, they were asked to ascend forward and
descend backward from a 10-cm step to the beat of a metronome for
90-seconds, in three conditions, a single-task, an auditory stimulus,
and a visual stimulus. In a trial with a visual-task, the subjects
were asked, while stepping repeatedly, to read an animal’s name
that was displayed on a computer monitor. In an auditory-task, they
asked to identify an instrument’s name after hearing the sound
while stepping repeatedly. As a stepping parameters, medial-lateral
and anterior-posterior center of foot pressure excursion (CFP) and
velocity during obstacle negotiation, foot clearance and step length
over the obstacle were recorded. To determine the relationship
between MSL and stepping performance while performing a dual-
task, subjects were divided into two groups, a lower MSL group
and a higher MSL group. A static force platform (Unimec Corp.) for
CFP and a three-dimensional kinematics and kinetics system (UM-
CAT II, Unimec Corp.) were used for collecting data. ANALYSIS: All
group comparisons were performed using paired t-tests. In addition,
correlations between parameters were confirmed using simple linear
regression. RESULTS: The higher MSL group showed greater CFP
moving posteriorly during the initial phase of initiation (P < 0.05) and
lateral shift towards the stance limb as the swing limb unloaded
(P < 0.01) than the lower MSL group, when cognitive tasks were given
in stepping performance. Both visual and auditory task performance
decreased vertical clearance between the top of the obstacle and
the lowest point of the foot in the lower MSL group. There were
no significant differences between an auditory-task and a visual-
task on stepping performance. CONCLUSIONS: The net CFP is
the integrated control variable of the center of mass (COM). When
both of cognitive tasks were asked, the lower MSL group showed
smaller CFP posterior shift at the initial phase of initiation and
lateral shift towards the stance limb. This means that they couldn’t
initiate the start of a forward fall to accelerate the COM ahead of
the base of support and lift up the leading leg enough to avoid
obstacle contact. IMPLICATIONS: Results of this study indicate that
MSL is one of reliable measures to identify individuals at a risk of
falling and stepping exercise over an obstacle while performing a
secondary cognitive task may be an effective balance-intervention
program. KEYWORDS: Maximal step length, Dual-task, Center of
foot pressure. FUNDING ACKNOWLEDGEMENTS: None.
ETHICS COMMITTEE: The Aino University institutional review board
S41
Research Report Platform Presentation
1397 Sunday 3 June 09:10
VCEC Meeting Room 16
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
and Physical Therapy, University of Southern California, Los
Angeles, CA, USA; 2 Department of Aging and Geriatric Research,
University of Florida, Gainesville, FL, USA; 3 Department of
Statistics, University of Florida, Gainesville, FL, USA
PURPOSE: Locomotor Experience Applied Post-Stroke (LEAPS)
is a phase III, single-blinded, multi-site, randomized clinical trial
with an anticipated enrollment of 400 patients conducted in five
community-based rehabilitation hospitals in regionally distant cities
in the United States. The purpose of this study is to present
the LEAPS standardization process used to determine evaluation
competency across all sites and to report the results of the inter-
rater reliability of one of the outcomes measures: the Fugl-Meyer
Motor and Sensory Assessment (FM). RELEVANCE: The use and
standardization of blinded evaluators is a crucial aspect of clinical
trial design. Demonstrating inter-tester reliability among clinical trial
sites and therapists is an important consideration that contributes to
the strength and validation of the clinical trial outcomes. In addition,
the education of clinicians in standardized assessment procedures
facilitates translation of valid and reliable clinical assessments such
as the FM into practice. PARTICIPANTS: Thirteen individuals (age:
59.9 yrs. +/− 10.5, 62% female) with acute ischemic stroke (post-
stroke onset: 32.2 +/− 21.5 days) provided IRB approved consent
to be evaluated and videotaped. The performance of 9 physical
therapists from all 5 LEAPS clinical sites is reported. METHODS:
Standardization training included a lecture and demonstration style
workshop, practice and formal feedback with a patient under
supervision of a trained Clinical Research Coordinator, and use of
an electronic discussion board to field and respond to questions
across sites. Competency was determined by a score of>90% on a
skills checklist of a videotaped evaluation session submitted by each
therapist. Thirteen videotapes and rating sheets were submitted for
the upper extremity motor (UEM), lower extremity motor (LEM), and
light touch/proprioception sensory (SFM) subcomponents of the FM.
Evaluation sessions were videotaped and scored by 9 competency-
trained physical therapists across 5 clinical sites. The observing rater
who viewed and scored all videotapes was one of the study Principal
Investigators with expertise in the FM (KS). ANALYSIS: Data were
analyzed using the Intraclass Correlation Coefficient (ICC, 3,1) for
mean outcome scores of the UEM, LEM, and SFM components of
the FM. The Kappa statistic was used for individual item scores.
RESULTS: Inter-tester reliability for each FM subcomponent was as
follows: UEM 0.99 (95% CI: 0.97-1.00), LEM 0.95 (95% CI: 0.90-
0.98), and SFM 0.75 (95% CI: 0.56-0.96). Agreement was good
to perfect (weighted Kappa: 0.60–1.00) for all except two items
each on the UEM and LEM. CONCLUSIONS: A comprehensive
competency-based training and standardization program produced
strong inter-rater reliability between standardized LEAPS evaluators
and an experienced researcher using the FM. Establishment of
high inter-rater reliability will serve to strengthen the results of the
overall trial. The individual item analysis is instructive regarding
items that require additional attention during training. Future work
would include determining reliability in a larger, more diverse, cohort
of physical therapists. IMPLICATIONS: The standardized training
and competency program used for LEAPS evaluators provides an
example of effective standardization of outcome measures such as
the FM in community-based, regionally dispersed, clinical trials. This
model could be easily adapted for physical therapist training in both
clinical practice and educational settings. KEYWORDS: Fugl-Meyer,
Reliability, Clinical Trials. FUNDING ACKNOWLEDGEMENTS: Na-
S42
tional Institutes of Health; 1 R01 NS050506-01A1. CONTACT:
tilson@usc.edu
ETHICS COMMITTEE: University of Florida Institutional Review
Board
Research Report Platform Presentation
1686 Sunday 3 June 09:10
VCEC Meeting Room 17
IS THE LEVEL OF PHYSICAL ACTIVITY IN ADULTS WITH
CEREBRAL PALSY ASSOCIATED WITH DEMOGRAPHIC
FACTORS OR FUNCTIONAL ABILITIES?
Maltais D1,2 , Dumas F1,2 , Boucher N1,2 , Corriveau D3 ,
Beauregard L1 , Pelletier M3 , Pichard L3 , Robitaille M1,2 ,
Roy K1 , Richards C1,2 ; 1 Centre for Interdisciplinary Research in
Rehabilitation and Social Integration, Quebec City, Canada; 2 Laval
University, Quebec City, Canada; 3 Quebec Rehabilitation Centre,
Quebec City, Canada
PURPOSE: To determine, for adults with cerebral palsy (CP), the
relationship between physical activity (PA) and selected demographic
factors and walking ability. RELEVANCE: It is well accepted that
the level of PA is an important predictor of health in the general
adult population. Even though it is typically assumed that PA is
low in adults with CP (since that is the case for children with
CP), there is little literature available about PA in these adults.
Information regarding demographic and physical factors relevant to
PA in adults with CP could therefore guide future physical therapy
research and interventions, and in the long term, have health
implications for this group. PARTICIPANTS: All study participants
(n=73 men, 72 women; 28 yr ±5.6) had a diagnosis of CP and
were previous clients of the local pediatric rehabilitation centre. The
distribution frequency (%) across Gross Motor Function Classification
Levels (GMFCS) was: (Ambulators: Level I=29.5; Level II=8.9; Level
3=15.8; Non-Ambulators: Level IV=32.2; Level V=13.7). There was
no significant difference in the distribution of age across the five
GMFCS levels. METHODS: A questionnaire on health and lifestyle
was administered as either a telephone or face-to-face interview, or
as a form sent to the participant by mail. The questionnaire was
based on that used in a province-wide (Quebec) survey of lifestyle
and health (1998). ANALYSIS: Descriptive statistics were used to
summarize demographic data. The relationships between PA and
the other factors of interest were analyzed using the Chi-square
test with significance set at p = 0.05. RESULTS: The participants’
level of PA was assessed (more active = 20-30 minute activity bouts
two or more times weekly; less active = 20-30 minute bouts less
than twice weekly). About half the individuals of both sexes were
more active and half were less active (n=37 men, n=42 women
more active; n=36 men, n=30 women less active; ns). For those with
very good walking ability (GMFCS Level I, n=43), however, there
was a trend towards a greater number being more active (n=27
more active; n=16 less active, p = 0.09). With individuals who had
more than a minor difficulty walking (GMFCS Levels II-V) there was
no significant difference in the number of those who were more or
less active. Whether or not walking had deteriorated over the last
three years was also assessed (n=86). Of the individuals in this
group who were more active (n=50), a greater number reported
no change in walking ability (n=37 no change; n=13 deterioration,
p < 0.001). CONCLUSIONS: Overall, the number of men or women
with CP who are more active is similar to the number of them
who are less active. For those who walk, however, their level of PA
is related to their walking ability. IMPLICATIONS: Interventions to
increase PA should target both sexes. Since a significant number of
less active individuals were only found in the group whose walking
skills had deteriorated, interventions addressing walking skills to
improve PA may be most efficacious for this group. Further research
is needed to test these hypotheses. KEYWORDS: cerebral palsy,
walking, physical activity. FUNDING ACKNOWLEDGEMENTS: This
study was supported by the Centre for Interdisciplinary Research
WCPT 2007, Research Reports
in Rehabilitation and Social Integration, the Laval University Chair
in Cerebral Palsy Research, and the Cerebral Palsy Consortium.
CONTACT: Desiree.Maltais@cirris.ulaval.ca
ETHICS COMMITTEE: Institutional review board of the Québec
Rehabilitation Centre
Research Report Platform Presentation
2227 Sunday 3 June 09:10
VCEC Meeting Room 18
REHABILITATION CARE PATHWAYS FOR HIP AND KNEE
JOINT REPLACEMENT IN ONTARIO: SYNTHESIS OF THE
LITERATURE AND ENVIRONMENTAL SCAN
Jaglal S1,2,4 , Fancott C1 , Quan V2 , Davis A1,3 , Hawker G4 ,
Mohamed N3 ; 1 Toronto Rehabilitation Institute; 2 Department of
Physical University of Toronto; 3 Toronto Western Research Institute;
4 Women’s College Hospital
PURPOSE: To examine the type and amount of rehabilitation
services used by the total hip and knee joint replacement population
in Ontario; to identify factors that may influence outcomes; and, to
determine how current and future needs will be met by clarifying the
role of rehabilitation in the continuum of care. RELEVANCE: The
landscape of care for total joint replacement patients has undergone
enormous change in recent years. PARTICIPANTS: Twenty-three key
informants from fifteen acute care and rehabilitation facilities across
Ontario participated. Key informants were leaders and staff members
who had in-depth information on current practices, processes,
and structures. Administrative database information of hospital
discharges for total hip and knee joint replacement. The total number
of index discharges of patients in Ontario who received total hip and
knee replacement surgeries from April 1, 2002 to September 30,
2004 before any exclusions was 56,258. The total number excluded
was 6,975; the remaining cohort was comprised of 49,283 acute
care discharges. METHODS: Information was gathered from three
sources: 1) a literature review that focused on factors associated
with improved outcomes for the total joint replacement population;
2) administrative data review of the Discharge Abstract Database
(DAD), the National Rehabilitation Reporting System (NRS), and the
Home Care Administrative System (OHCAS) for the years 2002–
2005 (where available); and 3) key informant interviews. ANALYSIS:
Administrative data analysis included descriptive statistics to examine
the utilization of rehabilitation services and rehabilitation patterns
of practice across the province; and statistical models to identify
factors associated with discharge from acute care to inpatient
rehabilitation. A descriptive analysis of key informant interviews
was conducted to identify themes related to best-practices and
areas of future consideration in total joint care. RESULTS: There
was geographic variation in utilization of inpatient rehabilitation
based on access and availability. Practice changes were noted
with a shift to discharge directly home rather than to inpatient
rehabilitation. Patients who are older; female; have more comorbidity,
or have a shorter acute care length of stay are more likely to
receive inpatient rehabilitation. Key informant interviews identified
a principal focus of care was the reduction of lengths of stay in
acute care to allow for increasing volumes of patients and smoother
integration of care across the continuum. Two main themes emerged:
processes of care, and structures which supported these processes.
CONCLUSIONS: Recommendations to improve lengths of stay in
acute care facilities include the implementation of partnerships
and communication with key stakeholders; the management of
patient and family expectations through the preoperative process;
and, weekend rehabilitation services to maintain care pathways.
Continued movement toward discharge directly home from acute
care can be facilitated by having appropriate outpatient and CCAC
supports in place, and extending acute care pathways to home
settings to ensure continuity and quality of care. IMPLICATIONS:
With the implementation of Local Health Integration Networks
(LHINs) across Ontario, this may be a prime opportunity to
Platform Presentations, Sunday 3 June
standardize care processes and promote “best practice” for total joint
replacement and to ensure integration across the continuum of care.
KEYWORDS: total joint replacement; rehabilitation; care pathways.
FUNDING ACKNOWLEDGEMENTS: Ontario Ministry of Health and
Long-Term Care. CONTACT: susan.jaglal@utoronto.ca
ETHICS COMMITTEE: Toronto Rehabilitation Institute
Research Report Platform Presentation
1658 Sunday 3 June 09:30
PP Crystal Pavilion B & C
IMPACT OF PELVIC STABILIZATION AND LOWER-LIMB
POSITION ON TRUNK EXTENSORS ACTIVITY DURING
DYNAMIC LUMBAR EXERCISES IN EXTENSION
da Silva R1 , Larivière C2 , Arsenault B1 , Nadeau S1 , Plamondon A2 ;
1 University of Montreal and CRIR – Montreal Rehabilitation
Institute, Montreal (Qc), Canada; 2 Occupational Health and Safety
Research Institute Robert-Sauvé (IRSST), Montreal (Qc), Canada
PURPOSE: To examine the effect of pelvis stabilization and of two
lower-limb configurations on the electromyographic (EMG) activity of
back and hip extensor muscles during a dynamic back extension
exercise on a machine. RELEVANCE: Since the lumbar extensors
and hip extensors both contribute to lumbar trunk extension, it is
important to identify specific exercises that might help to isolate
the activity of the back muscles relatively to the hip muscles during
dynamic extension movement. PARTICIPANTS: Twenty-two healthy
volunteers (11 males and 11 females), aged between 20 and 55
years, participated in this study. METHODS: The subjects performed
five trunk flexion-extension cycles at 40% of their maximal voluntary
contraction (MVC) in a machine designed for back exercise (Biodex
dynamometer system). Two different positions were used: I) seated
position (seat horizontal, knees at 90º) and II) semi-standing position
(seat slightly tilted forward at approximately 15º, knees at 135º).
In each position, three pelvic stabilization conditions were tested:
(1) unrestrained (control condition), (2) partially restrained (pad
posteriorly at the sacrum level) and (3) totally restrained (same as
(2) plus one pad at the pelvis level anteriorly). The EMG signals were
recorded with 12 pairs of surface electrodes placed bilaterally on four
back muscles (at L4, L3, L1 and T10 levels), as well as on two hip
extensor muscles (Gluteus and Biceps femoris). For each muscle, the
EMG amplitude in the extension phase (concentric action) of each
cycle was identified and then, the Muscular Utilization Ratio (MUR),
defined as the percentage of EMG amplitude relative to the maximal
EMG obtained from MVCs, were computed. These MURs were used
to compare the level of muscular activation of each muscle group
across exercises. ANALYSIS: Two-way repeated measures ANOVA
applied to the MUR values served to identify the effect of pelvic
stabilization and lower-limb positions on the trunk extensor muscles.
RESULTS: No significant interaction (P > 0.05) was found between
the pelvic-stabilization and lower-limb position for each muscle group.
Regardless of the lower-limb position, using a pelvic stabilization
(partially and totally restrained) significantly (P < 0.05) increased the
activity of all back muscles (average of 12%) but did not changed
the hip extensor activities. However, for the three pelvic conditions,
the semi-standing position significantly decreased (range of 10 to
21%) the activity of hip extensors compared to the seated position.
CONCLUSIONS: This study demonstrated that pelvic stabilization
enhances back muscles activation during lumbar dynamic exercises
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
S43
and Safety Research Institute Robert-Sauvé (IRSST). CONTACT:
rubens.alexandre.silva@umontreal.ca
ETHICS COMMITTEE: Ethic committee of CRIR-site Montreal
Rehabilitation Institute
Research Report Platform Presentation
2969 Sunday 3 June 09:30
VCEC Ballroom A
INSTRUCTIONAL STYLE INFLUENCES PAIN PERCEPTION
DURING TENS
Barr J, Hird K, Koch M, Vaughan J; Physical Therapy Department,
St. Ambrose University, Davenport, Iowa, USA
PURPOSE: The manner in which verbal instructions are presented
during active or sham (control) interventions may influence the
outcomes of those interventions. This study determined the affect
of instructional style (directive vs. neutral) on experimental pain
threshold and tolerance during active and sham TENS. Enhancement
of a placebo effect by directive instructions may limit the ability of a
randomized control trial to disclose an active treatment effect. As a
result, an intervention may be deemed ineffective. RELEVANCE: Re-
searchers and clinicians assessing the effectiveness of TENS should
be aware of the influence that instructions may have in enhancing
active and placebo effects associated with TENS. PARTICIPANTS:
40 male college students, 18-25 years old. Exclusion criteria:
cardiac disorders; decreased sensation; TENS or medications for
pain; pain ratings exceeding noxious stimulator output. METHODS:
Participants randomly assigned to either: directive instructions /
active TENS; directive / sham TENS; neutral instructions / active
TENS; neutral / sham TENS. Pain induced by noxious electrical
stimulation of the fifth digit, dominant hand. Pain threshold and
tolerance pre-instruction / TENS. Videotaped instructions were
directive (authoritative; suggestive of pain control) or neutral (neutral
tone; not suggestive of pain control). TENS (frequency = 60pps;
phasewidth = 40 microsec) next given to ventromedial forearm. Active
TENS initially produced paresthesia from forearm into digit; after 4
min, readjusted to assure paresthesia; TENS continued. Sham TENS
produced local paresthesia under electrodes only lasting <5 sec;
TENS turned off; readjusted after 4 min to produce local paresthesia
lasting <5 sec; TENS turned off. Pain threshold and tolerance
again measured post-instruction / TENS. ANALYSIS: Performed via
two-way ANCOVAs, with pretreatment pain threshold and tolerance
as covariates. RESULTS: Pain threshold was not significantly
influenced by instructional style (p = 0.301), TENS (p = 0.774), or by
their interaction (p = 0.809). Directive instructional style significantly
increased pain tolerance (p = 0.015). TENS (p = 0.732), or the
interaction of instruction and TENS (p = 0.484), did not significantly
influence pain tolerance. CONCLUSIONS: A directive instructional
style used in association with TENS was the important factor
for increasing pain tolerance. IMPLICATIONS: The type of verbal
instructions used can influence treatment outcomes with TENS.
Such influences can confound studies that determine TENS to
be ineffective in laboratory and clinical applications. Researchers
need to carefully control the tone of verbal instructions provided
to study participants. KEYWORDS: Electroanalgesia, TENS, Pain.
FUNDING ACKNOWLEDGEMENTS: This study was funded by the
Physical Therapy Department of St. Ambrose University. CONTACT:
BarrJohnO@sau.edu
ETHICS COMMITTEE: The Institutional Review Board of St.
Ambrose University approved this study.
S44
Research Report Platform Presentation
1511 Sunday 3 June 09:30
VCEC Meeting Rooms 8&15
INTER-RATER RELIABILITY AND BETWEEN-DAYS
REPEATABILITY OF EIGHT PHYSICAL PERFORMANCE TESTS
Horneij E1 , Holmström E1 , Hemborg B1 , Isberg P2 , Ekdahl C1 ; 1 Lund
University, Department of Health Sciences, Section of Physiotherapy,
Lund, Sweden; 2 Lund University, Dep of Statistics, Lund, Sweden
PURPOSE: Results of reliability studies on physical performance
tests are often conflicting. The main purpose of this study was to
analyse, by different statistical methods, the inter-rater reliability and
between-days repeatability of a set of eight physical performance
tests on a female working population. Six of the tests were on the
impairment level and two of the tests were on the activity level.
RELEVANCE: The prevalence of neck, shoulder and back pain is
higher among health care workers, especially among nursing aides,
compared with employees in other occupations. Individually adapted
physical fitness training for women working in the health-care section
has earlier been shown to reduce symptoms from the neck, shoulder
and back, indicating that physical performance may have a positive
impact on these disorders. However, few physical performance tests
have been shown to predict future disorders of the neck, shoulder or
back. This may be due to the precision of the tests, i.e. reliability
and validity. PARTICIPANTS: Twenty-two nursing aides/assistant
nurses (42±11 years) were tested twice, with on average, a five
days’ interval. Seventeen of these (40±11 years) were tested again,
after on average 16 days. METHODS: Isometric endurance of
the neck flexors, abdominal, back and shoulder muscles, standing
balance and two lifting tests (lumbar and cervical PILE tests)
were evaluated. ANALYSIS: The statistical analyses were carried
out using the SPSS 9.0 package. Intraclass correlation coefficient
(ICC2.1), standard error of measurement (SEM), the within-subjects
coefficient of variation (CV) and limits of agreement (LOA and
LOAratio) were calculated. RESULTS: The inter-rater reliability was
high for all tests. The between-days repeatability, however, differed
depending on the statistical method employed. Only one of the
tests: the cervical PILE test was considered reliable between-days.
Muscular endurance tests, lumbar PILE test and standing balance
tests, as performed in this study, did not give reliable between-
days results. CONCLUSIONS: The between-days repeatability was
considered acceptable for only one of the two lifting-tests on activity
level: the cervical PILE test. IMPLICATIONS: When evaluating the
results from physical performance tests, physiotherapists should be
aware of within which limits the test-re test may normally vary.
The evaluation of physical performance tests referring to absolute
reliability and different types of validity is an important area for
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: eva.horneij@med.lu.se
ETHICS COMMITTEE: The study was approved by the Ethical
Committee of the Faculty of Medicine, University of Lund, Sweden
(LU 286-95)
Research Report Platform Presentation
2047 Sunday 3 June 09:30
VCEC Meeting Rooms 11-12
ASSESSMENT OF WALKING SPEED AND DISTANCE IN
SUBJECTS WITH AN INCOMPLETE SPINAL CORD INJURY
van Hedel H1,2 , Curt A2,3 , Dietz V1,2 ; 1 Spinal Cord Injury Center,
Balgrist University Hospital, Zurich, Switzerland; 2 European
Multicenter Study on human Spinal Cord Injury (EM-SCI) Group;
3 ICORD, University of British Columbia, Vancouver, Canada
PURPOSE: To determine whether testing short and long distances
as well as preferred and maximum speeds provides additional
information about walking capacity in subjects with an incomplete
WCPT 2007, Research Reports
spinal cord injury (iSCI). RELEVANCE: The 10 Meter Walk Test
(10MWT) and 6 Minute Walk Test (6MinWT) are used in iSCI
subjects to evaluate the recovery of walking function. However,
long distance testing is less reliable, difficult to standardize and
more time-consuming. Information about maximum walking speed
in iSCI subjects is lacking. PARTICIPANTS: Fifty-one iSCI subjects
performed the 6MinWT and 10MWT (preferred speed) at 1, 3 and
6 months after injury. Eighteen iSCI subjects performed both the
10MWT and 6MinWT at preferred and maximum speed. Thirty-eight
iSCI and 41 healthy subjects performed the 10MWT at preferred
and maximum speed. METHODS: Longitudinal and cross-sectional
study designs were used. The tests were applied by trained physical
therapists. ANALYSIS: The results of the 10MWT (in seconds) and
the 6MinWT (in meters) were converted into speed [m/s] and a
ratio of maximum divided by preferred walking speed (M/P-ratio)
was calculated. Statistically, ANOVA for repeated measures, linear
and multiple regression analyses were used. RESULTS: During
recovery, the mean preferred 6MinWT walking speed increased
from 1 month (0.37±0.52 m/s) to 3 (0.87±0.56 m/s) and 6 months
(1.14±0.52 m/s). Similarly, the 10MWT walking speed increased
from 1 (0.40±0.53) to 3 (0.88±0.51) and 6 months (1.12±0.51
m/s; for all: P < 0.001). Walking speed did not differ between the
tests [F(1,50) = 0.06; P = 0.81]. At preferred speed, the 6MinWT
speed was 1.03 × 10MWT speed + 0.05. At maximum speed, the
6MinWT speed was 0.91 × 10MWT speed + 0.11. The relationship
between preferred and maximum walking speed was constant in
iSCI subjects who were tested between 16 days and 13.4 years
after their injury (M/P-ratio = 1.37). This ratio was not affected
by the elapsed time after injury and it remained constant when
corrected for variables such as age, gender, body height, weight
and the need for walking aids or physical assistance. In healthy
subjects, the M/P-ratio was 1.74 and was influenced by age, gender
and body height. CONCLUSIONS: The 6MinWT and the 10MWT
provide comparable information in iSCI patients, both at preferred
and maximum walking speed. Comparably to stroke patients (Kollen
et al. Arch Phys Med Rehabil 2006;87:358-63), iSCI subjects show
a fixed relationship between preferred and maximum walking speed.
IMPLICATIONS: Due to the easier applicability, we recommend to
use the 10MWT in the clinical setting. In central movement disorders,
either due to stroke or SCI, the modulation of walking speed is limited.
The relationship between preferred and maximum speed appears to
remain constant, which would make additional testing at maximum
speed redundant. KEYWORDS: walking capacity, timed walking
tests. FUNDING ACKNOWLEDGEMENTS: The International Spinal
Research Trust (Clinical Initiative Phase II; CLI006) funded this work.
CONTACT: hvanhedel@paralab.balgrist.ch
ETHICS COMMITTEE: Cantonal Ethics Comittee from Zurich
Research Report Platform Presentation
2548 Sunday 3 June 09:30
VCEC Meeting Room 16
PRACTITIONER AND ORGANIZATIONAL BARRIERS TO
EVIDENCE-BASED PHYSIOTHERAPY FOR PERSONS WITH
STROKE
Salbach N1 , Jaglal S1 , Korner-Bitensky N2 , Rappolt S3 , Davis D4,5 ;
1 Department of Physical Therapy, University of Toronto, Toronto,
Canada; 2 School of Physical and Occupational Therapy, McGill
University, Montreal, Canada; 3 Department of Occupational Science
and Occupational Therapy, University of Toronto, Toronto, Canada;
4 Knowledge Translation Program, University of Toronto, Toronto,
Canada; 5 Li Ka Shing Knowledge Institute, St Michael’s Hospital,
Toronto, Canada
PURPOSE: To identify practitioner and organizational barriers
to evidence-based physiotherapy for persons with stroke and
sociodemographic and practice characteristics associated with each
barrier. RELEVANCE: The integration of research evidence in
clinical decision-making among physiotherapists is sub-optimal. An
Platform Presentations, Sunday 3 June
understanding of practitioner and organizational barriers will help
develop strategies to improve the implementation of evidence-
based practice (EBP) among physiotherapists, and, ultimately, health
outcomes for persons with stroke. PARTICIPANTS: Participants were
270 physiotherapists providing services to persons with stroke. Age
ranged from 23 to 68 years and 89% of respondents were women.
A Bachelor degree was held by 77% of participants and 45% had
practiced more than 15 years. METHODS: A cross-sectional postal
survey was conducted in Ontario, Canada. A questionnaire was
developed to evaluate practitioner factors (education, attitudes and
beliefs, interest, perceived role and self-efficacy) and organizational
factors (resources and peer support) considered relevant to EBP.
ANALYSIS: Frequencies and percentages were used to describe
item-level responses. Logistic regression was used to identify
characteristics associated with each practitioner and organizational
barrier. RESULTS: Education on EBP was part of the academic
preparation of 43% of respondents; education was associated with
young age, a high level degree and few years of practice experience.
Seventy-eight percent of respondents agreed that research findings
are useful and agreement was associated with participation in
research activities. Ninety percent of respondents agreed they were
interested in learning skills to implement EBP; these individuals were
more likely to hold a Bachelors degree than a Masters degree. Only
half agreed that physiotherapists should be responsible to conduct
their own literature reviews and agreement was less likely among
clinicians treating 11-15 patients/day than among those treating 1-
10 patients/day. Average ratings of perceived ability (self-efficacy)
were between 50% and 80% to search and appraise the literature
and below 50% to appraise psychometric properties of standardized
measures and understand statistical analyses. Younger age, few
years of practice experience, being male and holding a Masters
degree was associated with a higher self-efficacy summary rating.
Access to the Internet, financed continuing education, professional
journals, and a resource person was available to 80%, 74%,
65% and 57% of respondents, respectively, and more often in
community than acute-care hospital settings. An organizational
mandate supporting EBP was rarely reported (16%) and more
likely to exist in large organizations; protected time to search and
appraise the literature was least frequently cited (8%) and had
no significant correlates. CONCLUSIONS: Substantial barriers to
EBP may include perceived role of physiotherapists in EBP, self-
efficacy, availability of human resources, organizational mandates
and protected time. Physiotherapists with many years of practice
may have the greatest need to enhance EBP skills; community-
based practitioners appear to have little access to EBP resources.
IMPLICATIONS: Physiotherapists lacking self-efficacy to search and
appraise the literature are unlikely to perform these activities when
clinical questions arise. Given half of respondents do not consider
the conduct of literature reviews as part of their professional role,
it is questionable whether training in these skills is indicated or an
alternate model for ensuring the integration of high quality research
evidence in stroke rehabilitation. KEYWORDS: evidence-based
practice, physiotherapy, stroke. FUNDING ACKNOWLEDGEMENTS:
Nancy Salbach was supported by an Ontario March of Dimes-
Canadian Institutes of Health Research postdoctoral fellowship to
conduct this research. CONTACT: nancy.salbach@utoronto.ca.
ETHICS COMMITTEE: The research ethics board at the University
of Toronto approved the study protocol.
S45
Research Report Platform Presentation
2337 Sunday 3 June 09:30
VCEC Meeting Room 17
DO ANKLE FOOT ORTHOSES IMPROVE BALANCE IN
CHILDREN WITH SPASTIC DIPLEGIA?
Jackson D1,2 , Mayston M2 , Alderson L1,3 , Brayley K1 , Main E1,2,4 ;
1 Physiotherapy Department, Great Ormond Street Hospital,
London, UK; 2 Department of Physiology, University College,
London; 3 University of Hertfordshire; 4 Institute of Child Health,
University College London
PURPOSE: Ankle Foot Orthoses (AFOs) in children with spastic
diplegia are thought to prevent deformity and improve functional
balance by increasing the base of support, stabilizing the ankle
joint and influencing the kinematics of more proximal joints. This
study evaluated balance in children with spastic diplegia during
walking and other activities in AFOs, shoes alone and barefoot
using the GAITRite walkway and the Pediatric Balance Scale (PBS).
RELEVANCE: There is considerable debate with respect to whether
the use of AFOs remains appropriate following corrective orthopaedic
surgery or once skeletal maturity is attained and deformities are
unlikely to progress. Some physiotherapists believe AFOs remain
useful for improving the child’s functional balance and it is important
to provide evidence-based advice to families regarding their ongoing
use. PARTICIPANTS: Ten children aged between 7-15 years with
spastic diplegia were recruited. They were community ambulators
and had been using AFOs for at least a year. None had undergone
orthopaedic surgery or botulinum toxin injections in the preceding
year, nor had any medical problems which may have influenced
balance. METHODS: Each child was asked to walk four times
along the GAITRite electronic walkway at their preferred speed
in AFOs, shoes and barefoot. The order of these conditions was
randomized to limit the effects of fatigue or increasing confidence.
Normalized velocity, cadence, stride length and percentage of gait
cycle in single leg support were selected as surrogate measures
of stability. The child’s balance during other functional activities was
then assessed with the PBS. The 14 items were scored on the 0-4
criterion based scale. Data for all conditions was collected on the
same day by the same therapist. ANALYSIS: A two-way analysis
of variance (ANOVA) was conducted to explore any differences in
gait in AFOs, shoes or barefoot and post hoc comparisons were
performed to test where these differences lay. Friedman’s test was
used to test for differences in PBS scores between subjects in
AFOs, shoes and barefoot. RESULTS: Mean normalized velocity,
stride length and percentage of gait cycle in single leg support were
significantly greater (p  0.02) when wearing AFOs compared with
barefoot. Whilst there were also improvements in mean values for
these parameters in shoes compared to barefoot, only the difference
in stride length reached statistical significance (p  0.01). There
were no significant differences in PBS scores in shoes or AFOs
compared with barefoot. CONCLUSIONS: AFO’s improved balance
in gait but had no significant effect on balance in other activities
measured by the PBS in children with spastic diplegia. Whilst the
shoes themselves had a positive impact on the child’s gait, the
most significant effects were seen in the AFO footwear combination.
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: jacksd1@gosh.nhs.uk
ETHICS COMMITTEE: The Royal National Orthopaedic/Institute of
Orthopaedics & Musculoskeletal Science Research Ethics committee
S46
Research Report Platform Presentation
2233 Sunday 3 June 09:30
VCEC Meeting Room 18
PATIENT REPORTED OUTCOMES AS A QUALITY INDICATOR
OF STANDARDIZED CARE PLANS FOR TOTAL JOINT
REPLACEMENT
Brien H1 , McGlasson R2 , Mahomed N3 , Davis A4 , Flannery J5 ,
Levy C6 ; 1 Toronto Community Care Access Centre, Toronto,
Ontario, Canada; 2 Total Joint Network, Toronto, Ontario, Canada;
3 Toronto Western Hospital, Toronto, Ontario, Canada; 4 Toronto
Western Hospital, Toronto, Ontario, Canada; 5 Toronto Rehabilitation
Institute, Toronto, Ontario, Canada; 6 GTA Rehab Network, Toronto,
Ontario, Canada
PURPOSE: To determine if Western Ontario and McMaster Arthritis
Index (WOMAC) pain and function outcomes and patient satisfaction
were maintained after the institution of a new standardized care
pathway for people undergoing primary hip or knee replacement
(TJA). Relevance: The standard pathway for post TJA surgery was no
longer sustainable in Toronto, RELEVANCE: The standard pathway
for post TJA surgery was no longer sustainable in Toronto, Ontario
Canada and a new model for rehabilitation services needed to
be tested. Based on a partnership of 23 institutions, this care
pathway was designed to provide a seamless transition from acute
to rehabilitation sectors by pre-surgery streaming of patients to
inpatient or home-based physiotherapy and to reduce length of stay
(LOS) PARTICIPANTS: 529 people consented to participate. Results
are based on 279 people who returned follow-up questionnaire 3
months post surgery METHODS: Subjects recruited to the evaluation
completed the WOMAC pre-surgery with follow-up including a
satisfaction questionnaire 3 months later. The WOMAC is a 24-
item questionnaire completed by the patient that focuses on joint
pain and loss of function related to osteoarthritis of the knee
and hip. Therapy destination and LOS were tracked against bench
marks of minimum 50% discharged home and an inpatient rehab
stay of 7 days. ANALYSIS: Descriptive statistics including means,
standard deviations, and proportions were calculated for all variables.
The sample of 500 ensured the 99% confidence interval (CI) of
the mean of WOMAC pain and function would be within 2 and
5 points respectively of a previous randomized trial where TJA
patients received home-based or inpatient rehabilitation. RESULTS:
On average greater than 50% of people were discharged home from
acute care and over 50% of people receiving inpatient rehab were
discharged in 7 days, with 80% discharged by day 10. 529 patients
(mean age 67, 295 females) have had their surgery and 279 have
completed 3 month follow-up. Those patients discharged to home
rehabilitation have mean pain and physical scores of 80.5 and 76.6%
(high scores are better pain relief and function) and those receiving
inpatient rehabilitation have pain and function scores of 77.5 and
72.5%. These values are within our a priori CI for outcome. Only 5%
of individuals reported dissatisfaction with the rehabilitation planning
and care. CONCLUSIONS: This model of care achieved the goals
of increasing the proportion of people discharged home following
TJA and decreased rehab LOS with increased system capacity
for rehab. The patient outcomes are maintained. The remainder
of the participants will be followed and variances from the care
pathways will be evaluated. IMPLICATIONS: This evaluation of the
care pathways confirmed positive patient outcomes as measured by
the WOMAC and the patient satisfaction questionnaire for people
receiving rehabilitation in either home or inpatient settings. These
findings provide the basis for increased dialogue between acute
care, community service settings in order to optimize the use of
less expensive home-based services for people undergoing unilateral
primary hip or knee replacements. KEYWORDS: TJA, WOMAC,
Pathway. FUNDING ACKNOWLEDGEMENTS: Ontario Ministry of
Health and Long Term Care, Toronto Region Office. CONTACT:
heather.brien@toronto.ccac-ont.ca
ETHICS COMMITTEE: University Health Network, Toronto, Ontario,
Canada. Affiliated with the University of Toronto
WCPT 2007, Research Reports
Research Report Platform Presentation
2101 Sunday 3 June 09:30
VCEC Meeting Rooms 19-20
A QUALITATIVE STUDY INVESTIGATING THE MORAL ROLE OF
PHYSICAL THERAPIST: A VIEW FROM THE EXPERTS, PART I
Triezenberg H; Central Michigan University
PURPOSE: This study investigated the moral and social factors that
underlie the practice of physical therapy from the perspectives of 15
individuals identified as experts in the area of rehabilitation ethics.
RELEVANCE: A clearer understanding of the moral and social roles
and responsibilities of physical therapists can inform public policy
and ethical decision-making by therapists. This understanding can
also guide physical therapist educators when designing curricula
and learning experiences in ethics. PARTICIPANTS: A purposive
sample of 15 individuals in the United States who met the following
criteria were invited to participate: (1) practiced physical therapy
for more than 5 years; (2) completed additional education or an
advanced degree in a discipline related to ethics or the psychosocial
aspects of patient care; and (3) were recognized by peers as experts
and contributors to knowledge and understanding of the social or
ethical aspects of physical therapy practice through their history of
publication and presentations. All 15 individuals agreed to participate
in the study. METHODS: Semi-structured interviews were completed
with each participant followed by focus group discussions with a
sub-sample of participants. Interviews and focus group discussions
centered around 6 primary questions. Two questions are addressed
in this presentation: (1) What characterizes the moral role of a
physical therapist in today’s health care environment?; (2) What is
the single most important core ethical consideration for physical
therapy? Interviews and focus group sessions were audiotaped
and transcribed verbatim. ANALYSIS: Transcripts were analyzed
using an inductive approach employing constant-comparison for
within individual and across individual analysis. Codes, categories,
and themes were generated to identify patterns in the data.
RESULTS: Respondents suggested that the rehabilitation encounter
presents a unique set of moral roles and responsibilities that
shapes the professional identity of physical therapists. Two primary
categories of interactions were identified; each of which carry specific
moral and social foundations and responsibilities. Interactions and
relationships with patients were viewed as personal and fiduciary
in nature; interactions and relationships with “non-patients” were
based more on formal and informal social contracts. Core ethical
considerations that apply to therapist encounters with both patients
and non-patients were identified by participants and included the
importance of respect, compassion, competence, providing benefit,
and putting patient needs before their own. CONCLUSIONS:
Findings suggest there are core ethical considerations at the
center of the moral role of physical therapists. The related moral
responsibilities of physical therapists may be defined by the unique
nature of, and foundations for, the relationship with patients and
non-patients. Interactions with these individuals in the context of
rehabilitation practice may require differing ethical analysis and sets
of behaviors. IMPLICATIONS: A clearer understanding of the unique
characteristics and responsibilities associated with the moral role of
physical therapists can help guide therapists in their interactions with
patients and non-patients in their everyday practice. Furthermore, it
can assist educators in formulating ethics curricula, teaching and
learning experiences. Finally, these findings provide a framework
for future studies of the moral role and attendant responsibilities
of physical therapists. KEYWORDS: Ethics, Moral Role, Education.
FUNDING ACKNOWLEDGEMENTS: Central Michigan University
Sabbatical Award. CONTACT: triez1hl@cmich.edu
ETHICS COMMITTEE: The Internal Review Board (IRB) of Central
Michigan University.
Platform Presentations, Sunday 3 June
Research Report Platform Presentation
2900 Sunday 3 June 09:50
PP Crystal Pavilion A
HEALTH CARE IN THE FUTURE: WILL PHYSIOTHERAPY
SERVICES BE ADEQUATE FOR OLDER PEOPLE?
Hobbs C, Dean C, Higgs J, Adamson B; The University of Sydney,
Sydney, Australia
PURPOSE: The purpose of this study was to determine if students’
knowledge of older people changed throughout their physiotherapy
undergraduate program and to describe any changes over time.
RELEVANCE: The ageing population in Australia, as with many
countries, presents a significant challenge for healthcare provision
as this population is increasing in number and in proportion to the
total population. Physiotherapy service shortages for older people
already exist and the magnitude will increase unless practition-
ers recognise the opportunities that are available. Unfortunately,
beginning practitioners also seem reluctant to work with older
people. PARTICIPANTS: Of the 208 students eligible to participate
in this study, 198 volunteered. An 80% or more participation
rate throughout the 3-year duration of the study was achieved.
METHODS: The Facts on Ageing Quiz 1 (FAQ 1) measured
participants’ knowledge of older people at three points of time,
during their education. Two variables, knowledge as percentage
FAQ1 correct responses and ignorance measured as percentage
of “don’t know” responses were examined. ANALYSIS: Changes
over time were analysed using paired t-tests with significance set at
p < 0.05. RESULTS: Initial knowledge about older people was poor
with a mean score of 43.6% and subsequent results significantly
increased over time to a mean score of 51.7% (p = 0.0001). The
improvement in knowledge was accompanied by a decrease in
ignorance over the study period (p = 0.0001). CONCLUSIONS:
The level of knowledge attained suggests that educational and
workplace sectors need to address the real issues confronting
workforce preparation of physiotherapists in relation to the care of
older people. IMPLICATIONS: This is particularly important because
students’ ideology will become the foundation for their professional
behaviour and the norms of their profession. This suggests that the
profession runs the risk of producing beginning practitioners with
minimal base knowledge of physiotherapy practice for older people.
KEYWORDS: physiotherapy, older people, knowledge,. FUNDING
ACKNOWLEDGEMENTS: This research was supported by a grant
from the Teaching and Learning Committee at the University of
Sydney. CONTACT: hobbs@hotkey.net.au
ETHICS COMMITTEE: The Ethics Committee, The University of
Sydney
Research Report Platform Presentation
2223 Sunday 3 June 09:50
PP Crystal Pavilion B & C
DEVELOPMENT AND VALIDATION OF THE CLARITYSMART
SPINAL MOTION ANALYSIS RESEARCH TECHNOLOGY
Abbott J1 ,McCane B2 ; 1 New
Zealand Centre for Physiotherapy
Research, University of Otago, PO Box 56, Dunedin 9054, New
Zealand; 2 Department of Computer Science, University of Otago,
PO Box 56, Dunedin 9054, New Zealand
PURPOSE: To develop an accurate and time-efficient computer-
assisted method for measuring displacement kinematics of lumbar
spine segments from flexion-extension radiographs. RELEVANCE:
Lumbar segmental mobility disorders, such as lumbar segmental
instability and lumbar segmental rigidity, are believed to be associated
with recurrent and chronic low back pain. Research of these
disorders requires accurate measurement of lumbar segmental
kinematics to diagnose the presence of a disorder, or measure
change in movement characteristics. PARTICIPANTS: A subset
of 138 patients with recurrent or chronic low back pain, 30
asymptomatic volunteers, and dried human vertebral specimens.
S47
METHODS: Development of the computer assisted measurement
methodology started with a literature review identifying previously
developed methodology. We critiqued the published methods and
critical discussions, incorporating the most successful strategies into
our developing plans. We developed a Java-based computer program
for estimating the planar transformation of a rigid body. Version 3
of our program used the iterative closest point algorithm to perform
least-squares matching of cubic spline curves which were placed in
a graphic user interface by a mouse or pen digitiser. The parameters
computed were angle of rotation, finite centre of rotation (FCR),
centre of reaction, and translation. We compared our methodology
to the methods of Bogduk et al, Frobin et al, and Crisco et al.
ANALYSIS: We tested the reliability and validity of our methodology
and calculations in five phases: concurrent validity of rotation
was tested against the NIH Image program; concurrent validity of
translation was tested against manual constructions provided by
an independent researcher; validity of rotation and finite centre of
rotation were tested by computer-simulated trials, and finally by an
in vitro error study; reliability was assessed by analysing the results
of repeated measures. RESULTS: Intraclass correlation coefficient
(ICC) values for agreement of rotation measurement between
ClaritySMART and NIH Image were ICC3,4 0.98 (95% confidence
interval 0.92, 1.00). Agreement of centre of reaction and translation
measurements between our method and the method of Bogduk et
al. were ICC3,1 0.99 (0.97, 1.00) and 0.98 (0.97, 1.00) respectively.
Validity assessed by computer-simulated trials demonstrated our new
method to result in significantly lower angle error (p < 0.001) and FCR
error (p < 0.05) than competing methodologies. In vitro true FCR error
was significantly lower than competing methodologies (p < 0.001,
and p < 0.02) at less than 7.3mm (sd 8.3). Intra-rater reliability
coefficients (ICC3,1) were: rotation 0.97 (0.95, 0.98); translation
0.89 (0.80, 0.94); it is necessary for mathematical reasons to
exclude cases with rotation <1.0º to achieve satisfactory reliability
for FCR measurements of 0.82 (0.67, 0.91) for the x axis, and
0.66 (0.41, 0.81) for the y axis, and centre of reaction 0.75 (0.57,
0.87). CONCLUSIONS: Our new methodology for measurement
of displacement kinematics of lumbar segmental motion is more
accurate and more efficient than previously available methods. We
recommend it for research involving lateral flexion-extension radio-
graphs, and have made it freely available at www.claritysmart.com.
IMPLICATIONS: This new methodology significantly reduces the
error of measuring motion from flexion-extension radiographs, making
possible research designs that were previously not possible due to
limitations of older technology. KEYWORDS: low back pain, lumbar
spine, segmental motion, measurement, displacement, kinematics.
FUNDING ACKNOWLEDGEMENTS: University of Otago Research
Grants. CONTACT: haxby.abbott@otago.ac.nz
ETHICS COMMITTEE: Otago and Canterbury Regional Ethics
Committees; University of Otago Ethics Committee
Research Report Platform Presentation
549 Sunday 3 June 09:50
VCEC Ballroom A
AN INVESTIGATION INTO THE EFFECTIVENESS OF
CRYOTHERAPY FOLLOWING TOTAL KNEE REPLACEMENT
Barry S1 , Wallace L1 , Lamb S1 ; 1 Coventry University, Coventry, UK;
2 Coventry University, Coventry, UK; 3 Coventry University, Coventry,
UK
PURPOSE: Cryotherapy is commonly used during physiotherapeutic
rehabilitation of patients following total knee replacement (TKR).
Evidence for treatment effectiveness within the current literature
is contradictory and there are no clinical guidelines to inform
cryotherapy treatment within this particular patient group. This
study investigates cryotherapy treatment efficacy in the acute post-
operative management of TKR patients. RELEVANCE: Following
TKR early postoperative recovery is hindered by a substantial degree
of pain and swelling caused by a localised severe inflammatory
S48
response in the soft tissues of the knee. This study investigates the
treatment effectiveness of cryotherapy and whether the timing of the
first application of cryotherapy has any impact upon clinical outcome.
PARTICIPANTS: In total 133 consecutive TKR patients were
recruited and consented to take part in this pragmatic randomized
clinical trial (RCT). METHODS: This RCT investigated cryotherapy
treatment efficacy in the acute post-operative management of TKR
patients. Patients were randomised into three groups; no cryotherapy
(NC), delayed cryotherapy (DC) and immediate cryotherapy (IC).
The primary outcome measure was post-operative pain with knee
swelling, active range of motion (AROM), function and levels of
physiotherapy input assessed as secondary outcome measures.
Observations were taken pre-operatively and at 3, 7 and 42 days
post-operatively. ANALYSIS: testing was used to compare scores
between the three treatment groups in relation to pain scores,
swelling, AROM and functional tests; Chi Square was used to test
for differences in the requirement for post discharge physiotherapy.
RESULTS: This RCT indicated that patients in IC group had
significantly less post-operative pain than the NC and DC groups at 3
days. Mean difference, with significance level set at p < 0.05, 95% CI,
in post-operative visual analogue scores (VAS, scale 0-10) was −1.6
(p < 0.001, CI −2.49 to −0.707) between IC and NC groups; and
−0.922 (p = 0.044, CI −0.183 to −0.009) between IC and DC groups.
At 7 and 42 days there were significant reductions in VAS scores
in both cryotherapy groups compared to the NC group. There was
significant improvement in knee swelling, AROM, ability to transfer
and need for additional physiotherapy in both cryotherapy treatment
groups although no significant reduction in opiate requirement
was found. CONCLUSIONS: The use of cryotherapy combined
with compression, as compared to a no cryotherapy treatment,
led to significant reductions in patient reported pain, less post-
operative swelling, greater recovery of AROM, faster return of
function and less reliance on OPD physiotherapy treatment. However,
there are no clinically significant differences in outcome between
immediate and delayed treatment. IMPLICATIONS: It is concluded
that cryotherapy combined with compression has an important role
to play in the acute rehabilitation of TKR and should be considered
as part of routine management. KEYWORDS: Cryotherapy, Pain,
Knee. FUNDING ACKNOWLEDGEMENTS: The British Orthopaedic
Association Wishbone Fund. CONTACT: s.barry@coventry.ac.uk
ETHICS COMMITTEE: Coventry Health Authority Ethics Committee,
Coventry University Research Degree Committee and Walsgrave
Hospitals NHS Trust’s Local Research and Development Committee.
Research Report Platform Presentation
1779 Sunday 3 June 09:50
VCEC Meeting Rooms 8&15
EVALUATION OF THE CORE OUTCOME MEASURE IN
WHIPLASH
Rebbeck T, Refshauge K, Maher C, Stewart M; School of
Physiotherapy, University of Sydney
PURPOSE: To comprehensively evaluate the psychometric prop-
erties of a 5-item version of the Core Outcome Measure (COM)
in people with whiplash. RELEVANCE: Most outcome measures
for whiplash have only been evaluated in neck pain populations
and they are lengthy. The 7-item COM was initially proposed as
a brief health outcome measure for use in low back pain. To
date this measure has not been comprehensively assessed in a
whiplash population. A briefer, valid measure of outcome in whiplash
would greatly assist practice and outcome measurement in the
field of musculoskeletal physiotherapy. PARTICIPANTS: Data were
sourced from three separate whiplash cohorts (total n = 481)
encompassing acute, early-chronic and late-chronic whiplash among
primary care and insurance populations. METHODS: We re-analysed
data derived from longitudinal cohort studies. Subjects completed a
5-item version of the COM for whiplash (Core Whiplash Outcome
Measure; CWOM), the Functional Rating Index, the Neck Disability
WCPT 2007, Research Reports
Index, the SF36 and perceived recovery questionnaires at baseline
and short-and long-term follow-up periods. Psychometric evaluation
of the CWOM included assessing questionnaire responses, internal
consistency, construct validity and internal and external responsive-
ness. ANALYSIS: Internal consistency was determined by calculating
Cronbach’s Alpha. Construct validity was evaluated using Pearson’s
r for continuous data (eg correlations between the total score of
the CWOM with the total score of the Functional Rating Index) and
Spearman’s Rho was used for ordinal data (eg correlations between
the 5 individual items of the CWOM and the SF36 scales). Internal
responsiveness was determined by calculating the effect size (mean
change score/ SD baseline score), and standardized response mean
(mean change score / SD change score). External responsiveness
was calculated with the perceived recovery scale as the external
criterion of change. Improvement was defined as scoring  2 on
this scale. This information was used to plot an ROC curve for
each measure. RESULTS: Internal consistency was excellent at all
stages of whiplash (Cronbach’s alpha=0.76 in the acute stage and
0.83 in the late-chronic stage). Convergent validity was observed
between the CWOM and the Functional Rating Index (Pearson’s r
=0. 81), the Neck Disability Index (Pearson’s r = 0.76) and the SF36
Physical Health Summary Measure (Pearson’s r = −0.65). Divergent
validity was observed between the CWOM and the SF36 Mental
Health Summary Measure (Pearson’s r = −0.45). The internal and
external responsiveness of the CWOM was similar to other neck-
specific outcome measures. CONCLUSIONS: We recommend the
5-item CWOM as a brief clinical measure for whiplash because it
is quick to administer and score, and has excellent measurement
properties. The CWOM may need to be supplemented with other
questionnaires, for example, when assessment of psychological or
emotional health is required. IMPLICATIONS: The 5-item CWOM
can now be used in clinical practice to measure outcomes
for whiplash. Because it is briefer, yet a valid and responsive
measure, it has advantages over lengthier standard questionnaires.
KEYWORDS: Whiplash Injuries, Outcome assessment (health care),
psychometrics. FUNDING ACKNOWLEDGEMENTS: Funding for
this study was received from the Motor Accidents Authority of New
South Wales, Australia. CG Maher’s research fellowship is funded
by the National Health and Medical Research Council, Australia.
CONTACT: baystphysio@optusnet.com.au
ETHICS COMMITTEE: University of Sydney Human Ethics Commit-
tee.
Research Report Platform Presentation
2619 Sunday 3 June 09:50
VCEC Meeting Rooms 11-12
KINEMATIC ANALYSIS AND MUSCLE ACTIVATION PATTERNS
IN GAIT OF ELDERLY WOMEN WITH KNEE OSTEOARTHRITIS
Dias J, Arantes P, Kirkwood R, Alencar M, Dias R; Department
of Physical Therapy, Federal University of Minas Gerais, Belo
Horizonte, Brazil
PURPOSE: This study was conducted to compare the kinematics
of hips, knees and ankles as well as the muscle activation pattern
in the gait of elderly women with and without knee osteoarthritis
(OA) and to investigate the association between quadriceps strength
and phase of load response. RELEVANCE: Knee OA is the
main cause of incapacity in elderly people. Understanding gait
alterations of elderly women with knee osteoarthritis is critical for
the outlining effective physical therapy interventions to prevent the
incapacity knee OA generates. PARTICIPANTS: The sample of
this study was composed by 21 community-dwelling elderly women
with clinical and radiographic diagnosis of knee osteoarthritis and
21 asymptomatic age and mass-matched elderly women with no
diagnosis of knee OA. This study was approved by the Federal
University Ethics Committee-number 2005/05). METHODS: A motion
analysis system was used to track the usual gait of the subjects.
Intensity and duration of the activity of the vastus lateralis, biceps
Platform Presentations, Sunday 3 June
femoris, tibialis anterior, gastrocnemius and soleus muscles while
walking was assessed through surface electromyography. Isokinetic
dynamometry was used to assess the strength of the quadriceps and
hamstrings muscles. ANALYSIS: Shapiro-Wilk and Lilliefors tests
were carried-out to verify the normality distribution of the variables.
ANOVA test was used to determine differences between groups
and correlations were calculated using the Pearson correlation
coefficient. The level of significance was set at 5%. RESULTS: No
statistical difference was found between subject’s age (p = 0.970)
and BMI (p = 0.300). Elderly women in the OA group walked
with a significantly reduced gait velocity (p= 0.017), cadence
(p = 0.009) and stride length (p = 0.010), and a significantly increased
gait cycle duration (p = 0.012) when compared to asymptomatic
elderly women. Subjects in the knee OA group, demonstrated
less peak knee flexion during the initial swing phase (p = 0.003),
less knee flexion excursion during weight acceptance (p = 0.019)
and stance (p = 0.046) and less hip extension excursion during
stance (p = 0.007). There were no significant differences between
groups with regard to muscle activation patterns during gait or
strength of quadriceps and hamstrings. CONCLUSIONS: Elderly
women with knee osteoarthritis walk with different hip and knee
kinematics than matched asymptomatic subjects. There were no
differences in muscle function between groups, suggesting that gait
alterations may occur even with no decrease in strength. Further
studies are needed to clarify the effects of a rehabilitation program
on the kinematics parameters of gait in elderly women with knee
osteoarthritis. IMPLICATIONS: The results of this study suggest that
Physical Therapy programs for elderly women with knee OA should
also focus on gait rehabilitation to enhance functional performance in
daily living activities. KEYWORDS: elderly women, knee osteoarthri-
tis, gait kinematics. FUNDING ACKNOWLEDGEMENTS: Financial
support: CNPq – Brazilian Funding Research Agency. CONTACT:
jmdd@ufmg.br
ETHICS COMMITTEE: Federal University Ethics Committee-number
2005/05
Research Report Platform Presentation
2587 Sunday 3 June 09:50
VCEC Meeting Room 16
FACTORS ASSOCIATED WITH PHYSIOTHERAPISTS’ USE OF
RESEARCH FINDINGS IN STROKE REHABILITATION
Salbach N1 , Jaglal S1 , Korner-Bitensky N2 , Rappolt S3 , Davis D4,5 ;
1 Department of Physical Therapy, University of Toronto, Toronto,
Canada; 2 School of Physical and Occupational Therapy, McGill
University, Montreal, Canada; 3 Department of Occupational Science
and Occupational Therapy, University of Toronto, Toronto, Canada;
4 Knowledge Translation Program, University of Toronto, Toronto,
Canada; 5 Li Ka Shing Knowledge Institute, St Michael’s Hospital,
Toronto, Canada
PURPOSE: To identify practitioner and organizational factors asso-
ciated with physiotherapists’ use of research findings when making
clinical decisions for persons with stroke. RELEVANCE: Research
findings indicate that physiotherapists need to more consistently
incorporate research evidence in clinical practice. Identification of
practitioner and organizational factors that are associated with the
use of research evidence in clinical decision-making will help guide
the development of educational interventions aimed at increasing
the quality, and, ultimately, the effectiveness of physiotherapy
services for persons with stroke. PARTICIPANTS: A total of 270
Canadian physiotherapists providing services to persons with stroke
participated. Average age was 40 years (SD=10, Range 23-68 years)
and 89% of participants were women. For 77%, a Bachelor degree
was the highest degree obtained. METHODS: A cross-sectional
postal survey was carried out in Ontario, Canada. A questionnaire
was developed to measure practitioner factors (sociodemographics,
education, attitudes and beliefs, interest, perceived role and self-
efficacy) and organizational factors (resources and peer support)
S49
considered important to evidence-based practice (EBP), and the
frequency of use of research findings in clinical decision-making
(rated as 0-1, 2-5 or 6+ times in a typical month). ANALYSIS:
Stepwise ordinal regression, appropriate for dependent variables
with three response categories, was used to identify practitioner
and organizational factors (independent variables) associated with
the use of research findings in clinical decision-making (dependent
variable). An alpha level of 0.05 determined statistical significance.
RESULTS: Of 263 respondents with complete data, the number that
reported using research findings in clinical decision-making 0-1, 2-
5 and 6+ times in a typical month was 89 (34%), 139 (53%), and
35 (13%), respectively. Univariate analyses showed that academic
preparation in the foundations of EBP, working 31-40 hours a week,
participation in research, positive attitudes towards EBP, agreement
that physiotherapists should be responsible for critically appraising
research literature, high levels of perceived ability (self-efficacy) to
perform EBP activities, perceived facility support and Internet access
were independently associated with a higher reported frequency of
using research findings in clinical decision-making. When modeled
together, the following four variables remained statistically significant
and were retained in a final model that explained 25% of the
variability in use: the attitude that literature and research findings
are useful (agree/neutral or disagree; OR=3.3, 95% CI 1.7-6.3),
self-efficacy to perform EBP activities (OR for 30% difference in
score=3.0, 95% CI 1.7-5.3), Internet access at work (yes/no; OR=2.3,
95% CI 1.3-4.0) and participation in research (yes/no; OR=2.4,
95% CI 1.2-5.0). CONCLUSIONS: At the practitioner level, high self-
efficacy, a positive attitude regarding the usefulness of research
findings and participation in research activities appear to promote
physiotherapists’ use of research findings in clinical decision-making
for persons with stroke. The type and extent of involvement in
research activities that is beneficial, however, requires further inves-
tigation. At the organizational level, the provision of Internet access
appears to facilitate use. IMPLICATIONS: The effectiveness of
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
and enhancing practitioner behaviour. KEYWORDS: evidence-based
practice, physiotherapy, stroke. FUNDING ACKNOWLEDGEMENTS:
Nancy Salbach was supported by an Ontario March of Dimes-
Canadian Institutes of Health Research postdoctoral fellowship to
conduct this research. CONTACT: nancy.salbach@utoronto.ca.
ETHICS COMMITTEE: The research ethics board at the University
of Toronto approved the study protocol.
Research Report Platform Presentation
3024 Sunday 3 June 09:50
VCEC Meeting Room 17
THE EFFECT OF A GROUP AQUATIC THERAPY PROGRAM ON
MOTOR SKILLS OF CHILDREN WITH CEREBRAL PALSY
Jelley W1,2 , Albert K1,2 , Mazerolle C1,2 , Saab K1,2 ; 1 University
of Ottawa; 2 Centre régional de réadaptation La RessourSe
PURPOSE: The objective was to evaluate the effect of a 10 week
group aquatic therapy program on gross motor skills of children
with cerebral palsy (CP). RELEVANCE: In the current Canadian
health care system, children with CP who are able to ambulate
independently without aids are not regularly treated in physiotherapy
once they reach school age. Despite their functional independence,
they still demonstrate areas of weakness in their gross motor skills. A
group intervention program, such as aquatic therapy, can be effective
in addressing motor deficits. However, presently there is a lack of
research on the effect of group aquatic therapy programs on motor
skills in children with CP. PARTICIPANTS: The 6 participants, 3 girls
and 3 boys, were children between 8.5 and 10.5 years of age. All 6
had a diagnosis of CP, Level I or II on the Gross Motor Functional
Classification System. None of the children were currently being
S50
treated by a physical therapist. METHODS: The participants took part
in a 10 week aquatic therapy program. The program consisted of 1-
hour weekly sessions at a rehabilitation centre pool. The program
activities focused on balance and general strengthening. Each of
the participants was accompanied by a friend. The study employed
a repeated-measures design with the participants acting as their
own controls. Participants were evaluated using the Gross Motor
Function Measure −66 (GMFM-66) 4 weeks prior to the start of
the program and 4 weeks after the program’s completion. As well
an individualized goal attainment scale (GAS) was established for
each participant based on the results of the initial GMFM-66.The
GAS was used to monitor the participants’ status over the course of
the program. ANALYSIS: The data from the two administrations of
the GMFM-66 were entered into the Gross Motor Ability Estimator
which allowed for the scores to be accumulated and graphically
represented. The participants’ scores on the GAS were looked at
to see if and when improvement in motor skills occurred. RESULTS:
Based on the GMFM-66 results the participants’ scores on a scale
of 100% increased in a range from 1.65% to 16.89%, with an
average improvement of 5.89% on the overall score. Similarities were
found between participants on the GMFM-66 items that demonstrated
the most improvement. These items were static balance and one
foot hopping. The outcomes of the GAS showed that the motor
improvements were gradual and consistent over the 10 week length
of the program. CONCLUSIONS: The results suggest that an
aquatic therapy program which includes balancing and strengthening
activities may have beneficial effects on gross motor abilities, such
as static and dynamic balance as measured by the GMFM-66, for
children with CP. IMPLICATIONS: The aquatic therapy program that
was developed could be reproduced in a community pool and carried
out by a qualified swim instructor. For children who are no longer
actively followed by a physical therapist but who still have areas
of weakness in their gross motor skills community-based programs
are necessary. KEYWORDS: Aquatic therapy; Cerebral Palsy; Gross
Motor Function Measure. FUNDING ACKNOWLEDGEMENTS: This
project was funded by the School of Rehabilitation Sciences at the
University of Ottawa.
ETHICS COMMITTEE: Centre de recherche interdisciplinaire en
réadaptation
Research Report Platform Presentation
2823 Sunday 3 June 09:50
VCEC Meeting Room 18
FUNCTIONAL MOVEMENT PATTERNS AND KINEMATICS OF
THE HIP AND LUMBAR SPINE AT 2 YEARS POST TOTAL HIP
REPLACEMENT
Coutts F1 , Scott O2 , Nicol A3 ; 1 Queen Margaret University
College, Duke Street, Edinburgh, EH6 8HF; 2 School of Health &
Bioscience, University of East London, London, UK; 3 Department
of Bioengineering, University of Strathclyde, Glasgow, UK
PURPOSE: This ethically approved study explores movement
patterns and hip and lumbar spine kinematics during walking
in participants at 2years post Total hip replacement (THR) and
compares these to age matched adults with no pathology. It was
hypothesised that individuals with THR will have altered hip and
lumbar spine kinematics and movement patterns whilst walking at
a self selected walking speed. RELEVANCE: THR is a common
place surgical event for patients with hip osteoarthritis and although
successful at reducing pain (Keener et al, 2003), full functional
recovery is not guaranteed (Andriacchi & Hurwitz, 1997). Accelerated
rehabilitation programmes are now the norm in the UK but there
is minimal evidence to assess their effect on return of functional
recovery. PARTICIPANTS: 24 participants at 2 years post THR,
5M 19F mean age 74.81 years (+4.89) were matched by age
and gender with 24 adults 8M, 16F mean 73.04 years (+4.05),
with no lower limb joint pathology, injury, pathology of the back
or pelvis, systemic or neuromuscular disease. All were able to
WCPT 2007, Research Reports
walk independently for a minimum of 10 meters on a repeated
basis. METHODS: Kinematic and kinetic data of the lower limb and
kinematic data for the lumbar spine were collected when walking over
10m at self selected walking speed using a six camera Kinemetrix
Motion analysis system (MIE Ltd, Leeds, UK) and one Bertec Force
Platform (MIE Ltd, Leeds, UK). Static lumbar posture and dynamic
hip and lumbar spine range of movement data were collected using
standardised clinical measures. ANALYSIS: Key variables included
for analysis were: temporal characteristics, lumbar spine/hip/knee
angles, and external hip/knee/ moments, during self selected walking
speed and clinical measures of hip and lumbar spine movement.
One way ANOVA was performed to determine possible significant
differences between participants with THR and controls. Statistical
significance was defined as p < 0.05. RESULTS: Analysis of clinical
measures show that those at 2 years post THR had significantly
less sagittal (p < 0.0001) and frontal plane (p < 0.05) hip movement
than the controls. Lumbar spine flexion was greater in the controls
(p < 0.001) but extension was less although not statistically significant.
Walking speed and cadence were significantly reduced in the THR
group. The movement patterns between the hip and the lumbar
spine in the frontal and sagittal plane were analysed through angle/
time and angle/ angle diagrams showing significant differences in
their interaction and these will be demonstrated graphically. The
interaction of hip and lumbar spine movement during walking in those
with THR is significantly different to those with no hip pathology.
CONCLUSIONS: Results indicated that at two years post THR hip
and lumbar spine kinematics and movement pattern interactions have
not recovered to those of a matched population with no hip pathology.
IMPLICATIONS: There is no indication at this stage that altered
kinematics and movement patterns present at two years post surgery
may cause consequent joint problems or damage the prosthesis. The
long term benefits of THR surgery however may be in jeopardy and
this warrants further investigation with an intervention and longevity
study. References: Keener JD, et al (2003). J.Bone & Joint Surgey
85-A(6): 1066-72. Andriacchi TP, Hurwitz DE (1997) Gait & Posture 5:
256-264. KEYWORDS: Total Hip Replacement, Functional Recovery,
Movement Patterns. FUNDING ACKNOWLEDGEMENTS: This study
was not funded. CONTACT: FCoutts@qmuc.ac.uk
ETHICS COMMITTEE: University of East London, London, UK
Research Report Platform Presentation
2192 Sunday 3 June 09:50
VCEC Meeting Rooms 19-20
A QUALITATIVE STUDY INVESTIGATING THE MORAL ROLE OF
PHYSICAL THERAPIST: A VIEW FROM THE EXPERTS, PART II
Triezenberg H; Central Michigan University
PURPOSE: This study investigated the moral and social factors that
underlie the practice of physical therapy from the perspectives of 15
individuals identified as experts in the area of rehabilitation ethics.
RELEVANCE: A clearer understanding of the moral and social roles
and responsibilities of physical therapists can inform public policy
and ethical decision-making by therapists. This understanding can
also guide physical therapist educators when designing curricula
and learning experiences in ethics. PARTICIPANTS: A purposive
sample of 15 individuals in the United States who met the following
criteria were invited to participate: (1) practiced physical therapy
for more than 5 years; (2) completed additional education or an
advanced degree in a discipline related to ethics or the psychosocial
aspects of patient care; and (3) were recognized by peers as experts
and contributors to knowledge and understanding of the social or
ethical aspects of physical therapy practice through their history of
publication and presentations. All 15 individuals agreed to participate
in the study. METHODS: Semi-structured interviews were completed
with each participant followed by focus group discussions with a
sub-sample of participants. Interviews and focus group discussions
centered around 6 primary questions. Two questions are addressed
in this presentation: (1) Are there aspects of our professional
Platform Presentations, Sunday 3 June
behaviors that need to be examined in relation to the ethical role
of the physical therapist; (2) How is the ethical position of physical
therapy similar different from other professions? Interviews and
focus group sessions were audiotaped and transcribed verbatim.
ANALYSIS: Transcripts were analyzed using an inductive approach
employing constant-comparison for within individual and across
individual analysis. Codes, categories, and themes were generated to
identify patterns in the data RESULTS: The reponses identified three
general areas, with many components, of professional behaviors
that need further examination. These include: (1) aspects of the
therapist’s interaction with patients, (2) the therapist’s relationships
to other professions and groups (non-patients), and (3) the ethical
decision making process(es) used by physical therapists. Responses
to the second question described both similarities and differences
of physical therapy to other professions. The comparisons were
primarily in the areas of: (1) goals for intervention with patient/client,
(2) the characteristics of the relationship that is established, and (3)
professional boundaries or scope of practice. The professions that
were compared most often included: social work, teaching, nursing,
clergy, and medicine. CONCLUSIONS: The respondents suggested
areas of professional behaviors that need to be further examined in
relation to the ethical role of physical therapy. Responses to the sec-
ond question suggested that other professions share aspects of our
ethical role in the characteristics of goals of intervention, patient/client
relationships, and professional boundaries. Suggested differences
in these characteristics also identified aspects the uniqueness the
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
that understanding the points of similarity and difference in the
ethical position of physical therapy as compared to other professions
will provide insights for understanding and guiding our behaviors.
KEYWORDS: Ethics,. FUNDING ACKNOWLEDGEMENTS: None.
CONTACT: triez1hl@cmich.edu
ETHICS COMMITTEE: Internal Reiew Board (IRB) of Central
Michigan University
Research Report Platform Presentation
3146 Sunday 3 June 10:10
PP Crystal Pavilion A
USE OF INFORMATION AND COMMUNICATION TECHNOLOGIES
(ICT) IN PHYSIOTHERAPY EDUCATION IN PORTUGAL
Lopes A1 , Ferreira C2 , Grazina M, Casaquinha P, Godinho J;
1 Escola Superior de Saúde do Alcoitão, Estoril, Portugal;
2 Faculdade de Motricidade Humana (UTL), Cruz Quebrada, Portugal
PURPOSE: This study aims to determine the use of Information
and Communication Technologies (ICT) in Physiotherapy teaching
in Portugal, namely the characterization of the usage of the ICT by
the institutions that offer the Physiotherapy course, as well as by
Physiotherapy teachers and students. RELEVANCE: The European
Region of the World Confederation for Physical Therapy refers in its
document European Benchmark Statement that the Physiotherapist
should have skills in the area of ICT, so that he/she is able to
search for the required evidence to validate his/her practice, as well
as managing the data and records stemming from his/her clinical
practice. Therefore those skills should be developed during their basic
training, and so should teachers be able to introduce the ICT in
the teaching process, keeping in mind the institutional framework
of this process. PARTICIPANTS: The sample of teachers(n=116)
and students(n=982)in the school year of 2003/2004 was taken
from a population comprising the total of institutions(n=16) that offer
Physiotherapy course. METHODS: A questionnaire was especially
set up and was validated by a panel of experts and by a pre-
test. This questionnaire was subdivided into 6 dimensions (sample
characterization, equipment characterization, usage characterization,
attitudes and knowledge, barriers and necessities. ANALYSIS: The
procedures used were essentially descriptive statistics. RESULTS:
S51
Regarding accessing the Internet in the institution, 98% of the
teachers and students refer having access to Internet linked
computers. When inquired about the usage of the computer for
academic activities, 99% of the teachers and students answered
affirmatively, of which 35% of the teachers use it more than 10
hours per week and 28% between 5 to 10 hours. As for the
students, the percentage of weekly usage is 42.6% between 0 and
3 hours and 36.7% between 3 and 5 hours. Furthermore 81% of
the inquired teachers and 57.4% of the inquired students referred
to fully agree in the matter of the importance of ICT usage in the
school context. Although 84% of the inquired teachers reported
to have knowledge in the area of the ICT, almost 51% pointed
out the lack of specific training for integration/usage of the ICT
as being the main barrier in the usage, then followed by the
inexistence of strategies that facilitate the integration of the ICT in
education/learning (44%). CONCLUSIONS: Through the analysis
of the results of this study it is demonstrated that although the
good accessibility to the ICT by teachers and students in their
institutional and home environment, it is yet scarce due to the
lack of specific training in this area. IMPLICATIONS: There seems
to be the need to create institutional programs and projects that
promote the usage of ICT by investing in the training of teachers
and through the integration of those skills in the Physiotherapy
course. KEYWORDS: Education, Information and Communication
Technologies(ICT), Survey. FUNDING ACKNOWLEDGEMENTS:
This work was unfunded. CONTACT: aalopes@essa.pt
Research Report Platform Presentation
2788 Sunday 3 June 10:10
PP Crystal Pavilion B & C
MUSCULAR AND KINEMATIC RESPONSES OF THE TRUNK
AND LOWER LIMB TO SUDDEN LOADING: EFFECTS OF
POSTURE, WARNING, AND FATIGUE
Mawston G, McNair P, Boocock M; Physical Rehabilitation
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
standing posture, with two levels of warning, before and after fatigue.
RELEVANCE: A significant percentage of low back injuries are
attributed to sudden anterior loading of the trunk. During such a
loading event the neuromuscular system must respond quickly to
produce appropriate muscle and joint responses to counter the
external load in such a way that maintains stability, without placing
excessive forces on the lumbar spine. Postural responses to sudden
loading may also be influenced by the posture adopted at the time of
perturbation, the degree of muscular fatigue, and whether sufficient
forewarning of the loading event has been provided. Understanding
how posture, fatigue, and level of warning affect muscle and joint
responses will allow an insight into the mechanisms of low back injury,
as well as providing essential information for the rehabilitation and
prevention of injuries of clients returning to vocational activities that
include lifting tasks. PARTICIPANTS: Thirty male subjects between
the age of 18 and 35 years with no recent history of low back
pain participated in the study. METHODS: Subjects in either an
upright or stooped standing posture held a pre-weighted box that was
suddenly pulled downwards. Surface electromyography was used to
detect onset latencies of the right lower limb and trunk muscles.
Two-dimensional video data of trunk and lower limb motion in the
sagittal plane were simultaneously collected. Subjects were exposed
to a series of randomised sudden loading trials in the upright and
stooped standing posture, with and without prior warning of the
loading event. This was then repeated immediately following either a
lifting induced fatigue task or light catechistic exercises. ANALYSIS:
Muscle and joint onset latencies were calculated using purpose
built software (LabVIEW version 6i, National Instruments, Austin,
TX, USA). A mixed model MANOVA with repeated measures was
used to determine main effects for posture, warning, and fatigue.
S52
RESULTS: The provision of warning decreased all muscle response
times in the erect standing posture, but only the lower erector spinae
onset latencies were shown to decrease in the stooped posture
(p < 0.05). Perturbation in the stooped posture was less reliant on
abdominal muscle activation and produced an overall different joint
movement initiation pattern, with less joint displacement than in
the upright standing position (p < 0.05). Prior to fatigue, warning
reduced joint displacement of the lower limb and lumbosacral region
in response to sudden loading (P < 0.05). However, following fatigue
warning had no influence on joint displacement. CONCLUSIONS:
Findings from this study showed that prior warning of a sudden
loading event in the upright standing resulted in earlier initiation
of postural responses, decreasing overall joint motion. In contrast,
warning had minimal effect on postural responses in the flexed
posture. Fatigue appears to have minimal influence on muscle
and kinematic response to sudden loading. IMPLICATIONS: These
findings provide the therapist with greater insight into the mechanisms
of low back injury and serve to direct the physiotherapy management
of postural instability. KEYWORDS: Sudden loading; low back injury;
Posture. FUNDING ACKNOWLEDGEMENTS: New Zealand Society
of Physiotherapy. CONTACT: gmawston@aut.ac.nz
ETHICS COMMITTEE: Auckland University of Technology Ethics
Committee
Research Report Platform Presentation
3018 Sunday 3 June 10:10
VCEC Ballroom A
A MODEL OF ISCHEMIC PAIN IN THE CALF AND TENS
MODIFICATION OF LOWER LIMB PAIN: PRELIMINARY RESULTS
Roche P1 , Santos D1 , Snijder J1 , Seenan C1 , Weddell A1 ,
Ballantyne E1 , Sweers I; 1 School of Health Sciences, Queen
Margaret University College, Edinburgh, UK
PURPOSE: To develop a model of laboratory induced ischemic
calf pain; to test the analgesic efficacy of TENS for calf pain, and
to describe induced calf pain, in healthy volunteers. RELEVANCE:
We aimed to modify the sub maximum effort tourniquet technique
(SMETT), a standardised method of inducing experimental ischemic
pain into the upper limb of volunteers, to create a laboratory model of
lower limb ischemia (LLI). With exercise, LLI could serve as a model
of intermittent claudication (IC) – the exercise induced ischemic
pain that is the main symptom of Peripheral Arterial Disease (PAD).
Testing TENS for LLI pain could indicate its potential efficacy in
IC related to PAD. PARTICIPANTS: 14 healthy males volunteered
for Experiment 1 (E1) and 20 healthy females for Experiment 2
(E2). Subjects met inclusion and exclusion criteria for SMETT.
METHODS: E1 was a within subject, crossover, single-blind study.
A pilot study was undertaken with 4 independent subjects. The
SMETT technique (with broad pressure cuff) was applied to the
thigh. Subjects then performed 20 resisted plantar-flexion / dorsi-
flexion exercises, using a pulley and weight apparatus developed for
the study, in order to induce ischemia over a period of 5 minutes.
Measurment of the Post Occlusive Reactive Hyperaemic response
(PORHmax), demonstrated that ischemia had occurred in the calf
of each subject, via the adapted SMETT technique. The main study
in E1 applied (A) the standard SMETT in the upper limb and 20
minutes later (B) the modified SMETT (minus PORHmax) in the
lower limb. Each application was for a maximum of 20 minutes. A
linear pain scale rated subjective reports of pain intensity, at intervals
between self-reported ‘pain threshold’ and ‘pain tolerance’. The cuff
was deflated at ‘pain tolerance’, or at 20 minutes, whichever came
first. Subjects retrospectively described the ischemic pain in (i) the
forearm and (ii) the calf, five minutes after cuff deflation. E2 utilised
the E1 procedure for inducing lower limb ischemia and recording
pain, to conduct an independent subject study of continuous TENS
(100Hz, 200us) for induced LLI. Subjects were randomly allocated
to a Control or TENS group. In the TENS group, electrodes were
placed proximal and distal to the area of pain in the calf. ANALYSIS:
WCPT 2007, Research Reports
Parametric or nonparametric tests examined differences between
conditions; linear pain scales and weighted-rank MPQ – Pain Rating
Index (PRI) scores For all statistical tests p < 0.05. RESULTS: In
E1, pain ratings at 300, 600, 900 12000 seconds showed similar
incremental increases in pain intensity that are typical of SMETT
induced ischemic pain, over time. In E2, TENS significantly raised
the mean pain threshold and tolerance levels, and reduced MPQ-PRI
scores, compared to controls (P < 0.01 all comparisons). Qualitative
MPQ descriptions reliably identified 4 sensory and 1 affective
subclass of words to describe induced LLI pain. CONCLUSIONS:
Lower limb ischemic pain induced with a modified SMETT can
be modified by continuous TENS. IMPLICATIONS: A study into
the efficacy of TENS during exercise in patients with PAD is
indicated. Ref. 1. ROCHE PA et al.Physiotherapy Theory and Practice
2001, 18: 129–138 KEYWORDS: Pain; laboratory model, electrical
stimulation. FUNDING ACKNOWLEDGEMENTS: None. CONTACT:
proche@qmuc.ac.uk
ETHICS COMMITTEE: Ethics Committe, Queen Margaret University
College, Edinburgh
Research Report Platform Presentation
882 Sunday 3 June 10:10
VCEC Meeting Rooms 8&15
DEVELOPMENT AND PSYCHOMETRIC PROPERTIES OF THE
HIGH-LEVEL MOBILITY ASSESSMENT TOOL
Williams G1 , Robertson V2 , Greenwood K3 , Morris M4 , Goldie P5 ;
1 Epworth Hospital, Melbourne; 2 The University of Newcastle,
Newcastle; 3 RMIT University, Melbourne; 4 The University of
Melbourne and NHMRC CCRE Clinical Gait Analysis and Gait
Rehabilitation, Melbourne; 5 La Trobe University, Melbourne
PURPOSE: To develop a new high-level mobility assessment tool
(HiMAT) for traumatic brain injury (TBI). RELEVANCE: High-level
mobility is poorly measured following TBI despite its importance for
social, leisure and sporting activities and quality of life in general.
Existing scales used to quantify mobility following TBI are susceptible
to a significant ceiling effect. PARTICIPANTS: Data were collected
from 103 TBI patients, aged 14-60 who were willing and able
to provide informed consent and had no pre-existing neurological
deficits. METHODS: The 20 original HiMAT items included walking
tasks, running tasks, balance tasks, and skipping, hopping, jumping
and stair tasks. Performances were recorded quantitatively (i.e.
time or distance) and qualitatively (a rating based on quality of
performance) modified from the coding qualifiers scale in the ICF.
Data on the gross function component of the Rivermead Mobility
Assessement (RMA) and motor FIM were also collected to investigate
concurrent validity and presence of a ceiling effect. ANALYSIS:
Due to the confounding influence of cognition, behaviour and
upper limb function on higher level mobility tasks, all items were
analyzed to ensure unidimensionality. Rasch analysis was used
to identify 1) items that quantify mobility with minimal influence
from other domains, and 2) items that discriminate ability over a
large range of performance. Correlations were performed between
the quantitative and qualitative data to determine which method
was better for measuring high-level mobility. Further correlations
were performed to investigate the concurrent validity of the HiMAT.
RESULTS: Rasch analysis identified several misfitting items which
were removed from the item pool. Further analysis showed that
quantitative data and qualitative data were very highly correlated,
but the qualitative ratings of performance suffer from a ceiling
effect when compared to quantitative measures. Rasch analysis
also identified a hierarchical ordering of high-level items in motor
performance difficulty, and demonstrated a significant ceiling effect
of the gross function RMA and motor FIM when compared to the
HiMAT. The correlation between the HiMAT and motor FIM was
poor (r = 0.53, p < 0.01), largely due to a substantial ceiling effect
of the motor FIM. The correlation between the HiMAT and gross
function RMA was good (r = 0.87, p < 0.01), but the gross function
Platform Presentations, Sunday 3 June
RMA was also susceptible to a ceiling effect with 51.5% achieving
the maximal score. CONCLUSIONS: The HiMAT is a unidimensional
mobility scale that quantifies mobility to a higher level than existing
scales. The utilization of Rasch analysis in the initial stages of scale
development allows for identification of discriminative items that can
be used to generate an efficient measurement tool. This process also
increases the likelihood that a measurement tool will be responsive
to change because items that are evenly spaced throughout the
mobility continuum can be identified. IMPLICATIONS: The HiMAT
is a simple clinical tool that requires little training to use and can be
performed in 5-10 minutes in most clinical environments. It can be
used to quantify if people with TBI have the mobility prerequisites for
participation in many employment, social, leisure and sporting ac-
tivities. KEYWORDS: traumatic brain injury, mobility, measurement.
FUNDING ACKNOWLEDGEMENTS: La Trobe University Faculty
Research Grant. CONTACT: gavin.williams@epworth.org.au
ETHICS COMMITTEE: La Trobe University (FHEC 01/140, FHEC
02/094) Epworth Hospital (No. 20902)
Research Report Platform Presentation
3071 Sunday 3 June 10:10
VCEC Meeting Rooms 11-12
LESSENING THE LOAD: GAIT COMPENSATIONS AND KNEE
JOINT LOADING IN PATIENTS WITH KNEE OSTEOARTHRITIS
Hunt M1,2 , Birmingham T1,2 , Bryant D2 , Jones I1 , Giffin R1 ,
Jenkyn T1 ; 1 Wolf Orthopaedic Biomechanics Laboratory: London,
Ontario, Canada; 2 School of Physical Therapy, University of
Western Ontario: London, Ontario, Canada
PURPOSE: To evaluate the effect of commonly observed gait
compensations on knee joint loading in patients with medial compart-
ment knee osteoarthritis (OA) and varus alignment. RELEVANCE:
The substantial burden of knee OA, the weight bearing joint
most commonly affected, on individuals and society has led to
increased attempts to identify modifiable risk factors and develop
appropriate interventions. Lower limb malalignment and excessive
joint loading during walking gait have been identified. Although it
has been proposed that patients with varus alignment and medial
compartment knee OA may benefit from adopting compensatory gait
characteristics that lessen the load on the knee, the relationships
among commonly observed gait compensations and knee joint
loading are presently unclear. PARTICIPANTS: 75 patients were
recruited from a consecutive sample of individuals presenting to an
orthopaedic injuries clinic for treatment of knee pain. All patients
had radiographically confirmed varus alignment of the lower limb
and knee OA predominantly affecting the medial compartment.
METHODS: Double-limb standing anteroposterior radiographs were
used to measure static varus alignment (mechanical axis angle).
Participants underwent three dimensional gait analyses during which
they were instructed to walk barefoot across the 8-meter lab floor
at their self-selected comfortable pace while kinematic and kinetic
data were collected using an 8-camera optical motion capture system
and floor mounted force platform. An indirect measure of dynamic
knee joint load (knee adduction moment), the magnitudes of toe-
out and lateral trunk lean, and walking velocity were calculated
based on five-trial averages. ANALYSIS: Pearson product moment
correlations were used to assess the relationships among individual
variables. Two multiple regression models were constructed to
predict the magnitude of knee joint load: one with static varus
alignment as the only independent variable, and one with static
varus alignment, plus toe-out, lateral trunk lean, and velocity during
walking as independent variables. RESULTS: Knee joint load was
most highly correlated with lateral trunk lean (r = −0.58), followed
by toe-out angle (r = −0.42), and static varus alignment (r = 0.34).
Knee joint load and velocity were not significantly correlated (r=0.18,
p > 0.05). Static varus alignment accounted for 12% of the variation
in knee joint load. Addition of the compensatory gait characteristics
explained a further 43% of knee joint load variance. CONCLUSIONS:
S53
Individuals with varus alignment and medial compartment knee OA
exhibit gait patterns that include lateral trunk lean and toe out
and contribute substantially to lessening the dynamic knee joint
load. IMPLICATIONS: Identification of dynamic gait compensations
may enable a better understanding of the ability to cope with
knee OA and may aid in the development of more targeted
rehabilitative interventions such as gait retraining. KEYWORDS:
knee, osteoarthritis, gait. FUNDING ACKNOWLEDGEMENTS: This
research was undertaken, in part, thanks to funding from the Canada
Research Chairs Program and the Canadian Institutes of Health
Research.
ETHICS COMMITTEE: University of Western Ontario Research
Ethics Board for Health Sciences Research Involving Human
Subjects
Research Report Platform Presentation
2629 Sunday 3 June 10:10
VCEC Meeting Room 16
CLINICAL PRACTICE GUIDELINE IN PHYSIOTHERAPY STROKE
MANAGEMENT IN THE NETHERLANDS, BASED ON A
SYSTEMATIC REVIEW OF AVAILABLE EVIDENCE
Van Peppen R1−3 , Hendriks E4 , Van Meeteren N1,2,5 , Helders P6 ,
Kwakkel G5,7 ; 1 Department of Physiotherapy-Research,
Academy of Health Sciences, University Medical Center,
Utrecht, the Netherlands; 2 Master of Science Programme
in Physiotherapy-Research, Utrecht University, Utrecht, the
Netherlands; 3 University for Professional Education Utrecht, Institute
for Human Movement Studies, Department of Physiotherapy; 4
Maastricht University, Department of Epidemiology, Maastricht,
the Netherlands; 5 Rudolf Magnus Institute of Neuroscience,
Department Neurology and Neurosurgery, Section Rehabilitation,
University Medical Center Utrecht, Utrecht, the Netherlands; 6 Chair
of Physiotherapy Utrecht University and University Medical Center
Utrecht; 7 Department of Physical Therapy, VU University Medical
Center, Amsterdam, the Netherlands
PURPOSE: To develop a clinical practice guideline for the physiother-
apy management of persons with stroke, as support for the clinical
decision-making process, especially with respect to selection of
appropriate interventions, prognostic factors and outcome measures.
RELEVANCE: Physiotherapists have a high caseload of persons
with stroke, so there is a need to identify effective evidence-based
physiotherapy procedures. The availability of a guideline that includes
information about prognostic factors, interventions, and outcome
measures would facilitate clinical decision-making. PARTICIPANTS:
literature search METHODS: A systematic computerized literature
search was performed to identify evidence concerning the use of:
1) prognostic factors related to functional recovery; 2) physiotherapy
interventions in persons with stroke; and 3) outcome measures to as-
sess patients’ progress in functional health. Experts, physiotherapists
working in the field of stroke rehabilitation, and a multidisciplinary
group of health professionals reviewed the clinical applicability and
feasibility of the recommendations for clinical practice and their com-
ments were used to compose the definitive guideline. ANALYSIS:
Of 9482 relevant articles, 322 were selected. These were screened
for methodological quality. RESULTS: Seventy-two recommendations
for clinical practice were retrieved from these articles and included
in the guideline: 6 recommendations concerned the prediction of
functional recovery of activities of daily living (ADL), including walking
ability and hand/arm use; 65 recommendations concerned the choice
of physiotherapy interventions; and 1 recommendation concerned
the choice of outcome instrument to use. A core set of seven
reliable, responsive, and valid outcome measures was established,
to determine impairments and activity limitations in persons with
stroke. CONCLUSIONS: The guideline provides physiotherapists
with an evidence-based instrument to assist them in their clinical
decision making regarding persons with stroke. IMPLICATIONS:
As most of the recommendations included in the guideline came
S54
from studies of persons in the post acute and chronic phase
of stroke, and in general involved patients with less severe and
uncomplicated stroke, more needs to be learned about the more
complex cases. KEYWORDS: clinical practice guideline, physiother-
apy, rehabilitation, stroke, prognostic factors, interventions, outcome
measures. FUNDING ACKNOWLEDGEMENTS: This project is
supported by a grant from the Dutch Physiotherapy Association
(KNGF), grant reference number: IKPZ/KNGF/05/2000. CONTACT:
roland.vanpeppen@hu.nl
Research Report Platform Presentation
3208 Sunday 3 June 10:10
VCEC Meeting Room 17
MOVEMENT STRATEGIES USED BY INFANTS WITH CEREBRAL
PALSY AND DOWN SYNDROME DURING SELF-INITIATED
PRONE PROGRESSION
Kolobe T1 , Pidcoe P2 ; 1 University of Oklahoma Health Sciences
Center; 2 Virginia Commonwealth University
PURPOSE: A fundamental barrier to learning and independence in
children with or at risk for cerebral palsy is mobility. The earliest
form of movement that is compromised in these children is prone
progression. This study examined prone progression strategies
used by children with CP and Down syndrome. A self-initiated
prone progression crawler (SIPPC) was used to gather movement
data. The SIPPC is designed as a mobility aid and consists of a
wheeled platform, interdependent drive wheels controlled by an on-
board computer, and load cells that collect information about the
infant’s effort to move. RELEVANCE: Prone progression is important
because it affects other areas of development that children use to
solve problems that require movement, interact with others, and
meet the demands of learning later in school. Recent theories on
brain plasticity in children provide a compelling argument for new
and innovative strategies that take advantage of the experience-
expectant and experience-dependent characteristics of learning and
skill acquisition to address mobility constraints. Such innovation can
help link interventions to theories that have been empirically tested,
and be used to maximize functional independence. PARTICIPANTS:
Participants were 10 infants, aged 4–22 months, who were stratified
into 3 groups based on diagnosis: 3 with CP, 3 with Down syndrome,
and 4 were typically developing. METHODS: The infants were placed
on the SIPPC and encouraged to propel it using a set protocol of 3
timed trials. The protocol was repeated twice a week for 8 weeks.
Data from the computer on board the SIPPC and load cells were
recorded to a laptop computer attached to the SIPPC. In addition,
a camera was used to records the infants’ movements. ANALYSIS:
Data collected from the SIPPC provided movement direction, speed,
and support force from the infants. Movement data and its derivatives
were correlated with the force data collected from the load cells.
Data from the camera were digitalized, coded, and correlated with
movement data. RESULTS: Movement direction and speed data
showed that in all cases, infants with CP and Down syndrome
performed with less amplitude, disorganized direction and purpose
when compared to the typically developing infants. Unlike infants with
typical development who were able to use the SIPPC independently
between 6–7 months of age, infants with CP and Down syndrome
a slow learning curve. Qualitative differences were noted from the
video recordings. CONCLUSIONS: These preliminary findings are
promising, and suggest that the SIPPC can be used effectively to
study: a) early movement strategies used by infants with motor
disabilities during prone locomotion, b) their learning styles, and
c) the impact of experience-expectant and experience-dependent
characteristics of learning and skill acquisition. IMPLICATIONS:
The development and use of the SIPPC is based on theories
of neuroplasticity, particularly the neuronal group selection theory,
which emphasizes the importance of environmental experience
(experience-dependent plasticity) in shaping the development of the
brain and function. Providing stability through the use of the SIPPC
WCPT 2007, Research Reports
may bypass the early mobility constraints experienced by infants with
motor disability and helps facilitate not only their motor but other
domains of development. KEYWORDS: Infants, Mobility, Cerebral
Palsy. FUNDING ACKNOWLEDGEMENTS: This work was partially
funded by the Presbyterian Health Foundation, Oklahoma Health
Sciences Office of Vice Provost for Research, and College of Allied
Health. CONTACT: hkolobe@ouhsc.edu
ETHICS COMMITTEE: Institutional Review Board of the University
of Oklahoma Health Sciences Center
Research Report Platform Presentation
1430 Sunday 3 June 10:45
PP Crystal Pavilion A
WHICH INFORMATION SOURCES DO PHYSIOTHERAPISTS
USE WHEN SELECTING TREATMENT TECHNIQUES: SURVEY
OF MANUAL THERAPY AND PRIMARY CARE PRACTITIONERS
Ni Choirbin M1 , Turner P2 , Connell A1 ; 1 Physiotherapy Department,
University of Limerick Ireland; 2 Department of Social Sciences
and Law, University of Teesside, UK
PURPOSE: Physiotherapy has been perceived in the past as a
profession that bases its practice primarily on anecdotal evidence;
that physiotherapists use treament techniques that have little or
no scientific support and select these techniques without regard to
the evidence (Bohannon & LeVeau 1986, Turner & Whitfield 1999,
Palfreyman 2003). This research aimed to establish what sources of
information Irish Chartered Physiotherapists are using when selecting
treatment techniques and whether practice is evidence based.
RELEVANCE: Evidence based practice (EBP)is firmly established
as the gold standard of healthcare requiring the integration of
current research, clinical expertise and patient preference when
making clinical decisions(Sackett 1997). Degree programmes equip
physiotherapists with the skills to use current research in their clinical
practice. The Irish healthcare system is undergoing considerable
reform and it is important that physiotherapists are able to respond
to the call for EBP. The Irish Chartered Society of Physiotherapists
(ISCP)requires all its members to attain degree standard education
to practice standard and to promote EBP. PARTICIPANTS: Following
ethical approval, the ISCP special interest groups in Manual Therapy
(n=217) and Community Care (n=92)members were selected. These
groups were chosen to provide a sample of physiotherapists working
in the three clinical service areas of acute services, primary care and
private practice. A convenience sample of 50% from each group were
sent questionnaires by taking alternate names on the lists to limit the
effect of geographical location. METHODS: Turner and Whitfield’s
(1999) questionnaire was piloted and adapted for the Irish context.
The questionnaire asked for information on the 1)year of qualification
2) treatment techniques used and frequency of use 3) reasons
for the choice of treatment techniques. A postal questionnaire was
distributed to 45 physiotherapists with a special interest in community
care and 105 to the manual therapy group. Consent to participate
was assumed by return of the completed questionnaire which
were anonymous. ANALYSIS: All data was entered onto an Excel
database. Main themes were identifieded for technique selection and
information sources. RESULTS: The response rate was 54%. 45%
of the manual therapy group qualified in the last 10 years, 40%
of the community care group qualified over 10 years ago. There
were no significant differences between the two special interest
groups. Undergraduate education and clinical experience are the
most influential factors in determining the selection of treatment,
cited as the primary reason by 65%. Use of research literature
accounted for a further 9% and continuing professional development
(CPD)activites a further 6%. Exercise was selected or prescribed by
98% of physiotherapists. Electrotherapy was not used 64% of the
participants. CONCLUSIONS: In line with previous studies, under-
graduate education continues to be a primary influence in clinical
practice. Clinical experience is equally important. The use of research
and CPD in informing practice is higher than previously reported.
Platform Presentations, Sunday 3 June
Exercise is central to practice. Electrotherapy does not have a
large role in physiotherapy practice in Ireland. IMPLICATIONS: EBP
is evident within this study population. Undergraduate curriculum
content and design should reflect the needs of the future health
demand given the persistent influence of training KEYWORDS: prac-
tice; education; ebp. FUNDING ACKNOWLEDGEMENTS: None.
CONTACT: amanda.connell@ul.ie
ETHICS COMMITTEE: University of Limerck Research Ethics
Committee
Research Report Platform Presentation
933 Sunday 3 June 10:45
PP Crystal Pavilion B & C
TO INVESTIGATE THE LEVEL OF KNOWLEDGE ABOUT OSTEO-
POROSIS AMONG PHYSIOTHERAPISTS AND OCCUPATIONAL
THERAPISTS WORKING IN PRIMARY CARE IN IRELAND
Farrell C, Culleton -Quinn E; Trintiy College Dublin
PURPOSE: The aim of this study is to investigate the level
of knowledge about osteoporosis among physiotherapists and
occupational therapists working in primary care in the Republic
of Ireland. RELEVANCE: Osteoporosis is a preventable disease
affecting millions of people. It is a major cause of long-term
disability and creates dependency on the world’s health services. It
is characterised by decreased bone mass with micro-architectural
deterioration of bone tissue, resulting in bone fragility and thus
increasing risk of fractures (O’Brien 1995). Primary care physio-
therapists and occupational therapists have a role in dealing with
promotion of “Bone Health” throughout the lifespan. It is essential
that therapists have sufficient knowledge so as to facilitate effective
patient care. PARTICIPANTS: A list of all physiotherapists and
occupational therapists working in the primary care setting, in the
Republic of Ireland, was drawn up from an up to date hospital
community resource file. The results include responses from 40
physiotherapists (response rate 50%) and 34 occupational therapists
(response rate 49%), a total of 74 questionnaires. METHODS: A
self-administered postal questionnaire was distributed to primary
care therapists throughout the Republic of Ireland. ANALYSIS:
The questionnaire was initially coded and the responses were
then entered onto the Microsoft Excel Package. Data analysis was
primarily descriptive in nature. RESULTS: The results of this study
indicate dissatisfaction with knowledge levels among therapists. Only
15% of physiotherapists and 12% of occupational therapists were
satisfied with their knowledge. Physiotherapists demonstrated good
knowledge regarding incidence of osteoporosis for women, the age
one reaches peak bone density, age at which osteoporosis occurs,
bones commonly effected, some risk factors and management.
Knowledge gaps existed regarding incidence of osteoporosis for men,
definitions of osteopenia and osteoporosis, RDA calcium and some
risk factors. Occupational therapists demonstrated good knowledge
regarding the age one reaches peak bone density, age at which
osteoporosis occurs, bones commonly affected, some risk factors
and management. Gaps in knowledge existed regarding incidence
of osteoporosis for women and men, definition of osteoporosis and
osteopenia, RDA calcium and some risk factors. CONCLUSIONS:
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: clarefarrell64@gmail.com
ETHICS COMMITTEE: Trinity College Dub;in Ethics Committee
S55
Research Report Platform Presentation
1580 Sunday 3 June 10:45
VCEC Ballroom A
PAINFUL RESPONSE TO MEDIAN NEURODYNAMIC TEST 1 IN
HEALTHY SUBJECTS
Barbero M1,2 , Castelli E3 , Gatti R3 ; 1 School of Physiotherapy,
University of Applied Sciences of Southern Switzerland; 2 Master
in Rehabilitation of Musculoskeletal Disorder, University of Genoa,
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
response to median neurodynamic test 1 (MNT1). Parameters that
must be considered during MNT1 are pain provocation, range of
motion and resistance through range. Normal response to MNT1 and
modifications have been described and variability between subjects
reported. The aim of this study is to verify the inter-tester and intra-
tester reliability of painful response to MNT1 in healthy subjects
by performing the test in a purely clinical set-up. RELEVANCE:
Knowledges on normal painful response to MNT1 are useful to
assess neurogenic pain disorder. PARTICIPANTS: Fifteen healthy
students (22.1+/−0.7 years; 11 females, 4 males) from the school
of physiotherapy with no history of upper quadrant disorder were
recruited. None of the subjects had any previous experience with
neural provocation tests All students signed an informed consent
form and the study was approved by the ethical committee of the
San Raffaele Hospital METHODS: Three physiotherapists (M, R,
E) after a period of training on MNT1 were involved in the study
as assessors. The fifteen participants were randomly allocated to
five sessions in group of three. During each session assessors
performed the MNT1 twice (t1, t2) on both sides (R,L) to all the
subjects. Assessor and side order were randomized and subjects
wait at least fifteen minutes before receiving a test on the same
side. Subjects were instructed to stop the test at submaximal pain
and to record the response on a body chart. ANALYSIS: To analyze
pain distribution body charts were divided into seventeen anatomical
regions and data were extracted. Significant differences between
left and right were investigated using Wilcoxon test. To verify intra-
tester and inter-tester reliability correlation analysis was performed
using Spearman’s rank test. RESULTS: Pain response: 91.1% of
the body charts reported pain in the hand, 87% in the forearm and
17.9% in the arm. Wilcoxon test showed no significant difference
between left and right (Mt2R to Mt2L p = 0.84; Rt1Rto Rt1L p = 0.22,
Rt2R to Rt2L p = 0.2; Et1R to Et1L p = 0.45; Et2R to Et2L p = 0.84)
except one case (Mt1R to Mt1L p = 0.3). All the assessors showed
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
R=0.91; Rt1L to Rt2L R=0.87; Et1R to Et2R R=0.87; Et1L to Et2L
R=0.76). Also good correlation between assessors for both sides
was verify (Mt1R to Rt1R R=0.93; Mt1R to Et1R R=0.76; Rt1R to
Et1R 0.71; Mt1L to Rt1L R=0.89; Mt1L to Et1L R=0.79; Rt1L to Et1L
R=0.8). All correlations were significant (P < 0.05). CONCLUSIONS:
Our results indicate that on healthy subjects painful response to
MNT1 has a good reliability. IMPLICATIONS: Additional studies
on pathological subjects are needed to determine the diagnostic
potential of MNT1 KEYWORDS: neurodynamic tests, neurogenic
pain, reliability. FUNDING ACKNOWLEDGEMENTS: N.A.
ETHICS COMMITTEE: Ethical committee of the San Raffaele
Hospital
S56
Research Report Platform Presentation
666 Sunday 3 June 10:45
VCEC Meeting Rooms 11-12
PILLOW TYPE AND WAKING CERVICO-THORACIC SYMPTOM
BEHAVIOUR IN SIDE SLEEPERS
Gordon S1,2 ; 1 University of South Australia, Adelaide, Australia;
2 James Cook University, Townsville, Australia
PURPOSE: To compare the prevalence and temporal behaviour
of cervical pain, cervical stiffness, headache and scapular pain
reports when subjects slept on their usual pillow and the five
most commonly used pillows in the general Australian population:
polyester, foam, feather and rubber pillows of a regular shape and
foam contour pillows. Sleep quality and pillow comfort ratings were
also used as outcome measures. RELEVANCE: Physiotherapists
in clinical practice are frequently asked by patients with cervical
spine symptoms to recommend a pillow. No previous study has
investigated the association between pillow use and cervical spine
related temporal symptom behaviour. PARTICIPANTS: One hundred
and six participants who reported preference for the side sleep
position with one pillow aged over 18 years were recruited to
the study. METHODS: A comparative field study was undertaken.
Participants completed a baseline diary of waking and retiring
symptoms, sleep quality and pillow comfort for one week while
sleeping on their usual pillow, then randomly allocated to sleep on
each of the trial pillows while completing a diary. Subjects slept on
their own pillow for one week between trial pillows to ameliorate any
interaction effect between trial pillows. ANALYSIS: Percentages were
used for descriptive analysis and to test for strength of association
statistical analysis was conducted using odds ratios in Epiinfo Version
5, an epidemiological statistical program (Epiinfo Users Manual
1985). RESULTS: Feather pillows were significantly associated with
increased reports of waking symptoms, production of symptoms
overnight, low pillow comfort ratings and low sleep quality ratings
when compared to the other pillows. In contrast the rubber pillow was
significantly associated with decreased reports (protective) of waking
cervical pain, headache and scapular pain, overnight production of
all waking symptoms, low pillow comfort and sleep quality ratings
when compared to the other pillows. Regular shaped polyester
pillows were significantly associated with waking headache reports
and the abolition of cervical stiffness overnight when compared with
regular pillows of other contents. Regular foam pillows were found
to have no significant association with any symptom production
or abolition when compared with all other regular shaped pillows
and also when compared to a contour foam pillow. The use of
a contour foam pillow had no affect on symptom behaviour when
compared to a regular shaped foam pillow. CONCLUSIONS: This
study found that rubber pillows performed best in terms of waking
symptom prevalence reports, overnight symptom production, sleep
quality and pillow comfort. Feather pillows performed the worst
IMPLICATIONS: Recommendation for pillow use with regard to
patient reports of temporal cervical spine related symptoms can
now be provided to patients. KEYWORDS: Pillow, cervical spine,
symptom behaviour. FUNDING ACKNOWLEDGEMENTS: Tontine
for providing the polyester pillows. Dentons for providing the regular
and contour shaped foam pillows. University of South Australia for
providing the rubber pillows. CONTACT: susan.gordon2@jcu.edu.au
ETHICS COMMITTEE: Ethics approval supplied by the ethics
committee of the University of South Australia.
WCPT 2007, Research Reports
Research Report Platform Presentation
753 Sunday 3 June 10:45
VCEC Meeting Room 16
COMPARISON OF HOME-BASED PHYSIOTHERAPY WITH
ADHERENCE ENHANCING STRATEGIES VERSUS CLINIC-
BASED PHYSIOTHERAPY REHABILITATION FOR PATIENTS
WITH ANKLE SPRAINS
Bassett S1 , Prapavessis H2 ; 1 School of Physiotherapy, Auckland
University of Technology, Auckland, New Zealand; 2 School of
Kinesiology, University of Western Ontario, London, Ontario, Canada
PURPOSE: This study compared the effects of home-based
physiotherapy steeped in adherence enhancing strategies with its
clinic counterpart on rehabilitation adherence, ankle function and
psychological factors in ankle sprain patients. Correlations amongst
the adherence, ankle function and psychological factors were also
investigated. RELEVANCE: Poor attendance at physiotherapy has
caused inferior physiotherapy treatment outcomes for patients with
ankle sprains. Also psycho-social factors and physical function are
known to influence rehabilitation adherence. PARTICIPANTS: 47
people with new or recurrent ankle sprains, who were about to start
a course of physiotherapy were recruited from four physiotherapy
clinics. METHODS: A prospective experimental design was employed
whereby participants were randomly assigned to either the clinic or
home physiotherapy groups before commencing rehabilitation. Both
groups received a standard physiotherapy programme, with only
the number of clinic appointments differing (clinic 8.44±4.12, home
4.68±1.78). The clinic group’s physiotherapy was supplemented with
a small home programme, whilst the home group’s rehabilitation
was done predominantly at home, aided by equipment, a treatment
booklet and cognitive-behaviour strategies. Clinic- and home-
based adherence and attendance were measured throughout the
rehabilitation. Before and after the rehabilitation, questionnaires
evaluated psychological factors (motivation, and recovery locus of
control) and ankle function, and the Motor Activity Scale tested
function objectively. ANALYSIS: Group comparisons involved Chi-
square tests, Analysis of Variance (ANOVA), and repeated measures
ANOVA investigated change over the physiotherapy rehabilitation.
Pearson correlations examined relationships between adherence,
ankle function and psychological factors. The alpha level was set
at 0.05. RESULTS: The home group had a significantly higher
percentage of attendance (p < 0.04) and rate of completion of
their physiotherapy (p < 0.004). The groups were similar for their
adherence to the clinic and home based physiotherapy (all p values
>0.05). Over the rehabilitation participants’ ankle function scores
improved significantly (all p values <0.0001). While the groups’ scores
were similar on the objective function measure (p > 0.05), initially
the clinic group had significantly poorer self-reported ankle function
(p < 0.024), but at the end of the rehabilitation the groups did not
differ(p > 0.05). The groups’ scores did not differ on the psychological
factors over the duration of the rehabilitation (all p values >0.05).
Significant positive correlations existed between adherence and
psychological factors (all p values <0.05) and between adherence
and ankle function (all p values <0.05). Furthermore, significant
positive correlations were found between psychological factors and
ankle function (all p values <0.05). CONCLUSIONS: Physiotherapy
with a large home based component and adherence enhancing
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
Platform Presentations, Sunday 3 June
(Inc.) Scholarship Trust Fund, Wellington, New Zealand. CONTACT:
sandra.bassett@aut.ac.nz
ETHICS COMMITTEE: Auckland Ethics Committee X, Auckland
Ethics Committees, Ministry of Health, Auckland, New Zealand,
Research Report Platform Presentation
722 Sunday 3 June 10:45
VCEC Meeting Room 17
SELF-CONCEPT IN CHILDREN WITH CEREBRAL PALSY-
COMPARISONS WITH THEIR PARENT’S PERCEPTION OF
THEIR COMPETENCE
Shields N, Dunn N, Dodd K, Taylor N; School of Physiotherapy,
La Trobe University, Melbourne, Australia
PURPOSE: To determine if a difference existed between the self-
concept ratings of children with cerebral palsy and their parent’s
perception of their child’s abilities and attributes. RELEVANCE:
Physical therapists need to take into account the view a child with
cerebral palsy has of themselves (their self-concept) when deciding
on appropriate treatment, as the child’s sense of self-worth can
influence treatment decisions. With family-centered practice, physical
therapists also need to consider the views of the child’s parents, as
they provide important insights into the child’s abilities and make
decisions on their child’s behalf. Balancing the views of the child
and their parents could be potentially difficult if the parent’s and
the child’s perceptions differ. It is important that physical therapists
know if discrepancies exist so that therapy is directed appropriately.
A systematic review identified only three studies comparing the
self-concept of children with cerebral palsy to their parent’s rating,
but all used different outcome measures for the parents and the
children. PARTICIPANTS: Thirty children (16 male, 14 female) and
their parents were recruited from the orthopedic department of a
metropolitan pediatric hospital. The children were aged between 8
and16 years (mean 11 years 5 months, SD 2 years 6 months),
had been diagnosed with spastic cerebral palsy (hemiplegia or
diplegia) and had gross motor skills classified as level I and II
on the Gross Motor Function Classification Scale. METHODS:
The Self-Perception Profile for Children was used to measure
the self-concept of the children and the accompanying Parent
Rating Scale was used to measure the parent’s perception of their
child’s abilities and attributes. Comparisons were performed for five
domains of self-concept: Scholastic Competence, Social Acceptance,
Athletic Competence, Physical Appearance and Behavioral Conduct.
ANALYSIS: Correlation tests (Pearson’s correlation coefficient, r)
were performed to determine if there was a relationship between
the scores of the children and their parents. If no correlation
was found, comparisons were made using independent t-tests and
if a significant correlation was found, data were analyzed using
paired t-tests. RESULTS: No significant differences were found
between the ratings of children and their parents for the domains of
Scholastic Competence, Social Acceptance and Behavioral Conduct.
Parents rated the Physical Appearance of their children significantly
higher than the child’s rating (t = −4.85, p < 0.01) and Athletic
Competence significantly lower compared to the child’s rating (t=
3.45, p < 0.01). CONCLUSIONS: This is the first study to compare
the self-concept of children with cerebral palsy with their parent’s
perception of their child’s abilities using a directly comparable
rating scale. Parents can provide reliable information about their
child’s Scholastic Competence, Social Acceptance and Behavioral
Conduct. However, there may be discrepancies between child and
parents ratings of Athletic Competence and Physical Appearance.
IMPLICATIONS: The routine assessment of self-concept in children
with cerebral palsy and the concurrent assessment of their parent’s
perceptions of their child’s abilities and attributes may enlighten
the goal setting process of family-centered practice. It may also
be a useful method of stimulating discussion on disability between
the parent and child. KEYWORDS: Self-concept, cerebral palsy,
S57
children, parents. FUNDING ACKNOWLEDGEMENTS: This work
was unfunded. CONTACT: N.Shields@latrobe.edu.au
ETHICS COMMITTEE: Ethics approval was granted by the La
Trobe University Ethics Committee and the Royal Children’s Hospital,
Melbourne Ethics Committee.
Research Report Platform Presentation
1028 Sunday 3 June 10:45
VCEC Meeting Room 18
EFFECTIVENESS OF PROLONGED USE OF CONTINUOUS
PASSIVE MOTION (CPM) AS AN ADJUNCT TO PHYSIOTHERAPY
FOLLOWING TOTAL KNEE ARTHROPLASTY
Lenssen T1 , Crijns Y1 , Waltje E1 , Roox G1 , van Steyn M2 ,
Geesink R2 , van den Brandt P3 , de Bie R3 ; 1 Department of
Physical Therapy, University Hospital Maastricht, Maastricht,
Netherlands; 2 Department of orthopeadics, University Hospital
Maastricht, Netherlands; 3 Department of epidemiology, Maastricht
University, Maastricht, Netherlands
PURPOSE: Adequate and intensive rehabilitation is an important
requirement for successful total knee arthroplasty (TKA). The primary
focus of early rehabilitation is ambulation and regaining range of
motion (ROM) in the knee. Rapid return of knee ROM accompanied
by earlier return to functional activities of daily life is one of the
potential effects of continuous passive motion (CPM) treatment.
Although research findings favour the use of CPM in the first
rehabilitation phase following surgery, there is substantial debate
about the total period of CPM application and the duration of
individual sessions. RELEVANCE: A Cochrane review on the topic
concluded that short-term use of CPM leads to a more rapid
recovery of ROM. It also suggested, however, that future research
should concentrate on the period during which CPM should be
administered, and therefore called for research into longer-term
use, involving long-term follow-up. PARTICIPANTS: 60 patients were
included in the study. All patient received a unilateral primary TKA
as a result of osteoarthritis of the knee. Patients were included if
they had less than 80º of total passive ROM 4 days after surgery,
were able to understand and speak Dutch, were not suffering
from mental disabilities and were resident inside the ‘Maastricht’
region. Patients were excluded if showing relevant co-morbidity
influencing mobility (e.g. claudicatio, other prosthesis) or were
operated upon through minimally invasive surgery. METHODS: The
study design was a randomised controlled trial, with blinded treatment
allocation, assessment and analysis, in which patients undergoing
a unilateral TKA were evaluated to assess the added value of 14
days of CPM use at home, when added to regular physical therapy
treatment. All patients received daily CPM treatment in combination
with physical therapy sessions during the in hospital period. After
discharge the control group received regular Physical therapy. In the
experimental group daily CPM treatment was added. Main outcome
was function and range of motion. ANALYSIS: Ancova techniques
were applied using the ‘intention-to-treat’ principle. Primary and
secondary outcome measures ware reported for the in-hospital and
home situations, and for 6-week and 3-month follow-up. RESULTS: A
significant short term difference was found on the primary outcome
measure ROM (increase in rom of 17.6º(12.9) in the CPM group
vs 11.6 (9.4) in the control group). No differences were found in
function (Knee Society Score) nor on any of the secondary outcome
measures. At follow up (six weeks and three months after surgery)
no significant differences were found on any outcome measure.
CONCLUSIONS: Two weeks of cpm use after hospital discharge
leads to better short term range of motion, when added to regular
physical therapy in TKA patients with limited range of motion at
discharge from the hospital. Better range of motion does not relate
to detectable better functioning. The short term benefits diminish
within six weeks after surgery. IMPLICATIONS: Although there are
short term effects on range of motion of prolonged use of cpm after
total knee arthroplasty, administration should be reconsidered since
S58
it does not seem to generate any detectable longer term benefits.
KEYWORDS: Total knee artroplasty Knee osteoarthritis; continuous
passive motion. FUNDING ACKNOWLEDGEMENTS: This work was
funded by the Maasticht university Hospital and Maastricht university.
CONTACT: alen@pmzl.azm.nl
ETHICS COMMITTEE: Maastricht University Hospital and Maastricht
University Medical Ethics Committee
Research Report Platform Presentation
815 Sunday 3 June 10:45
VCEC Meeting Rooms 19-20
EFFECTS OF AGING ON LEARNED MOVEMENTS
Braden H1 , Shea C2 ; 1 Department of Physical Therapy, University of
Texas Health Science Center, San Antonio, Texas; 2 Department of
Health and Kinesiology, Texas A&M University, College Station, Texas
PURPOSE: The purpose of this research is to examine the manner in
which sequence movement information is used to optimize response
in the aging population. Recent laboratory studies of movement
tasks demonstrate how structure in the sequence of motion result
in more efficient execution (e.g., Park & Shea, 2002, Park, Shea &
Wilde, 2003). RELEVANCE: Movement skills are practiced in order
to optimize efficiency and enhance performance. While sequential
motor tasks generally become more efficient with practice, the extent
to which older people follow this trend is unknown. PARTICIPANTS:
Participants were young (N=8: Age 19-23) and older adults (N=8: Age
65-68). METHODS: The task required participants to move a lever as
quickly as possible to targets sequentially projected on a table top. At
various stages during practice, random practice blocks were inserted
between the repeated sequence blocks. Retention and random
sequence tests were administered after 24 hours. ANALYSIS: To
analyze the acquisition performance on the random and repeated
sequences, we analyzed mean element duration in a 2 (practice
group: young or older) x 16 (blocks: 1-16) analysis of variance
(ANOVA) with repeated measures on block. Repeated and random
sequence retention tests performance was analyzed in a 2 (practice
group: young or older) x 3 (test: repeated or random) x 16 (Element:
1-16) ANOVA with repeated measures on test and element. Element
is included in the retention test analysis in order to determine if the
response structure used on the repeated and random retention tests
differed. The post-experiment recognition and completion tests were
analyzed using separate Practice group x Response frequency Chi
squares. RESULTS: Young adults performed the repeated sequence
substantially faster than the older adults and this difference increased
over practice F(15,239)= 9.36, p < 0.01. The effective organization
of response elements into subsequences by the younger adults
resulted in the most fluent production of the movement sequence.
On the retention tests, there were no differences in response time
for the random blocks, but the young performers were substantially
faster than the older on the retention test where the repeated
sequence was used F(30,480)= 10.33, p < 0.01. No differences were
detected in the interview or on the recognition and completion tests
designed to determine explicit/implicit knowledge of the sequence.
CONCLUSIONS: Analysis of the sequence structure indicated that
the older adults did not organize their responses into subsequences
as effectively as the young adults IMPLICATIONS: The failure of older
adults to optimally arrange movement sequences may contribute to
the overall slowing of movement production. KEYWORDS: Aging,
Movement Tasks, Sequential Movement, Motor Learning. FUNDING
ACKNOWLEDGEMENTS: n/a. CONTACT: bradenh@uthsca.edu
ETHICS COMMITTEE: Texas A&M University
WCPT 2007, Research Reports
Research Report Platform Presentation
1633 Sunday 3 June 11:05
PP Crystal Pavilion A
PHYSICAL THERAPY DIAGNOSIS IN CLINICAL PRACTICE: A
SURVEY OF ORTHOPEDIC CERTIFIED SPECIALISTS IN THE
UNITED STATES
Miller Spoto M, Collins J; Nazareth College of Rochester Rochester,
NY US
PURPOSE: The purpose of this study is to investigate how
orthopedic physical therapists view and approach diagnosis in the
United States. RELEVANCE: Diagnosis is a central element of
patient management in the health care professions. Much of the
attention given to physical therapy diagnosis has been devoted to
specific but disparate classification systems utilized in orthopedic
practice in the treatment of low back pain. What is not well
understood is how orthopedic clinicians engage in the diagnostic
process in the “trenches” of practice, and whether or not there is
a uniform concept of physical therapy diagnosis. PARTICIPANTS:
Subjects consisted of 253 board certified orthopedic physical therapy
specialists. METHODS: A survey was developed to collect both
quantitative and qualitative data related to diagnostic process and
classification in orthopedic practice. The survey was mailed to
a published list of orthopedic certified specialists who indicate
low back pain as a practice focus. A total of 850 surveys were
administered; 253 surveys were completed, representing a return
rate of 30%. ANALYSIS: Demographic and quantitative data were
analyzed with SPSS. Qualitative data was first hand coded, then
analyzed with Ethnograph (TM). Common themes for how physical
therapists approach diagnosis in practice were identified by two
investigators. Each investigator coded responses independently
according to the agreed upon themes. RESULTS: Eighty-four
percent of the respondents report patient care as their primary
professional practice area. Seventy-six percent of the subjects utilize
a diagnostic classification system distinct from the medical diagnosis
when managing patients with low back pain. Of those, the largest
percentage, 38%, utilize a general pathophysiologic classification
system, 32% utilize the McKenzie system, and in decreasing
order of frequency, treatment-based classification (9%), movement
impairment classification (7%), and the practice patterns found in
the “Guide to Physical Therapist Practice” (7%). The majority of
those surveyed, 67%, agree that it is important for the profession
to develop a standard classification system for low back pain.
Qualitative data suggest considerable variation in how orthopedic
specialists approach diagnostic classification in patient management,
with several themes emerging: (1) physical therapy diagnosis may
incorporate the medical diagnosis, but moves beyond it, (2) physical
therapy diagnosis occurs across multiple levels or systems, (3)
physical therapists tend to view diagnosis in a process-oriented way
with its primary purpose to guide treatment decisions, (4) the focal
point of physical therapy diagnosis lies in the relationship between
body structure and function. CONCLUSIONS: Although there is a
lack of consensus on the basis for classification in physical therapy
diagnosis, clinicians largely agree on the role of diagnosis in patient
managment. The majority of orthopedic practioners diagnose patient
conditions within a framework that reflects the complex relationship
between structure and function. IMPLICATIONS: As physical therapy
evolves from a profession that treats by prescription to a doctoring
profession, it should give serious attention to diagnosis – the very
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: mspoto7@naz.edu
ETHICS COMMITTEE: The Human Subjects Research Committee
of Nazareth College
Platform Presentations, Sunday 3 June
Research Report Platform Presentation
2395 Sunday 3 June 11:05
VCEC Ballroom A
EXPLORING THE MULTIDIMENSIONALITY OF THE TAMPA
SCALE FOR KINESIOPHOBIA
Lundberg M1 , Styf J1 , Jansson B2 ; 1 Division of Occupational
Orthopaedics, Sahlgrenska University Hospital & Göteborg
University, Göteborg, Sweden; 2 Department of Psychology,
Göteborg University, Sweden
PURPOSE: The aim of the present study was to explore the
conceptual dimensions of the TSK questionnaire based on a large
Swedish sample of patients with persistent musculoskeletal pain.
RELEVANCE: The Tampa Scale for Kinesiophobia is one of the most
frequently employed measures. It has been in use for more than a
decade and has proved valuable for research as well as in clinical
settings. Since kinesiophobia is about fear of movement it is a central
phenomenon for physical therapists. The psychometric properties
of the Tampa Scale for Kinesiophobia have been evaluated. It
has, however, been emphasized that it is not sufficient to examine
the reliability and validity of a psychometric scale. It must also
be examined whether or not a specific scale is uni-dimensional,
as the uni-dimensionality or otherwise of a specific scale must
also be investigated. Usually, the uni-dimensionality of a concept
is analysed by means of factor analysis. PARTICIPANTS: Seven
hundred and eleven patients (361 women, 350 men) attending three
different orthopaedic outpatient clinics in Region Västra Götaland
were invited to participate. Inclusion criteria were as follows:
18 to 65 years of age, non-malignant persistent musculoskeletal
pain and good knowledge of the Swedish language. Exclusion
criteria were malignant pain, neurological and rheumatic diseases.
METHODS: The questionnaires were posted to the patients prior to
their first visit to the orthopaedic clinic. The patients returned the
completed questionnaires to an independent researcher. Informed
consent was obtained from all subjects before inclusion in the
study. ANALYSIS: An exploratory factor analysis was conducted
to investigate the factor structure of the TSK-SV, after which the
five-factor model was validated against convergent measures which
assessed general anxiety (STAI), physical disability (DRI), fear-
avoidance beliefs (FABQ), general fearfulness (FSS-II), and pain
intensity (VAS). RESULTS: The factor analysis indicated a five-
factor solution, which accounted for 60% of the variance. The five
factors were labelled: Factor I; Fear of bodily harm, Factor II; Fear of
movement/(re)injury, Factor III; Bodily anxiety, Factor IV; Importance
of activity and Factor V; Avoidance of activity. The strongest
correlations were found between the TSK-SV and physical disability
and anxiety. CONCLUSIONS: The TSK-SV is a multidimensional
questionnaire which measures different conceptual aspects related
to the phobic components of fear and avoidance. IMPLICATIONS:
TSK was constructed as a one-dimensional instrument. The problem
of evaluating the construct validity of kinesiophobia boils down to the
lack of a consistent conceptual definition of the phenomenon. Instead
of continuing to divide the TSK into smaller factor models, consensus
should be reached regarding conceptual and operational definitions.
Since kinesis is about movement it is of relevance that physical
therapists are involved in reaching such a consensus. KEYWORDS:
Construct validity, explorative factor analysis, persistent pain, psycho-
metric properties, Tampa Scale for Kinesiophobia (TSK). FUNDING
ACKNOWLEDGEMENTS: This study was supported by grants from
the Health and Medical Care Executive Board of the Region Västra
Götaland. CONTACT: mari.lundberg@orthop.gu.se
ETHICS COMMITTEE: Göteborg University
S59
Research Report Platform Presentation
931 Sunday 3 June 11:05
VCEC Meeting Rooms 11-12
THE EFFECT OF CERVICAL MOBILISATION ON MOTOR
FUNCTION AND PAIN PERCEPTION IN PAIN-FREE INDIVIDUALS
Wright A1 , Schmid A2 , Soon B3 , Fridriksson E4 , Gresslos E5 ,
Cheong P6 ; 1 School of Physiotherapy, Curtin University of
Technology, Perth, Western Australia; 2 University Hospital Balgrist,
Zurich, Switzerland; 3 National University Hospital, Singapore; 4
Hospital of Westman Islands, Iceland; 5 Manuell Terapi Klinikken,
Sarpsborg, Norway; 6 Advance Physiotherapy Services (APS),
Perth, Australia
PURPOSE: Spinal manual therapy (SMT) has been shown to elicit
effects on pain perception, autonomic function and motor function in
subjects who experience musculoskeletal pain. The improvement in
motor function may be a direct effect of the treatment or secondary
to a hypoalgesic effect. This study aims to demonstrate whether it
is possible to alter motor function following joint mobilisation, where
motor performance is not impaired by pain. RELEVANCE: This study
adds to our further understanding of potential mechanisms of action
for manual therapy techniques. PARTICIPANTS: 24 healthy subjects
without any previous experience of manual therapy participated in the
study. METHODS: The study used a double-blind, controlled, within-
subjects design comparing three different interventions performed
at the left C5/6 segment: SMT involving a grade III unilateral
postero-anterior mobilisation, manual contact control which involved
light manual contact on the segment without mobilisation and a
control condition without any physical contact. The following outcome
measures were investigated before and after the interventions:
EMG signals of the left sternocleidomastoid muscle (SCM) were
recorded during the staged cranio-cervical flexion test (CCFT).
Decreased SCM EMG activity during the CCFT has been shown
to be associated with increased activity of the deep neck flexors.
Moreover, pressure pain threshold (PPT) was measured on the
posterior aspect of the left articular pillar of C5/C6 using an electronic
digital algometer. ANALYSIS: One-way repeated measures ANOVA
was used to analyse the PPT data and two-way ANOVA was
used for the CCFT EMG data. RESULTS: The results indicate no
significant change in PPT following unilateral cervical mobilisation
(P = 0.846). There was no significant difference in superficial neck
flexor activity (P = 0.713). Post-hoc power analysis demonstrated the
ability to detect a 15% difference in EMG activity with 70% power.
CONCLUSIONS: The findings of this study suggest that there is
no significant influence of SMT on motor function of the deep neck
flexors in painfree individuals. The improvement in motor function
demonstrated in previous studies was not replicated suggesting
that either it is only possible to produce an effect when motor
function is impaired, or the change in motor function is secondary
to the pain inhibitory effect of the treatment. Further research
is required to establish a clear understanding of the mechanism
by which SMT influences motor function. Future studies should
investigate the effect of mobilisation on motor function in subjects
with impaired motor function who are not currently experiencing
pain. IMPLICATIONS: The mechanisms behind previously shown
improvement in motor function after SMT remains to be further
elucidated. KEYWORDS: spinal manual therapy, motor function,
cervical mobilisation. FUNDING ACKNOWLEDGEMENTS: This
study was part of the Master of Manipulative Therapy course at Curtin
University of Technology in Perth. No additional funding sources were
available. CONTACT: anninaschmid@hotmail.com
ETHICS COMMITTEE: Curtin University Human Research Ethics
Committee
S60
Research Report Platform Presentation
1057 Sunday 3 June 11:05
VCEC Meeting Room 16
RESPONSIVENESS OF CLINICAL OUTCOMES AND THEIR
VALUE AS INDICATORS OF RECOVERY DURING THE FIRST
TWO MONTHS FOLLOWING LATERAL ANKLE SPRAIN
Perron M1,2 , Luc J. H2,3 , Hélène M2,4 , Sylvain B2,5 ; 1 Canadian
Forces, Valcartier Garrison, 5th Field Amb, CSV, Quebec City,
Canada; 2 Laval University, Faculty of Medicine, Quebec City,
Canada; 3 Canadian Forces Health Services Headquarters, Ottawa,
Canada; 4 Center for Interdisciplinary Research in Rehabilitation
and Social Integration, Quebec Rehabilitation Institute, Quebec
City, Canada; 5 Centre Hospitalier Universitaire de Québec, Quebec
City, Canada
PURPOSE: To assess the responsiveness of clinical outcome
measures commonly used with patients with a lateral ankle sprain
(LAS) and to determine which of these measures are the best
indicators of functional recovery during the first two months following
a LAS. RELEVANCE: The responsiveness of currently used outcome
measures in the early phase of recovery following LAS is unknown.
PARTICIPANTS: A sample of convenience of 26 soldiers with an
acute grade I or II LAS. METHODS: The subjects participated in two
evaluations at 5 days or less (E1) and 8 weeks (E2) after a LAS. The
following tests were administered: the Lower Extremity Functional
Scale (LEFS), the measurement of ankle girth, the weight bearing
(WB) and non-WB (NWB) ankle range of motion and pain intensity
at the end of the range, and the maximal isometric strength of the
ankle muscles. ANALYSIS: A paired t-test was computed to compare
the test scores at E1 and E2. Pearson correlation coefficients were
calculated to establish the relationships between changes in the
LEFS scores and all other variables. The Standardized Response
Mean (SRM) with a 95% confidence interval (95% CI) was computed
to compare the relative responsiveness of each measure. RESULTS:
A significant improvement (p < 0.05) was observed from E1 to E2
in most measures. The largest changes occurred in the LEFS
score, ankle girth, pain intensity during inversion and strength of
the evertor muscles. Changes in the isometric strength of ankle
evertors (r = 0.70) and in the range of plantarflexion in NWB (r
= 0.63) were significantly (p < 0.001) correlated with the change in
the LEFS score. The LEFS (SRM 1.81; 95% CI 1.06-2.55) and pain
intensity during inversion (SRM 1.31; 95% CI 0.81-1.81) were the
two most responsive measures, followed by ankle girth (SRM 0.93;
95% CI 0.14-1.71), pain intensity during dorsiflexion with knee flexed
in NWB (SRM 0.81; 95% CI 0.21-1.41) and with knee extended
in both WB (SRM 0.76; 95% CI 0.22-1.31) and NWB (SRM 0.68;
95% CI 0.15-1.22), isometric strength of the evertors (SRM 0.74;
0.08-1.39) and range of dorsiflexion with knee flexed in NWB
(SMR 0.65; 95% CI 0.03-1.26). CONCLUSIONS: Eight of the 22
outcomes measured had moderate to high levels of responsiveness
(SRM > 0.50). The level of disability (LEFS) and the pain intensity
during ankle inversion showed the highest levels of responsiveness.
These results apply to the early phase of recovery after LAS. The
level of responsiveness of the outcomes may vary considerably in
the later phase of recovery. In particular, the evertor’s strength, which
was both moderately responsive and associated to function, may be
more appropriate to monitor clinical changes. Future studies will aim
at confirming these results in a larger patient population and evaluate
longer time intervals. IMPLICATIONS: Measures of impairment and
disability with known responsiveness can now be used to track
changes in the early phase of recovery in patients with a LAS.
KEYWORDS: ankle sprain, responsiveness, outcome measures.
FUNDING ACKNOWLEDGEMENTS: Funded by the REPAR and the
OPPQ. CONTACT: perron.mm@forces.gc.ca
ETHICS COMMITTEE: This study was approved by the ethics
committee of the Centre de santé Valcartier
WCPT 2007, Research Reports
Research Report Platform Presentation
801 Sunday 3 June 11:05
VCEC Meeting Room 17
DO PARENTS OF CHILDREN WITH CEREBRAL PALSY
EXPRESS DIFFERENT CONCERNS IN RELATION TO THEIR
DIAGNOSIS, AGE AND LEVEL OF DISABILITY?
Knox V; Bobath Centre, 250 East End Road, London N28AU,
England
PURPOSE: This retrospective study aimed to investigate the range
of parents’ concerns for their children with cerebral palsy and
whether concerns varied according to age, type of cerebral palsy
(diagnosis) and level of disability. RELEVANCE: It is important that
health professionals are aware of which issues parents consider
priorities for their child’s therapy. Currently there is little information
within published research literature regarding what concerns parents
may have for their children. This information would be useful
in understanding the needs of families and planning treatment.
PARTICIPANTS: Past medical records of children with cerebral
palsy, who attended the Bobath Centre in London over a two year
period were analysed, with information collected from 170 visits.
METHODS: Information was collected on the parents’ concerns,
child’s age, diagnosis, and level of disability, as measured on the
Gross Motor Function Classification System (GMFCS). This classifies
children into five levels, according to their degree of independent
mobility. ANALYSIS: Data was analysed using conceptual analysis
to search for common themes and quantitatively using cross
tabulation and Chi squared tests to determine if differences existed
between the concerns for different ages, diagnoses or disability
levels. RESULTS: Twelve categories of concerns were identified:
activities of daily living, hand function, eating/drinking, floor mobility,
sitting, stand/walk, transfers, stiffness, communication, therapy, visual
perception and behaviour. Significant differences were found to
exist between the concerns of parents of children of different
ages, diagnoses and levels of disability. In relation to diagnosis,
concerns regarding hand function (p = 0.012) were higher for children
with hemiplegia, concerns about standing /walking (p = 0.0001)were
highest in children with spastic diplegia, and concerns about sitting
(p = 0.001), communication (p = 0.0001), floor mobility (p = 0.001),
eating/drinking (p = 0.018) were highest in children with spastic
quadriplegia and athetosis. In relation to age, significant differences
in the number of concerns were seen for stiffness (p = 0.004)
where concerns increased with age, floor mobility (p =0.006) where
concerns reduced with age; communication (p = 0.014) concerns
peaked between 4 and 6 years; and standing and walking (p = 0.037)
which increased after 2 years. Significant differences in the number
of recorded concerns related to level of disability occurred within
sitting (p =0.0001) and communication (p = 0.03) which were highest
in level V children, standing/walking (p = 0.0001) was a concern for
all children but especially levels II and III; and floor mobility concerns
(p = 0.01) increased with reducing level of ability. CONCLUSIONS:
Within this sample it is apparent that clear themes emerge regarding
parents’ concerns related to their child’s diagnosis, age and level of
disability. Concerns appeared to be appropriate in relation to their
child, for example having more concerns about hand function in a
child with hemiplegia, but more concerns about floor mobility in a
young child. This suggests that parents have specific, realistic and
appropriate concerns in relation to what might be possible for their
child to achieve. IMPLICATIONS: This information can be helpful for
therapists, to understand the range of concerns which are important
to parents for their children, to enable working in collaboration
with parents, and to set joint goals. KEYWORDS: Cerebral palsy;
Parents; Concerns. FUNDING ACKNOWLEDGEMENTS: Work was
unfunded. CONTACT: virginia@bobathlondon.co.uk
ETHICS COMMITTEE: Barnet, Enfield & Haringey Local Research
Ethics Committee, North London, UK
Platform Presentations, Sunday 3 June
Research Report Platform Presentation
1446 Sunday 3 June 11:05
VCEC Meeting Room 18
AGILITY AND PERTURBATION TRAINING FOR PATIENTS AFTER
TOTAL KNEE ARTHROPLASTY. A CASE-CONTROL STUDY
Bizzini M1 , Croci-Maspoli I2 , Buechele S2 , Maffiuletti N1 ,
Munzinger U3 ; 1 Research Department, Schulthess Clinic,
Zürich, Switzerland; 2 Physical Therapy Department, Schulthess
Clinic, Zürich, Switzerland; 3 Department of Orthopaedic Surgery,
Schulthess Clinic, Zürich, Switzerland
PURPOSE: The purposes of this study were: a) to describe
the development and implementation of an adapted agility and
perturbation training program for patients after primary total knee
arthroplasty; and b) to compare the functional outcome of these
patients with patients following standard rehabilitation in the first three
postoperative months. RELEVANCE: Modern surgical techniques in
total knee arthroplasty allow for quicker range of motion recovery,
rapid pain reduction, and earlier full weight-bearing. Standard
rehabilitation includes range of motion/strengthening exercises, and
gait training. Neuromuscular control of the operated knee may be
enhanced by a specific agility and perturbation training. Therefore,
adding this type of training to traditional rehabilitation exercises,
patients may achieve better functions in the activities of daily living.
PARTICIPANTS: 15 patients (8 females, 7 males, mean age 64.8
years) followed standard rehabilitation and a specific agility and
perturbation training program (mean number of sessions: 12.9) in
the first three months after undergoing total knee arthroplasty (group
I). 15 patients (9 females, 6 males, mean age 63.9 years) followed
standard rehabilitation (mean number of sessions: 12.1), and served
as a control group (group II). All patients received the same type of
implants by the same surgeon. METHODS: The study utilized a case-
control design (non-matched, non randomized), and was approved by
the Local Committee on Human Research (Schulthess Klinik Zürich).
Measurements were taken before and after discharge of physical
therapy. Outcome variables were: passive range of motion in flexion
and extension, visual analogue scale for pain, get up and go test,
and the knee outcome survey for activities of daily living (KOS-ADLS;
scale: 0-70 points) questionnaire. ANALYSIS: A two-way ANOVA on
all outcome measures was performed to study the effect of group (I
versus II) and time (baseline versus follow up). Independent Student
t-tests were performed to search for pre-post differences (outcome
measures) between groups. Statistical analysis were undertaken by
using SPSS 11.0. RESULTS: There were no significant group by time
interactions on all outcome measures (two-way ANOVA, p > 0.05).
The patients following the additional agility and perturbation training
program showed a significant (t-test, p < 0.05) larger improvement
of the KOS-ADLS score (mean ± SD = 18±9.3) compared to
the patients following the standard rehabilitation (mean ± SD =
10.2±5). CONCLUSIONS: Supplementing rehabilitation programs
for patients after total knee arthroplasty with an adapted agility
and perturbation training program may allow them to regain better
functions in the activities of daily living within the first three
postoperative months. Considering the limitations of this (pilot) study,
further research is needed. IMPLICATIONS: This study may deliver
interesting information for optimizing the postoperative rehabilitation
and improving treatment effectiveness in patients after total knee
arthroplasty. KEYWORDS: agility/perturbation training, rehabilitation,
total knee arthroplasty. FUNDING ACKNOWLEDGEMENTS: This
work received no funding. CONTACT: mario.bizzini@kws.ch
ETHICS COMMITTEE: The study was approved by the Local
Committee on Human Research (Schulthess Klinik Zürich).
S61
Research Report Platform Presentation
1660 Sunday 3 June 11:05
VCEC Meeting Rooms 19-20
THE IMPACT OF AGE AND STROKE ON COMPLEX MOTOR
SEQUENCE LEARNING
Boyd L1,2 , Vidnoi E2 , Siengsukon C2 ; 1 University of British
Columbia, Vancouver, Canada; 2 University of Kansas Medical
Center, Kansas City, USA
PURPOSE: Our purpose was to determine if age or stroke
differentially effects motor sequence learning of a complex task
with embedded motor, spatial and temporal sub-sequences. The
impact of aging on motor sequence learning has been debated;
however, no past work controlled for nor quantified task complexity.
This study did both. RELEVANCE: Past work examining motor
learning has shown that neither age nor stroke uniformly impact the
acquisition of learned motor sequences. Worldwide the population
at large is aging. Increasing knowledge of the effect of age and
stroke on complex motor learning is critical for the design of
effective therapeutic interventions. PARTICIPANTS: Neurologically
intact younger (mean 27 years; n=12) and older (mean 77 years;
n=17) adults, and people with stroke (mean 64 years; n=10) in the
middle cerebral artery distribution participated. METHODS: Each
subject signed an approved consent form. All practiced a novel serial
response task containing repeated motor, spatial and temporal sub-
sequences (2 days, 50 sequence trials = 5 blocks/day). Two blocks
of random sequence responses were collected (1/day). A delayed
retention test assessed learning (day 3, 1 block). Performance and
learning were indexed by change in response time (RT; difference
between RT for random versus repeated sequences). Information
theory quantified task complexity. Learning the repeated sequence
required encoding 57 bits of information; past research typically
used single-element sequences that demanded learning 12 bits
of information. ANALYSIS: Analysis of variance (ANOVA) with a
repeated measures correction was used to assess differences in
performance during acquisition (Group (younger, older, stroke) X
Block (1-10)). A one-way ANOVA of change scores from retention
tested for between group differences in learning. Last, regression
analyses determined the relationships between age, stroke and
ability to learn a complex motor sequence. RESULTS: A group
by block interaction revealed differences in acquisition practice
(p = 0.003). Post-hoc tests demonstrated that the younger group
made more change in RT as compared to the stroke (p = 0.022) or
older (p = 0.023) groups. These between group differences persisted
at retention where the younger group showed larger change in RT
as compared to the older (p = 0.023) or stroke (p = 0.017) groups.
A strong inverse relationship between age and ability to learn (as
demonstrated by RT change) was evident in the regression analysis
(R2=.462). No relationship existed between stroke and the ability to
learn (R2=.063). CONCLUSIONS: Our data demonstrate an age-
related deficit in the ability to learn complex sequences of action.
Stroke did not predict the ability to (or not to) learn complex motor
sequences. It appears that age is a more powerful influence on
complex motor sequence learning than stroke. Our results extend
our understanding of learning because we examined complex motor
sequence learning which more closely approximates activities of
daily life. IMPLICATIONS: In this work, older adults were unable to
take advantage of regularities in their responses to show learning;
the net result was a failure to improve performance with practice.
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:
laraboyd@interchange.ubc.ca
ETHICS COMMITTEE: University of Kansas Medical Center Human
Subject Committee
S62
Research Report Platform Presentation
1947 Sunday 3 June 11:25
PP Crystal Pavilion A
CONTROLLING MANUALLY APPLIED FORCES IN MANUAL
THERAPY TECHNIQUES
Waddington G1 , Adams R2 ; 1 University of Canberra; 2 University
of Sydney
PURPOSE: To control force applied in manual therapy an experi-
mental version of a mobilizing device incorporating a dynamometer.
RELEVANCE: In both simulation and manual therapy studies,
substantial variability has been shown when therapists attempt to
replicate an applied force. Knowledge about the forces employed
during treatment could reduce this variability and improve both
reliability and clinical safety. PARTICIPANTS: Thirty physiotherapists
were recruited from two major teaching hospitals in the Canberra
Australia region. METHODS: Therapists used the device to apply
applied a randomised sequence of the standard grade I, II, III or IV
mobilisation forces to a plinth surface. The dial was obscured and the
therapists were using their concept of the force appropriate for each
grade to guide force production with no feedback. Comfort ratings
of grade III force applied by hand and a 100N force applied with
the device dial visible were also obtained. After each condition the
therapist was asked to rate their comfort during the performance of
the PA pressure on a 100mm visual analogue scale. ANALYSIS:
Reliability: The ICC(2,1) reliability index was calculated for manual
force production without feed back and whenusing the dial readout of
the dynamometer to control force application. To compare variance in
concept-guided and device-guided forces, F-ratios were formed using
the variance between the mean forces generated over three attempts
by thirty physiotherapists in the numerator, and the variance over
10 repetitions of visually guided force application on a set of digital
scales in the denominator. Scores for hand comfort during a PA force
application using the mobilisation dynamometer or the therapist’s
hands alone were compared with a repeated measures ANOVA.
RESULTS: The ICC(2,1) was found to be 0.63 (95% CI = 0.36-0.93)
for manual force production without feed back on occasions. When
three forces (50, 100 and 200 N) were applied ten times to digital
scales, using the dial readout of the dynamometer to control force
application, the ICC (2,1) was 0.999 (95% CI 0.996-0.9999). Relative
variance in force production values was significant with all p values
<0.001. The mean (sd) scores for hand comfort during a PA force
application using the mobilisation dynamometer or the therapist’s
hands alone were 8.3 (0.8) and 5 (2.0) respectively. Comfort ratings
were higher when using the device than when using the pisiform
grip [F(1,29) = 86.1, p < 0.01]. CONCLUSIONS: Forces produced by
different physiotherapists trying to push at the same grade varied, and
to a significantly greater extent than force productions made with the
same device but guided by the use of the dynamometer dial readout.
The device was found to be significantly more comfortable to use
than the hands in the pisiform grip. IMPLICATIONS: Physiotherapy
mobilization techniques require the application of specified forces,
quantification of these forces, to determine the amount of force
corresponding to pain onset (for reference in future treatment
sessions), and to allow inter-therapist treatment comparisons, has
previously only been possible with instrumented plinths. Development
of a device that improves therapist feedback regarding force
and improves therapist comfort in a clinical environment may
lead to improved patient outcomes. KEYWORDS: Manual therapy,
dynamometer, force variability. FUNDING ACKNOWLEDGEMENTS:
Nil. CONTACT: gordon.waddington@canberra.edu.au
ETHICS COMMITTEE: University of Sydney Ethics Committee
WCPT 2007, Research Reports
Research Report Platform Presentation
1838 Sunday 3 June 11:25
PP Crystal Pavilion B & C
EFFECTS OF HIGH-IMPACT TRAINING AND DETRAINING ON
FEMORAL NECK STRUCTURE IN PREMENOPAUSAL WOMEN:
AN 18-MONTH RCT WITH A 5-YEAR FOLLOW-UP
Heinonen A1,2 , Mäntynen J1 , Kannus P2,3 , Uusi-Rasi K2 ,
Nikander R2 , Kontulainen S2 , Sievänen H2 ; 1 Department of Health
Sciences, University of Jyväskylä, Finland; 2 Bone Research Group,
UKK Institute for Health Promotion Research, Finland; 3 Department
of Surgery, University of Tampere, Finland
PURPOSE: The purpose of this study was to evaluate training effects
and their maintenance of an 18-month exercise intervention with
the 5-year follow-up on femoral neck structure in premenopausal
women. RELEVANCE: Exercise seems to be a promising action to
promote bone health also in adulthood. Total bone strength is known
to be a combination of material and structural properties most of
the exercise studies have focused on measuring only bone mineral
mass as an outcome of the exercise intervention. A little is known
also about the maintenance of the exercise-induced benefits on
bone structure. PARTICIPANTS: In the original study design, 84 (of
the 98 participants), sedentary premenopausal women aged 35-45
years completed the initial randomized controlled 18-month exercise
intervention. At the 18-month and 5-year follow-up measurements,
DXA image data of 22 trainees and 22 controls were available for Hip
Strength Analysis (HSA). METHODS: The DXA derived HSA method
was used to estimate the section modulus (Z, an index of a bending
resistance), cross-sectional area (CSA) and subperiosteal width (W)
at the narrowest section of the femoral neck. Besides the DXA scans
the physical performance was assessed at baseline, after 18 months
and after 5 years. ANALYSIS: The univariate general linear model
(GLM) was used to calculate the between-group differences at 18
months and 5 years. The differences between the groups for bone
and neuromuscular variables were adjusted for the baseline values.
RESULTS: The body height, weight and age adjusted between-
group differences were observed after the 18-month intervention in
favour of trainees in Z (3.2%, p = 0.047) and CSA (2.8%, p = 0.043).
At the 5-year follow-up point the exercise intervention benefits in
Z and CSA were lost. Between-group differences were observed
in favour of trainees after the intervention (4.2%, p = 0.002) and
at 5-year follow-up (5.1%, p = 0.003) in lower limbs power and
in maximal oxygen uptake 5.6% (p = 0.002) and 4.6% (p = 0.005),
respectively CONCLUSIONS: The results of this study indicate that
high-impact type of exercise can increase the femoral neck strength
in addition of bone mineral gain by improving structural properties
of bone. Although the differences between the groups were not
statistically significant a positive trend in favour of the trainees was
observed also in the maintenance at least some of the exercise-
induced bone benefits on femoral neck. IMPLICATIONS: Even the
training effects on bone mineral amount and on bone structure are
biologically quite small in adulthood exercise can offer an inexpensive
and safe option to prevent or slow down age-related bone loss
and promote bone health both in women and men. KEYWORDS:
Bone strength, bone structure, exercise, osteoporosis prevention.
FUNDING ACKNOWLEDGEMENTS: The Ministry of Education,
Finland.
ETHICS COMMITTEE: The study was approved by the Ethics
Committee of the Pirkanmaa Hospital District, Tampere, Finland
Platform Presentations, Sunday 3 June
Research Report Platform Presentation
2469 Sunday 3 June 11:25
VCEC Ballroom A
IS ULTRASOUND USING TISSUE DOPPLER IMAGING A VALID
AND RELIABLE METHOD TO DETERMINE THE ONSET OF
SKELETAL MUSCLE ACTIVITY?
Pulkovski N1 , Schenk P1 , Maffiuletti N2 , Mannion A2 ; 1 University
Hospital Zürich, Department of Rheumatology and Institute of
Physical Medicine, Zürich, Switzerland; 2 Schulthess Clinic, Zürich,
Switzerland
PURPOSE: This study investigated whether ultrasound Tissue
Doppler Imaging (TDI) gives a reliable and valid measure of the
onset of activity in Musculus vastus lateralis (VL) compared with
the gold standard, electromyography (EMG). RELEVANCE: The
onset of muscle contraction during a given functional activity is
often investigated in relation to suspected motor control dysfunctions.
For example, in knee pathologies such as osteoarthritis and
patellofemoral pain, patients show a delayed onset of VL during
stair climbing. The onset of skeletal muscle activity is typically
recorded using EMG. However, surface EMG is susceptible to
cross-talk (i.e. the electrodes overlying one muscle may also
pick up signals from a neighbouring muscle) and more selective
alternatives require invasive techniques (needle or fine-wire EMG).
We therefore investigated whether TDI velocity could provide an
alternative, non-invasive method for determining the onset of muscle
activity. PARTICIPANTS: 10 healthy active adults (5 women, 5 men)
31.3 (±1.9) years old; with no history of knee pain were tested.
METHODS: Subjects performed maximal knee extension exercises
at 0º/s (isometric) and 60, 120, 180 and 240º/s (5 times each, on each
side), using an isokinetic dynamometer (Biodex II). Simultaneous
recordings of the electromyographic signal (using bipolar surface
electrodes) and of muscle tissue velocity (using M-mode ultrasound
and TDI (Philips HDI 5000 with a linear array transducer L12-
5 MHz)) were made from the VL. All tests were repeated one
week later. Muscle onsets were determined by visual inspection of
blinded EMG and TDI-velocity signals and expressed relative to the
start of the movement (isokinetic) or the rise in torque (isometric).
ANALYSIS: Pearson correlation coefficients were used to express
the strength of association between the time of onset of VL measured
by EMG and by TDI-velocity changes. The mean difference and SD
between the two methods was analysed. The standard error of the
measurement or “typical error” was used to indicate the range of
scores that could be expected on retesting. RESULTS: There was
a highly significant correlation (p < 0.0001) between the onset-times
determined with TDI-velocity and with EMG: r = 0.78 (day 1), and
r = 0.80 (day 2). The mean difference (and SD) in muscle onset-
time between the two methods (TDI − EMG) was −20.3 ±31.0 ms
(day 1) and −17.4 ±27.2 ms (day 2). The between-day standard
error of measurement (“typical-error”) for the difference in onset-times
between methods was 15.3 (95% CI 13.7-17.4) ms. CONCLUSIONS:
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
mechanical signals (approximately 20 ms) is likely explained by
the electromechanical delay. IMPLICATIONS: Ultrasound using TDI
represents a valid, non-invasive and accurate alternative to EMG for
the measurement of the time of onset of a muscular contraction. Its
future application in the assessment of deep-lying or small muscles
requires further investigation. KEYWORDS: Motor control, Musculus
vastus lateralis and Isokinetic. FUNDING ACKNOWLEDGEMENTS:
The equipment for this project was supported by the National
Research Programme NRP53 “Musculoskeletal Health – Chronic
Pain” of the Swiss National Science Foundation (Project 405340-
104787/2). CONTACT: Natascha.Pulkovski@usz.ch
ETHICS COMMITTEE: Local Ethic Comity (Kantonale Ethikkommis-
sion Zürich)
S63
Research Report Platform Presentation
961 Sunday 3 June 11:25
VCEC Meeting Rooms 11-12
DECREASED NECK MUSCLE ENDURANCE IN NON-SPECIFIC
NECK-PAIN PATIENTS AND IN PATIENTS AFTER ANTERIOR
CERVICAL DECOMPRESSION AND FUSION
Peolsson A, Kjellman G; Dept of Health and Society, Div of
Physiotherapy, Faculty of Health Sciences, Linköping University,
Linköping, Sweden
PURPOSE: To investigate differences in ventral and dorsal neck
muscle endurance (NME) among patients with non-specific neck
pain (NP) or cervical disc disease (ACDF) and healthy controls (C).
RELEVANCE: There is no knowledge of proportions of patients
with disability of NME either before or after treatment for neck
disorders. Furthermore there is no knowledge if there are differences
in NME between NP and ACDF patients. PARTICIPANTS: NME
was measured in NP (n=77) and ACDF (n=34) patients before
treatment and at 12-month follow-up and results was compared
to gender-specific reference values from C (n=116) both on
individual and group levels. METHODS: Ventral and dorsal NME
was measured in seconds in a standardized and reliable manner
in lying down position. Neck pain on Visual Analogue Scale and
neck specific disability (NDI) were obtained. NP, and after anterior
cervical decompression and fusion also ACDF group were treated
polyclinically by physiotherapists. ANALYSIS: Statistical significance
within and between groups was analyzed by paired and unpaired
two-tailed Student’s t-test and by factorial Analysis of Variance with
the Bonferroni/ Dunn post-hoc test. Deficit in NME on individual
level was defined as>1 Standard Deviation below the gender specific
mean value of the control group and on group level defined as below
95% lower Confidence Interval (CI). Pearson correlation coefficient
analysis was used to investigate relationship between NME and pain
intensity or NDI. Significance was accepted at a level of p < 0.02
in the ANOVA and otherwise p < 0.05. RESULTS: Patients had
mainly significantly (p < 0.01) decreased NME compared with C.
ACDF women had lower ventral NME than NP women (p < 0.01).
29-100% of patients had disability (>1 SD below mean of C) in
NME, mainly with group mean below 95% CI of C. Only NME in
NP women (p < 0.05) improved after treatment. Flexion/ extension
ratio normalized after treatment in NP (p = 0.36) but not in ACDF
(p < 0.0001). NME in ACDF group correlated with both pain intensity
and neck specific disability (NDI) (r = −0.51 to −0.78, p < 0.01). NME
in NP group were mainly uncorrelated to pain but mainly weakly
correlated to NDI (−0.31 to −0.38, p < 0.02). CONCLUSIONS: A
great deal of patients had impairment in NME before, but also
after treatment. IMPLICATIONS: Specific training of NME and
longer treatment period may improve outcome and should be taken
into consideration in clinical practice. KEYWORDS: Neck muscles,
physical endurance, treatment. FUNDING ACKNOWLEDGEMENTS:
This study was supported by the Faculty of Health Sciences,
Linköping University. CONTACT: anneli.peolsson@ihs.liu.se
ETHICS COMMITTEE: Linköping Ethics Committee
Research Report Platform Presentation
1533 Sunday 3 June 11:25
VCEC Meeting Room 16
EFFECT OF FOCUS OF ATTENTION ON REHABILITATION OF
POSTURAL CONTROL FOLLOWING LATERAL ANKLE SPRAIN
Rotem-Lehrer N1 , Laufer Y1 , Ronen Z2 , Khayutin G2 , Rozenberg I2 ;
1 Department of Physical Therapy, Haifa University, Haifa, Israel;
2 Physical Therapy, Medical Corps, IDF, Israel
PURPOSE: To determine the effect of training utilizing an internal
(IFA) versus an external focus of attention (EFA) on performance,
retention and transfer of a postural control task in participants
following a lateral ankle sprain (LAS). RELEVANCE: Motor learning
research focuses on the principles underlying the acquisition,
S64
retention and transfer of motor skills. Current evidence suggests that
instructions directing an external focus of attention (EFA) towards
the effect of a given movement, may be more effective at promoting
learning than instructions inducing an internal focus of attention
(IFA) in which the focus of attention is on the movement itself.
However, the effect of attentional direction has not been tested in
populations following a disease or injury in which postural control
is impaired. PARTICIPANTS: Forty participants, referred to physical
therapy following a LAS were recruited and randomly allocated to
a group training either with an EFA or with an IFA METHODS:
Balance assessment and training were carried out using the Biodex
Stability System (BSS). Postural control training consisted of ten, 20-
sec trials, performed on three consecutive days, at stability levels
6 and 4 of the BSS. Training instructions directed the participants
either to an internal or to an external focus of attention. Assessments
at the trained stability levels were conducted pre- and post-training,
and 48 hours following the last session (retention test). Additionally,
assessments of stability at an untrained less stable level (level 2)
were conducted pre-training and at the retention assessment to
determine skill transfer. Outcome measures obtained were: Overall
Stability Index (OSI); anterior-posterior stability (APS); and medio-
lateral stability (MLS). ANALYSIS: Separate mixed-model two-way
(2X3) repeated-measures analyses of variance (ANOVAs) were
utilized for each variable at levels 6 and 4. Similarly, two-way
(2X2) ANOVAs were used for the level 2 assessments. Alpha error
level was set at p < 0.05. RESULTS: Stability at the trained levels
improved in both groups immediately post training. An interaction
effect in OSI and APS indicates greater improvement in the group
practicing with an EFA. Gains in stability made immediately following
training were retained two days later. Improvements in postural
control in the untrained level demonstrate that EFA is more effective
for skill transfer as determined by all stability indices used in the
study. CONCLUSIONS: Directing subjects to an EFA during balance
training may enhance the acquisition and transfer of balance control
following an ankle injury. IMPLICATIONS: Rehabilitation of balance
control following injury may be enhanced by directing the focus of
attention during training towards the effect of the movement and
away from the movement itself. Principles of motor learning obtained
from the study of individuals without impairment are applicable to
treatment of individuals with impairments. KEYWORDS: Balance-
training, attention, focus. FUNDING ACKNOWLEDGEMENTS: un-
funded. CONTACT: nirit.rotem@gmail.com
ETHICS COMMITTEE: Medical Corps Ethical Review Board.
Research Report Platform Presentation
992 Sunday 3 June 11:25
VCEC Meeting Room 17
HOW DO CHANGES IN IMPAIRMENT, ACTIVITY AND
PARTICIPATION RELATE TO EACH OTHER IN A GROUP OF
CHILDREN WITH CEREBRAL PALSY
Wright V1 , Rosenbaum P2 , Goldsmith C2 , Fehlings D1 , Law M2 ;
1 Bloorview Research Institute/Bloorview Kids Rehab, Toronto,
Canada; 2 McMaster University, Hamilton, Canada
PURPOSE: The overall goal was to evaluate associations among
changes in spasticity and changes in higher level activities and
participation following lower extremity Botulinum Toxin Type-A (Bt-
A) injections in children with cerebral palsy (CP). RELEVANCE:
Rehabilitation today is focused increasingly on ‘activity’ and
‘participation’ goals with less emphasis on ‘body structure and
function/‘impairment’ changes as primary outcomes. Moderate to
strong associations have been reported between measures at
these different International Classification of Function (ICF) levels
at a single time, but change score relationships are unknown. For
this study, it was necessary first to identify an intervention for
which impairment changes are known to occur. This has been
demonstrated with Bt-A injections, a common spasticity-reducing
intervention. PARTICIPANTS: Thirty-five ambulatory children with
WCPT 2007, Research Reports
CP, ages 3 to 9 years, in Gross Motor Function Classification
System (GMFCS) Levels I, II and III. Convenience sample, pediatric
rehabilitation center-based. METHODS: A prospective one-group
before-after design with measures of ‘impairment’ (modified Tardieu
scale, 20 metre timed walk), ‘activity’ (GMFM Stand/Walk, PEDI),
and ‘participation’ (POSNA measure). Assessments occurred pre-Bt-
A (baseline [b]), 2 and 6 months (m) post-Bt-A. Repeated-measures
ANOVA evaluated change. Linear regression assessed relationships.
Regression predictors included baseline and change scores, age,
GMFCS Level. ANALYSIS: Repeated measures analysis of variance
determined change over time, and regression techniques evaluated
score relationships. Predictors included the various baseline (b) and
change score values as well as age group and GMFCS Level
RESULTS: Spasticity decreased 2 m post-Bt-A (Tardieu R1 gains
for gastrocnemius [P = 0.0009] and hamstrings [P = 0.048]), and
partially recurred by 6 m. Timed walk scores improved at 2 m (P =
0.03), and were maintained at 6 m. There were significant GMFM
and POSNA gains at 2 m (P < 0.02) with continuing improvement
at 6 m. PEDI gains occurred at 6 m (P  0.001). Baseline score
relationships were moderate to strong for impairment vs. GMFM
scores (0.49 < r < 0.73), and fair to strong for impairment vs. PEDI
and POSNA scores (0.30 < r < 0.73). GMFM, PEDI and POSNA
b relationships were strong (r>0.65). Change score relationships
at 2 m and 6 m were poor to fair (r < 0.40) between impairment,
timed walk, GMFM, PEDI and POSNA change scores. Predictor
combinations accounted for <60% of change score variation.
Impairment scores accounted for <50% of explained variation within
GMFM, PEDI and POSNA models. Predictors often pertained
to underlying child characteristics (b score, GMFCS level, age).
CONCLUSIONS: Relationships among changes at different ICF
levels are complex. Despite moderate/strong relationships between
measures at b and similar directions of change at 2 m, change
scores were not strongly correlated. ‘Activity’ and ‘participation’ gains
post-Bt-A likely were greatly influenced by individual factors such
as physical therapy, motivation, skill practice and integration into
daily life. IMPLICATIONS: Challenges to the assumption about direct
associations between change scores at different ICF levels need to
be considered by physiotherapists when deciding on the goal focus
of interventions, and in the interpretation of observed outcomes.
KEYWORDS: Pediatrics, Outcomes, International Classification of
Function. FUNDING ACKNOWLEDGEMENTS: Bloorview Childrens
Hospital Foundation, 2002-2005. CONTACT: vwright@bloorview.ca
ETHICS COMMITTEE: Bloorview Kids Rehab REB, Toronto, Canada
Research Report Platform Presentation
1502 Sunday 3 June 11:25
VCEC Meeting Room 18
CLINICAL IMPLICATIONS OF 1-YEAR LOWER EXTREMITY
FUNCTIONAL STATUS RECOVERY PROFILES POST TOTAL
KNEE ARTHROPLASTY
Kennedy D1,2 , Stratford P2 , Hanna S2 , Gollish J1 ; 1 Sunnybrook
Holland Orthopaedic & Arthritic Centre, Toronto, Canada; 2 School
of Rehabilitation Sciences, McMaster University, Hamilton, Canada
PURPOSE: To describe change in lower extremity functional status
of patients over 1-year following total knee arthroplasty (TKA). Secon-
darily, to illustrate how this information can be applied to set treatment
goals, establish prognosis and determine optimal assessment times,
including endpoints in clinical trials. RELEVANCE: Osteoarthritis
(OA) accounts for significant disability in older adults. Information
about expected rate of change post arthroplasty is critical to making
appropriate rehabilitation decisions including establishing prognosis.
PARTICIPANTS: A convenience sample of 84 patients (44 females)
with a mean age of 66 years (s=9) and an average body mass index
of 31 kg/m2 (s=5) was chosen. All had knee OA and underwent
primary TKA. METHODS: The institution’s research and ethics board
approved the study and written informed consent was obtained.
Repeated measurements of the Lower Extremity Functional Scale
Platform Presentations, Sunday 3 June
(LEFS) and 6-minute walk test (6MWT) were taken over 1-year.
To allow for a more accurate representation of change over time,
measurements were scheduled at different time points. The earliest
assessment point was approximately 1-week post arthroplasty.
ANALYSIS: Data were plotted to gain an impression of the pattern
of change over time. Subsequently, we evaluated several nonlinear
models of change which related the dependent variable of functional
status – either LEFS scores or 6MWT distances – to the independent
variable, number of weeks post arthroplasty. The final equation was:
functional status = limit + (y0 − limit) × e(−e(change rate) × weeks),
where functional status is the LEFS or 6MWT, e is the base of the
natural logarithm, weeks equals number of weeks postoperatively; y0
is the parameter representing the y-intercept value; limit represents
the maximum LEFS or 6MWT value; and change rate is the rate
of improvement at which patients approach the limit of functional
status. Parameters were estimated using the nonlinear mixed-effects
modeling package in S-Plus. Different models were explored; our
final model specification named the limit, y-intercept and change
rate parameters as fixed effects, and the limit and y-intercept as
random effects. Separate models were created for females and
males. RESULTS: The results from the nonlinear mixed effects
models were applied to generate profiles of change in functional
status characterized by the predicted LEFS and 6MWT values. The
greatest change period occurred over the first 10-weeks post TKA
and was similar for males and females. On average no clinically
important change was noted beyond 6-months. Limit values for the
LEFS scores for males and females were 60 and 54 respectively
(t82 =1.97, p2 =0.053). Limit 6MWT distances for males and females
were 578 and 467 meters (t82 =4.63, p2 =<0.001). CONCLUSIONS:
Our findings demonstrate that the greatest improvement occurs
in the first 12-weeks post arthroplasty; improvement continues to
occur from 12-weeks to 26-weeks, however at a slower rate; and
little improvement occurs beyond 26-weeks post arthroplasty. Future
work will include replication of the results in a larger sample.
IMPLICATIONS: Our results can be used to make prognoses
concerning the rate of improvement in functional status post TKA
and the expected time specific and terminal functional status scores.
KEYWORDS: Activity Limitation, Knee Arthroplasty, Functional
Recovery. FUNDING ACKNOWLEDGEMENTS: A Research Grant
from the Orthopaedic and Arthritic Foundation supported this
research. CONTACT: d.kennedy@utoronto.ca
ETHICS COMMITTEE: The Sunnybrook and Women’s College
Health Sciences Centre Research Ethics Board
Research Report Platform Presentation
1834 Sunday 3 June 11:25
VCEC Meeting Rooms 19-20
IMPACT OF MUSCULOSKELETAL HAND CONDITIONS IN A
COMMUNITY DWELLING POPULATION OF OLDER ADULTS
Dziedzic K1 , Nicholls E1 , Myers H1 , Peat G1 , Handy J1 ,
Thomas E1 , Wood L1 , Tyson C2 , Hay E1 ; 1 Primary Care
Musculoskeletal Research Centre, Keele University, Staffordshire,
United Kingdom; 2 North Staffordshire Combined Healthcare Trust,
Leek, Staffordshire, United Kingdom
PURPOSE: The impact of musculoskeletal hand conditions such as
osteoarthritis of the hand (HOA), carpal tunnel syndrome (CTS),
Dupuytren’s contracture (D) and trigger finger (TF) has not been
studied in a community dwelling population of older adults. The aim
of this study was to investigate hand pain and disability in older adults
with self-reported hand problems. RELEVANCE: Musculoskeletal
hand problems are common in older people, but their impact on
everyday life is unclear. PARTICIPANTS: Consenting participants in
the North Staffordshire Osteoarthritis Project – Clinical Assessment
Study of the Hand (CAS-HA), aged 50 years and over, reporting
hand pain or problems in the previous twelve months in a survey
questionnaire were invited for a clinical assessment. METHODS:
A standardised clinical assessment of hand symptoms (e.g. pain,
S65
numbness), clinical features (e.g. palmar thickening) and specific
clinical tests (e.g. Phalens) was undertaken. Participants were
classified as HOA (American College of Rheumatology criteria),
CTS (classification without nerve conduction Birmingham, UK), D
and TF. Participants with inflammatory arthritis were excluded.
Hand pain and disability were measured using subscales of the
Australian/Canadian (AUSCAN) Osteoarthritis Hand Index. Grip
(Jamar) and pinch strength (B&LTM gauge) were measured and
averaged across hands as bilateral problems frequently occurred
(83%). ANALYSIS: We compared pain, disability and hand strength
in each of the separate clinical subgroups (HOA, CTS, D, TF).
Using analysis of covariance (ANCOVA), pain, disability and hand
strength were compared between those with single and multiple
conditions (adjusting for age, gender and duration of hand problem).
RESULTS: Of 1369 participants invited to take part, 623 (46%)
attended clinical assessment (mean age 64yrs; 62% Female). After
allowing for exclusions and missing data (N=50), 218 had a single
classification (HOA, CTS, D or TF), 202 had multiple conditions and
153 could not be classified into any of the 4 groups. In participants
with a single condition, 49 had HOA alone, 93 CTS, 50 D and 26
TF. Participants with HOA alone had higher levels of self-reported
pain and disability than any other single group (HOA versus other
single conditions: pain −2.02 (95% CI = −3.22, −0.81), disability −2.38
(95% CI = −4.48, −0.28)), however hand strength measures were
similar (grip 0.49 (95% CI = −5.68, 4.70), pinch 0.38 (95% CI = −0.70,
1.46)). Participants with multiple hand conditions reported increased
pain and disability and reduced hand strength compared to those
with a single clinical condition (p-value to detect group difference
<0.006 in all outcome models). CONCLUSIONS: In community
dwelling older adults with hand problems, hand OA had the greatest
impact in terms of pain and disability. Having multiple conditions
led to increased pain and disability and reduced hand strength
compared to those with a single clinical condition. However a large
group of people could not be classified according to the criterion
and this warrants further investigation. IMPLICATIONS: Evaluation
of the impact of musculoskeletal hand problems contributes to a
greater understanding of the clinical presentation of such condi-
tions. KEYWORDS: clinical epidemiology, musculoskeletal, hand.
FUNDING ACKNOWLEDGEMENTS: Medical Research Council,
UK, Support for Science funding North Staffordshire Primary Care
Research Consortium, Arthritis Research Campaign. CONTACT:
k.s.dziedzic@keele.ac.uk
ETHICS COMMITTEE: North Staffordshire Local Research Ethics
Committee UK
Research Report Platform Presentation
2229 Sunday 3 June 11:45
PP Crystal Pavilion A
THORACIC SPINE MOBILITY AND POSTURE IN YOUNG
FEMALE OPERA SINGERS. A PRELIMINARY INVESTIGATION
Johnson G, Skinner M; Centre for Physiotherapy Research, School
of Physiotherapy, University of Otago, Dunedin, New Zealand
PURPOSE: The aim of this study was to examine the hypothesis
that mastery of postural techniques necessary for the effective
voice production in female opera singers would be reflected in
both their thoracic spinal posture and range of motion parameters.
RELEVANCE: Adverse changes in thoracic spinal mobility and
posture of elderly women, particularly secondary to osteoporosis,
are well documented. However there is little information about factors
such as occupation that may maintain thoracic mobility and limit the
potential for such changes. Instructors in vocal performance hold
that postural alignment is not an inherent trait. Thus when training
young opera singers, selected exercises for training postural muscles
are incorporated to enhance vocal performance. PARTICIPANTS:
Thirty five healthy female volunteers agreed to participate in the
study. Eight of the participants (mean age 21.3±4.9 years, mean
body mass index (BMI) 23.88±1.79kg/m2 ) were enrolled in a
S66
professional voice programme. The second group of 27 participants
(mean age 41.0±12.2 years, mean BMI 22.97±1.78kg/m 2 ) had
no singing background. Participants were excluded if they had
current or a recent (4 weeks) history of backpain and/or a physical
limitation in maintaining a standing posture. METHODS: The Spinal
Mouse(Idiag,Voletswil, Switzerland), an electronic computer-aided
device and licensed to the School of Physiotherapy was used to
collect the thoracic spine measurements. A previous study has
demonstrated that the Spinal Mouse can be reliably implemented
for in-vivo studies of the sagittal profile and range of motion of
the human spine. The sagittal thoracic profile and spinal range of
movement were recorded for each participant, twice on a single
occasion, in the upright standing and maximum flexed and extended
positions. ANALYSIS: Descriptive statistics and unpaired t-tests were
used to examine the group mean segmental and global values
describing thoracic upright posture and maximum ranges of thoracic
flexion and extension for the singing (n=8) and healthy control
(n=27) group. Significance was accepted at the 5% level. RESULTS:
No difference(p = 0.86) was found between the singers’ group
mean global thoracic angle (34.68º±8.13º)and the healthy control
group (34.94º±4.80º). Similarly, there was no difference(P = 0.39)
between the total range of flexion and extension in the group mean
global kyphotic angle for the singers’ group (19.11º±11.39º) and
the control group (16.53º±11.36º). However, when group mean
segmental (T1-T12) values were examined significant differences
in the segmental ranges of movement were identified in the lower
thoracic spine of the singers when compared to those of the
control group. CONCLUSIONS: The preliminary data suggest there
is an association between physical tasks undertaken by opera
singers and that of spinal mobility, namely, an increased segmental
mobility specific to the lower thoracic spine but not the upper
thoracic spine. This is preliminary work and further investigation
is required with age-matched controls and a wider population
sample in order to establish whether the increased lower thoracic
mobility is a feature specific to young female opera singers alone.
IMPLICATIONS: A clear, quantified understanding of the potential
relationship between the physical attributes of thoracic spine and
the influence of occupation in young women will provide insight into
more precise directions for therapeutic and educative interventions.
KEYWORDS: Thoracic spinal posture, Spinal mobility, Occupation.
FUNDING ACKNOWLEDGEMENTS: The study was supported by
the Mark Steptoe Memorial Fund and an Otago Research Grant from
the University of Otago. The donation of the Spinal Mouse by Dr Vert
Mooney, to the School of Physiotherapy, University of Otago is also
acknowledged. CONTACT: gill.johnson@otago.ac.nz
ETHICS COMMITTEE: Human Ethics Committee, University of
Otago, Application #’s(04/166 & 05/135).
Research Report Platform Presentation
1858 Sunday 3 June 11:45
PP Crystal Pavilion B & C
VIOLENCE AMONG CANADIAN WOMEN LIVING WITH DISABIL-
ITIES: IMPLICATIONS FOR PHYSICAL THERAPY PRACTICE
Yoshida K, Odette F, Du Mont J, Lysy D; Department of Physical
Therapy, University of Toronto, Toronto, Canada
PURPOSE: Violence among women living with “disablities” has been
largely under-studied within PT (physical therapy) research. We
will present victimization data from a survey of 1095 women with
disabilities. This information will include: 1)Who experienced abuse?
2) What forms of abuse were experienced?, 3)What factors were
associated with being abuse? RELEVANCE: Physical therapists
are primary health service providers who work with women with
disabilities across the continuum of service. We need to be aware
of the circumstances and forms of victimization for women living
with disabilities. This knowledge and understanding will allow us
to provide support and services for these women. PARTICIPANTS:
Survey participants were 18 years of age and older. A convenience
WCPT 2007, Research Reports
sample of women residing in Canada was used. Disability in this
survey was defined in a number of ways. Living with “disability”
could mean: living with a long term health condition; loss of specific
functions (e.g. seeing); activity limitations; and use of personal
assistance. METHODS: A self-completed mailed survey was used
to gather information. A modified Dillman procedure was used
to facilitate the response rate. Given the cross-disability nature
of the survey, alternate forms of the survey (e.g. computer disk)
were used to increase the accessibility of the study to women.
ANALYSIS: We used descriptive statistics to describe the sample
and the type of abuse (physical, emotional and sexual) experienced
by the women. In the bivariate and multivariate analyses, the
dependent variable of abuse was experienced physical and/or sexual
abuse – yes or no. Bivariate analyses were conducted to screen
variables (p  0.15) for inclusion into the logistic regression. Co-
linearity was checked for all relevant variables prior to sequential
logistic regression. RESULTS: Preliminary results suggest that
women who were older (OR=0.455, 95% CI: 0.282-0.733) and
women who had not received information about sexuality (OR=0.638;
95% CI: 0.423-0.961) were less likely to have experienced abuse.
Not identifying primarily as Canadian (OR=1.927; 95% CI: 1.117-
3.324) was associated with having experiencing abuse. Having an
income which was less than $20,000/year (OR=3.21, 95% CI: 1.966-
5.249) or an income between $20-49,999 (OR=2.078, 95% CI: 1.285-
3.359) were also associated with abuse. Having more than one
health condition was associated with having experienced abuse
(OR=3.2, 95% CI: 1.926-5.318). Finally, being limited in activities
by pain was associated with having experienced abuse (OR=1.611,
95% CI: 1.079-2.407). CONCLUSIONS: These findings show that
both sociodemographic and disability variables are associated with
experiences of victimization. Physical therapists can help women
seek information and resources in this area. Future research should
focus on educating PT in this important area so they can provide
appropriate services. IMPLICATIONS: The implications for PT are
multi-faceted. First, PT education in this area should be integrated
into university curriculum and continuing education courses. The
practice of PT should see issues of abuse/victimization for women
with disabilities and those without as a priority area and create
policies that reflect this priority. KEYWORDS: violence, women,
abuse, health. FUNDING ACKNOWLEDGEMENTS: Grant funded
by the Social Science and Humanities Research Council. CONTACT:
karen.yoshida@utoronto.ca
ETHICS COMMITTEE: University of Toronto Research Services
Research Report Platform Presentation
2488 Sunday 3 June 11:45
VCEC Ballroom A
THE EFFECT OF UPPER LIMB TENSION TEST 1 ON BRACHIAL
BLOOD PRESSURE
Kerry R1 , Newey L1 , Peebles C2 , Taylor A3 ; 1 Division of
Physiotherapy Education, University of Nottingham, UK;
2 Department of Physiology, University College London, UK;
3 Nottingham Nuffield Hospital, Nottingham, UK
PURPOSE: This study investigated the effect of upper limb neural
tension test 1 (ULNTT1) on brachial blood pressure as part of a
programme of studies designed to test the theory of a vascular
basis to tension test arm positioning. Results of this study will
serve to inform the manual therapy knowledge base with regards
to differential diagnosis of non-specific arm pain. RELEVANCE:
Non-specific arm pain is often attributed to a neurogenic cause.
This diagnosis is often supported by a positive upper limb neural
tension test (ULNTT) result. The mechanical basis of the ULNTT
is well-documented as being a mechanical stress applied to a
neural structure with adverse movement. Early work surrounding the
ULNTT suggested that the procedure was structurally differentiating
as the arm movement involved in the test was selective to neural
structures, and not to any other anatomical structures in the arm.
Platform Presentations, Sunday 3 June
However, later studies reported that the commonly used ULNTT
for the Median Nerve (ULTT1) may produce a significant strain
on the subclavian artery, thereby questioning the true mechanical
basis of neural tension testing. Other authors have reported changes
in brachial blood pressure of above 30mmHg in response to arm
tension positioning as being diagnositic for arterial pathology in the
subclavian vessels. PARTICIPANTS: 48 asymptomatic subjects were
recruited to this study (mean age 28y, 4y SD). METHODS: The
subjects rested in supine lying for 15mins. Resting bilateral brachial
systolic blood pressure (sBP) (mmHg) was taken at 5 minute intervals
during this rest period. The subject’s arm (subjects were randomly
assigned to either dominant arm (DA) first or non-dominant arm
(NDA) first) was placed in a standardised ULNTT1 position and sBP
was recorded in both arms. This test procedure was repeated 3
times with 5 minutes rest intervals in between. The test procedure
was then repeated with the other arm (DA or NDA depending on
group) in the test position. ANALYSIS: Recordings were tested
for difference using student t-tests for pairs of all combinations of
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 =
2.3mmHg); DA rest v DA rest during NDA ULNTT (p = 0.0067; mean =
3mmHg); NDA rest v NDA rest during DA ULNTT (p = 0.0267; mean =
2.3mmHg). All measurements were decreased when the arm was in
ULNTT1 position. CONCLUSIONS: The results of this study suggest
that sBP is influenced by the ULNTT1 position in asymptomatic
subjects. However the degree of change is considerably less than
previously reported measures said to indicate vascular pathology.
IMPLICATIONS: As the participants used in this study were
asymptomatic, these results may support the diagnositic utility of this
test for arterial dysfunction. The mechanical basis of neural tension
test positions, and the true diagnostic utility of this testing, are,
however, still uncertain. The clinician should consider results of such
testing with this in mind. KEYWORDS: Differential diagnosis; Man-
ual Therapy; Neuromuscular. FUNDING ACKNOWLEDGEMENTS:
Manipulation Association of Chartered Physiotherapists (Elsevier
Research Award). CONTACT: roger.kerry@nottingham.ac.uk
ETHICS COMMITTEE: 1) University of Nottingham School of Health
and Community Sciences (Faculty of Medicine). 2) Nottingham City
Hospital Research and Development Unit
Research Report Platform Presentation
996 Sunday 3 June 11:45
VCEC Meeting Rooms 11-12
PREDICTING SHORT TERM RESPONSE AND NON-RESPONSE
TO NECK STRENGTHENING EXERCISE FOR CHRONIC NECK
PAIN
De Nardis R1 , Keating J2 ; 1 Melbourne Whiplash Centre, Melbourne
Australia; 2 Monash University, Peninsula Campus, Melbourne,
Australia
PURPOSE: People with chronic neck pain respond variably to
exercise therapy. The likely success of exercise for chronic neck
pain cannot be predicted. RELEVANCE: This prospective study
tested the relationship between patient characteristics assessed prior
to intervention and response to an exercise program for chronic
neck pain PARTICIPANTS: Data were collected on 336 consecutive
patients receiving physiotherapy for chronic neck pain METHODS:
Subject age, sex, duration of symptoms, compensation status, Neck
Disability Index (NDI) item and total scores, cervical spine range of
movement and isometric strength were assessed prior to treatment.
Response to therapy was defined as a change of 14/100 or more
NDI points. Subjects received a progressive, concentric/eccentric,
strengthening program using computerized equipment designed for
cervical spine assessment and rehabilitation. Logistic regression
formulae for predicting outcome at the completion of the program
were developed on one sample (n=122) data and tested on another
S67
(n=214). ANALYSIS: Logistic regression formulae for predicting
outcome at the completion of the program were developed on one
sample (n=122) data and tested on another (n=214). RESULTS:
In the first sample, NDI scores and item responses predicted
response or non-response with approximately 70% accuracy. When
tested on the second sample, a prediction model using NDI item
scores predicted responders (positive predictive value 56%) and
non-responders (negative predictive value 74%) with considerable
loss of responder prediction accuracy. Participants with low initial
NDI scores (higher functional ability) appeared to benefit less from
the exercise program. CONCLUSIONS: Functionally able patients
may benefit less from exercise for chronic neck pain than those
with greater functional limitations. IMPLICATIONS: Functionally able
patients may benefit less from exercise for chronic neck pain
than those with greater functional limitations. KEYWORDS: chronic
neck pain, prediction, strengthening. Multi-Cervical Unit. FUNDING
ACKNOWLEDGEMENTS: nil. CONTACT: rjd@whiplashcentre.com
ETHICS COMMITTEE: Ethics Committee – La Trobe University
Research Report Platform Presentation
2503 Sunday 3 June 11:45
VCEC Meeting Room 16
THE MANAGEMENT OF ACUTE ANKLE SPRAINS: A
SYSTEMATIC REVIEW OF RANDOMISED CONTROLLED TRIALS
Bleakley C1 , McDonough S1 , MacAuley D2 ; 1 Health and
Rehabilitation Sciences Research Institute, University of Ulster,
Northern Ireland; 2 Hillhead Family Practice, Belfast, Northern Ireland
PURPOSE: This study aimed to enhance the evidence base for
managing acute soft tissue injuries. The specific objective was to
undertake a systematic review to assess the clinical evidence base
for the treatment of acute ankle sprains. RELEVANCE: Lateral ankle
sprains are common soft tissue injuries; however there is no evidence
to suggest which intervention best augments functional treat-
ment, and currently practitioners treat ankle sprains pragmatically.
PARTICIPANTS: Randomised controlled trials METHODS: A com-
puterized literature search using nine databases (Medline, CINAHL,
AMED, Proquest, ISI Web of Science, CDSR, DARE, CCTR, PEDro)
was carried out up to April 2005. This was supplemented with citation
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
in English, describing human adults recovering from an acute ankle
sprain with the therapy consisting of a physiotherapeutic, electrother-
apeutic or pharmacological intervention. Comparisons should have
been made to no treatment, placebo, or a different physiotherapeutic,
electrotherapeutic or pharmacological intervention. ANALYSIS: Data
was extracted for the following outcomes measures: pain, swelling,
function, re-injury, subjective instability, objective instability and or
overall improvement. Two reviewers independently assessed the
validity of included trials using the PEDro scale, disagreement arising
between the first two raters, were resolved by either consensus
discussion or by consultation with the PEDro project officer.
Individual study-effect estimates were calculated using the Cochrane
Collaboration Review Manager (4.2) software program. RESULTS:
21 trials met the inclusion criteria. The mean PEDro score was 5.1
/ 10. There was little evidence to suggest that electrotherapeutic
modalities have any significant effect after ankle sprains. However
due of the lack of RCTs employing clinically appropriate parameters,
in particular with regards to the cryotherapy, it is not yet possible
to come to any definitive conclusion in this area. Non-steroidal
anti-inflammatory drugs (NSAID’s), both oral and topical, are of
significant benefit in short term recovery after injury, but they may
cause increased mechanical instability, and no studies included
a long term follow up. There is evidence from two lower quality
studies that neuromuscular exercises may decrease complaints of
functional instability and re-injury, and evidence from one high
quality study that physiological mobilisations can increase range of
S68
movement. CONCLUSIONS: More high quality studies will provide
further evidence of which modalities, or combination of modalities
can best supplement functional recovery after ankle sprains. Future
studies into the effectiveness of electrotherapeutic modalities must
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
stages of ankle sprain, their long-term efficacy is not yet known, and
future studies must include a long term follow-up. IMPLICATIONS:
Lateral ankle sprains are a very common soft tissue injury. Based
on the current review, practitioners may have difficulty adopting an
evidence based management approach. KEYWORDS: ankle sprain,
management, evidence base. FUNDING ACKNOWLEDGEMENTS:
None. CONTACT: chrisbleakley@hotmail.com
Research Report Platform Presentation
1034 Sunday 3 June 11:45
VCEC Meeting Room 17
PEDI, USED AS A QUESTIONNAIRE
Christensen J; Department of Physiotherapy, Glostrup University
Hospital, DK-2600 Glostrup, Denmark
PURPOSE: The purpose of the study was to develop and examine
a Danish questionnaire version of Pediatric Evaluation of Disability
Inventory (PEDI).Proper outcome measurements are important tools
for planing and evaluating interventions in all parts of physiotherapy.
Outcome measurements should be valid and reliable and if possible
translated to different languages, so that international comparison
studies can be made. PEDI is one such measurement tool aimed at
children with disabilities. RELEVANCE: Until now very few standard-
ized outcome measurement tools for children have been translated
into Danish. Looking for a suitable measurement tool for children
with disabilities, PEDI was the obvious choice, having already been
translated into several languages and validated internationally. In
addition PEDI is a generic measurement tool for children, with good
psychometric properties. We therefore found PEDI suitable for use
in a Danish context. PARTICIPANTS: Parents to 39 children with
Cerebral Palsy (age 2-7.5 years) filled in the Danish PEDI ques-
tionnaire. All the parents had Danish as their primary language and
their children followed the common outpatients program at the Neuro-
pediatric Department, Glostrup Hospital, Denmark. METHODS: The
original American version of PEDI was translated into Danish and
transformed into a questionnaire. Pilot trials was performed among
professionals and parents. The questionnaire was then given to
parents along with a brief standardized instruction. The parents filled
in the questionnaire on their own at home. After completing PEDI, the
parents were asked to assess PEDI for difficulties, comprehension
of instructions, doubts, relevance and the time spend on completing
the questionnaire. The final Danish questionnaire version has then
been translated back into English for approval by the authors of
PEDI. ANALYSIS: Descriptive statistics was used for data analysis.
Problematic items was reviewed for further conceptual and semantic
improvements. RESULTS: The majority of parents were able to com-
plete PEDI (95%). In total only 5.7% of answers were problematic –
mainly on items concerning activities that were no longer relevant
for the child. Almost all parents found PEDI relevant. However some
parents found PEDI long and complicated, but in general instructions
and content were considered understandable. Completion of PEDI
took on average 55 minutes. CONCLUSIONS: The PEDI question-
naire version was tested for feasibility and parents impressions with
success. The Danish questionnaire version of PEDI can be used
by parents at home or as an interview guide for professionals. The
parents found PEDI relevant and were in favour of incorporating
PEDI into the children’s test program. Many parents commented that
PEDI gave better insight to the abilities of their children during daily
activities. Further reliability and validity studies using questionnaire
versions of PEDI is recommended. IMPLICATIONS: PEDI used as a
questionnaire can involve parents in the measuring and goal setting
WCPT 2007, Research Reports
of their children’s rehabilitation and thus contribute to family centered
rehabilitation. KEYWORDS: Feasibility study, PEDI, Questionnaire.
FUNDING ACKNOWLEDGEMENTS: Grants from Pampers & Fisher
Price and the Danish Association of Physiotherapists.
Research Report Platform Presentation
2551 Sunday 3 June 11:45
VCEC Meeting Room 18
A SYSTEMATIC REVIEW OF PHYSIOTHERAPY EXERCISE
PROGRAMMES FOLLOWING DISCHARGE FROM HOSPITAL
AFTER TOTAL KNEE ARTHROPLASTY
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
PURPOSE: To evaluate the extent to which post discharge physio-
therapy exercise is effective, in terms of improving function, mobility,
range of motion, quality of life and strength, for osteoarthritic patients
following elective primary total knee arthroplasty. RELEVANCE:
Although knee joint arthroplasty is a common orthopaedic procedure,
there are surprisingly few published evidence-based rehabilita-
tion guidelines/programmes available for use in clinical practice.
This research was undertaken to inform the development of
an evidence-based physiotherapy interventions for these patients.
PARTICIPANTS: The participants for inclusion in this review were
patients undergoing elective total hip or knee arthroplasty for
osteoarthritis who have received a physiotherapy exercise rehabili-
tation intervention following discharge from hospital post-operatively.
METHODS: The Cochrane Collaboration guidelines and the Quorom
statement were followed throughout. The review identified and
included prospective comparative clinical trials relevant to the review
question. For this review the term physiotherapy exercise referred
to any exercises or exercise programme advised or provided by
physiotherapists/physical therapists during the rehabilitative period
after discharge from hospital after surgery occurring in the out patient,
community or home setting. Trials were included if they compared
a physiotherapy intervention versus usual or standard care or
compared two different types of relevant physiotherapy intervention.
The quality of trials was independently assessed by two reviewers.
The outcomes included in this review were: self report measures of
function, walking, muscle strength, quality of life and range of joint
motion. ANALYSIS: Narrative and Meta-Analyses were performed
using fixed effect models, weighted mean differences, standardised
effect sizes, and tests for heterogeneity. RESULTS: 6 trials were
identified, 5 of which were suitable for inclusion in meta-analyses.
A small to moderate standardised effect size, in favour of functional
exercise, was seen for function at 3-4 months post operatively.
Small to moderate weighted mean differences, in favour of functional
exercise, were seen for range of joint motion and quality of life at 3-
4 months post operatively. Post treatment benefits were not carried
through to 1year. CONCLUSIONS: The review supports the use of
functional exercise interventions following discharge, over traditional
physiotherapy, to obtain short term benefit following elective primary
knee arthroplasty. Although the results are not conclusive, they
indicate that functional exercise interventions following discharge
show promise for this patient group. The results also support the need
for further research in this area. IMPLICATIONS: From the evidence
to date, the authors propose that functional exercises should be
considered for inclusion in post discharge physiotherapy programmes
following knee arthroplasty. Traditional programmes, which concen-
trate on isometric muscle exercises and exercises to increase joint
range of motion, may be less effective in the short term following total
knee arthroplasty. KEYWORDS: Total knee arthroplasty, rehabilita-
tion, systematic review. FUNDING ACKNOWLEDGEMENTS: This
research has been funded by a Department of Health Allied Health
Professional Researcher Development Award from the Department
of Health, UK. CONTACT: catherine.minnslowe@noc.anglox.nhs.uk
Platform Presentations, Sunday 3 June
Research Report Platform Presentation
2534 Sunday 3 June 11:45
VCEC Meeting Rooms 19-20
THE PREVALENCE AND CHARACTERISTICS OF THORACIC
DISC DEGENERATION AND OTHER PATHOLOGY IN MEN
Niemeläinen R1 , Videman T, Battié M; 1 Faculty of Rehabilitation
Medicine, University of Alberta, Edmonton, Canada
PURPOSE: This study examined the prevalence of degenerative and
pathological findings in the thoracic spine in a general population
sample of adult men, for which little is currently known. The objective
of the study was to obtain normative data on thoracic degenerative
findings which is essential for recognizing the clinical significance
of related observations in patients. RELEVANCE: The occurrence
of degeneration and pathology have been extensively studied in the
cervical and lumbar spines, however, the extent of these findings
in the thoracic spine still remains unknown, as well as the possible
role of disc degeneration in symptoms. Yet, thoracic pain is common
and can be disabling among men. A prior analysis revealed that
17% of the subjects in the current study had thoracic pain in the
previous year and, of those, approximately one-quarter reported
difficulties in daily activities because of the pain. PARTICIPANTS:
A population sample of 532 men aged 25-70 years, representative
of the general population of Finnish men selected from a twin
cohort containing all twins born before 1958 and alive in 1975.
METHODS: Qualitative and quantitative assessments of thoracic
disc degeneration were obtained from MR images (levels T6-L1).
Qualitative assessments were performed by a spine surgeon and
custom-made software was used to acquire quantitative data on
disc degeneration. ANALYSIS: Descriptive statistics were acquired
using SPSS statistical software. RESULTS: Moderate or severe disc
bulging was present in at least one disc in 7.9% of subjects being
most common at the two lowest levels. The prevalence of disc
herniations was 0.8%. Moderate or severe disc height narrowing
varied from 2.7% to 9.7% by disc level with 22.4% of subjects having
at least one narrowed disc. Four or more wedged vertebrae (5º)
were present in 68 subjects and 13 had coexisting Schmorl’s nodes
meeting a criterion for Scheuermann’s disease. Seven subjects
(1.3%) met the more stringent criteria with three or more wedged
vertebrae, endplate changes and sclerosis and disc height narrowing.
Age correlated with disc signal intensity (r= 0.31-0.40 depending on
the disc level). CONCLUSIONS: The prevalence of disc degeneration
is lower in the thoracic spine than has been reported in the cervical
and lumbar spines. However, one-fifth of the subjects had markedly
narrowed discs, which have been associated with symptom history
in the lumbar region. The symptomatology of these findings still
remains unclear and therefore should be studied in the future. Age
is known to be associated with the overall degeneration and in
this study age explained 9.9% to 15.8% of the variance in disc
signal intensity. IMPLICATIONS: Knowledge of the disc degeneration
in thoracic spine in the general population offers an important
reference for clinical observations. KEYWORDS: thoracic spine, disc
degeneration and MR imaging. FUNDING ACKNOWLEDGEMENTS:
The research was supported by grants from the NIH NIAMS
(R01 AR40857), EURODISC (QLK6-CT-2002-02582), the Finnish
Academy, the Alberta Heritage Foundation for Medical Research, the
Alberta Provincial CIHR Training Program in Bone and Joint Health,
and the Helsingin Sanomat Centennial Foundation. CONTACT:
riikka.niemelainen@ualberta.ca
ETHICS COMMITTEE: Ethical Committee of the Department of
Public Health, University of Helsinki, and the University of Alberta.
S69
Research Report Platform Presentation
2616 Sunday 3 June 12:05
VCEC Ballroom A
ARE THERE RELIABLE AND VALID CLINICAL METHODS FOR
MEASURING LEG LENGTH DISCREPANCY?
Oosterveld F1 , Kamp N1 , de Jong R1 , ten Brinke A1,2 , van den
Engh F2 ; 1 Saxion University, Enschede, The Netherlands; 2 Hospital
Medisch Spectrum Twente, Enschede, The Netherlands
PURPOSE: There is significant inconsistency regarding research into
measurements of leg length discrepancy. RELEVANCE: The aim of
this study was to investigate the intra observer reliability and validity of
four different methods that are currently being used in clinical settings
to determine leg length discrepancies. PARTICIPANTS: 25 Healthy
male subjects, with a mean age of 49 years were enrolled in the study.
Women were excluded from the study, because their reproductive
organs cannot be protected adequately during the X-rays. In addition,
also volunteers who had actual complaints of the musculoskeletal
system and those who were unable to assume the desired position
without complaints of pain were excluded. METHODS: The methods
under study were 3 standing methods (the Calliet method, the Laser
method and the Pelvic-leveling device method) and 1 supine method
(the DeltaLeg method). The iliac crest symmetry was assessed and
expressed on a nominal scale (left higher / even / right higher) and
the difference, if present, was measured in cm (continuous scale).
All measurements of the four different methods were performed
twice by an experienced observer in the morning and twice by
an inexperienced observer in the afternoon on the same subjects.
Subjects were kept unaware of their own measurement results
(blinded). To blind the observers each subject was assigned a
different code number for each session and they were measured
in a random order, without knowledge of the previous results. During
the afternoon also an X-ray was made of each subject, showing the
femur heads and the crista iliacii. This standing X-ray was used as a
golden standard for validation. ANALYSIS: The data was analyzed
using SPSS 12. To estimate intra observer agreement for nominal
data Cohen’s Kappa was used and for continuous data Pearson’s
correlation coefficient was calculated. Also, differences between the
measurements were expressed in mean and standard deviation. To
transform the group reliability results to the level of the individual
patient from the SD’s the Smallest Detectable Difference (SDD) was
calculated. RESULTS: Reliability for all the observers was relatively
low. Cohen’s Kappa’s vary from 0.18 to 0.50 and SDD’s of 5.5 to
13.0 mm were found. The experienced observer had overall higher
intra observer reliability than the inexperienced observer. Kappa’s
(−0.05–0.17) and correlation coefficients (−0.12–0.39) showed very
low validity of all methods as compared to X-ray. The reliability as well
as validity increased to acceptable levels taking in account only the
subjects in which a difference of 5 mm or 8 mm was found by the
observers. CONCLUSIONS: This study showed that intra observer
reliability and validity of the 4 tested measurement procedures in
a healthy population is rather poor. The intra observer reliability
and the validity of the methods improve with increasing leg length
discrepancies. IMPLICATIONS: In general measured differences
less than approximately 0.8 cm should not have any clinical or
therapeutic consequences. KEYWORDS: measurements, validity,
reliability. FUNDING ACKNOWLEDGEMENTS: None. CONTACT:
f.g.j.oosterveld@saxion.nl
ETHICS COMMITTEE: Ethics committee of hospital Medisch
Spectrum Enschede, The Netherlands
S70
Research Report Platform Presentation
1579 Sunday 3 June 12:05
VCEC Meeting Rooms 11-12
A RANDOMISED CONTROLLED TRIAL COMPARING GRADED
EXERCISE TREATMENT WITH USUAL PHYSIOTHERAPY FOR
PATIENTS WITH NECK PAIN
McLean S1,2 , Klaber Moffett J1 , Sharp D1,2 , Gardiner E1 ; 1 Institute
of Rehabilitation, University of Hull; 2 Hull and East Yorkshire
Hospitals NHS Trust
PURPOSE: Neck pain is a prevalent musculoskeletal condition,
however research into management of neck pain is sparse. There
is little good quality evidence to support the use of exercise
programmes as a way of treating neck pain. Additionally there is little
evidence identifying variables which predict outcome of neck pain
following treatment. The primary aim of this study was to investigate
the effectiveness of a graded neck and upper limb exercise
programme compared with usual physiotherapy. The second aim was
to investigate which patient psychological, sociodemographic and
physical variables were predictive of outcome following intervention.
RELEVANCE: Clinicians are unable to predict which patients are
likely to develop recurrent,persistent or chronic neck pain. They
also have difficulty directing patients towards the most effective
treatment approaches. This study will help to address these gaps
in knowledge. PARTICIPANTS: 151 adult neck pain patients were
selected from the waiting list of 4 NHS physiotherapy departments
in the United Kingdom to participate in this randomised controlled
trial. Patients were randomised to one of two interventions; 1)
graded exercise treatment (GET) or 2) usual physiotherapy (UP).
Patients were stratified according to treatment centre and neck pain
disability score. METHODS: At baseline, patients completed a series
of self administered questionnaires relating to neck pain, upper limb
disability, psychological, sociodemographic and clinical variables.
Following treatment patients were followed up at 6 weeks and 6
months using postal questionnaires. The primary outcome measure
was the Northwick Park Neck Pain Questionnaire (NPQ). ANALYSIS:
Repeated measure ANOVAs were used to test for differences on
outcome measure between the graded GET group and UP group
at each time point. ANCOVA, using general linear models, was
used to test the influence of baseline variables on NPQ score at
6 month follow-up. RESULTS: After 6 months both interventions
reduced neck pain by a clinically significant amount (GET 5%;
UP 7.7%)(p = 0.013). There was no significant difference between
GET and UP (p = 0.317). After adjusting for baseline NPQ scores and
intervention type, general linear modelling identified that regardless
of intervention, deprivation status (p = 0.002) significantly predicted
treatment outcome at 6 months. Baseline fear avoidance beliefs
scores and intervention type interacted to predict 6 month outcome
such that patients with higher than average fear avoidance beliefs
were predicted to have better outcome following GET intervention.
Those with lower than average fear avoidance beliefs were predicted
to have better outcome following the UP intervention (p = 0.011)
CONCLUSIONS: This study provides preliminary evidence that
graded neck and upper limb exercise and usual physiotherapy are
effective methods of managing neck pain. GET appears to be
particularly beneficial for patients exhibiting higher than average
levels of associated fear avoidance beliefs. UP appears to be
more beneficial for neck pain patients with lower than average
levels of associated fear avoidance beliefs. IMPLICATIONS: Graded
neck and upper limb programmes are a viable form of treating
patients with neck pain, particularly if they have high levels of
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:
s.m.mclean@hull.ac.uk
ETHICS COMMITTEE: Multi-centre research ethics approval from
Hull and East Riding Research and Ethics Committee
WCPT 2007, Research Reports
Research Report Platform Presentation
1682 Sunday 3 June 12:05
VCEC Meeting Room 16
FUNCTIONAL DEFICITS AFTER SURGICAL HIP DISLOCATION
Luder G, Rocourt M, Deschner G, Radlinger L; Research
Physiotherapy, University Hospital Berne, Switzerland
PURPOSE: The aim of this study was to characterise the deficits
concerning functional aspects of gait, stair climbing and standing
balance after surgical hip dislocation (SHD). In addition the pain and
disability were investigated and compared with functional capacity.
RELEVANCE: After SHD the person walks with reduced weight-
bearing for 8 weeks. For physiotherapists it is important to know which
functional deficits occur after such a period. The knowledge about
functional and subjective deficits of persons after surgery will help to
establish an adequate therapy. PARTICIPANTS: This cross-sectional
prospective study involved a total of 91 persons: three months after
SHD (G3, n=29, 28.1±5.8 years, 76.7±17.1 kg), 12 months after
SHD (G12, n=28, 30.1±5.1 years, 80.4±15.7 kg) and a healthy
control group (G0, n=34, 28.0±4.9 years, 67.4±11.0 kg). METHODS:
The following measurements have been performed: ground reaction
forces (GRF) in gait and stair climbing, time-distance-parameters
in gait, standing balance, questionnaires for pain, disability and
performance (SMFA-D and COPM). ANALYSIS: From the GRF-
curves force and time parameters were detected. For standing
balance the area of centre of pressure (COP) was calculated. From
the SMFA-D indexes of function and disability were calculated (0 =
best, 100 = worst), as well as COPM performance and satisfaction
(10 = best, 1 = worst). Descriptive statistics and group differences
(nonparametric: Kruskal-Wallis-H, post-hoc: Mann-Whitney-U) were
computed using SPSS. RESULTS: GRF-parameters on stair in G3
were lower for Fz2 and higher for t2 and thus the loading rate was
lower compared to G0 in ascent and descent. For G12 similar values
as G0 were found except for Fz2 and Fz3 in ascent. Gait velocity was
similar in all groups, while relative stance phase showed a tendency
to increase for G3 and G12. For standing balance no significant
differences were found in the area of the COP. SMFA-D showed a
function-index for G3 of 19.7, for G12 of 12.3 and for G0 of 2.3 and
a disability-index for G3 of 14.6, for G12 of 12.5 and for G0 of 1.
All differences were highly significant. Similar significant differences
were found in the COPM, where performance and satisfaction in
G3 were 5.9 respectively 5.6 and in G12 7.1 respectively 6.2
compared to G0 with 9.7 respectively 9.6. Furthermore most of all
persons after SHD mentioned pain in some daily-life-activities, such
as longer walking or standing and stair climbing. CONCLUSIONS:
The functional measurements showed clear differences between the
groups only in stair climbing, whereas the other tasks might have
been too less demanding to find differences. However both exper-
imental groups showed in the questionnaires clearly less function,
performance and satisfaction and more disability and pain in daily-
life. IMPLICATIONS: Persons after SHD showed clear deficits in the
subjective perception of pain and function, but these findings were not
confirmed by the functional measurements we performed. Functional
measurements for assessment in physiotherapy should be more
adapted to daily-life problems, i.e. with higher impacts or physical
fatigue. KEYWORDS: Immobilisation, Functional deficits, Functional
assessment. FUNDING ACKNOWLEDGEMENTS: Swiss Associ-
ation of Physiotherapy, Switzerland. CONTACT: gere.luder@fisio-
burgernziel.ch
ETHICS COMMITTEE: The study was approved by the Ethics
committee of Canton Berne, Switzerland
Platform Presentations, Sunday 3 June
Research Report Platform Presentation
1286 Sunday 3 June 12:05
VCEC Meeting Room 17
CHALLENGES FACED BY CAREGIVERS OF CEREBRAL
PALSIED CHILDREN ATTENDING THE DR G MKHARI
HOSPITAL,GAUTENG PROVINCE-RSA IN PERFORMING A
HOME PROGRAM
Taukobong N, Mwenya J, Mukansoneye M, Sebuyi T; UNIVERSITY
OF LIMPOPO-MEDUNSA CAMPUS,RSA
PURPOSE: During follow up vists at the Dr. George Mkhari
hospital Cerebral Palsy(CP)clinic, caregivers are ussually requested
to demonstrate the child’s home program as part of re-assessment.
Most of them fail to do so hence the purpose of this study was
to determine the factors that affect the caregivers retention and
performance of the physiotherapy home program for a child with
CP. RELEVANCE: Effectiveness of a physiotherapy home program
depends on the caregivers ability to retain and reproduce a set
of exercises and handling activities.Failure to perform an effective
home program lead to unattainable therapy goals and development
of complications which could have been prevented. PARTICIPANTS:
A group of 30 caregivers of CP children under the age of 5years,
who had attended the clinic for at least three consecutive times,
constituted the sample for the study. All caregivers who did not meet
the set criteria were excluded from the study. METHODS: Ethical
clearance was obtained from the university of Limpopo research,
ethics and publications commitee. A permission to conduct the study
at the hospital was granted by the superintendent. Consent was
also obtained form participants following a thorough explanation of
the objectives of the study.Descritive survey was conducted using a
structred interview utilizing a self contructed questionnaire. Aspects
covered were ability to perform home program in the abscence of
a physiotherapist, daily routine activities, family support, confidence
and anxiety level when doing the activities at home. ANALYSIS:
Descriptive statistics using frequency distributions was conducted
to analyze the data which was then represented in histograms,
pie-charts and tables for ease of intepretation with the help of
a statistician. RESULTS: Only female caregivers participated in
the study and their age ranged from 15yrs to 45yrs.70% of them
were single parents and only 13% were employed.Only 46.7% felt
that the home program interferred with thier daily routine.23% felt
confident when performing the activities whilst 60% become very
anxious during the performance of a home program. Only 40%
received support from the other family members during activities.All
partcipants reflected an understanding of the importance of carrying
through the physiotherapy home program. CONCLUSIONS: The
main challenges faced by caregivers of CP children attending the
CP clinic at the Dr. George Mkhari hospital are increased level
of anxiety when performing the home program and lack of family
support. IMPLICATIONS: Caregivers have an extremely tough life
dealing with a child diagnosed with CP(Brinchmann:1999)and this
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
clinic.Involvement and support of the family is important in guiding
the caregiver to carry out the home program(Granet et al:2002) and
visits by more than one member of the family to the clinic should be
allowed and introduced to encourage family involvement and support
at all times. KEYWORDS: Challenges; Caregivers; home program.
FUNDING ACKNOWLEDGEMENTS: The project was not funded.
ETHICS COMMITTEE: University of Limpopo Research, Ethics and
Publication Commitee(REPC)
S71
Research Report Platform Presentation
2875 Sunday 3 June 12:05
VCEC Meeting Room 18
EFFECTS OF AQUATIC RESISTANCE TRAINING ON KNEE
EXTENSOR-FLEXOR MUSCLE POWER, TORQUE AND
MOBILITY AFTER TOTAL KNEE ARTHROPLASTY
Pöyhönen T1 , Valtonen A1 , Sipilä S2 , Heinonen A2 ; 1 Rehabilitation
and Pain Unit, Central Hospital of Kymenlaakso, Kotka, Finland;
2 Department of Health Sciences, University of Jyväskylä, Finland
PURPOSE: This randomised controlled clinical trial was conducted
to investigate the effects of a progressive 12-week aquatic resistance
training on knee extensor and flexor muscle power, torque and mo-
bility in persons with unilateral total knee arthroplasty. RELEVANCE:
Knee replacement reduces pain but also causes knee extensor and
flexor muscle weakness in the operated leg. This often results in lower
mobility, especially severe difficulties in ascending stairs and standing
up from the chair. Aquatic physiotherapy has beneficial effects in
persons with joint diseases but the effects of aquatic training after
total knee arthroplasty have been poorly studied. PARTICIPANTS: 51
volunteers (31 women and 20 men, 55-75 years old) with unilateral
knee replacement 9.5±4.4 months postsurgery were recruited from
the hospital records. They were randomly assigned into aquatic
exercise group (N=26) which conducted a 12-weeks progressive
aquatic training and control group (N=25) METHODS: Maximal knee
extensor and flexor power and torque of the operated and non-
operated legs were measured isokinetically at constant angular
velocities of 60 and 180degs-1. In addition, maximal stair ascending
and repeated sit-to-stand times were measured. ANALYSIS: The
effects of the aquatic training were assessed using ANOVA for
repeated measures. RESULTS: At 12 weeks, knee extensor and
flexor power improved significantly in the aquatic exercise group
compared to the control group, the differences being 30% (p < 0.001)
and 34% (p < 0.001), respectively. Significant difference in change
between the aquatic training group and control group was seen for
60degs-1 torque of the knee extensors and flexors, 12% (p = .011)
and 18% (p = .009), and for 180degs-1 torque 14% (p < 0.001)
and 36% (p < 0.001), respectively. In addition, the exercise group
improved stair ascending 14% (p = .002) and sit-to- stand test time
17.5% (p = .008) compared to controls. CONCLUSIONS: The results
showed that 12 weeks of progressive aquatic resistance training
resulted in significant improvement in muscle power and torque
of the knee extensors and flexors accompanied with improvement
in mobility. IMPLICATIONS: Progressive aquatic resistance training
can be recommended after major knee surgery such as total
knee replacement. KEYWORDS: hydrotherapy, knee replacement,
older. FUNDING ACKNOWLEDGEMENTS: State’s Special Share
Funds of Kymenlaakso Hospital District, Kotka, Finland. CONTACT:
tapani.poyhonen@kymshp.fi
ETHICS COMMITTEE: Ethics committee of Kymenlaakso Hospital
District, Kotka, Finland
Research Report Platform Presentation
3154 Sunday 3 June 12:05
VCEC Meeting Rooms 19-20
TRENDS IN LOWER EXTREMITY POWER ACROSS THE
LIFESPAN IN WOMEN. A PILOT STUDY
Newstead A1 , Korff T2 , Jensen J3 ; 1 University of Texas Health
Science Center at San Antonio; 2 Brunel University, West London,
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
S72
of functional task skills (e.g. stair climbing), and therefore a
loss of independence, increased disability and reduced quality of
life. PARTICIPANTS: Participants were moderately active, healthy,
community dwelling adult women (average of 3-6 METS per day):
younger (G1: 29.8±5.7y; n=5), middle-aged (G2: 50.4±3.5y; n=5)
and older women (G3: 72.3±2.5y; n=2). METHODS: Lower extremity
peak power delivered to the crank during the downstroke (0-1800),
was determined during repeated bouts of pedaling at incremental
cadences between 60 and 120 revolutions per minute (rpm) at
15% peak predicted power. While reduction in power production
is consistently observed in older adults (>65 yrs), the working
hypothesis was that power production decrements would be evident
earlier in the lifespan. Thus, it was expected that peak power
production during the downstroke would be greatest in G1 compared
to G2 compared to G3. We anticipated that timed stair climb (TSC)
would be inversely related to power production with increased age.
ANALYSIS: Descriptive analyses were used to depict participants
and power production. A regression analysis was used to compare
the relationship of power for each group to functional timed stair
climb, and timed stair climb to age. RESULTS: Consistent with
our expectation, peak power during the downstroke for 60, 80, and
100 rpm cadences was greatest for G1 (with reduced peak power
production for G2. Expectedly, G3 produced smaller peak powers
compared to G2. This relationship held up for the 120 rpm condition,
but the comparison was limited to G1 and G2 (G1 > G2) because
not all members of G3 could consistently perform at 120 rpm.
Specifically, peak total crank power (Pcrank; unitless) delivered to
the pedal during the downstroke (0-1800) was least for G3 (3.55) at
60 rpm than both G2 (3.66±0.40) and G1 (4.23±0.60); at 80 rpm
Pcrank was increased for all groups (Gp3=3.75; Gp2=4.55±0.47;
G1=4.55±0.47), as well as at 100 rpm (G3=4.71; G2=4.94±0.72;
G1=5.93±0.91). At 120 rpm, different results were found, and one
participant could not achieve the 120 target cadence (G3=5.48
[n=1]; G2=4.48±0.81; G1=5.89±0.85). G3 demonstrated the slowest
time to complete the stair climb (22.9±0.8s) compared with both
G2 (15.9±1.7s) and G1 (12.3±1.4s). A linear regression revealed
a strong inverse relationship between timed stair climb and age
(R2=0.80), and a weak relationship between timed stair climb and
pedaling power during the downstroke was demonstrated (R2=0.04-
0.34). CONCLUSIONS: Our preliminary findings support the ex-
pectation of ‘mid-life’ declines in power production limits – despite
the characteristics of moderately active women. IMPLICATIONS:
Designing intervention programs that include power production
strategies are needed to reverse lower extremity power losses earlier
in life. KEYWORDS: power, stair climb, lifespan, women, cadence.
FUNDING ACKNOWLEDGEMENTS: * The research was supported
by the National Science Foundation under Grant No. 9986221.
CONTACT: newstead@uthscsa.edu
ETHICS COMMITTEE: University of Texas Health Science Center at
San Antonio, University of Texas at Austin, Brunel University
Research Report Platform Presentation
2796 Sunday 3 June 12:45
PP Crystal Pavilion A
DIFFERENTIAL ACTIVITY OF THE DEEP & SUPERFICIAL
THORACIC PARASPINAL MUSCLES DURING CHALLENGES TO
SPINAL STABILITY & POSTURAL EQUILIBRIUM
Lee L, Coppieters M, Hodges P; Division of Physiotherapy, School
of Health and Rehabilitation Sciences, University of Queensland,
Brisbane, Australia
PURPOSE: The thorax is an important region of load transfer
between the upper and lower body. However, little is known about the
strategies used by the nervous system to control mobility and stability
of the thorax. Fast voluntary arm movements are an established
method to challenge spinal equilibrium and stability. This study aimed
to determine whether anticipatory activity of the thoracic paraspinal
muscles is associated with bilateral and unilateral arm movements,
WCPT 2007, Research Reports
to investigate whether thoracic multifidus/rotatores and longissimus
thoracis are differentially active during arm movements, and to
compare muscle activity between thoracic regions(T5, T8, T11).
RELEVANCE: Evidence of differential function between deep and
superficial muscles in the lumbar and cervical spines have facilitated
the development of effective exercise rehabilitation programs for
people with back and neck pain. Clinical approaches for people with
thoracic pain are currently based on extrapolation from studies in
those regions. Studies of thoracic muscle function are needed to
guide treatment. PARTICIPANTS: Ten volunteers (five males, five
females) without history of spinal pain, any neurological condition, or
participation in asymmetric sport at a competitive level participated
in the study. METHODS: Recordings of electromyographic(EMG)
activity of the right deep (multifidus/rotatores) and superficial
(longissimus thoracis) paraspinal muscles at T5, T8, and T11 were
made with fine-wire electrodes. Subjects performed fast bilateral and
unilateral flexion and extension of both arms in response to a light.
ANALYSIS: Raw data was displayed randomly to visually identify
onsets of deltoid EMG. EMG amplitude of the trunk muscles was
calculated during 25 ms intervals for 150 ms before and 400 ms after
the onset of deltoid EMG. EMG amplitude was normalised to the peak
activity during tasks and was compared between conditions using a
repeated measures MANOVA. RESULTS: Multifidus and longissimus
had similar responses to bilateral arm flexion movements (two bursts
of activity, the first burst initiated prior to deltoid EMG onset), and
to bilateral arm extension movements (one burst after deltoid EMG
onset). Although similar in these features of the response, the
muscles were differentially active during unilateral arm movements
depending on the direction of trunk rotation that was induced by
the arm movement. Longissimus EMG was greater with left arm
flexion (induced left trunk rotation) than with right arm flexion (induced
right trunk rotation)(p < 0.03). Multifidus showed the opposite pattern
(p < 0.04). There were no differences in the response of the muscles
between thoracic regions (T5, T8, T11)(p = 0.98). CONCLUSIONS:
Thoracic multifidus and longissimus are similarly active in response
to sagittal plane perturbations of the trunk, but are differentially active
during movements which induce rotation around the vertical axis
in addition to the sagittal plane perturbation. These findings are
consistent with anatomical data suggesting that the muscles control
opposite rotational torques. IMPLICATIONS: These data suggest
that specific exercises may be required to differentially train the
deep and superficial thoracic muscles. In lumbar and cervical spine
pain there are impairments in function of the deep muscles; further
studies in patients with thoracic pain are required to investigate
whether changes in function of the deep and/or superficial muscles
occur in this region of the spine. KEYWORDS: thorax, stability,
electromyography. FUNDING ACKNOWLEDGEMENTS: Linda-Joy
Lee is supported by the Canadian Institutes of Health Research
(CIHR). Paul Hodges is supported by the National Health and Medical
Research Council of Australia. Michel Coppieters is supported by the
University of Queensland. CONTACT: ljlee@alumni.ubc.ca
ETHICS COMMITTEE: Medical Research Ethics Committe of the
University of Queensland
Research Report Platform Presentation
507 Sunday 3 June 12:45
PP Crystal Pavilion B & C
CROSS-CULTURAL ADAPTATION OF THE DASH
QUESTIONNAIRE: PUERTO RICAN VERSION
Mulero A, Colón Santaella C, Cruz C; Department of Graduate
Programs, College of Health Related Professions, Medical Sciences
Campus, University of Puerto Rico
PURPOSE: The purpose of this study was to translate into Spanish
and culturally adapt for Puerto Rico the Disabilities of the Arm,
Shoulder and Hand (DASH) questionnaire (McConnel, Beaton and
Bombardier, 1999). The questionnaire had already been translated in
Spain. However, a pretest of that version, followed by probing various
Platform Presentations, Sunday 3 June
health professionals, raised concerns in the meaning and terminology
used in some items. Therefore, the need for a cross-cultural
adaptation was established. The DASH questionnaire is a self-
report measure on physical and social role function. It includes two
additional modules, which measure function at work, in sports, and
performing arts. RELEVANCE: The DASH questionnaire is a self-
report measure on physical and social role function. It includes two
additional modules, which measure function at work, in sports, and
performing arts. PARTICIPANTS: The pilot test was performed with a
nonprobability sample of 32 normal subjects (13 males, 19 females;
age range = 21-75 years). METHODS: The recommendations for
the Cross-Cultural Adaptation of Health Status Measures by the
American Academy of Orthopaedic Surgeons (Beaton, Bombardier,
Guillemin & Ferraz, 2002) were followed. A translation of the
questionnaire from the U.S.-English into Puerto Rico-Spanish was
made by two independent translators who are native speakers.
This was followed by an integration of the two forward translations
into one Spanish version. This Spanish version was back-translated
into English by two independent translators, native U.S.-English
speakers. An expert committee composed of translators, an expert
in methodology, a linguist, and health professionals discussed the
discrepancies of the four versions (two in Spanish and two in English)
and produced a final version to be pilot tested. The expert committe’s
goal was to achieve semantic, idiomatic, experiential and conceptual
equivalence between the English and Spanish versions. ANALYSIS:
A pilot study was conducted to evaluate the interpretation of the
items on the questionnaire. During the pilot test, the Puerto Rico-
Spanish DASH version was administered individually, followed by
a structured interview to probe the understanding of each item.
Both the meaning of the items and responses were explored. The
distribution of responses was examined to look for a high proportion
of missing items or single responses. If two or more subjects reported
difficulty with understanding an item, that item was revised with the
expert in linguistics and the research methodologist for reformulation.
RESULTS: The final version of the Puerto Rico-Spanish DASH ques-
tionnaire was submitted for appraisal and received full approval of
the American Academy of Orthopaedic Surgeons. CONCLUSIONS:
The Puerto Rico-Spanish DASH questionnaire is published in
the official DASH Outcome Measure website, sponsored by the
Institute for Work & Health of Canada and the American Academy
of Orthopaedic Surgeons (http://www.dash.iwh.on.ca/translate.htm).
IMPLICATIONS: The availability of a functional evaluation translated
and culturally adapted for the Spanish-speaking population in Puerto
Rico advances patient care, as valid and reliable data can be col-
lected when examining upper extremity function. KEYWORDS: upper
extremity function; cross-cultural adaptation; health status measure.
FUNDING ACKNOWLEDGEMENTS: NIH NIGMS/MBRS SCORE
S06 GM008224 support. CONTACT: anamulero@cprs.rcm.upr.edu
ETHICS COMMITTEE: Institutional Review Board, Medical Sciences
Campus, University of Puerto Rico
Research Report Platform Presentation
1718 Sunday 3 June 12:45
VCEC Ballroom A
LONGITUDINAL EXCURSION AND STRAIN IN THE MEDIAN
NERVE DURING NOVEL NERVE GLIDING EXERCISES FOR
CARPAL TUNNEL SYNDROME
Coppieters M, Alshami A; Division of Physiotherapy, School of
Health and Rehabilitation Sciences, The University of Queensland,
St Lucia (Brisbane), Australia
PURPOSE: To measure longitudinal excursion and strain in the
median nerve at the wrist during various types of nerve gliding
exercises for carpal tunnel syndrome (CTS). RELEVANCE: Nerve
and tendon gliding exercises are widely recommended in the
conservative and postoperative management of CTS. However,
traditionally advocated exercises induce nerve gliding by elongation
of the nerve bed (the tract formed by the structures that surround
S73
the nerve). Since this elongation may be associated with deleterious
strain in the median nerve with the risk of symptom exacerbation and
reduced benefits from nerve gliding, we aimed to identify exercises
which are associated with a substantial longitudinal excursion but
result in a minimal increase in nerve strain. PARTICIPANTS: Six
intact embalmed cadavers were used for this study (5 males, 1
female; age at time of death between 65 and 92 years). METHODS:
Longitudinal excursion (digital calliper) and strain (differential variable
reluctance transducer) were measured in the median nerve at the
wrist during six mobilisation techniques involving the wrist and elbow:
(1) a ‘sliding technique’ (simultaneous movement at two joints in
which one movement loaded the peripheral nerve (wrist extension)
while the other movement concurrently unloaded the nerve (elbow
flexion)); (2) a ‘tensioning technique’ (combined movement resulting
in a concurrent increase in length of the median nerve bed at two
joints (wrist and elbow extension)); (3-4) wrist extension with the
elbow in flexion and in extension; and (5-6) elbow extension with
the wrist in neutral and in extension. Techniques were performed in
random order. ANALYSIS: A one-way repeated-measures analysis
of variance was conducted with Duncan’s tests for post-hoc analysis.
The level of significance was set at p < 0.05. RESULTS: Although
all techniques resulted in nerve gliding at the wrist (p  0.006),
there were significant differences in the amount of nerve gliding
between different techniques (p < 0.00001). The excursion associated
with the ‘sliding technique’ (12.4 mm) was at least 30% larger
than the nerve movement in any of the other techniques (2.9-8.9
mm) (p  0.0002). Strain in the median nerve also differed strongly
between techniques (p  0.00001), with the lowest values for the
‘sliding technique’. CONCLUSIONS: The findings confirm the clinical
assumption that a ‘sliding technique’ results in a large longitudinal
excursion and that the increase in nerve strain due to nerve bed
elongation at one joint (e.g., wrist extension) can be counterbalanced
by a simultaneous decrease in the length of the nerve bed at an
adjacent joint (e.g., elbow flexion). Substantial differences in the
amount of nerve gliding and strain highlighted that different types of
nerve gliding techniques should not be regarded as a homogenous
group of exercises. IMPLICATIONS: Different types of nerve gliding
exercises have largely different mechanical effects on the median
nerve. This may have important implications for the selection of
effective and safe exercises in the treatment of CTS. A ‘sliding
technique’ may be more biologically plausible in the early stages of
rehabilitation than currently advocated exercises which induce nerve
gliding by elongation of the nerve bedding. KEYWORDS: carpal
tunnel syndrome; neurodynamics; nerve gliding exercises. FUNDING
ACKNOWLEDGEMENTS: The study was supported by an Early
Career Research grant from The University of Queensland, St Lucia
(Brisbane), Australia. CONTACT: m.coppieters@uq.edu.au
ETHICS COMMITTEE: Anatomy Ethics Committee, School of
Biomedical Sciences, The University of Queensland
Research Report Platform Presentation
2936 Sunday 3 June 13:05
PP Crystal Pavilion A
DEVELOPMENT OF A MOBILISATION DYNAMOMETER FOR
APPLYING CONTROLLED FORCES IN THE MANUAL THERAPY
CLINICAL SETTING
Lau G1 , Waddington G2 , Adams R1 ; 1 School of Physiotherapy,
University of Sydney, Sydney, AUSTRALIA; 2 School of Health
Sciences, University of Canberra, Canberra, AUSTRALIA
PURPOSE: To create a clinically suitable mobilising dynamometer
(MobDyn) that generates force readouts that give control of applied
force and enable treatment-to-treatment monitoring of changes in
the amount of pressure needed for pain response. Further, an
ergonomic grip on the device may reduce the risk of hand and
wrist work-related musculoskeletal disorders (WMSD) in the practice
of manual therapy. RELEVANCE: High volume of manual therapy
work stresses the structures of the hands and wrists, and can lead
S74
to WMSD, and possibly to injuries that force therapists to leave
their profession. Hence, a mobilising tool with instant force readout,
that can reduce hand injury risk and provide a way of gauging
patient progress between sessions, is needed. PARTICIPANTS:
36 healthy physiotherapy students who had passed courses on
spinal mobilisation techniques. All subjects had no history of hand
or back pain three months prior to testing, and were recruited
via advertisements at University of Sydney, Faculty of Health
Sciences. METHODS: All testing was performed in pairs, where
one subject assumed the role of the simulated-therapist whilst
the other was the simulated-patient. The independent variables
were spinal segment (T6 and L3), method of force application
(Pisiform grip and MobDyn), and grade of mobilisation (Grades I,
II, and III). Posteroanterior mobilisation forces were standardised
by use of a force plinth with force display for feedback. After each
combination has been performed, both subjects rated their hand
and back comfort respectively on a 10 cm visual analogue scale
(VAS). ANALYSIS: A 2 x 2 x 3 analysis of variance was used to
determine significance and interactions between the independent
variables spinal segment, method of force application, and grade
of mobilisation in terms of rated back comfort and hand comfort.
RESULTS: Back comfort with tool mobilisation was significantly
less comfortable than hand mobilisation (p < 0.001, mean = 14
mm, 95% CI 7.6–20.8 mm on a 100 mm VAS), and back comfort
decreased as the grade of mobilisation increased from Grade I
to Grade III (p < 0.001, mean = 27 mm, 95% CI 19.5–34.5 mm)
regardless of the method of force application. Because the difference
between the hands and the tool was approximately half the discomfort
experienced as grade was increased from Grade I to Grade III,
this difference in comfort was deemed to be acceptable. Hand
comfort, also decreased as grade increased (p < 0.001, mean =
20, 95% CI 13.5–27.2 mm), but the method of force application
was not significant (p = 0.199). CONCLUSIONS: The MobDyn has
been found to be acceptably comfortable at the hands, with
an acceptable level of patient comfort. It can now be used in
research in physiotherapy clinics. IMPLICATIONS: The mobilising
dynamometer warrants further testing regarding use in manual
therapy for the prevention of hand and wrist WMSD. Further testing
is necessary by therapists who are getting hand pain, and with
patients experiencing back pain. KEYWORDS: Manual therapy, Tool.
FUNDING ACKNOWLEDGEMENTS: Neither the candidate nor the
supervisors on this research project have any financial interest
involved. CONTACT: gordonhlau@gmail.com
ETHICS COMMITTEE: Human Research Ethics Committee, Univer-
sity of Sydney
Research Report Platform Presentation
645 Sunday 3 June 13:05
PP Crystal Pavilion B & C
CLINICAL OUTCOME MEASURES INVITE RECIPE ORIENTATED
PRACTICE
Copeland J, Taylor W, Dean S; Rehabilitation Teaching and
Research Unit, Department of Medicine, Wellington, New Zealand
PURPOSE: Clinical outcome measures (COM) are tools for monitor-
ing the effectiveness of interventions over time. This study examines
factors influencing their use by New Zealand (NZ) physiotherapists
when treating low back pain (LBP). RELEVANCE: Treatment of
LBP forms an important component of musculoskeletal physiotherapy
practice. However physiotherapists often struggle to convince funders
their treatment is evidence-based and cost-effective in producing
long term sustainable outcomes. PARTICIPANTS: Participants were
NZ physiotherapists. Purposeful sampling was used for two focus
groups, one in a private practice (N=6) and one in a public hospital
(N=6). A mail survey was then sent to all private practices listed
on a telecommunication database, and public hospital physiotherapy
outpatient departments. METHODS: This cross sectional study
employed two data methods: focus groups were conducted and
WCPT 2007, Research Reports
results were used to refine a structured questionnaire sent to
survey participants. The questionnaire included space for comments.
Two follow up mail outs were done. ANALYSIS: Focus groups
were analysed using an inductive approach allowing patterns and
categories to emerge. The independent variable for the survey data
was ‘Use of back related COM’. Nominal data was analysed using the
Chi squared test. A factor analysis of a 23 part Likert scale question
provided six new variables. These were analysed using independent
t tests or Mann Whitney U. Finally a multivariate logistic regression
analysis was performed. RESULTS: Key themes emerging from the
focus groups related to methods currently used for assessment and
measurement and perceived barriers to COM. These themes were
incorporated into the questionnaire. The mail survey achieved a 69%
response rate and showed NZ physiotherapists use improvements in
individual functional activities as their main outcome measure. Only
30% used back related COM in their practice. Statistically significant
factors determining use of COM in the multivariate analysis were an
increased level of knowledge of outcome measurement p = 0.001; OR
= 1.75 (95% CI 1.45-2.09) and having a Masters degree p = 0.053;
OR 2.50 (95% CI 0.98-6.36). Lack of time, frequently mentioned as an
excuse did not reach statistical significance p = 0.19, OR 1.11 (95% CI
0.94-1.30). Free text survey responses included concerns that COM
‘invite recipe orientated practice’. CONCLUSIONS: COM for routine
treatment of LBP are not widely used by NZ physiotherapists. Conflict
existed between beliefs patients were individuals and treatments
should be patient centred, versus the emphasis on COM and ‘recipe’
approaches to treatment. However logistic regression modelling
explained only 22% of variability in COM use. Further research is
needed to identify other factors that may be involved, for example
the degree of acceptance of evidence-based practice and what
role funding bodies play in directing routine use of COM by NZ
physiotherapists. IMPLICATIONS: Knowledge emerged as the main
factor influencing use of COM and this could be addressed by future
education initiatives. The low level of use may indicate that standard
COM for LBP do not meet the needs of busy clinicians who see
predominately acute presentation LBP patients and are expected to
treat them in a few visits. KEYWORDS: Clinical outcome measures;
Low back pain; Physiotherapy. FUNDING ACKNOWLEDGEMENTS:
Wellington Branch of New Zealand Society of Physiotherapists Inc. –
Searchwell Grant. CONTACT: janet@urban.org.nz
ETHICS COMMITTEE: University of Otago Human Ethics Commit-
tee, University of Otago, PO Box 56, Dunedin, New Zealand
Research Report Platform Presentation
2451 Sunday 3 June 13:05
VCEC Ballroom A
AN ALTERNATIVE APPROACH TO TREATING LATERAL
EPICONDYLITIS. A RANDOMIZED, PLACEBO-CONTROLLED,
DOUBLE BLINDED STUDY
Nourbakhsh M, Fearon F; North Georgia College and State
University
PURPOSE: Lateral Epicondylitis (LE) is a pathology mainly as-
sociated with repeated and overload wrist and hand movements.
Symptoms of LE are attributed to degenerative changes and
inflammatory reactions in the common extensor tendon induced by
microscopic tear in the tissue after repetitive or overload functions
of the wrist and hand extensor muscles. Conventional treatments,
provided for reducing soft tissue inflammation, have shown 39 to
80% failure rate. An alternative approach suggest that symptoms
of LE could be due to active tender points developed in the origin
of hand and wrist extensor muscles after overuse or repetitive
movements. Based on this hypothesis, the purpose of this study
was to investigate the effect of localized tender point treatments
with Neuroprobe on pain, grip strength and functional abilities of
subjects with chronic lateral epicondylitis. RELEVANCE: Clinical
relevance: Interventions with emphasis on tender point treatments
could provide an effective alternative treatment for symptoms of
Platform Presentations, Sunday 3 June
chronic LE. PARTICIPANTS: Eighteen subjects participated in this
study. A number of subjects had bilateral symptoms, thus a total
of 24 cases of chronic lateral epicondylitis were included. Prior
to their participation, all subjects were screened by an orthopedic
clinical specialist to rule out cervical and other pathologies that could
possibly contribute to their lateral elbow pain. Subjects who met
the inclusion criteria were randomized into treatment and placebo
treatment groups by a second (treating) therapist. Subjects and
the screening therapist were blinded to the group assignment.
METHODS: Subjects in the treatment group received six sessions
of Neuroprobe treatments. Subjects in the placebo group received
the same treatment with the Neuroprobe, except the intensity of the
electrical stimulation was kept at zero during the whole placebo-
treatment session. Jamar Dynamometer, Patient Specific Functional
Scale (PSFS) and Numeric Rating Scale (NRS) were used to
measure grip strength, functional status, pain intensity and pain
limitation respectively. The screening therapist who was blinded to
the subjects’ group assignment performed pretest, posttest and six-
months follow up measurements. ANALYSIS: We used Repeated
Measure analysis for within goup and used Multivariate Analysis of
Variance for between group comparisons. RESULTS: Subjects in
the treatment group showed both clinically and statistically significant
improvement in grip strength (P = 0.04), function (P = 0.002), pain
intensity (P = 0.001) and pain limitation (P = 0.003) compared
with those in the placebo group. Follow up data showed that
100% of subjects maintained the improved level of function and
83% of the subjects remained pain free for at least six months
post treatment. CONCLUSIONS: Symptoms of LE may be due to
active tender points that can be effectively treated by Neuroprobe.
IMPLICATIONS: The findings of this study provide strong evidence
for an alternative treatment for symptoms of lateral epicondylitis.
KEYWORDS: Chronic pain; Lateral epicondylitis; Elbow. FUNDING
ACKNOWLEDGEMENTS: This project was not funded. CONTACT:
mrnourbakhsh@ngcsu.edu
ETHICS COMMITTEE: IRB committee at Norht Georgia College and
State University
Research Report Platform Presentation
3108 Sunday 3 June 13:25
PP Crystal Pavilion A
ADAPTABILITY OF LEARNING ON JOINT MOBILIZATION
SKILL WITH AUGMENTED FEEDBACK BY USING A JOINT
TRANSLATION SIMULATOR
Chang J1 , Chang Chien C2 , Chang G1 , Chung K1 , Hsu A3 ;
1 Institute of Biomedical Engineering, National Cheng Kung
University, Tainan, Taiwan; 2 Department of Electrical Engineering,
National Cheng Kung University, Tainan, Taiwan; 3 Department of
Physical Therapy, National Cheng Kung University, Tainan, Taiwan
PURPOSE: Joint mobilization is a complicated task to teach and
learn and is characterized by great inter-subject and inter-session
variability. With the use of a joint translation simulator (JTS)
capable of simulating behavior of joints with varying stiffness, the
present study was implemented to investigate effects of training
with augmented concurrent or terminal feedbacks on enhancing the
perception of specific grade of mobilization, more specifically, on the
effect of transference of learning to joint models of different stiffness.
RELEVANCE: The JTS simulates 1-D joints with different stiffness
and provides quantitative feedback for learning specific grades
of joint mobilization. PARTICIPANTS: Thirty-six undergraduate
physical therapy students were randomly assigned into control,
concurrent feedback, and terminal feedback groups. Each subject
read and signed an informed consent. The experimental protocol
was approved by the institutional review board of the National
Cheng Kung University Hospital. METHODS: The JTS was designed
and developed to simulate tissue resistance against displacement
based on load-displacement relations derived from material property
testing of glenohumeral joint specimens. Quantitative feedbacks
S75
were provided to subjects during training to apply specific grade
of mobilization in feedback groups either concurrently or terminally
via a monitor. The control group received no quantitative feedback
during the training. Pretest and no-feedback retention tests were
conducted by using the same joint model as was used during
training. A novel joint model was also implemented during the
retention tests to investigate the effect of transference of learning.
ANALYSIS: Effects of grouping, grade of mobilization and learning
on performance (mean normalized error ‘NE’) were assessed by
three-way ANOVA with repeated measures for data obtained from
the resting position and the end position models. Tukey’s test was
used for post hoc comparisons. The a value was set at 0.05.
RESULTS: During acquisition and retentions, both feedback groups
showed smaller NE than did the control group (p < 0.01 for all
grades of mobilization in all models tested). No difference in NE
was found between the terminal feedback group and the concurrent
feedback group during retention. During retention tests significantly
less NEs was found in the novel models than those of the pretest
(p < 0.01 for any grade of mobilization in any model) indicating a
positive transfer of learning in the feedback groups. CONCLUSIONS:
Less variability, thus more consistency was achieved by using
the JTS as a tool for mobilization skill acquisition. Adaptability
or transference of learning was retained immediately and five
days after skill acquisition. However, guidance hypothesis was not
supported as the current feedback showed no superior effectiveness
on improving mobilization skill performance. Learning effects of
mobilization can be enhanced either by quantitative concurrent
feedback or by terminal feedback. IMPLICATIONS: The JTS is useful
in learning the perception of mobilization grade forces. KEYWORDS:
Physical therapy, Feedback, Learning, Joint mobilization. FUNDING
ACKNOWLEDGEMENTS: This study was supported in part by grant
(NSC 92-2320-B-006-033) from National Science Council, Taiwan.
CONTACT: arthsu@mail.ncku.edu.tw
ETHICS COMMITTEE: Institutional review board of the National
Cheng Kung University Hospital
Research Report Platform Presentation
751 Sunday 3 June 13:25
PP Crystal Pavilion B & C
DEVELOPMENT AND VALIDATION OF THE WHEELCHAIR-
RELATED SELF-EFFICACY SCALE (PORTUGUESE VERSION)
Martins A, Pais Ribeiro J; Faculdade de Psicologia e Ciências
da Educação, Universidade do Porto, Portugal
PURPOSE: Persons who adjust well to unexpected events, generally
lead healthy, active and happy lives after injury but those with
negative acceptance have a harder time accepting their changes
in appearance and have difficulty in coping. Studies showed that
a person’s confidence in being able to perform a behaviour (self-
efficacy) is a good predictor of social participation and is an
area to target in future physiotherapy contexts. Relationships have
been established between self-efficacy and a variety of functional
measures, including those of balance, instrumental activities of
daily living, and exercise adherence. As no specifically instrument
designed to measure wheelchair users perception of self-efficacy
existed, we developed the Wheelchair-Related Self-Efficacy Scale
and tested its psychometric properties. RELEVANCE: Intervention
programs over few weeks are probably insufficient to achieve
significant changes in impairments, activity limitations and restrictions
on participation with well-established chronic conditions, but clients
who are efficacious continue to perform desired behaviours learned
in treatment after they are discharged. A better understanding of
wheelchair users’ self-efficacy beliefs could help physiotherapists
develop interventions that are effective in altering their clients’
confidence, reason to choose this personal factor as a primary
outcome measure. PARTICIPANTS: Seventy three adults aged 18
to 77 years with mobility impairment severe enough to require the
continuous use of a wheelchair, who attended physiotherapy services
S76
from central regions of Portugal (68.5% from Coimbra district) took
part. METHODS: An extensive literature review was conducted to
identify general and specific self-efficacy outcome measures. The
instrument was developed through a process of item generation,
selection and scaling, according to the process consistent with
Bandura’s (1986) recommendations regarding the development of
domain-specific self-efficacy measures, and subjected to wheelchair
users to the initial validation and reliability tests. Face validity was
derived from direct patient input. ANALYSIS: Analyses included
descriptive statistics, factor analysis and Cronbach’s alpha. Ques-
tionnaires for 73 respondents (46.6% female; mean [SD] age, 39
[14.5] years; and mean [SD] number of years since adoption of
the wheelchair, 12 [7.5] years) were analyzed. RESULTS: Using
factor analysis with varimax rotation, three subscales explained
58.6% of the variance in our 13-item questionnaire. The domains
reflecting three aspects of wheelchair-related self-efficacy: symptoms
management, personal efficacy and coping. Cronbach’s alpha of
the entire instrument was 0.81, and for the three individual scales
scores were 0.80, 0.70 and 0.77, respectively. Interscale correlations
were moderate-to-high. Significant correlations were found between
domain and overall scale scores. CONCLUSIONS: The psychometric
properties of the Wheelchair-Related Self-Efficacy Scale seem to be
highly acceptable. It was easily used by a wide range of persons
without formal training and has the advantage of being very brief
and it should be a useful measure in needs assessment and
rehabilitation outcomes. Further validation of its use across diferent
cultural settings is required. IMPLICATIONS: It is important that
health professionals should have knowledge and understanding of
self-efficacy perception of wheelchair users. Physiotherapy programs
providing skills for physical training, self-management in activities
of daily living and social participation, problem-solving strategies
and gaining self-confidence depend on and influence self-efficacy.
KEYWORDS: Wheelchair users, outcome measures, self-efficacy.
FUNDING ACKNOWLEDGEMENTS: This work was unfunded.
CONTACT: anabelacmartins@mail.pt
ETHICS COMMITTEE: Faculty ethics committee
Research Report Platform Presentation
2684 Sunday 3 June 13:25
VCEC Ballroom A
SENSORIMOTOR DEFICITS IN TENNIS ELBOW: RESULTS OF
A RANDOMISED CONTROLLED TRIAL
Bisset L1 , Darnell R2 , Vicenzino B2 ; 1 Griffith University, Gold Coast,
Australia; 2 The University of Queensland, Brisbane, Australia
PURPOSE: The purpose of this randomised controlled trial was
to evaluate the effect of a physiotherapy programme, corticosteroid
injections or a wait and see approach on sensorimotor performance
in patients with tennis elbow (TE). RELEVANCE: TE is a chronic
musculoskeletal condition affecting approximately 1-3% of the
general population. The poorly understood aetiology of TE is
reflected by the multiple clinical treatments currently in use. Recent
research suggests a neurophysiological component, evidenced by
sensorimotor deficits such as upper limb reaction time and speed of
movement in the order of 11-32%. However, changes in sensorimotor
deficits in reponse to currently accepted treatments have not been
assessed. PARTICIPANTS: 198 participants aged (mean ± SD)
47.6 ±7.8 with a clinical diagnosis of unilateral TE were selected
from the general community. Exclusion criteria included bilateral
symptoms or any other systemic, neck or upper limb pathologies.
In addition, a healthy control group of 40 participants (aged 48.4
±7.7) with no history of neck or upper limb pathology were included
in the baseline data collection. METHODS: TE participants were
randomised into one of three groups: the wait and see group
received advice; the corticosteroid injection group received up to
two injections and the physiotherapy group received eight treatments
which consisted of “Mobilization with Movement” manipulation
technique and an exercise program. Outcome measures of upper
WCPT 2007, Research Reports
limb reaction time, upper limb speed of movement, pain severity
and global improvement were taken at baseline, then at 3, 6,
12, 26 and 52 weeks post-randomisation. ANALYSIS: Outcome
measures were estimated using linear mixed models with participant
defined as a random effect and treatment and time as fixed
effects (p < 0.01). Significant effects were further assessed using
ANOVAs at the primary endpoints of six and 52 weeks (p < 0.01).
Linear regression analyses were used to examine the relationship
between sensorimotor measures and patient characteristics (age,
sex, duration of condition, previous elbow symptoms, additional
treatment during follow up, recurrence of condition during follow
up). Finally, comparison of baseline and 52-week sensorimotor
measures between the TE cohort and controls were assessed using
ANOVAs (p < 0.01). RESULTS: Significant deficits in reaction time
and speed of movement in the TE group compared to controls were
confirmed at baseline (p = 0.003), with no difference between sides.
Although sensorimotor measures significantly improved over time
(simple reaction time (SRT) mean change 0-52 weeks: 17.3msec;
99%CI 11.7 to 22.9), there were no significant differences between
interventions (p = 0.718). At 52 weeks the TE cohort remained
significantly worse compared to controls (SRT mean difference
17.9msec, 99%CI 4.2 to 31.6), despite the majority of participants
reporting success (159/190). CONCLUSIONS: It appears that upper
limb reaction time and speed of movement are affected bilaterally
in unilateral TE. Sensorimotor measures change over time, but
this change is independent of treatment and not strongly related
to baseline clinical characteristics. IMPLICATIONS: Sensorimotor
deficits appear to be a part of the aetiological profile of TE,
however current treatments do not preferentially affect these deficits.
Treatments that specifically address sensorimotor deficits should be
incorporated into the overall management of patients with TE. The
clinical significance of sensorimotor deficits requires further investiga-
tion. KEYWORDS: Manual therapy, musculoskeletal, sensorimotor.
FUNDING ACKNOWLEDGEMENTS: Financial support from The
University of Queensland and National Health & Medical Research
Council (Primary Care Research), Australia #252710. CONTACT:
l.bisset@griffith.edu.au
ETHICS COMMITTEE: The University of Queensland Medical
Research Ethics Committee
Research Report Platform Presentation
958 Sunday 3 June 14:00
PP Crystal Pavilion A
SIGNIFICANT DECREASE IN SICK LEAVE USING HIGH
DOSAGE MEDICAL EXERCISE THERAPY IN PATIENTS WITH
UNILATERAL LONG LASTING SUBACROMIAL PAIN
Østerås H1 , Torstensen T, Haugerud L, Østerås B; 1 Sør-Trøndelag
University College, Trondheim, Norway
PURPOSE: Compare two different types of exercise programs in
relation to return to work in patients with long lasting subacromial
shoulder pain. RELEVANCE: There is increasing evidence that
exercise therapy is effective for this patient category, but no evidence
regarding what type of exercises and dosage is most effective
regarding return to work. PARTICIPANTS: 61 patients with unilateral
subacromial pain. METHODS: Multi center, randomized controlled
trial, where patients were randomly assigned either to a high dosage
HD medical exercise therapy group (n=30) or to a low dosage LD
exercise therapy group (n=31). Patients in the HD group performed
a total of 11 exercises consisting of 3 global exercises using a
stationary bike and 8 semiglobal and local exercises doing 3 sets
of 30 repetitions of each exercise. The LD group performed a global
exercise once for 10 minutes and performed 5 semiglobal and local
exercises doing 2 sets of 10 repetitions of each exercise. Both
groups received 3 treatments a week over 3 months. The difference
between the groups were time performing aerobic global exercises,
number of exercises, repetitions and number of sets. The patients
were supervised and the exercises were individually tailored and
Platform Presentations, Sunday 3 June
graded according to the clinical picture. Patients were assessed at
inclusion, end of treatment, at 6 and 12 months follow up. Data
on sick leave was blinded regarding intervention group and was
measured as number of days off work as well as % return to
work and was registered by the local insurance office. ANALYSIS:
Differences between the groups were analyzed using a one-tailed
Independent-Sample T-Test. RESULTS: There were no statistical
difference between the two groups at baseline. During treatment
5 patients (8%) dropped out, another 8 patients dropped out at
one year follow up. At end of treatment there was no statistical
difference between the groups, but a tendency for a higher return
to work in the in the HD group. At 6 and 12 months follow
up there was a significant difference (p < 0.05) between the two
intervention groups in favor of the HD medical exercise therapy
group. CONCLUSIONS: In patients with long lasting uncomplicated
subacromial pain, HD medical exercise therapy is an efficient
treatment approach getting more patients back to work as well as
getting patients faster back to work compared to the LD exercise
group. IMPLICATIONS: HD medical exercise therapy is an effective
treatment approach reducing sick leave significantly in patients with
long lasting subacromial shoulder pain. Patients, health professions
and third party payers should be aware that potential costs due
to long term sick leave are saved using HD medical exercise
therapy. KEYWORDS: Sick leave, shoulder pain, exercise therapy,
randomized controlled trial. FUNDING ACKNOWLEDGEMENTS:
None. CONTACT: havard.osteras@hist.no
ETHICS COMMITTEE: Regional health authorities, Nirway
Research Report Platform Presentation
806 Sunday 3 June 14:00
PP Crystal Pavilion B & C
THE RELATIONSHIP BETWEEN BALANCE, DISABILITY AND
RECOVERY AFTER STROKE
Tyson S1 , Selley A2 , Hanley M2 , Chillala J2 , Tallis R2 ; 1 Centre
for Rehabilitation & Human Performance Research, University
of Salford, Salford UK; 2 University of Manchester, Manchester, UK
PURPOSE: To examine the influence of balance on function and the
recovery of function after stroke using a balance measurement tool
that covered a wide range of abilities. RELEVANCE: Physiotherapy
is a mainstay of stroke care and in order to set suitable therapeutic
goals, devise effective treatment plans and facilitate discharge
planning information is needed about the patients’ expected degree
of recovery. The absence of static sitting balance in the acute
stages after stroke is known to be a negative predictor for recovery
but this is a relatively crude measure that affects a minority
of people with stroke. However other measures which involve a
range of balance abilities have rarely been included in predictive
models of stroke outcome. PARTICIPANTS: One hundred and
two people with weakness following 1st-time anterior circulation
stroke, 75 of whom completed follow-up assessment at 3 months
METHODS: A cross-sectional survey design was used to assess
consecutive admissions to six NHS hospitals (UK) 2-4 weeks
after stroke. The following parameters were administered in an
one-off measurement session: Demographics – age, sex, pre-
morbid disability; Stroke pathology – side of hemiplegia, stroke
type (infarct or haemorrhage), stroke severity (Oxford Community
Stroke Project Classification); Stroke related impairments – balance
(Brunel Balance Assessment), weakness (Motricity Index), Sensation
(Rivermead Assessment of Somoato-sensory Perception), Neglect
(Star Cancellation and Line Bisection tests); function (Barthel Index
and Rivermead Mobility Index). Recovery was assessed using the
Barthel Index and Rivermead Mobility Index at 3 months post-
stroke. ANALYSIS: Univariate and linear regression using the ‘enter’
method; cross-tabulations RESULTS: Balance was the strongest
predictor of function in the acute stages. Weakness was also an
independent predictor. Recovery was independently predicted by
balance, weakness, age and pre-morbid disability. At 3 months, a
S77
minority of people with limited sitting balance (0-22%) and standing
balance (25-50%) recovered independent functional mobility. Most
people who could walk initially recovered independent functional
mobility (66%-84%), but 16% suffered a decline in their mobility
and 44% had enduring limitations in everyday mobility activities.
CONCLUSIONS: Initial balance disability is a strong predictor of
function and recovery after stroke. IMPLICATIONS: The results of
this study can be used to inform clinical decision making. Balance
disability is strongly associated with function and the recovery
of function so the restoration of balance abilities should be a
physiotherapy priority. Few people with an initial loss of sitting
balance can be expected to regain independent mobility and so
physiotherapy should focus on alternative means of mobility in the
first instance. Most people who are able to walk in the acute
stages after stroke should be expected to remain independently
mobile. However a significant minority suffer a deterioration in
mobility and enduring mobility limitations at three months post-
stroke. Therefore their mobility should be monitored and they should
be offered rehabilitation to prevent deterioration and maximise
their activity. KEYWORDS: Stroke, physiotherapy, balance, recovery.
FUNDING ACKNOWLEDGEMENTS: Stroke Association, Humphrey
Booth Charities. CONTACT: s.tyson@salford.ac.uk
ETHICS COMMITTEE: SAlford & Trafford Local Research Ethics
Committee
Research Report Platform Presentation
1589 Sunday 3 June 14:00
VCEC Ballroom A
EVERYDAY PHYSICAL ACTIVITY IN EARLY RHEUMATOID
ARTHRITIS. A RANDOMIZED CONTROLLED STUDY OF A
ONE-YEAR SUPPORT PROGRAM
Brodin N1 , Eurenius E2 , H. Opava C1,3 , PARA study group4 ; 1 Division
of Physiotherapy, Department of Neurobiology, Care Sciences and
Society, Karolinska Institutet, Huddinge, Sweden; 2 Rehabcentrum,
Skellefteå Hospital, Skellefteå, Sweden; 3 Department of Medicine,
Division of Rheumatology, Karolinska University Hospital – Solna,
Stockholm, Sweden; 4 Marita Algebrandt, Linköping University
Hospital, Ingrid Almin, Örebro University Hospital, Britt Andersson,
Karolinska University Hospital/Solna, Gunhild Bertholds, Skövde
Hospital, Catarina Forsberg, Falun Hospital, Emma Haglund,
Spenshult Rheumatology Hospital, Ann-Marie Holmén-Andersson,
Sahlgrenska University Hospital, Mölndal, Anna Hultman, Uppsala
University Hospital, Claudia Lennartsson, Karolinska University
Hospital/Huddinge, and Elin Norman, Danderyd Hospital/Stockholm
PURPOSE: To evaluate the outcome of a one-year support program
for healthy physical activity behaviour in daily life among patients
wirh early rheumatoid arthritis (RA). RELEVANCE: Physical inactivity
threatens public health in the western world. The level of physical
activity among people with RA is even lower than that in the general
population. This might be due to pain and generally poor health,
but also to conceptions on benefits or risks of physical activity.
Physical activity might be even more important in people with RA
in order to prevent disability, poor quality of life and the increased
risk of comorbidity related to this condition. PARTICIPANTS: Two
hundred and twenty-eight patients (74% women, median age 56
years, disease duration one year) were randomized to an intervention
group (IG, n=94, 72% women, median age 54 years) and a control
group (CG, n=134, 75% women, median age 56 years). They
were recruited from nine rheumatology clinics in different parts of
Sweden. METHODS: Effects of a one-year support program for
healthy physical activity (30 minutes, daily, moderately intensive).
The program included extra information, frequent tests of body
functions with written feed-back, problem-solving strategies, goal-
setting for physical activity behaviour, activity logs, and a ‘personal
coach’. The control group received ‘ordinary treatment’, including
S78
general patient information and necessary prescriptions of hospital-
based training or home exercise programs with no specific follow-
up. Questionnaires on exercise and physical activity and on health-
related quality of life (Euro-QoL) were filled out and testing of joint
motion (EPM-ROM scale), muscle function (Grippit, Timed stands
test), and functional balance (walking in a figure of an 8) was
performed at the physiotherapy departments within ten days prior
to or after physician visits, where data on disease activity, including
pain and general health perception (VAS), activity limitation (HAQ),
and inflammatory activity (DAS28), were collected. ANALYSIS: Data
were analyzed with the Mann-Whitney U-test and all randomized
patients were included in the analyses with ‘Baseline value carried
forward’. RESULTS: At study start the two groups were comparable
in all investigated variables except in grip strength and functional
balance, where the IG performed better (p = 0.005 and p = 0.007
respectively). Seventy-seven (82%) patients of the IG and 114 (85%)
of the CG completed the study. After the intervention there was no
change in self-reported physical activity in either of the two groups.
However, the IG significantly improved their timed standing and grip
strength compared to the CG (p < 0.001 and p = 0.003 respectively).
Moreover, the IG improved significantly over the CG in health-related
quality of life (p = 0.026). No other changes occurred between the two
groups. CONCLUSIONS: It thus seems as if the one-year support
program resulted in improved muscle function and health-related
quality of life in these patients with early RA. Possible explanations
for our failure to demonstrate improved exercise behaviour might
be that the self-reporting questionnaires were not enough sensitive
to change or that the patients’ perception of their own physical
activity did not change. IMPLICATIONS: The present results make
a case for physical activity as a complement to medical treatment
in patients with early RA. KEYWORDS: Randomised controlled
trial, rheumatoid arthritis, physical activity behaviour. FUNDING
ACKNOWLEDGEMENTS: The Health Care Science Postgraduate
School of Karolinska Institutet, the Swedish Rheumatism Association,
the Swedish Research Council. CONTACT: nina.brodin@ki.se
ETHICS COMMITTEE: The research ethics comittée at the
Karolinska Institutet. D nr: 00-010
Research Report Platform Presentation
977 Sunday 3 June 14:00
VCEC Meeting Rooms 11-12
MEASUREMENT OF MUSCLE TORQUE IN CHILDREN BY HAND-
HELD DYNAMOMETRY: A NEW STANDARD IN REHABILITATION
Hebert L1,2 , Lepage C3 , Saulnier J3 , Crete M3 , Perron M4 ;
1 National Defense of Canada, CFHS HQ – HS Delivery, Ottawa,
Canada, K1A 0K6; 2 Faculty of Medicine, Department of Radiology,
Laval University, Quebec City, Canada; 3 Quebec Rehabilitation
Institute, Quebec city, Canada; 4 Centre de santé Valcartier,
Valcartier Garrison, Quebec City, Canada
PURPOSE: To test 1) the feasibility of a standardised protocol
for isometric muscle torque assessment in a paediatric population
using a hand-held dynamometer (HHD), 2) its intra- and inter-rater
reliability, and 3) concurrent validity with the Cybex dynamometer.
RELEVANCE: In addition to validating a new HHD protocol to assess
muscle torque in children of all ages, this study is a preliminary
step towards the establishment of reference values. PARTICIPANTS:
A random probabilistic sample was established from a student list
of a primary and secondary school. Seventy-four children from 4
to 17.5 years of age participated in the study. METHODS: The
maximum isometric torque value of 11 muscle groups was measured
with a push-pull HHD. For each muscle group, the mean of two
trials was used for the final analysis. Measurements were taken
by two independent experienced physiotherapists (E1 and E2) in
four separate sessions (S1, S2, S3, S4). To confirm feasibility, E1
assessed the 74 children in S1. To examine the reliability and the
concurrent validity, a subgroup of 20 children selected from S1 was
WCPT 2007, Research Reports
reassessed in S2, S3 and S4. In order to estimate the intra- and inter-
rater reliability, E1 assessed the strength in S2 and E2 in S3. Lastly,
E1 reassessed the muscle torque with the Cybex dynamometer in S4.
ANALYSIS: Descriptive statistics (mean and standard deviations) of
maximal isometric muscle torque values were calculated. Intraclass
correlation coefficients (ICCs) were computed to determine the intra-
and inter-rater reliability as well as the concurrent validity. The amount
of measurement error was estimated by calculating the standard
error of measurement (SEM). RESULTS: The muscle torque varied
according to the age and muscle group (p < 0.05). The intra and inter-
rater reliability of all tested muscle groups was good to excellent
(ICCs: 0.67 to 0.98) except for the plantarflexor muscles (ICC =
0.48). The concurrent validity of HHD with the Cybex was good to
excellent (ICCs = 0.69 to 0.94). The SEM was ranging from 0.5 to
8.5 Nm according to gender and muscle group. CONCLUSIONS:
The results showed that muscle torque assessment with a HHD
using the same standardized protocol with children of all ages is
feasible and has good to excellent measurement properties. The
knowledge of the SEM will allow the clinician to accurately identify
muscle weaknesses and make better conclusions about clinical
changes over time. The development of reference values of maximal
isometric muscle torque with a valid and reliable HHD protocol is
essential to characterize the normal changes expected in muscle
strength during childhood and adolescence. IMPLICATIONS: The
results of this study and our future work will establish reference
values. This will help paediatric physiotherapists to determine a well-
aimed treatment plan and evaluate the effects of therapy including
physiotherapy interventions as well as medication and surgery,
especially in children that have bilateral impairments. KEYWORDS:
muscle strength, hand-held dynamometer, paediatric rehabilitation.
FUNDING ACKNOWLEDGEMENTS: This research was supported
by a grant from the Rehabilitation Institute of Quebec City.
ETHICS COMMITTEE: The Ethic Committee of the Quebec
Rehabilitation Institute approved the study protocol
Research Report Platform Presentation
538 Sunday 3 June 14:00
VCEC Meeting Room 16
IMPACT OF A CUEING PROGRAM IN THE HOME ON
GAIT RELATED MOBILITY IN PARKINSONS DISEASE: A
RANDOMISED CLINICAL TRIAL
Kwakkel G1 , Vanwegen E1 , Nieuwboer A2 , Willems A2 ,
Rochester L3 , Jones A3 ; 1 VU University Medical Centre,
Amsterdam, The Netherlands; 2 Katholieke Universiteit, Leuven,
Belgium; 3 Northumbria University, Newcastle, UK
PURPOSE: Gait and gait related mobility problems are common in
Parkinson’s disease (PD). This study aimed to investigate a rehabil-
itation approach using cueing therapy delivered at home to improve
gait and gait related activities in people with Parkinson’s disease
as an adjunct to the overall disease management. RELEVANCE:
Gait and gait related mobility problems are common in Parkinson’s
disease (PD). PARTICIPANTS: In this multi-centre, single-blind
randomised clinical trial with cross-over design, 153 patients with
idiopathic Parkinson’s disease (PD) were recruited (65 women and
88 men, mean age of 67.1 (±7.54), Hoehn & Yahr score 2.7 (±0.6)
and Unified Parkinson Disease Rating Scale part III (UPDRS III) 33.1
(±11.3)). METHODS: Patients were randomly allocated to receive
an early or late intervention in their home consisting of three 30
minute sessions of cueing therapy per week for 3 weeks given
by trained therapists using a prototype cueing device. Outcome
measures were conducted at baseline, 3, 6, and 12 weeks by an
independent assessor who was blinded to treatment allocation. The
primary outcome measures were the Posture and Gait Score (PG-
score), gait speed, step length, step frequency, Functional Reach
test (FR), Falls Efficacy Scale (FES), Freezing of Gait Questionnaire
(FOGQ), timed tests of tandem and single leg standing. Secondary
outcome measures included Nottingham Extended Activities of Daily
Platform Presentations, Sunday 3 June
Living Scale, Parkinson’s Disease Questionnaire (PDQ-39), UPDRS
III and the Carer Strain Index (CSI). ANALYSIS: Multiple linear
regression models (designed to account for repeated measures) were
used for continuous outcomes, with a trivariate normal distribution
for error components. Data were transformed where necessary to
meet normality assumptions. The intervention effects are reported
as b and standard error (SE) for the linear regression models, odds
ratios and hazard ratios (=exp(b)) with 95% confidence intervals
for the logistic and Cox regression models, respectively. RESULTS:
Seventy-six patients were included in the early and 77 in the late
intervention group. Multiple linear regression models for repeated
measures showed a significant improvement of cueing therapy on the
PG-score (p = 0.005), gait speed (p = 0.005), step length (p < 0.0001),
FES (p = 0.03), balance (timed tandem and single leg stance tests)
(p = 0.003) and UPDRS III (p = 0.03). There was no increase in risk
of falling following intervention. Overall, the effects of intervention
were significantly reduced at 12 weeks. CONCLUSIONS: Cueing
therapy in the home improves gait and balance and does not
increase the risk of falling in PD. These effects generalize to
functional activities but do not affect overall health-related quality.
IMPLICATIONS: Cueing therapy can be seen as a useful adjunct
to the overall multidisciplinary management of patients with PD.
KEYWORDS: Parkinson’s disease, rehabilitation, cueing. FUNDING
ACKNOWLEDGEMENTS: We gratefully acknowledge the financial
support from the European Commission Framework V funding;
QLK6-2001-00120. We would like to acknowledge the contribution
of Professor Rowena Plant in gaining funding. Prof. E.C.H. Wolters
(MD, PhD), Dr. H.W. Berendse (MD, PhD), C.M. Zijlmans (MD, PhD)
Prof. R. Dom (MD, PhD), Dr D. Burn (MD) and Dr R. Walker (MD)
are acknowledged for referral of patients. We gratefully acknowledge
assistance with data analysis from S. Fieuws and K. Desloovere.
We particularly want to acknowledge the patients with Parkinson’s
disease and their carers who participated in this study. CONTACT:
g.kwakkel@planet.nl
ETHICS COMMITTEE: The study was approved by the ethics
committee of each participating University.
Research Report Platform Presentation
980 Sunday 3 June 14:00
VCEC Meeting Room 17
THE BIOMECHANICS OF CYCLING IN ADOLESCENTS WITH
AND WITHOUT CEREBRAL PALSY
Johnston T1,2 , Barr A2 , Lee S1−3 ; 1 Shriners Hospitals for Children,
Philadelphia, PA, USA; 2 Temple University, Philadelphia, PA, USA;
3 University of Delaware, Newark, DE, USA
PURPOSE: The purposes were to compare the biomechanics of
recumbent cycling between 1) adolescents with cerebral palsy (CP)
and adolescents with typical development (TD), and 2) cycling with
and without a shank guide designed to limit motion to the sagittal
plane for adolescents with CP. RELEVANCE: Cycling is a potential
intervention for fitness and general strength training in children with
CP. However, little is known about the biomechanics of cycling
in CP or which impairments are best addressed through cycling.
PARTICIPANTS: Twenty subjects (15.2 ±1.6 years) participated. Ten
subjects had TD, and 10 subjects had spastic CP and were classified
as levels III and IV using the Gross Motor Function Classification
System. METHODS: The stationary cycle had adjustable-length
crank arms, adjustable pedals, and an attached therapy bench as
the seat. The cycle was adjusted to the individual’s anthropometric
measurements and resistance provided was based on body weight.
Lower extremity joint kinematics and muscle electromyography were
measured during three 10-15 second trials. Crank position was
recorded via a rotary encoder, and 3-dimensional piezoelectric
force transducers measured force exerted on the pedals. Energy
expenditure and perceived exertion using the OMNI Scale were
collected during a 5-minute cycling test, and efficiency was calculated
(power output/metabolic input). If able, subjects were tested while
S79
cycling at 30 rpm and 60 rpm. Subjects with CP were also tested
while cycling with a shank guide designed to limit joint motion to
the sagittal plane. ANALYSIS: Non-circular data were analyzed via
mixed model ANOVAs. Circular data were analyzed using circular
t-tests. Accepted p-values were adjusted based on the number of
variables for each measure. RESULTS: Joint kinematics for subjects
with CP were different than those of subjects with TD for all motions
studied based upon crank position. Subjects with CP displayed earlier
onsets and later offsets of muscle activity, increased cocontraction of
agonist/antagonist muscles, and decreased efficiency as compared
to subjects with TD. There were no differences in perceived
exertion. Subjects with CP spent a greater percentage of the
revolution applying negative force (pulling instead of pushing) than
did subjects with TD. Use of the shank guide for subjects with
CP primarily affected joint kinematics, with few differences seen
in muscle activity and no changes seen with efficiency, perceived
exertion, or the percentage of the revolution spent applying negative
force. CONCLUSIONS: Subjects with CP appeared to use different
strategies to cycle than subjects with TD. The differences in cycling
biomechanics seen may be due to decreased strength and motor
control in the subjects with CP. Future work should examine
the outcomes of a cycling intervention for individuals with CP to
determine its effects on function, cardiovascular fitness, and the
musculoskeletal system. IMPLICATIONS: The findings of this study
can assist clinicians who use cycling as a therapeutic intervention
for individuals with CP by providing greater knowledge about cycling
strategies. KEYWORDS: Cycling, cerebral palsy, biomechanics.
FUNDING ACKNOWLEDGEMENTS: Shriners Hospitals for Chil-
dren, Grant #8530, Pediatric Section of the American Physical
Therapy Association. CONTACT: tjohnston@shrinenet.org
ETHICS COMMITTEE: Temple University Institutional Review Board
Research Report Platform Presentation
962 Sunday 3 June 14:00
VCEC Meeting Rooms 19-20
A PROSPECTIVE STUDY ON KNEE PROPRIOCEPTION AFTER
MENISCAL ALLOGRAFT TRANSPLANTATION
Thijs Y1 , Witvrouw E1 , Evens B1 , Coorevits P1 , Almqvist F2 ,
Verdonk R2 ; 1 Ghent University, Ghent, Belgium; 2 Ghent University
Hospital, Ghent, Belgium
PURPOSE: The meniscus plays an important role in the proprio-
ceptive ability of the knee joint. The aim of this prospective study
was to assess the short term influence of a meniscus replacement
on the proprioception of the knee. RELEVANCE: The results of
this study suggest that although no significant improvement of
pain and functionality of the operated knee occurred at this short
term follow-up period, a meniscal allograft transplantation seems to
have a significant positive effect on the joint position sense of the
previously meniscectomised knee. PARTICIPANTS: 14 patients who
had undergone a fresh meniscal allograft transplantation between
May 2001 and June 2003 in the Ghent University Hospital were
tested preoperatively and six months postoperatively. METHODS:
Disability regarding pain, stiffness and functionality of the affected
knee during daily activities was measured by the WOMAC-scale. The
knee joint position sense was assessed using the Biodex System
3® Isokinetic Dynamometer. ANALYSIS: Independent-Samples T-
tests were used to compare the preoperative proprioception results
of the affected knee with those of the unaffected knee. Paired-
Samples T-tests were used to test differences between the pre-and
postoperative proprioception results within the groups (operated and
contra-lateral knee). Changes in differences of the proprioception
between the affected and unaffected knee were analysed by means
of independent-samples T-tests on the change score of both groups.
The change score of a group was defined as the increase or
decrease made pre to post by that group. One-sample T-tests
were performed to determine significant differences between the
obtained proprioception results and the reference angles (30º and
S80
70º knee flexion). The results of the WOMAC-index were analysed
by paired-samples T-tests. RESULTS: The results of the WOMAC-
scale showed no significant differences concerning pain, stiffness or
knee function between the pre- and postoperative condition of the
knee. Assessment of the knee joint position sense at a reference
point of 70º of knee flexion revealed a significant improvement of
the proprioception of the operated knee at six months after surgery
compared to the preoperative condition. CONCLUSIONS: The
results of this study showed the appearance of a significant deficit
of knee joint proprioception after a total meniscectomy. Following a
meniscal allograft transplantation, a significant improvement of the
knee proprioception was seen at 70º of knee flexion at short term
(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
on the knee functionality in long term as the subjective stability
of the joint becomes more and more important when patients are
exposing their knee to higher demands in sports- or daily activities.
Therefore the results of this study are the first to suggest that the
long term functional results after a meniscal transplantation may also
be the consequence of an improved proprioception. KEYWORDS:
meniscus; meniscectomy; meniscal transplantation; proprioception;
knee joint position sense. FUNDING ACKNOWLEDGEMENTS: This
work was unfunded.
ETHICS COMMITTEE: Ethics Committee Ghent University Hospital
Research Report Platform Presentation
1512 Sunday 3 June 14:20
PP Crystal Pavilion A
EXERCISE THERAPY FOR THE MANAGEMENT OF MASSIVE
(INOPERABLE) TEARS OF THE ROTATOR CUFF: A
SYSTEMATIC REVIEW
Ainsworth R1 , Lewis J2,3 ; 1 Torbay Hospital, Torquay, UK; 2 Chelsea
and Westminster Hospital, London, UK; 3 St George’s Hospital,
London UK
PURPOSE: To review the evidence for the effectiveness of
therapeutic exercise for the treatment of massive (inoperable) tears
of the rotator cuff. RELEVANCE: Although there are many surgical
approaches for the management of full thickness rotator cuff tears,
there is little consensus as to the most effective method for repairing
massive cuff tears. There is a consensus that the outcome of rotator
cuff tendon surgery in the elderly is generally very poor. As such,
exercise therapy is usually recommended for this patient group.
Although commonly prescribed the evidence to support this approach
is equivocal. The aim of this study was to conduct a systematic review
of the literature to determine the efficacy of exercise therapy for the
management of full thickness rotator cuff tears. PARTICIPANTS:
Patients with a diagnosis of full thickness rotator cuff tears who
are treated with exercise therapy METHODS: A systematic review
was conducted to synthesise the available research literature on the
effectiveness of exercise therapy for full thickness tears of the rotator
cuff. Data Source: Reports up to and including September 2006
were located from MEDLINE, the Cumulative Index to Nursing &
Allied Health Literature (CINAHL), AMED, EMBASE, the Cochrane
Database of Systematic Reviews and the Physiotherapy Evidence
Database (PEDro) using the terms “rotator cuff” and “tear/s” and
“exercise” or “physiotherapy” or “physical therapy” or “rehabilitation”.
Study Selection: Studies were included if they related to full
thickness rotator cuff tears and exercise. Data Extraction: Two
independent reviewers assessed the methodological quality of the
studies. Differences were resolved by consensus. ANALYSIS: Data
Synthesis: 10 studies met the inclusion criteria. 8 studies were
observational case series and 2 were single case studies. There
were no randomized clinical trials. RESULTS: Only 4 studies were
specific to massive rotator cuff tears. 1 study had a subgroup with
massive cuff tears and 5 studies were not specific as to the size
of the tear. Due to the heterogeneity of outcome measures used,
WCPT 2007, Research Reports
it was not possible to combine results but in all studies patients
showed an improvement in outcome scores. Exercise programmes
were well documented in 5 studies. CONCLUSIONS: No randomised
controlled trials met the inclusion criteria and the evaluation has
therefore been based on lesser quality case series. The case series
findings suggest that some evidence exits that supports the use of
exercise in the management of rotator cuff tears. IMPLICATIONS:
There is a definite need for well planned randomized controlled trials
investigating the efficacy of exercise in the management of massive
(inoperable) rotator cuff tears. KEYWORDS: Rotator cuff tears,
exercise, systematic review. FUNDING ACKNOWLEDGEMENTS:
This work was unfunded. CONTACT: roberta.ainsworth@nhs.net
Research Report Platform Presentation
1622 Sunday 3 June 14:20
VCEC Ballroom A
EXERCISE MAINTENANCE IN RHEUMATOID ARTHRITIS –
A QUALITATIVE STUDY AMONG INDIVIDUALS WITH REGULAR
EXERCISE BEHAVIOR
Swärdh E1,2 , Biguet G1 , H. Opava C1,3 ; 1 Karolinska Institutet,
Department of Neurobiology, Care sciences and Society, Division
of Physiotherapy; 2 Karolinska University Hospital, Department
of Physiotherapy; 3 Karolinska University Hospital, Department
of Rheumatology
PURPOSE: In chronic diseases such as rheumatoid arthritis (RA),
the individual often has to make permanent changes in lifestyle and
adopt new patterns of behavior such as exercise, in order to gain and
sustain health benefits. Further, it has been suggested that behavioral
strategies for exercise maintenance might differ from strategies
for adoption. Empirical work that sheds light on the exercise
maintenance in patients with RA is however scarce, and little is known
about the patients’ perspective. The purpose of this study was to
describe various ways of perceiving and reasoning about exercise
maintenance, in individuals with RA that already have adopted an
exercise behavior in a clinical setting. RELEVANCE: Considering the
emerging self-management paradigm and the economic constraints
of health care, demands on patients to maintain their exercise
behavior outside the clinical context have increased, and this calls
for new roles of health professionals including physical therapists.
PARTICIPANTS: Fourteen women and four men with RA of at least
two years’ duration were purposefully selected to participate. They
had all performed planned regular exercise with and without support
from a physical therapist. METHODS: Semi-structured interviews
were performed. ANALYSIS: Information from the interviews was
qualitatively analyzed in accordance with the phenomenographic
method. RESULTS: Five qualitatively different behavioral categories
relating to exercise maintenance were identified. Expected effects of
exercise, the role of the physical therapist, preferable exercise setting
and personal inner strengths seemed to be the most critical factors
in explaining differences between the categories. The categories
were; external control – monitoring and safety, sticks and carrots –
demands and support, a joint venture - shared responsibility and
confidence, the easy way – incentives and confidence, and on
one’s own terms – autonomy and confidence. CONCLUSIONS:
The findings revealed a knowledge basis, which increases the
understanding of different factors that could affect the way exercise
behaviors are maintained. The categories found could be a starting
point when designing individually tailored interventions. However, the
findings also raises questions as to whether any of the maintenance
behaviors are more optimal, and how different coaching approaches
can affect exercise maintenance on the basis of the five categories.
IMPLICATIONS: In order to minimize the risk for relapse into a
non-exercise behavior, the findings of the present study emphasize
the importance of broadening individuals’ knowledge, skills and
self-efficacy related to a variety of exercise types and settings.
Physical therapists should also be aware of both the positive
Platform Presentations, Sunday 3 June
and the negative impact he or she may have on patients’ self-
management initiatives by providing different support and coaching
approaches. KEYWORDS: Chronic disease, exercise behavior,
patient perspective. FUNDING ACKNOWLEDGEMENTS: Center for
Health Care Sciences at Karolinska Institute, Swedish Associations
of Registered Physiotherapists, and the Swedish Association of
Rheumatism. CONTACT: emma.swardh@karolinska.se
ETHICS COMMITTEE: Regional Ethical Review Board in Stockholm,
Sweden (Dnr 2005/371-31)
Research Report Platform Presentation
1437 Sunday 3 June 14:20
VCEC Exhibit Hall A
TRUNCUS ENDURANCE, HIP AND ANKLE MOBILITY
AND AEROBIC FITNESS IN 15-YEAR OLD NORWEGIAN
ADOLESCENTS IN 1968 AND 1997
Sjolie A1,2 ; 1 Amot Physiotherapy Clininc, 2450 Rena, Norway;
2 Hedmark University College, 2450 Rena, Norway
PURPOSE: There are theories that physical performance in young
people is declining due to a more passive lifestyle. The purpose of
this study was to explore potential changes in truncus endurance,
ankle and hip mobility, and aerobic fitness in Norwegian adolescents
over a time interval of one generation. RELEVANCE: There seems
to be an increase in musculo-skeletal diseases and other lifestyle
disorders also in young people. The frequency of low back pain
seems also to be on the rise in both young people and adults.
As health professionals physical therapists should participate in
exploring health factors. PARTICIPANTS: The material included 1329
15-year old Norwegian adolescents in Akershus county in Eastern
Norway in 1968, and 1105 15-year old adolescents in the same
region in 1997. METHODS: The investigations were supervised by
the same conductor at both occasions, and used identical physical
tests. The test battery included tests of dynamic endurance of
abdominal and low back muscles, hip flexion, ankle dorsiflexion,
and aerobic fitness. ANALYSIS: Mean values for the variables were
estimated for girls and boys, and the ratio between abdominal
and low back endurance was calculated. The statistical differences
were analysed by two-groups T-test. The level of significance was
set to P  0.05. RESULTS: Compared to 1968 low back extension
endurance in 1997 was almost 10% lower in both genders, the
endurance of the abdominal muscles was 4.8% poorer among boys
and 8.1% higher among girls. The ratio between abdominal and low
back extension endurance had increased over time 11.8% among
boys, and 26.4% among girls. Compared to 1968 hip flexion in 1997
was 8.3% higher in girls, while ankle dorsiflexion and aerobic fitness
in boys were 15% and 13.4% poorer. Compared to 1968 ankle
dorsiflexion and aerobic fitness in girls were 4.9% poorer and 2.5%
higher, respectively. CONCLUSIONS: The data indicate a general
decline during one generation in physical performance among boys, a
decline in low back endurance, and ankle mobility among girls, and an
increase in abdominal endurance among girls. The balance between
abdominal and low back endurance was changed to a stronger
abdominal dominance in both genders. IMPLICATIONS: Though
diverging, the data indicate a need for more physical activity in young
people, in particular activities that may increase low back endurance,
the balance between low back and abdominal muscles, and ankle
mobility in both genders, as well as activities that increase aerobic
fitness in boys. Physical therapists working in public health may
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.
CONTACT: asjolie@hotmail.com
S81
Research Report Platform Presentation
1087 Sunday 3 June 14:20
VCEC Meeting Rooms 11-12
INFLUENCE OF INCREASED WAIST CIRCUMFERENCE ON
MEASURES OF HAMSTRINGS FLEXIBILITY
Croft L, Mason J, Davey C, Holland S, Lane J; Queen Margaret
University College, Edinburgh, UK
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
goal. The sit-and-reach test is the most commonly used measure
of hamstrings flexibility and is shown to have good validity and
reliability. Clinical observations however suggest that apposition of
the abdominal soft tissues in overweight subjects may affect test
results. The WHO estimates that there are 1 billion overweight
people worldwide. Therefore, it would be useful to clinicians to know
how measures of hamstring flexibility are affected by increased
waist circumference. PARTICIPANTS: 22 (19 female, 3 male) non-
overweight (waist circumference <88cm) volunteers were recruited
from a student population. METHODS: Queen Margaret University
College approved this study. Exclusion criteria were: a history of low
back pain and/or recent hamstrings injury. Each subject undertook
4 tests of hamstring flexibility both with and without a ’fat-suit’
which increased the waist circumference by 60cms, thus placing
waist circumference of all subjects into the overweight category
(>88 cm for females and >105 cm for males). The tests were: sit-
and-reach (SAR), modified sit-and-reach (MSAR), chair sit-and-reach
(CSAR) and the straight leg raise (SLR). The order of all tests was
randomised. Two raters measured each test. ANALYSIS: Intra-class
correlation coefficients (2,1) and standard error of measurement
(SEM) were used to determine inter-rater reliability for each test. An
average of both raters was used to determine differences in each test
with and without the fat-suit, using a paired t-test. The alpha level was
set at 0.05. RESULTS: Inter-rater reliability for the three SAR tests
without the fat-suit were >0.98 and with the fat-suit were >0.96. ICC’s
for the SLR were slightly lower (without fatsuit = 0.756, with fatsuit =
0.797). The SAR tests without the fatsuit had a SEM of <1.4cm and
those with the fatsuit had a SEM of <1.6cm. The SLR had an SEM of
8º without the fatsuit and 4ºwith the suit. Paired t-tests showed that
tests with the fat-suit were significantly worse(p < 0.001) than those
without. CONCLUSIONS: Inter-rater reliability was good for the three
SAR tests and was not influenced by increased waist circumference.
Inter-rater reliability of the SLR was acceptable although increased
measurement error was observed with the fat-suit. All tests with
the fatsuit were significantly worse than those without, supporting
anecdotal evidence that increased waist circumference may affect a
subjects ability to undertake the tests, placing in doubt the validity of
the tests in those with an increased waist circumference. Although
the study is limited by the fact that increased waist circumference
was simulated, the fact that each subject acted as their own control
is a strength and a unique feature of the study. Future work
may consider whether there is a direct relationship between waist
circumference and measures of hamstring flexibility. IMPLICATIONS:
Measures of hamstrings flexibility may not be valid in subjects
who are overweight. KEYWORDS: hamstrings;flexibility;overweight.
FUNDING ACKNOWLEDGEMENTS: No funding was received in
support of this study. CONTACT: jlane@qmuc.ac.uk
ETHICS COMMITTEE: Physiotherapy Subject Area, Queen Margaret
University College.
S82
Research Report Platform Presentation
1813 Sunday 3 June 14:20
VCEC Meeting Room 16
INTERNAL CUES IMPROVE GAIT PERFORMANCE IN PATIENTS
WITH PARKINSON’S DISEASE
Pimentel Piemonte M, Hitori E, Xavier G; Department of Physical
Therapy of Medical School, University of Sao Paulo
PURPOSE: The aim of this study was to verify the efficiency of
internal cues coupled with motor training in improving-performance
of gait and daily life activities (DLA) of PD patients. RELEVANCE:
Strategies to minimize the gait disruption typical of patients with
Parkinson’s disease (PD patients) have posed a great challenge
for Physical Therapy Science. External cues have proven efficient
in improving some aspects of Parkinsonian gait, although further
evidence is needed concerning the efficacy of internal cues. This
type of strategy may therefore yield significant benefits to the daily
lives of patients, who can generate and manage their own cues
independently. PARTICIPANTS: Sixty patients with idiopathic PD
were selected for the present study complaining of gait alterations,
having a mean age of 68.08 years (St.Dev.= 8.24), mean duration of
the disease of 6.78 years (St.Dev. = 3.05), comprising 24 women and
36 men, with 39 at stage 2, and 21 at stage 3 of disease evolution
according to the Hoehn and Yahr classification.All participants
signed HCFMUSP institution’s Term of Free and Informed Consent.
METHODS: The patients were randomly divided into an Experimental
group (EG), which carried out 8 sessions (twice a week) of motor
training coupled with internal cues (ICT); and a Control group (CG),
which performed control training (CT) under identical conditions to
the EG, but without the aid of cues. Internal cues consisted of
information on the sequence of movements involved in normal gait,
which were memorized and evoked verbally by patients while walking.
ANALYSIS: The (1) performance in daily-life activities according to
section II (DLA) of the Unified Parkinson’s Disease Rating Scale
(UPDRS), and (2) gait performance in terms of speed to walk
20 meters, were compared before (BT), 48 hours (AT), and 3
months after the training (3mAT), using the ANOVA variance analysis
model for repeated measurements. Those factors yielding category
differences on mean comparison then underwent the Scheffé post-
hoc test to verify level of significance, two by two. RESULTS: The
results showed a significant improvement of performance in gait
with regard to speed, exclusively for the EG after ICT (ANOVA,
F=13.181; p < 0.000001), and confirmed by the post-hoc test showing
significantly improved in speed prior to, 48 hours and 3 months
after end of training, solely for the ICT (BT X AT – p < 0.0000001;
BT X 3mAT – p < 0.0000001), associated with an improvement in
performance of DLA (ANOVA, F=95.78; p < 0.000005), and confirmed
by the post-hoc test showing significantly improved average scores
prior to, 48 hours and 3 months after end of training, solely for
the ICT (BT X AT – p < 0.0000001; BT X 3mAT – p < 0.0000001).
This performance improvement in DLA proved to be directly related
to the improvement in gait performance (r = 0.6531; p < 0.000000).
CONCLUSIONS: Motor training coupled with internal cues leads
to significant improvements in gait performance compared with the
same training without cues. IMPLICATIONS: The internal cues can
be useful in the motor rehabilitation of such patients, constituting
a straightforward, inexpensive and swift form of training for PD
patients. KEYWORDS: Parkinson’s Disease, gait, cues. FUNDING
ACKNOWLEDGEMENTS: HCFMUSP. CONTACT: elisapp@usp.br
WCPT 2007, Research Reports
Research Report Platform Presentation
1221 Sunday 3 June 14:20
VCEC Meeting Room 17
THE EFFECT OF CONTINUOUS WALKING ON THE LOWER
LIMB KINEMATICS AND SURFACE EMG OF CHILDREN WITH
SPASTIC DIPLEGIC CEREBRAL PALSY
Sale T1 , Cramp M2 , Shortland A1 ; 1 One Small Step Gait Laboratory,
Guy’s & St. Thomas’ NHS Foundation Trust, London, UK; 2 School
of Health and Bioscience, University of East London, London, UK
PURPOSE: This study was designed to investigate changes in lower
limb kinematics, electromyography (EMG) and perceived exertion
(PE) during a 6 minute continuous walking task (6MWT) in children
with spastic diplegic cerebral palsy (SDCP). We hypothesised that
the task would induce measurable fatigue in the lower limb muscles
and a change in the gait pattern. RELEVANCE: Parents of children
with SDCP report that fatigue is one of the most significant limitations
to their mobility in the community. At present, we do not know
if the fatigue reported is due to central or peripheral factors,
and distinguishing these in disabled subjects may provide more
information to guide therapeutic intervention. PARTICIPANTS: Ten
boys with SDCP, aged 8 to 16 years (10.6±2.91yrs) took part. All
were able to walk independently, and were classified as GMFCS
level I or II. METHODS: Subjects undertook a 6MWT combined with
three dimensional gait analysis. Kinematics, EMG, spatiotemporal
data and PE (modified Borg CR-10) were collected on each lap
of a 33 metre circuit. The results recorded closest to each minute
were analysed. ANALYSIS: 34 key variables were extracted from
the time-varying kinematic data (e.g. minimum knee flexion in single
support; walking speed). The amplitude and the power density
spectrum was extracted from Fourier transformed EMG data, and
the median frequency (MF) derived. Significant differences between
variables gathered at different time intervals of each subject’s 6MWT
were assessed using parametric or non-parametric 2-way analysis
of variance as appropriate, and post hoc tests conducted. Statistical
significance was set at p<0.05. RESULTS: Continuous walking
did not result in any significant changes in kinematics, despite
a statistically significant increase in PE (p<0.0001). Reduction in
MF was significant in the tibialis anterior (TA) bilaterally (p<0.05),
but not in the other muscles tested. A significant reduction in the
EMG amplitude of the medial gastrocnemius (MG) (p<0.005) was
observed bilaterally. CONCLUSIONS: The 6MWT induced classic
signs of muscular fatigue in the TA only, in spite of a highly
significant increase in perceived exertion. The reduction in EMG
amplitude of the MG muscle suggests that this muscle may be
working close to its mechanical capacity. IMPLICATIONS: If the
MG is working close to capacity in children with SDCP when
walking, muscle strengthening is likely to be beneficial in increasing
baseline strength and thereby walking endurance. However, the
child’s ability to modulate their motor unit activation may limit
the impact of a strengthening programme. Further research is
required to develop techniques to quantify the relative contributions
of neurological and mechanical factors in the motor performance of
this group. KEYWORDS: Cerebral palsy; fatigue; gait. FUNDING
ACKNOWLEDGEMENTS: This work was supported by Guy’s and
St. Thomas’ Charitable Foundation and the Chartered Society of
Physiotherapy. CONTACT: tanya.sale@gstt.nhs.uk
ETHICS COMMITTEE: Approved by the Brighton and East Sussex
Research Ethics Committee and the University of East London Ethics
Committee.
Platform Presentations, Sunday 3 June
Research Report Platform Presentation
1345 Sunday 3 June 14:20
VCEC Meeting Rooms 19-20
THE EFFECTIVENESS OF BEHAVIORAL GRADED ACTIVITY
IN PATIENTS WITH OSTEOARTHRITIS OF HIP OR KNEE: A
RANDOMIZED CONTROLLED TRIAL
Veenhof C1 , Köke A2 , Dekker J3 , Oostendorp R4 , Bijlsma J5 ,
van Tulder M3 , van den Ende C6 ; 1 Netherlands Institute for
Health Services Research, Utrecht, The Netherlands; 2 University
Hospital Maastricht, Maastricht Hoensbroek Rehabilitation Center,
Hoensbroek, The Netherlands; 3 Institute for Research in Extramural
Medicine, VU University Medical Center, Amsterdam, The
Netherlands; 4 University Medical Center St. Radboud, Nijmegen,
The Netherlands; 5 University Medical Center Utrecht, Utrecht, The
Netherlands; 6 Rheumatology Centre St Maartenskliniek, Nijmegen,
The Netherlands
PURPOSE: To determine the effectiveness of a behavioral graded
activity program (BGA) compared to usual care (UC, mainly exercise
therapy) according to the Dutch guideline physical therapy in patients
with osteoarthritis (OA) of hip and/or knee. The BGA intervention
consisted of an exercise program with booster sessions, using
operant treatment principles with the goal to increase activity levels in
the long term. RELEVANCE: There is strong evidence that exercise
therapy has a short term benefit for patients with OA. However,
beneficial post-treatment effects of exercise therapy in patients with
OA seem to decline and finally disappear. To enhance long term
effects of exercise therapy, integration of exercise therapy with
daily performed activities, based on cognitive-behavioral principles
and additional booster sessions, seems promising. PARTICIPANTS:
A total of 200 patients were included in the study. Inclusion
criteria were OA of hip or knee according to the clinical criteria
of the American College of Rheumatology. METHODS: A cluster
randomized controlled trial was performed, comparing BGA with UC.
Primary outcome measures were pain (VAS and WOMAC), physical
function (WOMAC) and global patient assessment (GPA), which were
assessed by blinded research assistants, at week 0, 13, 39 and 65.
Secondary outcome measures were, among others, physical function
(MACTAR), walking time, and exercise adherence. ANALYSIS: Data
were analysed according to intention-to-treat principle. Change
scores were calculated and were compared for the two intervention
groups using Student’s t-test. In order to adjust for various covariates,
multiple linear regression analyses were performed. Additional
subgroup-analyses were performed. RESULTS: Both treatments
showed beneficial within-group effects both in the short term and long
term. The mean differences between the two groups for the primary
outcome measures pain and functional status were not statistically
significant. Significant differences in favor of BGA were found for
the functional scale MACTAR, 5 meter walking test at week 65, and
exercise adherence. Furthermore, significant interaction effects were
found for the subgroup of patients according to their baseline-level of
physical function on the outcomes pain and physical function. This
means that patients with a low level of physical function at baseline
responded significantly better on BGA-treatment compared to UC.
CONCLUSIONS: Since both interventions resulted in beneficial long
term effects, the superiority of BGA over UC, in general, could not be
demonstrated. However, evidence was found for the particular benefit
of BGA in the subgroup of patients with a low level of physical function
at baseline. IMPLICATIONS: BGA is recommended for patients with
OA of hip and/or knee with a low level of physical function at the
start of treatment. KEYWORDS: osteoarthritis, behavioral graded
activity, exercise therapy, randomized controlled trial, subgroups.
FUNDING ACKNOWLEDGEMENTS: The study was funded by the
Dutch Health Care Insurance Board. CONTACT: c.veenhof@nivel.nl
ETHICS COMMITTEE: Medical Ethical Committee of the VU Medical
Center, Amsterdam, The Netherlands
S83
Research Report Platform Presentation
1903 Sunday 3 June 14:40
PP Crystal Pavilion A
DESIGN OF A HIGH DOSAGE MEDICAL EXERCISE THERAPY
PROGRAM FOR PATIENTS WITH UNILATERAL CHRONIC
SUBACROMIAL PAIN. A RANDOMIZED CLINICAL TRIAL
Torstensen T1 , Østerås H2 , Harms-Ringdahl K3 ; 1 Holten Institute
AB, Stockholm, Sweden; 2 Sør-Trøndelag University College, Faculty
of Health Education and Social Work, Department of Physical
Therapy, N-7004 Trondheim, Norway; 3 Karolinska Institutet,
Stockholm, Sweden
PURPOSE: Designing an effective high dosage (HD) comprehen-
sive exercise program for patients with longstanding subacromial
pain/impingement RELEVANCE: There is today no agreement what
type of exercises or exercise dosage is most effective for patients
with long lasting subacromial shoulder pain. PARTICIPANTS: Sixty
one patients with unilateral subacromial pain METHODS: The high
dosage (H)D medical exercise therapy program consisted of twenty
minutes (stationary cycle, step machine), global (G) exercise, then
four semiglobal (SG) exercises each of 3 sets og 30 repetitions
performing deloaded exercises specifically for the arm and the
shoulder using lateral pulley, single pulleys, incline board, angle
bench and varies sizes of dumbbells and barbells, then another
global exercise for 10 minutes, continuing with 3 new (SG) and
one local (L) exercise for the arm and the shoulder, and finally
finishing with a 10 minutes (G) cycle exercise. The low dosage (LD)
treatment program consisted of one (G) stationary cycle exercise of
5 to 10 minutes and then the same 5 (SG) and the one (L) exercise.
Each exercise was performed doing only 2 sets of 10 repetitions.
In both groups the physiotherapist was present supervising the
patients making sure that the exercises were performed coordinated
and regraded according to clinical changes during the treatment
period. A pain contingent treatment approach was applied by
the physiotherapist. Both treatment groups were treated 3 days
per week for 3 months. The intensity of the global exercise(s)
were similar for both groups. ANALYSIS: Differences between the
groups were analyzed using a one-tailed Independent-Sample T-
test. RESULTS: The treatment time for the (HD) group varied from
80 to 90 minutes, compared to the (LD) exercise group which
varied from 20 to 30 minutes. Number of repetitions specifically
aimed at the arm/shoulder complex for the (HD) group were 720
repetitions versus 100 repetitions for the (LD) group. Time for global
exercise was 40 minutes for the (HD) group versus 10 minutes
for the (LD) group. The difference in exercise dosage resulted in
significant reduction in pain and improved function (p < 0.05). The
compliance was similar in both groups. CONCLUSIONS: A high
exercise dosage treatment performed three times a week over 3
months with high compliance resulted in significantly better clinical
outcomes than a low dosage exercise program. IMPLICATIONS: To
get optimal dose response effects using exercise as treatment for
improving function and decreasing pain in patients with long lasting
subacromial shoulder pain, health professions should take great care
designing exercise programs consisting of global, semiglobal and
local exercises. The physiotherapist must be present in the exercise
room motivating and supporting the patient, making sure the patient
understand why the exercise program must have a high dosage.
The physiotherapist must continuously help the patient re grading
exercises making sure that they are coordinated and performed
within the patients capability with a high but at all time appropriate
dosage. KEYWORDS: Subacromial pain, high dosage exercise ther-
apy, randomized trial. FUNDING ACKNOWLEDGEMENTS: none.
CONTACT: tom.torstensen@holteninstitute.com
ETHICS COMMITTEE: Human Review Committee (Trondheim,
Norway)
S84
Research Report Platform Presentation
1485 Sunday 3 June 14:40
PP Crystal Pavilion B & C
TRAINING SITTING BALANCE EARLY AFTER STROKE: A
RANDOMIZED CONTROLLED TRIAL
Dean C, Channon E, Hall J; Physiotherapy, Faculty of Health
Sciences, The University of Sydney
PURPOSE: The purpose of this randomised placebo-controlled study
was to investigate the efficacy of a sitting balance training protocol
in individuals who had suffered a stroke less than 3 months ago.
RELEVANCE: Poor sitting balance is a common problem after
stroke, yet sitting balance has been found to be a prognostic
indicator for walking outcome. Previous work has demonstrated
the efficacy of sitting balance training protocol in individuals who
had suffered a stroke 2-17 years previous (Dean and Shepherd
1997). By examining the efficacy of the same protocol early after
stroke, this research will not only expand the physiotherapy evidence
base but also have implications for intervention early after stroke.
PARTICIPANTS: Twelve individuals who had suffered a stroke less
than 3 months ago and were able to sit unsupported were recruited
from a rehabilitation facility. METHODS: Participants were randomly
allocated to the experimental or control group. The participants in
the experimental group completed a 2 week sitting balance training
protocol that involved practicing reaching tasks beyond arm’s length.
The control group completed a 2 week sham sitting balance training
protocol that involved practicing cognitive-manipulative tasks with
minimal perturbation to balance. Sitting balance was measured
pre and post training as well as 6 months later by examining the
performance of seated reaching tasks in 3 directions (ipsilateral,
forward and across). Sit-to-stand, walking and cognitive skills were
also measured. ANALYSIS: The immediate effects of training were
analysed by comparing post training scores between groups using
ANCOVA with the pretest score as a covariate. The retention
effects were analysed by comparing the 6 month scores between
groups using ANCOVA with the pretest score as a covariate.
RESULTS: Immediately after training, subjects in the experimental
group performed significantly better than the control group on the
reaching tests (p < 0.05). Experimental participants were able to
reach further and faster in all directions and were able to load
their affected foot more when required by the task than the control
group. In addition, the experimental group generated significantly
greater force production through their affected foot during sit-to-
stand than control subjects. Only 9 participants (4 Control and 5
Experimental) were available for 6 month evaluation. The significant
differences between the groups at 6 months were maintained for
maximum distance reached in the diagonal directions and also
in force production through the affected foot during sit-to-stand.
CONCLUSIONS: The sitting balance protocol used in this study was
effective immediately in improving sitting balance and sit-to-stand
early after stroke. Some of the benefits were maintained 6 months
after training. IMPLICATIONS: This sitting balance protocol should be
implemented early after stroke. KEYWORDS: Stroke rehabilitation,
balance, sitting. FUNDING ACKNOWLEDGEMENTS: This project
was funded by a grant from the Physiotherapy Research Foundation
in Australia. CONTACT: C.Dean@fhs.usyd.edu.au
ETHICS COMMITTEE: The University of Sydney and Southeastern
Sydney Area Health Service Ethics Committtee
WCPT 2007, Research Reports
Research Report Platform Presentation
1414 Sunday 3 June 14:40
VCEC Meeting Rooms 11-12
PHYSICAL ACTIVITY MONITORING IN HEALTHY ADULTS
Moorhead A1 , Liddle D1 , Hurley-Osing D2 , Häger-Ross C3 ,
Sundelin G3 , Baxter D4 , McDonough S1 ; 1 Health and Rehabilitation
Sciences Research Institute, University of Ulster, Newtownabbey,
United Kingdom; 2 Department of Community Medicine and
Rehabilitation, Umeå University, Umeå, Sweden; 3 School of
Physiotherapy and Performance Science, University College Dublin,
Dublin, Ireland; 4 School of Physiotherapy, University of Otago,
Dunedin, New Zealand
PURPOSE: Physical activity is beneficial for health and well-
being and is commonly measured using a range of physical
activity monitors. The aim of this study was to determine the
validity and reliability of the activPAL™ activity monitor to measure
physical activity in a laboratory-based setting. RELEVANCE: There
is currently no universally accepted benchmarking for measuring
physical activity in patients with chronic conditions such as low back
pain. Therefore the use of activity monitors will more accurately
reflect exercise adherence and patterns of activity in clinical
populations. PARTICIPANTS: Twenty-four healthy participants (12
males; 12 females) were recruited (age 25.5±2.2; BMI 21.8±2.2).
Ethical approval was obtained from the School of Health Sciences
Filter Committee, University of Ulster, U.K. METHODS: In an
experimental laboratory based study, the participants participated on
two occasions, one week apart. The participants worn the activPAL™
on their thigh and conducted a defined and timed (2 minutes) set of
activities. The activities were as follows: sitting at a computer; lying on
a treatment bench; walking/jogging on a treadmill at 3.2, 4.5 (with and
without incline), 8 km/h; cycling on an exercise bike at 45, 60, 75 rpm;
walking at normal pace and controlled speed on flat ground; and stair
walking. The concurrent validity was tested by comparing the time for
each defined activity, e.g. lying/sitting, as recorded by the activPAL™
with those periods of activity measured by an independent observer
at the time of recording and afterwards via video recording. An
independent observer recorded the number of steps to compare with
those recorded by the activPAL™. ANALYSIS: Data was analyzed
using the Statistical Package for the Social Sciences version 11.0
(SPSS, Chicago, IL, USA). Descriptive statistics was conducted for
the demographic data and each of the variables. T-tests were used
to examine the differences between the variables. The reliability
of the activPAL™ was tested using the limits of agreement test.
RESULTS: The number of steps for each activity recorded by the
activPAL™, observer and video recording were not significantly
different expect for jogging on the treadmill at 8.0 km/h (P = 0.000)
and walking on a treadmill with and without incline at 4.5 km/h
(P = 0.000). The time spent sitting/lying and walking recorded by
the activPAL™ did not differ significantly from the video recording.
The inter-monitor reliability was excellent for the activPAL™, as
there were no significant differences between the two occasions.
From the limits of agreement, the activPAL™ records the same
activity on two separate occasions within the ranges of −5.19 to
5.05, 95% of the time. CONCLUSIONS: The activPAL™ is valid and
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: a.moorhead@ulster.ac.uk
ETHICS COMMITTEE: Ethical approval was obtained from the
School of Health Sciences Filter Committee, University of Ulster.
Platform Presentations, Sunday 3 June
Research Report Platform Presentation
1866 Sunday 3 June 14:40
VCEC Meeting Room 16
OUTCOMES OF A PHYSICAL THERAPY-DESIGNED
COMMUNITY EXERCISE PROGRAM FOR PERSONS WITH
PARKINSON’S DISEASE
Steffen T, Mollinger-Riemann L, Petersen C, Komassa P; Programs
in Physical Therapy, Concordia University Wisconsin, Usa
PURPOSE: To measure the effects of group exercise on physical per-
formance in persons with Parkinson’s Disease (PD). RELEVANCE:
Immobility and falls are frequent complications for persons with PD.
There is little literature addressing the long-term benefits of exercise
for people with PD. PARTICIPANTS: Forty-six individuals (mean
age 70 years) diagnosed with PD were invited to participate in a
community fitness class for persons with PD. The class exercises
were developed by a P.T. Over the course of 18 months, the subjects
naturally formed three groups: 1) those who consistently participated
in the “group-exercise program” (N=15); 2) “independent exercisers,”
those who did not participate in the program but reported exercising
greater than 120 minutes per week (N=15); and 3) those who
reported minimal or “no exercise” (N=15). Participants reported an
average of 10 years since onset of PD symptoms and 7 years since
diagnosis of PD. METHODS: The group-exercise program included
trunk and lower extremity stretching/strengthening followed by
treadmill walking (10 minutes backwards, then 10 minutes forwards).
Data were collected on tests of physical function every 2 months for
a year and at 6 months after that: Six Minute Walk Test (6MWT), Gait
Speeds (GSs), Berg Balance Scale (BBS), Timed-Up-and-Go (TUG),
Forward Functional Reach (FFR), Backward Functional Reach (BFR),
Sharpened Romberg (SR) Tests, and Unified Parkinson’s Disease
Rating Scale (UPDRS). ANALYSIS: For each outcome measure and
each group, data analysis included descriptive statistics and serial
graphing of test results with a line of best fit calculated with regression
analysis. RESULTS: The line of best fit for people in the group-
exercise program suggested improvement in the 6MWT, FFR, and
BFR, minimal slope changes in fast and comfortable GSs, BBS,
and SR (eyes open), and declines in SR (eyes closed), UPDRS
total score, and TUG performance. People who were independent
exercisers showed a trend toward improvement on the 6MWT and
BBS, minimal changes in other functional tests, and a decline in SR
(eyes closed) and UPDRS total. There was high attrition in people
who were categorized as non-exercisers making the interpretation
of the lines of best fit unreliable. CONCLUSIONS: This is the first
longitudinal study following a group of individuals with PD who
exercise. The functional test results of those who exercise on a
regular basis demonstrate not only maintenance of function but also
progression of ambulation endurance (6MWT) and balance (FFR &
BFR). The attrition rate in the non-exercisers group created limitations
in the analyses. Although 18 months is a long research timeframe,
this may not be long enough to describe the effect of exercise
for persons with PD. Inclusion of exercises specific for sit-to-stand
to improve TUG scores and balance activities with eyes closed to
improve SR (eyes closed) is suggested for future exercise programs.
IMPLICATIONS: Group exercise designed by physical therapists to
meet individual needs of those with PD may be neuroprotective
and slow the decline of function, thus reducing long-term medical
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: TERESA.STEFFEN@CUW.EDU
ETHICS COMMITTEE: Concordia University Wisconsin, USA IRB
S85
Research Report Platform Presentation
1267 Sunday 3 June 14:40
VCEC Meeting Room 17
THE RELATIONSHIP BETWEEN POSTURE, MUSCLE TONE AND
UPPER LIMB FUNCTION IN CHILDREN WITH BRAIN DAMAGE
Rotem M1 , Lewitus H1 , Katz-Leurer M1,2 , Liebermann D2 ; 1 Alyn
Hospital Jerusalem Israel; 2 Physical Therapy Department, Sackler
Faculty of Medicine, University of Tel Aviv, Israel
PURPOSE: To assess the relationship between posture and hand
motor performance and muscle activity of the lower limbs in spastic
children with cerebral palsy (CP) and traumatic brain injury (TBI).
RELEVANCE: Hypertonicity in children with CP and TBI often
interferes with functional activities. The associated increase in muscle
tone affects control of the normal muscle patterns required for
locomotion and upper extremity functions. In the treatment of such
patients, therapists make extensive use of different positions (e.g.
weight bearing while standing) to reduce muscle tone since this
is assumed to enhance motor function. PARTICIPANTS: A group
of 20 children (Patient Group), 10 children with TBI and 10 with
CP (24 male and 16 female; mean age 8+2 years) and a Control
Group matched for sex and age, group of 20 typically developed
children, participated in the study. METHODS: Upper limb motor
functioning was assessed using the Box & Blocks test (maximal
number of blocks moved from one side to other side of a box in
60 sec) in sitting and standing positions. EMG was recorded (60
sec) bilaterally from the Gastrocnemius (GA) and the Tibialis Anterior
(TA) muscles while subjects were active (B&B task) and passive (no
upper limb action) during sitting or standing. The EMG amplitudes
and frequencies were used to assess changes in muscle activity
ANALYSIS: Posture effect on hand motor performance and muscle
activity was analyzed using a repeated measure ANOVA model with
a between subjects factor of group (patients vs. controls), a within
subject factor of posture (sitting vs. standing), hand (preferred vs. non
preferred hand for motor performance) and activity (performing or not
the B&B test). RESULTS: Posture significantly associated with upper
limb functioning (p < 0.01). Patients and controls showed superior
performance with both upper limbs during standing. EMG analyses
did not fully account for such effects. The mean EMG amplitude for
the GA muscle tended to decrease during passive standing. For
the TA muscle, the mean EMG amplitude significantly increased
during standing (p < 0.01) both in active and passive conditions.
Comparisons of the averaged spectrograms of the GA and TA
(expressed as a proportion of the EMG spectrograms obtained for
the control group) showed different and complex patterns of muscle
activation in the CP and TBI subgroups. The GA muscle contribution
of fibers firing at>300 Hz was proportionally smaller in CP children as
compared to controls during sitting and passive standing, the TA was
nearly reversed in sitting conditions but not during standing. In the
TBI group the GA and the TA muscles presented a lower activation
at all firing frequencies. CONCLUSIONS: Changes in posture affect
upper limb performance but the underlying mechanisms cannot
be attributed to a reduction of muscle tone. Different postures
resulted in different patterns of muscle activation for TBI and CP
patients. IMPLICATIONS: Treating upper limb function can be ranked
by using different postures. Although hypertonicity is a common
denominator, it should not be treated as a single phenomenon in
these children in spite of similarities in their motor performance.
KEYWORDS: CP, TBI, Spasticity, Posture, Upper Limb Function.
FUNDING ACKNOWLEDGEMENTS: Alyn Hospital.
ETHICS COMMITTEE: Ministry of health in Israel
S86
Research Report Platform Presentation
1346 Sunday 3 June 14:40
VCEC Meeting Rooms 19-20
FACTORS INFLUENCING THE SUCCESS OF BEHAVIORAL
GRADED ACTIVITY IN PATIENTS WITH OSTEOARTHRITIS OF
HIP OR KNEE: A QUALITATIVE STUDY
Veenhof C1 , van Hasselt T1 , Köke A2 , Dekker J3 , Bijlsma J4 , van
den Ende C5 ; 1 Netherlands Institute for Health Services Research,
Utrecht, The Netherlands; 2 University Hospital Maastricht,
Maastricht Hoensbroek Rehabilitation Center, Hoensbroek, The
Netherlands; 3 Institute for Research in Extramural Medicine, VU
University Medical Center, Amsterdam, The Netherlands; 4 University
Medical Center Utrecht, Utrecht, The Netherlands; 5 Rheumatology
Centre, St. Maartenskliniek, Nijmegen, the Netherlands
PURPOSE: To investigate why certain patients treated with Be-
havioral Graded Activity (BGA) successfully integrate activities in
their daily lives and others do not. RELEVANCE: Recently, a
randomized controlled trial was conducted on the effectiveness
of BGA in patients with osteoarthritis (OA) of hip and/or knee,
compared to usual care (UC; exercise and advice, according to
the Dutch guideline for physical therapy). The BGA intervention is
performed by physiotherapists, aims to increase activity in the long
term and consists of an exercise program with boostersessions,
using operant treatment principles. Both interventions had beneficial
effects on pain, physical function, and patient global assessment,
both in short and in long term. However, some patients benefitted
more from BGA compared to others. PARTICIPANTS: We invited a
sample of participants treated with BGA to participate in this study.
Patients were included in the original trial if they were diagnosed
to have OA of the hip or knee according to the clinical criteria
of the American College of Rheumatology. For the present study,
we selected two sub-samples of patients based on their success
of treatment as assessed on patient global assessment (PGA).
One group of patients were selected with a low score on PGA
(ranging from completely recovered to improvement), and one group
of patients with a high score on PGA (ranging from worsened to vastly
worsened). METHODS: A qualitative study was performed, based
on open-ended in-depth interviews with 12 patients. A conservation
developed from the themes ‘aspects related to the content of
the BGA treatment’, ‘aspects related to experiences with physical
therapists’, and ‘aspects related to the patient’ and subsequent
questions were more specified. Data collection stopped after 12
interviews; no new relevant data seemed to emerge during the last
interviews. ANALYSIS: The method of data analysis was based
on a grounded theory approach. Initially, interview transcripts were
read to identify conceptual themes in the text which were then
coded. The codes in each interview were then compared and
codes expressing related concepts were grouped together to create
broader categories that linked codes across interview. RESULTS:
The findings from this study suggest that two factors influenced the
compliance of patients treated with BGA. First, patients’ motivation for
long-term goals seemed to relate to a higher compliance of patients.
Secondly, an active involvement of patients during the treatment-
process seemed to relate to a higher compliance. CONCLUSIONS:
Although the involvement of patients in the treatment process is
already part of the BGA protocol, it would be beneficial to emphasize
the importance of an active involvement of patients right from the
start of the treatment. Furthermore, to increase the success of
treatment, physical therapists should gain a clear understanding
of the patients’ motives for treatment and, subsequently, physical
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:
WCPT 2007, Research Reports
The study was funded by the Dutch Health Care Insurance Board.
CONTACT: c.veenhof@nivel.nl
ETHICS COMMITTEE: Medical Ethical Committee of VU University
Medical Center, Amsterdam, The Netherlands
Research Report Platform Presentation
2085 Sunday 3 June 15:00
PP Crystal Pavilion A
HIGH DOSAGE ENDURANCE TRAINING INCREASED MUSCLE
STRENGTH AND RANGE OF MOTION SIGNIFICANTLY IN
PATIENTS WITH LONG LASTING SUBACROMINAL PAIN
Haugerud L1 , Østerås H2 , Østerås B3 , Torstensen T4 ; 1 Moholt
Physical Institute, Trondheim, Norway; 2 Rosenborg Sport Clinique;
3 Melhus Physical Institute; 4 Holten Institute, Stockholm, Sweden
PURPOSE: Comparing two different types of exercise programs
effects on muscle strength and range of motion in patients with long
lasting subacromial shoulder pain. RELEVANCE: There is conflicting
evidence what type of training is best for improving impairments
like muscle strength and range of motion. PARTICIPANTS: 61
patients with unilateral subacromial pain. METHODS: Multi center,
randomized controlled trial, where patients were randomly assigned
either to a high dosage (HD) endurance training medical exercise
therapy group (n=30) or to a low dosage (LD) exercise therapy
group (n=31). Patients in the HD group performed a total of 11
exercises consisting of 3 global exercises using a stationary bike
and 8 semiglobal and local exercises doing 3 sets of 30 repetitions
of each exercise, a total of 80-90 minutes. The LD group performed
a global exercise once for 10 minutes and performed 5 semiglobal
and local exercises doing 2 sets of 10 repetitions of each exercise,
a total of 20–30 minutes. Both groups received 3 treatments a
week over 3 months. Patients were assessed at inclusion, end of
treatment and at 6 months follow up where isometric strength in
flexion, abduction, internal and external rotation was measured using
a using a digital dynamometer (MicroFET2, Westloch, Sweden).
Active range of motion was measured using a digital inclinometer
(Dualer IQ, JTech Medical, USA. ANALYSIS: Differences between
the groups were analyzed using a one-tailed Independent-Sample
T-Test. RESULTS: There were no statistical differences between the
two groups at baseline. During treatment 5 patients (8%) dropped out,
and another 10 patients dropped out at follow-up. At end of treatment
and at 6 months follow up the group receiving endurance training
as HD medical exercise therapy group came out significantly better
(p < 0.05) compared to the LD group with improved isometric strength
of abduction and external rotation and range of motion of flexion and
abduction. CONCLUSIONS: In patients with long lasting uncompli-
cated subacromial pain, endurance training like HD medical exercise
therapy resulted in significantly improved muscle strength and range
of motion. compared with an exercise program using number of
repetitions and sets similar to strength training. IMPLICATIONS:
Physiotherapists practicing low dosage exercise programs with only
2 sets of 10 repetitions should increase their exercise dosages to get
better clinical effects. However, there is a need for research regarding
the mechanisms behind these results understanding why patients
with pain increases both isometric muscle strength and range of
motion so significantly to an endurance type exercise program.
KEYWORDS: shoulder pain, muscle strength, range of motion,
randomized controlled trial. FUNDING ACKNOWLEDGEMENTS:
None. CONTACT: lhaugerud@yahoo.com
ETHICS COMMITTEE: Regional Ethics Committee, Norway
Platform Presentations, Sunday 3 June
Research Report Platform Presentation
1603 Sunday 3 June 15:00
PP Crystal Pavilion B & C
CHANGING PATTERNS OF DUAL TASK BALANCE
PERFORMANCE AMONG PEOPLE WITH STROKE AT SIX AND
12 MONTHS AFTER DISCHARGE FROM HOSPITAL
Hyndman D1 , Ashburn A1 , Yardley L1 , Fitton C1 ; 1 The Stroke
Association Rehabilitaton Research Centre, University of
Southampton, Southampton, UK
PURPOSE: This prospective experimental study explored the extent
and nature of changes in balance performance among people
with stroke when challenged by dual tasks at six and 12 months
post discharge from hospital. RELEVANCE: Amelioration of balance
impairments and fall prevention are important goals of stroke
rehabilitation. Cognitive motor interference has been linked to
poor recovery and falls but little is known about the patterns of
recovery of dual task balance ability. PARTICIPANTS: This study
was part of a larger project for which consecutively admitted
people with stroke were recruited at discharge from hospital. Fifty-
four participants (38 men, 16 women; mean age 66.6 sd. 11.6)
attended both assessment sessions (at six and 12 months post
discharge) at a gait laboratory. Of these, 25 had left and 29 had right
hemisphere infarctions. Twenty-three participants reported repeated
falls. METHODS: Ethics approval was obtained from Southampton
and South West Hampshire Local Research Ethics committee.
Participants completed assessments of attention, balance, functional
ability and fall history. Postural sway was examined using a Kistler
Force plate during quiet standing (under three conditions: preferred
stance, feet together and eyes closed). Tasks were performed
in isolation (multiple baselines) and whilst performing a cognitive
task. ANALYSIS: Statistical significance was tested using repeated
measures ANOVA. RESULTS: Whole sample: Between 6 and
12 months sway reduced for preferred stance (P < 0.05), feet
together (P < 0.01) but not for the eyes closed condition (P > 0.05).
At six months, the competing task influenced sway (P < 0.05)
during feet together and sway (P < 0.05) and cognitive performance
(P < 0.01) during the eyes closed condition. At 12 months sway
and cognitive performance were unaffected by the competing task
(P > 0.05) under any of the balance conditions. Repeat-fallers: A
interaction was noted for the dual task eyes closed condition;
while sway decreased over time among non-repeat-fallers, sway
increased among repeat-fallers (F=5.3, P = 0.028). At 12 months,
dual task cognitive performance during the eyes closed condition
deteriorated among repeat-fallers (F=11.7, P = 0.004); the interaction
in comparison to non-repeat-fallers just missed significance (F=4.1,
P = 0.05). CONCLUSIONS: While dual task performance influenced
sway and cognitive performance during the more demanding balance
situations at six months, most participants were able to cope with
competing tasks by 12 months post discharge from hospital. Repeat-
fallers were less able to perform the more demanding dual task
balance tasks. IMPLICATIONS: Recovery of motor and cognitive
performance should be considered together in rehabilitation to
identify clinically significant balance deficits that may be masked
under single task conditions. Dual task balance ability should be
considered when assessing fall risk. Further research is needed
to explore whether those prone to instability and falls benefit from
intervention to improve dual task balance ability in the later stages of
recovery post stroke. KEYWORDS: Stroke, Community, Dual tasks.
FUNDING ACKNOWLEDGEMENTS: This project was funded by
The Stroke Association. CONTACT: dh197@soton.ac.uk
ETHICS COMMITTEE: Southampton and South West Hampshire
Local Research Ethics Committee.
S87
Research Report Platform Presentation
2264 Sunday 3 June 15:00
VCEC Exhibit Hall A
RELATIONSHIPS BETWEEN PHYSICAL ACTIVITY AND SUN
PROTECTION IN AN ADULT STUDY POPULATION
Wilson C1 , Pandeya N2 , Green A2 ; 1 University of Queensland (UQ)
Brisbane, Australia; 2 Queensland Institute of Medical Research
(QIMR) Brisbane, Australia
PURPOSE: The primary aim of this study was to assess the physical
activity practices of an adult community with the objectives of: 1. Ex-
amining associations between skin cancer, sun protection (sunscreen
and hat use in particular) and physical activity. 2. Analysing other
possible associations with physical activity, including demographic
factors, body mass index, fruit and vegetable intake, alcohol and
smoking. RELEVANCE: A lot of physical activity takes place
outdoors. Examining the sun protective patterns of people and other
variables such as body mass index, occupation, education and
attitudes in relation to physical activity levels is important to build
the emerging evidence base on the benefits of physical activity
and the dangers of sun exposure, and to drive clinical practice
in terns of appropriate therapeutic exercise prescription in relevant
settings. PARTICIPANTS: This study was nested within a skin cancer
prevention trial in Queensland, a longitudinal study that has been
ongoing since 1986. A total of 963 people (99.2% response rate)
completed this study. METHODS: This cross sectional descriptive
study used data collected by self-administered questionnaire.
Additional information on sun protection and socio-demographic
variables was provided from data collected in previous questionnaires
between 1986 and 2002. ANALYSIS: Data analysis was carried
out using the statistical packages SPSS and SAS. Multinomial
logistic regression was used to verify the assocation between
individual variables and the outcome variable(physical activity) whilst
controlling for other predictor variables.The final multivariate model
was then analyses and reported with adjusted odds ratios, confidence
intervals and significance levels for associations with ‘some’ and
‘sufficient’ physical activity. RESULTS: Twenty nine per cent of
people, consisting of a similar proportion of males and females,
met the current international health related guideline of ‘sufficient
time and sessions’ of physical activity. The proportion of people
meeting this guideline increased progressively with age (p = 0.01).
Twenty six per cent (22% men and 28% women, p = 0.05) were
physically inactive or sedentary. These results compare unfavourably
with what is considered already low rates in the overall Australian
population and other industrialised nations. Meeting the health
guideline for sufficient physical activty was associated with a highly
significant increase in the use of sunscreen and hats (p  0.001).
The association of skin cancer with level of physical activity was
examined after adjusting for age. People who met the guideline
for sufficient activity were significantly almost twice as likely to
have skin cancer compared to sedentary people (AOR = 1.92,
95% CI =1.21 to 2.75). CONCLUSIONS: This is the first study to
explore physical activity practices in a fixed cohort involved in a
skin cancer prevention trial, and to examine the associations of sun
protection practices and other variables with physical activity levels
in adults. Only 29% of people were sufficiently active, or in other
words, over 70% of this population were either inactive or not doing
enough activity to acquire health benefits. IMPLICATIONS: Physical
activity is a cornerstone of chronic disease prevention strategy. The
need to promote greater participation in physical activty is urgent
and physiotherapists have a vital role in providing expertise and
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: cwilson@somc.uq.edu.au
ETHICS COMMITTEE: Queensland Institute of Medical Research
S88
Research Report Platform Presentation
1739 Sunday 3 June 15:00
VCEC Meeting Rooms 11-12
SHOULDER MUSCLE ACTIVITY DURING MAXIMAL ISOMETRIC
CONTRACTIONS
Boettcher C1 , Ginn K1 , Cathers I2 ; 1 Faculty of Medicine, The
University of Sydney, Sydney, Australia; 2 Faculty of Health
Sciences, The University of Sydney, Sydney, Australia
PURPOSE: 1) To identify a series of tests that could be used to
produce maximal activation for shoulder muscles during isometric
contractions, and 2) to quantify the relative electromyographic (EMG)
activation of these muscles during maximum effort isometric tests.
RELEVANCE: A detailed understanding of shoulder muscle activity
is necessary to assist in developing improved shoulder examination
and rehabilitation techniques. Maximal voluntary contractions (MVC)
have frequently been used to normalize recorded data when
examining muscle activity of the shoulder with electromyography
(EMG). Currently there are no standardized techniques for producing
MVCs for shoulder muscles and therefore comparisons of results
from different studies are difficult. PARTICIPANTS: The dominant
shoulder of 15 normal subjects between the ages of 18 and 50
years was examined. METHODS: EMG activity was recorded from
13 shoulder muscle sites using surface and intramuscular electrodes.
Rotator cuff muscles (supraspinatus, infraspinatus, upper and lower
subscapularis), scapulothoracic muscles (serratus anterior, upper,
lower and middle trapezius), and axio/scapulohumeral muscles
(anterior, middle and posterior deltoid, pectoralis major, latissimus
dorsi) were examined. Maximum isometric contractions in 15
shoulder positions were performed in randomized order. Shoulder
positions were selected for examination on the basis of their common
usage and previous research. ANALYSIS: Maxima of rectified and
low pass filtered (8th order, 3Hz) EMG were determined for all
muscles during all test positions. Repeated measure ANOVAs were
used to compare the activity level in all the muscles in all test
positions. Pairwise comparisons of maxima were also undertaken
using linear regression analysis. RESULTS: Isometric contractions
in four test positions is adequate to reliably generate an MVC from
all 12 muscles examined (p < 0.05). As well, axio/scapulohumeral
muscles were most active during positions requiring them to act
as torque producers. Scapulothoracic muscles were most active in
mid shoulder range test positions in which resistance was performed
with a long lever arm. Rotator cuff muscles were most active during
resisted rotation tests and in mid shoulder range test positions in
which resistance was performed with a long lever arm. As well,
rotator cuff, scapulothoracic, and axio/scapulohumeral muscles were
found to have highly linear relations in their levels of activation in the
15 tests performed e.g. supraspinatus and infraspinatus (R2=0.76),
supraspinatus and lower trapezius (R2=0.86), and supraspinatus and
middle deltoid (R2=0.63). CONCLUSIONS: A parsimonious set of
standardized tests for generating MVCs for shoulder muscles has
been identified. As well, results indicate that maximum isometric
shoulder tests performed in mid-range shoulder positions require
high levels of activity in the torque producing axio/scapulohumeral
muscles as well as in muscles that stabilize the humerus at the
shoulder joint and in the muscles that maintain the position of the
scapula. The high correlation of activation levels in shoulder muscles
during isometric MVC reinforces the crucial dynamic support function
of the rotator cuff and scapulothoracic muscles in normal shoulder
function. IMPLICATIONS: A standardized set of test positions for
generating MVCs will assist in future research. Results also illustrate
that shoulder muscles need to be trained in dynamic stabilizing as
well as torque producing roles when designing improved examination,
rehabilitation and training programmes. KEYWORDS: shoulder, elec-
tromyography, MVC. FUNDING ACKNOWLEDGEMENTS: None.
CONTACT: k.ginn@fhs.usyd.edu.au
ETHICS COMMITTEE: The University of Sydney Human Research
Ethics Committee
WCPT 2007, Research Reports
Research Report Platform Presentation
1790 Sunday 3 June 15:00
VCEC Meeting Rooms 19-20
PATIENTS’ PERCEPTIONS OF OUTCOME IN A RCT EXAMINING
THE EFFECTS OF HYDROTHERAPY AND SHORT-WAVE
DIATHERMY FOR RELIEF OF OSTEOARTHRITIC SYMPTOMS
Cusack T1 , McAteer M1 , Daly L2 , McCarthy C3 ; 1 UCD School
of Physiotherapy and Performance Science, Health Sciences
Centre, Belfield, Dublin 4, Ireland; 2 UCD School of Public Health
and Population Science, Health Sciences Centre, Belfield, Dublin
4, Ireland; 3 Department of Rheumatology, Mater Misercordiae
University Hospital, Dublin 7, Ireland
PURPOSE: Hydrotherapy and continuous short-wave diathermy
(CSWD) are frequently used by physiotherapists to relieve the
symptoms associated with osteoarthritis (OA) of the knee. The
primary aim of this work was to quantitatively examine the effect of hy-
drotherapy and CSWD, however it was considered equally important
to examine patients’ perceptions of their physiotherapy programme
and the subsequent results of that programme. RELEVANCE: In
order to define what patients consider important in terms of treatment
outcome they must be asked directly. This study examined the
effectiveness of the study interventions in terms of patient responses
gained at study completion. PARTICIPANTS: Patients aged between
50-70 years, presenting with osteoarthritis of their knees were
identified as potentially suitable for entry to the study from the
physiotherapy department waiting list. Patients were asked to give
informed written consent and were screened for inclusion prior to
participation. METHODS: Following a self-management programme
of education and exercise, patients were randomised to one of four
groups: combined hydrotherapy and CSWD, hydrotherapy alone,
CSWD alone and a control group that had neither intervention.
On completion of the study, structured interviews were undertaken
and tape-recorded by an independent observer unknown to the
patient. ANALYSIS: The interviews were then transcribed and
analysed according to a grounded theory approach. This involved
the identification and coding of recurring themes though out the
data. Patients’ perceptions of the interventions which they received,
together with any changes which they identified as occurring as
a result of these interventions, were analysed. RESULTS: Sixty
patients completed the study, n=15 in each group. Twenty-six of the
30 patients that had hydrotherapy as a component of their treatment
programme indicated that they had benefited from their programme
in terms of pain reduction and improved mobility, twenty-three of
the patients indicated that hydrotherapy was the most beneficial
component of their programme. Patients acknowledged that they
enjoyed the experience and indicated that they would continue to
exercise in their local swimming pool. Patients that had CSWD as
a component of their treatment programme were more likely to
indicate that they had increased pain and poorer mobility. In all groups
patients (n=23) identified that the self-management programme was
beneficial in terms of increasing their awareness and understanding
of OA while improving their mobility and stimulating them to continue
to exercise regularly. CONCLUSIONS: Hydrotherapy resulted in a
greater degree of patient satisfaction in terms of pain relief and
improved mobility than did CSWD, this concurred with the results
of the quantitative RCT. The structured self-management programme
was clearly recognised by patients as valuable and patients indicated
in several instances that they intended to modify their behaviour in
the future to include more exercise. IMPLICATIONS: Patients were
clearly perceptive in terms of recognising the beneficial components
of their treatment programme. This is clinically important since
physiotherapists frequently strive to encourage patients to modify
their behaviour for their long term benefit. It is evident from this
work that when patients perceive there has been a positive benefit
they certainly express intention to modify their behaviour in the
future. KEYWORDS: Qualitative; Hydrotherapy; Continuous short-
wave diathermy. FUNDING ACKNOWLEDGEMENTS: This work was
in part funded by the Coyle Hamilton Bursary presented annually
Platform Presentations, Sunday 3 June
by the Irish Society of Chartered Physiotherapists. CONTACT:
T.Cusack@ucd.ie
ETHICS COMMITTEE: Research Ethics Committee Mater Misericor-
diae Hospital, Eccles Street, Dublin 7
Research Report Platform Presentation
2824 Sunday 3 June 15:20
PP Crystal Pavilion A
THE INITIAL EFFECTS OF A SHOULDER MOBILIZATION WITH
MOVEMENT ON PAINFUL SHOULDERS
Teys P; The University of Queensland Brisbane Queensland,
Australia
PURPOSE: Mulligan’s mobilizations with movements (MWM) are
frequently advocated for the treatment of painful shoulders. The
objective of this study was to investigate the initial effects of a
glenohumeral MWM technique on shoulder range of movement
(ROM) and pressure pain threshold (PPT) in patients with anterior
shoulder pain. RELEVANCE: There is a dearth of high-quality trials
that support or refute the use of physiotherapy in shoulder pain.
Mobilisation with movement (MWM) is a class of manual therapy
techniques that is widely used in the management of musculoskeletal
pain. To date, no studies have investigated the effects of the MWM
in people with shoulder pain and reduced ROM. The aim of this
study was to evaluate the effect of a MWM on shoulder ROM
and PPT. PARTICIPANTS: Twenty-four participants (11 male and
13 female) aged between 20 and 64 years (mean 46.1 years SD
+ 9.86) were included in the study. The primary inclusion criterion
was the inability to elevate the arm greater than 100º because of
the presence of pain over the anterior aspect of either shoulder.
The duration of pain had to be greater than one month to ensure
that there was an established shoulder condition and less than one
year to limit the study population to those whose pain was not likely
to a result of such conditions as recalcitrant frozen shoulder. The
main exclusion criterion was shoulder pain that was deemed not
to be musculoskeletal in origin. METHODS: A repeated measures,
cross-over, double-blinded randomized, placebo controlled trial was
conducted to evaluate the initial effects of a shoulder MWM on
ROM and pain. The outcome measures (dependent variables)
used were range of glenohumeral elevation in the plane of the
scapula and PPT over the anterior shoulder, measured before and
after the application of MWM, sham and control conditions. Two
independent variables were incorporated in the research design;
treatment condition (MWM, sham, control) and time (pre-, post-
application). Prior to analysis, the average of triplicate measures of
ROM and PPT were calculated. ANALYSIS: A two-factor analysis of
variance (ANOVA) and appropriate post-hoc tests of simple effects
were then performed on each of the two dependent variables to
test the hypothesis that MWM produced changes in excess of sham
and control from pre- to post- application. (P < 0.05). RESULTS:
ROM demonstrated a significant mean improvement of 16º pre- to
post-treatment application compared with 3.9º for sham application
and 0.27º for the control condition. PPT demonstrated a significant
mean improvement of 62.5 KPa pre- to post-treatment application
compared with 25.9 KPa for the sham application and 20Kpa for
the Control. CONCLUSIONS: The results from this study indicate
that the shoulder MWM may be a useful manual therapy technique
to apply to patients with a painful limitation of shoulder elevation. It
has been demonstrated that an improvement in ROM occurs after
application of the technique. Further studies need to be performed to
investigate the duration of these effects over time. IMPLICATIONS:
This study indicates that the MWM has positive application in
the treatment of painful shoulder s KEYWORDS: Musculoskeletal,
manual therapy, shoulder pain. FUNDING ACKNOWLEDGEMENTS:
None. CONTACT: p.teys@shrs.au.edu.au
ETHICS COMMITTEE: The University of Queensland’s Medical
Research Ethics Committee
S89
Research Report Platform Presentation
1672 Sunday 3 June 15:20
PP Crystal Pavilion B & C
THE RELATIONSHIP BETWEEN FATIGUE, AEROBIC FITNESS,
AND BALANCE PERFORMANCE IN PEOPLE WITH CHRONIC
STROKE. A PILOT STUDY
Tseng B, Kluding P; University of Kansas Medical Center, Kansas
City, Kansas USA
PURPOSE: The purpose of this pilot study was to explore the
relationship between fatigue, aerobic fitness, and postural control
in subjects with various stroke severities in the lower extremity.
RELEVANCE: Fatigue is a common complaint among people
with chronic stroke. Previous research has suggested that post-
stroke fatigue can impact negatively on daily functions such as
walking ability or balance, which may increase the risk of falling.
Falls in people with chronic stroke represents a major public
health problem, however, despite the fact that many fall risk
factors have been addressed, the relationship between post-stroke
fatigue, aerobic fitness capacity, and balance deficits has not
been investigated. PARTICIPANTS: Nine subjects were recruited (2
males/7 females, mean age=56.78(±11.20) years; mean post-stroke-
time=3.96(±4.61) years). Subjects with Fugl-Myer-Lower-Extremity
(FMLE) score between 0-28 were placed in the moderate/severe
group; 29 and above in the mild group. METHODS: A Six-Minute-
Walk(6MW) test was performed to induce fatigue between two trials
of limits-of-stability(LOS) test without rest. The FMLE score, 6MW
distance, change in LOS completion time, and fatigue index(FI) were
recorded. The peak oxygen uptake(VO2peak) value was recorded
on a separate visit. ANALYSIS: Analysis of Variance(ANOVA) was
used to determine the differences in VO2peak, 6MW distance,
and LOS-time-change between the mild and the moderate/severe
group. Pearson Product Correlation Coefficient was used to analyze
the correlations between LOS-time-change, fatigue index(FI), and
VO2peak in all subjects. RESULTS: The mean VO2peak was
12.91(±3.697) ml/kg/min, 6MW distance was 969.44(±562.28) feet,
the mean change in LOS-time was 4.44(±26.66) seconds, and the
mean FI was 5.33(±2.00). Both FI and 6MW distance and showed
a strong correlation with LOS-time-change (r = 0.768, r = −0.682,
p = 0.05). VO2peak did not show significant correlation with LOS-
time-change (r = −0.416, p = 0.266) but a consistent moderate
negative correlation was observed. No significant difference was
found in VO2peak (p = 0.568), 6MW distance (p = 0.424), or LOS-
time-change (p = 0.398) between the two groups with different stroke
severity. CONCLUSIONS: Our preliminary findings indicate that
postural control can be negatively affected by the degree of fatigue
induced by distance walking in stroke survivors with diminished
aerobic fitness, regardless the stroke severity level. More specifically,
the better the endurance, the more efficient the postural control; while
the greater the fatigue detected, the less precise the postural control
after a fatigue-inducing activity. In addition, our observations also
suggested that the validity of testing people post-stroke using cycle
ergometer may be dependent on subject’s stroke severity in the lower
extremity. Because of the difficulty on cycle ergometer, future studies
should consider using a total-body-recumbent-stepper(TBRS) to
perform maximal graded exercise test in people with moderate/high
stroke severity. IMPLICATIONS: Improving aerobic fitness may
increase the resistance to fatigue or delay the onset of fatigue in
people with chronic stroke. Since fatigue is a complex measure with
multiple components, the relationship between aerobic fitness, onset
of fatigue, and postural control in people post-stroke will require
component-specific instruments and standardized fatigue-inducing
method in future investigations. KEYWORDS: stroke, fatigue,
postural control. FUNDING ACKNOWLEDGEMENTS: Unfunded.
CONTACT: ytseng@kumc.edu
ETHICS COMMITTEE: Human Subject Committee of University of
Kansas Medical Center.
S90
Research Report Platform Presentation
2438 Sunday 3 June 15:20
VCEC Ballroom A
DEVELOPING COMPREHENSIVE MODELS OF CARE FOR
ARTHRITIS: PATIENT PERSPECTIVES
MacKay C, Veinot P, Badley E; Arthritis Community Research
and Evaluation Unit, Toronto Western Research Institute, Toronto,
Canada
PURPOSE: The objectives of this study are to explore the impact
of arthritis on people living with the disease, and their perspectives
on health care delivery, including the acceptability of expanded roles
of health care providers such as physiotherapists in the provision
of specialist and community-based care. RELEVANCE: Arthritis is
a serious, disabling chronic condition for which there is no cure.
Pressure on access to services, and the need to manage the
long-term consequences of arthritis, is leading to the development
of alternative models of care and new roles for physiotherapists.
Incorporating the perspectives of people with arthritis is critical to
developing client-centred health care. PARTICIPANTS: Adults 18
years and older with a diagnosis of arthritis in Ontario were included.
Participants were recruited through a community rehabilitation
program, postings at rheumatologists’ and primary care physicians’
offices and consumer groups. METHODS: A qualitative method
using semi-structured interviews with an interview guide was utilized.
Interviews were recorded and transcribed verbatim. ANALYSIS:
Data were analyzed using a constant comparative approach to
identify common themes. RESULTS: Nineteen people participated
in the study. The majority of participants were female (17) and
had various types of arthritis, including rheumatoid arthritis and
osteoarthritis. Participants had limited disability with a mean score of
0.7, as measured by the Modified Health Assessment Questionnaire.
As well as pain and loss of mobility, the impact of arthritis
on participants’ lives included loss and change related to their
independence and sense of identity, in particular in relation to work.
Leisure activities such as sports and hobbies were often either
modified or avoided. Participants often relied on their families for
help with daily activities and emotional support. Participants identified
concerns about access including long waits for appointments and
lack of coordination between the health care system and community
resources. Participants identified a number of aspects of client-
centred care important to help them manage their disease. A
trusting and supportive relationship with one’s health care provider
was identified as being important in decision-making to be able
to take charge of the disease. Health care provider characteristics
such as empathy, knowledge and expertise in arthritis were also
identified. Education, emotional support, continuity of care, and
coordination of services were identified as important components
of health care delivery. The majority of participants were open to
receiving more of their care from health care providers, such as
physiotherapists working in expanded roles. CONCLUSIONS: The
physical and emotional strains of living with a chronic condition and
challenges in accessing the needed services are important threats
to well-being for patients with arthritis. Participants were receptive to
emerging roles of health care providers, such as physiotherapists, in
arthritis care. IMPLICATIONS: With the growing burden of arthritis,
physiotherapists can play a key role in promoting wellness and
disease management. Physiotherapists should be aware of patients’
experiences of living with chronic disease and their perspectives on
optimal care delivery. There is opportunity for the development of
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: cmackay@uhnres.utoronto.ca
ETHICS COMMITTEE: University Health Network Research Ethics
Board, Toronto, Canada
WCPT 2007, Research Reports
Research Report Platform Presentation
2414 Sunday 3 June 15:20
VCEC Exhibit Hall A
KNOWLEDGE OF STROKE AMONG HYPERTENSIVE PATIENTS
IN THE TANGA REGION, TANZANIA
Rhoda A, Tesha J; University of the Western Cape, Bellville, South
Africa
PURPOSE: The need for knowledge relating to the nature of stroke
and risk factors for stroke is still a substantial challenge in the world.
People with disabilities following stroke are lacking rehabilitation
services in developing countries due to various reasons which include
lack of knowledge about stroke and the provision of rehabilitation
services.The aim of this study is to determine the knowledge of stroke
amongst hypertensive patients. This inluded determining knowledge
of the risk factors, signs and symptoms of stroke. RELEVANCE:
Knowledge of stroke amongst at risk groups is important in the
prevention of stroke and in decreasing its impact. and Results of
this study revealed that the particpants had a low knowledge of
stroke. This information could be used by health professionals to
implement health prevention and promotion programmes relating
to stroke and hypertension. Rehabilitation professionals could also
use it to incorporate health education into their treatment regimes.
PARTICIPANTS: The study population comprised of all adult patients
with a known diagnosis of hypertension, attending the selected
hospitals for treatment and follow-up. Two hundred and fifty six
patients with hypertension were conveniently selected to partake
in the study. METHODS: A descriptive quantitative design using
a cross-sectional survey was used to collect data in the present
study. A structured self-administered questionnaire with both close
and open ended questions was used for data collection. This
questionnaire was adapted by the researcher, from the previously
used questionnaires by Wellwood et al (1994), Yoon et al (2001)
and Bogoshi et al (2003) which assesses knowledge and perception
of stroke as well as knowledge of stroke risk factors. The adapted
questionnaire was distributed to collegues in the field of stroke to
ensure content valididty.The participants completed the questionnaire
in the presence of the researcher and trained research assistants.
ANALYSIS: The Statistical Package for Social Scientist (SPSS)
version 13 and the Statistical Analysis System (SAS) version 9.1 were
employed in the analysis. These statistical tests were used to identify
the relationship between the knowledge of stroke and the socio-
demographic characteristics. The Kruskal-Wallis test was used to
establish the relationship between and within the knowledge of stroke
and the socio-demographic groups. RESULTS: Large numbers of the
particpants had a low level of knowledge of the risk factors (n=47.2%),
the signs (n=43.4%) as well as the symptoms (n=42.2%)of stroke
A statistical significance was found between the knowledge of the
risk factors of stroke and age, level of education and employment
status (p < 0.05). CONCLUSIONS: Patients with hypertention in the
Tanga region of Tanzania have low levels of knowledge of risk
factors, signs and symptoms of stroke. Health education programmes
need to be implemented to increase these patients’ knowledge of
stroke. This could decrease the occurance and consequesnces of
stroke in this population. IMPLICATIONS: Physiotherapists need
to implement health education programmes to improve the level
of knowledge of stroke in at risk groups. KEYWORDS: Stroke,
knowledge, education. FUNDING ACKNOWLEDGEMENTS: None.
CONTACT: arhoda@uwc.ac.za
ETHICS COMMITTEE: University of the Western Cape, Senate
research grants and study leave committee
Platform Presentations, Sunday 3 June
Research Report Platform Presentation
2304 Sunday 3 June 15:20
VCEC Meeting Rooms 11-12
PERCEIVED EXERTION DURING ARM CRANK EXERCISE IN
PARAPLEGIC AND ABLE-BODIED MEN
Hedlund M1 , Sojka P2,3 , Karp K3 ; 1 Department of Community
Medicine and Rehabilitation (Physiotherapy), Umeå University,
S-901 85 Umeå, Sweden; 2 Department of Community Medicine and
Rehabilitation (Rehabilitation Medicine), Umeå University, S-901
85 Umeå, Sweden; 3 Department of Surgery and Peri-Operative
Science (Clinical Physiology), Umeå University Hospital, Umeå
University, S-901 85 Umeå, Sweden
PURPOSE: To elucidate similarities and differences in ratings of
perceived exertion (RPE) and physiological responses in paraplegic
and able-bodied individuals during an exercise test. RELEVANCE:
Regulating exercise intensity using Borg’s RPE scale has been
extensively studied in able-bodied healthy people during various
types of exercises. As a result, the RPE scale is considered to be a
reliable tool for regulating exercise intensity for training prescriptions
for able-bodied subjects. Studies on perceived exertion in spinal cord
injured individuals are scarce and it has not yet been clearified
if RPE scale could be used in subjects with spinal cord injuries.
PARTICIPANTS: Six men with paraplegia (PARA) and six able-
bodied (AB) men were matched with respect to age, length and
body mass. METHODS: The subjects performed a discontinued,
progressive, maximal test on an arm crank ergometer. During the
test, the paricipants rated their perceived exertion according to Borg’s
RPE scale. In addition, oxygen uptake, heart rate and blood lactate
levels were measured. ANALYSIS: The data on RPE were plotted
for each subject against work load, oxygen uptake, heart rate and
lactate values. Comparison between groups was calculated with the
Mann-Whitney U test. RESULTS: RPE increased in a similar way with
increasing relative work intensity in both groups. However, mean RPE
was found to be around 1.5–2.5 steps lower for PARA during arm
exercise at working loads between 50-90% of VO2 peak (maximum
oxygen uptake). The difference was statistically significant (p < 0.05)
at 50% of VO2 peak. VO2 peak was statistically significantly (p < 0.01)
lower in PARA (1.8 + 0.2 l/min) than in AB (2.75 + 0.47 l/min) during
arm exercise. Blood lactate concentration of 4.0mM corresponded
to a higher percentage of VO2 peak in PARA (about 80% of VO2
peak) than in AB (about 50% of VO2 peak) during arm cranking.
CONCLUSIONS: During arm crank exercise, a similar RPE rating
was reported at a slightly higher percentage of V02 peak by PARA
than by AB. A lower increase in blood lactate level with increasing
work intensity in PARA may be an explanation to their lower RPE
ratings, according to the hypothesis that blood lactate is a major
contributor to the perception of effort. I has been suggested that
lower lactate levels in paraplegic persons during exercise is caused
by peripheral adaptations resulting from regular upper body training.
IMPLICATIONS: Borg,s RPE scale seems to be a usable tool, also for
people with paraplegia, in order to monitor exercise intensity during
arm crank exercise KEYWORDS: Spinal cord injury, oxygen uptake,
perceived exertion, exercise. FUNDING ACKNOWLEDGEMENTS:
No fundings. CONTACT: mattias.hedlund@physiother.umu.se
ETHICS COMMITTEE: The study was approved by the ethical
comimitte, Umeå University
S91
Research Report Platform Presentation
2778 Sunday 3 June 15:20
VCEC Meeting Room 16
EVALUATING THE BENEFITS OF GROUP EXERCISE
AND GROUP EXERCISE & EDUCATION PROGRAMS FOR
INDIVIDUALS WITH PARKINSON’S DISEASE (PD)
Klassen L1 , Dal Bello-Haas V1 , Sheppard M2 , Metcalfe A3 ; 1 School
of Physcial Therapy, University of Saskatchewan, Saskatoon,
Canada; 2 School of Physical Therapy, University of Saskatchewan,
Saskatoon, Canada; 3 Saskatoon Health Region, Royal University
Hospital, Saskatoon, Canada; 4 Department of Community Health
and Epidemiology, University of Saskatchewan, Saskatoon, Canada
PURPOSE: To evaluate the benefits of a group exercise program
and a group exercise & education program for community-dwelling
adults with early and mid stage PD. RELEVANCE: Individuals with
PD may benefit from community programs promoting self-efficacy
in the management of this chronic condition. There is currently
limited evidence of the benefits of combined exercise and education
programs for this population. PARTICIPANTS: Twenty-two (16 male)
individuals who completed a University of Saskatchewan Bio-
medical Research Ethics Board approved consent form participated.
Participants were 63.86 + 7.9 years of age, had been diagnosed
4.64 + 4.5 years prior to admission to the study, and presented
with Hoehn and Yahr Classification of Disability stage one (12),
stage two (6) and stage three (4). METHODS: A single blind,
randomized, pre and post test design, with a control group, an
exercise group and an exercise & education group, was used. For
12 weeks, exercise and exercise & education groups exercised
twice per week. The exercise & education group also attended an
education session once per week. The exercise program included
flexibility, strengthening, posture, balance, aerobic, and functional
task training. The education program emphasized active learning
methods and action plan development. Participants were tested
at baseline and post-intervention using the Parkinson’s Disease
Questionnaire-Short Form (PDQ – 8), the Stanford Self-Efficacy for
Managing Chronic Disease 6-Item Scale (SSE), the Northwestern
University Disability Scale (NUDS), the Schwab & England ADL Scale
(SE), the Activities-specific Balance Confidence (ABC) Scale, and
the Timed Up and Go Test (TUG). ANALYSIS: Kruskall-Wallis and
post-hoc trend analyses were used to compare the three groups.
RESULTS: There were no significant differences in scores among
groups at either pre-intervention or post-intervention evaluations.
Group differences in ABC scores approached significance at post-
intervention evaluation (.08). Post hoc analyses demonstrated: (1) a
trend toward greater improvement in PDQ-8 scores in the exercise
group, than in the exercise & education and control groups; (2) a
trend toward slight improvement in SES scores in the exercise &
education and education groups, and toward slight deterioration in
the control group; (3) a trend toward slight deterioration in NUDS
scores for all groups, with greatest deterioration in the exercise group;
(4) a trend toward improvement in SE scores for all groups; (5) and a
trend toward greater improvement in ABC and TUG scores in the
exercise & education group than in exercise and control groups.
CONCLUSIONS: Participant numbers were small, and group mean
scores were at, or above, the 80th percentile (ceiling effects) at
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
S92
ACKNOWLEDGEMENTS: Study funded by the Royal University
Hospital Foundation, Saskatoon, Saskatchewan, Canada.
ETHICS COMMITTEE: University of Saskatchewan Bio-medical
Research Ethics Board.
Research Report Platform Presentation
2206 Sunday 3 June 15:20
VCEC Meeting Room 17
THE PREVALENCE, DISTRIBUTION, AND IMPACT OF
PAIN AMONG ADOLESCENTS WITH CEREBRAL PALSY:
IMPLICATIONS FOR PREVENTION
Bartlett D, Doralp S; School of Physical Therapy, The University
of Western Ontario, London, Canada
PURPOSE: 1) to describe the prevalence of pain in adolescents with
cerebral palsy (CP) by Gross Motor Function Classification System
(GMFCS) level; 2) to describe painful body regions; 3) to describe
pain intensity; and 4) to determine the relationship between pain
intensity and effect on daily activities. RELEVANCE: Knowledge
of prevalence and characteristics of pain among children with CP
is critical for prevention and health promotion. PARTICIPANTS: A
representative sample of 104 girls and 126 boys, mean ages 14.7
(sd = 1.7) and 14.8 (sd = 1.7) years, were recruited from 18 of
19 children’s rehabilitation centres in Ontario, Canada. METHODS:
Participants completed a survey asking “have you experienced
physical pain in the past month?”. Those responding “yes” indicated
the body regions in which they experienced pain, the intensity of pain
(from 1 = very little pain to 10 = extremely painful) and the extent to
which pain interfered with daily activities (from 1 = not at all to 10 =
unable to carry out activities). ANALYSIS: Frequency distributions
described prevalence of pain and its presence in various body
regions; chi-square analysis determined differences in frequency of
pain; median and ranges of pain intensity were determined; and
Spearman’s rho determined the relationship between intensity of pain
and effect on daily activities. All analyses were done separately for
girls and boys across GMFCS levels. RESULTS: 1) 63.7% of girls
and 50.4% of boys reported pain in the past month (NS effects
of gender and GMFCS levels). 2) Pain was most frequent in the
feet & ankles, knees, and lower backs of girls and boys at levels
I, 2, 3 & 4. Participants at level IV also reported frequent pain
in the shoulders, hips, and thighs. Foot & ankle and knee pain
were also frequent at level V, but upper back and neck pain were
more common than low back pain. 3) Median values for intensity
of pain ranged from 3 to 5 for both genders, across GMFCS
levels. 4) The correlation (rs) between intensity of pain and effect
on daily activities was 0.75 (p < 0.01) and 0.82 (p < 0.01) for girls
and boys, respectively. CONCLUSIONS: More than half of the
participants in this population-based sample, regardless of gender
and GMFCS level, reported pain experiences across many body
regions at intensities sufficiently high to effect daily activities. Data
from some respondents with cognitive impairments were gathered
by proxy, which could under-estimate the prevalence and impact of
their pain experiences. IMPLICATIONS: This information contributes
to management of children and adolescents with CP by describing
the high prevalence of pain suggesting a greater focus on prevention.
Future work should focus on understanding factors that contribute to
or alleviate pain in these children. KEYWORDS: cerebral palsy, pain,
prevention. FUNDING ACKNOWLEDGEMENTS: This study was
funded by the Canadian Institutes of Health Research. CONTACT:
djbartle@uwo.ca
ETHICS COMMITTEE: The ethics committee at McMaster University,
Hamilton, Ontario, Canada.
WCPT 2007, Research Reports
Research Report Platform Presentation
2358 Sunday 3 June 15:20
VCEC Meeting Rooms 19-20
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
PURPOSE: Patient education is recommended as a first line man-
agement strategy for knee osteoarthritis (OA). For any programme to
be effective it should be tailored to the needs of the target population.
Most of the validated programmes are generic and designed for
western populations and may not be suited or acceptable to those
in different cultures. The aim of this project was therefore to
develop and conduct an exploratory testing of a patient education
programme (PEP) for women with knee OA in Saudi Arabia.
RELEVANCE: The patient education programme was delivered in
the native language of the target population (Arabic) as part of
physical therapy services within the study health care facility. It was
the first step to develop and promote self-management and client-
centred care for this population in Saudi Arabia. PARTICIPANTS:
The consented participants included (i) women with knee OA (age
between 40 and 65 years) (n=25); (ii) family members (n=21) and
(iii) Health care professionals (n=14). The programme content was
also reviewed by a group of judges; women with knee OA (n=10),
family members (n=5), health care professionals (n=5). An additional
sample of Saudi women (n=35) with knee OA took part in the
pilot testing. METHODS: The programme development consisted of
four stages; (i) Need’s assessment to study the educational needs
of the target population as perceived by women with knee OA
(n=25), family members (21), and health care professionals (n=14);
(ii) Programme development based on the needs’ assessment and
literature (iii) Programme content review by a group of judges (n=20);
(iv) Pilot testing of the programme with a sample of Saudi women
with knee osteoarthritis (n=35). Semi-structured interviews were
conducted in stages (i) and (iii). One-group-pre-post-intervention
repeated measure design was applied in the fourth stage. Due to
a lack of OA knowledge test in Arabic, a study was also conducted
to develop and validate a knee OA knowledge questionnaire. This
was used in combination with other validated tools (the Saudi
Knee Function Scale and Physical Performance Tests) and semi-
structured interviews to explore the acceptability and effectiveness
of the developed programme. ANALYSIS: The qualitative data were
analysed using a thematic framework approach while the quantitative
data were analysed using frequency tables and non-parametric
statistical measures to evaluate the variance and correlations.
RESULTS: This initial work suggested that this group of Saudi
women with knee OA have limited knowledge about their condition
and its management, limited understanding of ‘self-management’,
and no experience of educational programmes. Their perceived
benefits from the pilot study of this PEP were considerable, and
matched by improved knowledge. There were slight improvement
in other aspects such as physical function, exercise behaviour, or
joint protection. CONCLUSIONS: In conclusion, this initial work
suggests that a PEP that promotes self-management based on
client’s educational needs is acceptable in this population in Saudi
Arabia. IMPLICATIONS: This research was the first step towards
introducing patient education for rheumatic conditions in physical
therapy services in Saudi Arabia, which promotes self-management
and client-centred care. KEYWORDS: Patient education – knee
osteoarthritis – Saudi Arabia. FUNDING ACKNOWLEDGEMENTS:
This research was part of the PhD project of the first author, who
was sponsored by King Saud University in Riyadh, Saudi Arabia.
ETHICS COMMITTEE: Research Ethics Committee at King’s College
London (UK) and the Research Ethics Committee at King Khalid
University Hospital (Saudi Arabia)
Platform Presentations, Sunday 3 June
Research Report Platform Presentation
3096 Sunday 3 June 15:40
PP Crystal Pavilion A
CAN TAPING REDUCE ACROMIOCLAVICULAR JOINT
SEPARATIONS? A RADIOGRAPHIC EFFICACY STUDY IN
PATIENTS WITH ACUTE SPRAIN
Forwell L; Fowler Kennedy Sport Medicine Clinic and The University
of Western Ontario, London, Canada
PURPOSE: ACJ sprains are a common musculoskeletal injury
world-wide. There are over 70 different operative and non-operative
methods of treatment. Grade I and II injuries are not considered
for surgical repair but become symptomatic with residual problems
occurring in 70, 75, and 100% with grade I, II and III injuries
respectively. A taping technique has been proposed as a simple,
inexpensive, method of directly reducing the ACJ following injury.
The efficacy of taping for ACJ sprains has not been evaluated.
The present study evaluates the radiographic effects of taping
on ACJ separation. RELEVANCE: Physiotherapists world-wide are
faced with the acute and chronic management of ACJ injury. An
effective and available taping technique will facilitate care and
enhance the effects of rehabilitation. PARTICIPANTS: Subjects were
part of a larger ongoing randomized controlled trial evaluating the
effect of taping on long term functional outcomes. Subjects, age
18-65, sustained an ACJ sprain, as diagnosed by a physician,
within the previous 10 days. Subjects had to complete functional
outcome questionnaires in English and had no previous or associated
injuries to the shoulder, neck or thoracic spine or an allergy to
adhesives. METHODS: Ten patients were randomly allocated to
either a taping or sham-taping group. Standard xray views of
the shoulder and ACJ were taken without weights before, then
after, application of the assigned taping technique. Four pieces of
leucospore tape were laid across the ACJ using different directions
of pull. With the taped group, cranio-caudal pressure was applied
for reduction of the joint. In the sham group, no pressure or pull
was exerted. Ethics approval was obtained from the Institution’s
Research Ethics Board for Health Sciences Research. ANALYSIS:
Clavicle-to-acromion distances with and without tape were compared
in both the sham tape and true tape groups using paired t-tests.
RESULTS: Four patients were randomized to the sham tape group.
Six patients were randomized to the true tape group. Mean +/−
standard deviations were 4.63 mm +/− 2.29 mm without tape and
4.58 mm +/− 1.59 mm with tape, and 6.0 mm +/− 1.55 mm without
tape and 7.50 mm +/− 3.15 with tape, for the sham and true
tape groups, respectively. Changes were not statistically significant
(p = 0.96 and 0.14 for sham and true tape groups, respectively).
Mean changes with tape were 0.05 mm decrease (95% CI: −2.92,
3.01) and 1.5 mm increase (95% CI: −3.68., 0.68) for the sham and
true tape groups, respectively. CONCLUSIONS: Based on current
numbers, taping does not appear to reduce acute AC joint separation.
Owing to the wide confidence intervals, further data collection
is required. IMPLICATIONS: Health care professionals world-wide
are still searching for evidence-based, effective management for
ACJ sprains. Future work involving more subjects is required, and
might include: potential proprioceptive effects of taping, longterm
outcomes, different taping protocols, compliance and assessing the
effectiveness of family/friend application. KEYWORDS: acromioclav-
icular, RCT, taping. FUNDING ACKNOWLEDGEMENTS: Hip Hip
Hooray, Canadian Orthopaedic Foundation; Lawson Health Research
Institute. CONTACT: lforwell@uwo.ca
ETHICS COMMITTEE: University of Western Ontario Research
Ethics Board for Health Sciences Research Involving Human
Subjects (HSREB)
S93
Research Report Platform Presentation
2117 Sunday 3 June 15:40
PP Crystal Pavilion B & C
RELATIONSHIP BETWEEN STANDING BALANCE AND
HEALTH-RELATED QUALITY OF LIFE AFTER MILD OR
MODERATELY-SEVERE STROKE
Garland J1,2 , Ivanova T1 , Mochizuki G3,4 ; 1 School of Physical
Therapy, University of Western Ontario, London Canada;
2 Department of Physiology & Pharmacology, University of Western
Ontario, London, Canada; 3 Centre for Stroke Recovery, Sunnybrook
Health Sciences Centre, Toronto, Canada; 4 Toronto Rehabilitation
Institute, Toronto, Canada
PURPOSE: The purpose of this study was to examine the
relationship between standing balance and health-related quality
of life in individuals following mild and moderately-severe stroke.
RELEVANCE: Although it is often assumed that improvements in
functional balance and mobility will enhance an individual’s quality of
life, the relationship between balance and quality of life has yet to
be established in individuals post-stroke. PARTICIPANTS: Twenty-
four volunteers, who had sustained a stroke one month previously,
participated in the study. Subjects were categorized into mild (n=13)
and moderately-severe (n=11) groups. METHODS: This inception
cohort study had evaluations of functional and physiological balance
at 1 month and 3 months following stroke. Functional balance and
mobility were assessed using the Clinical Outcome Variables Scale
(COVS). Physiological standing balance was evaluated by having
subjects stand quietly with each foot on a separate force platform
and perform a rapid unilateral arm raise perturbation with the non-
paretic arm. The SF-36 was administered to evaluate health-related
quality of life. Age- and sex-matched normative Canadian data for
the SF-36 were used for comparison with subjects following stroke.
ANALYSIS: The area of the 95% confidence ellipse for the center
of pressure (CP) position quantifies the postural sway. The CP
ellipse area was the outcome measure for physiological balance.
The SF-36 has two summary scores: physical component summary
(PCS) and mental component summary (MCS). Two-way repeated
measures ANOVA (factors; time, group) were used for the COVS,
PCS, and MCS. Three-way repeated measures ANOVAs (factors;
time, group, side) were performed on the CP ellipse area. One-
way ANOVAs were used to compare PCS and MCS scores at
1 month and 3 months post-stroke with matched normative data,
for each group separately. Associations between quality of life and
balance were determined for all subjects combined with Pearson
correlations. RESULTS: Subjects in both groups had significant
improvements in the COVS, CP ellipse area, and PCS, between
one and three months post-stroke. The PCS was significantly lower
than normative values in both groups at both one and three months.
No difference in the MCS scores between normative data and
individuals following stroke was found in either group or at either
time. There were moderate significant correlations between the
PCS scores and COVS (r = 0.53) and CP ellipse area (r = −0.40)
at one month post-stroke but only between the PCS and COVS
at three months (r = 0.56). There was no correlation between MCS
scores and balance measures at either time. CONCLUSIONS: In this
study, the PCS but not MCS was negatively affected by stroke and
remained lower than normative values at three months post-stroke.
The significant correlation between PCS and balance measures at
one-month may indicate that the influence of impaired physiological
balance on quality of life is strongest in the acute phase post-
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
S94
Heart and Stroke Foundation of Ontario grants NA4838 and T5131.
CONTACT: jgarland@uwo.ca
ETHICS COMMITTEE: Research Ethics Board for Health Sciences
Research Involving Human Subjects, University of Western Ontario
Research Report Platform Presentation
2439 Sunday 3 June 15:40
VCEC Ballroom A
THE IMPACT OF A 4 WEEK MULTIDISCIPLINARY EDUCATION
PROGRAMME IN AN OUTPATIENT RHEUMATOLOGY SERVICE
Nolan M, O Gorman A, Doyle C; St James’s Hospital, Dublin 8,
Ireland
PURPOSE: Considerable evidence suggests that patient education,
especially that based on self-efficacy theory, leads to significant and
sustained improvements in the health status of patients with rheuma-
toid arthritis (RA). The multi-disciplinary team (physiotherapist,
occupational therapist, clinical nurse specialist) piloted this education
programme in a hospital setting with the following aims; increasing
self-efficacy, improving health status, influencing joint protection
behaviours, providing a group support network and promoting
compliance with therapy recommendations and self management
behaviours. RELEVANCE: Due to the chronic unpredictable nature
of RA, it has been found that health professionals need to assign
much importance to patient education as the majority of the
treatment must be undertaken in the home. Currently there does
not appear to be any formal multidisciplinary education programme
for patients with RA in operation in the Republic of Ireland, a forum
which has been shown to be of significant benefit to this patient
population. PARTICIPANTS: 17 subjects, all female, aged between
33 and 73 years (mean age 51.88 years), disease duration varied
from 18 months to 35 years (mean duration 15.15 years) were
recruited from the rheumatology, physiotherapy and occupational
therapy clinics. Purposeful sampling was used. METHODS: 4
education groups were completed, each group was of 4 weeks
duration, with 2 and 1/2 hours of education once per week. The
programme included education regarding the condition, medication
management and joint protection. The physiotherapy component
specifically looked at the role of exercise, exercise prescription,
pacing principles, action planning and goal setting. Pre and post
outcome measures were used to evaluate the programme. These
included the Arthritis Self – Efficacy Scale, the Health Assessment
Questionnaire, AIMS II short form, EuroQol, the Joint Protection
Knowledge Questionnaire, grip strength and pain verbal report scale.
A patient satisfaction survey was also utilized to gather relevant
qualitative data. ANALYSIS: Paired t-tests were used to compare
pre and post measurements. SPSS (v12) was used for statistical
analysis. RESULTS: All subjects completed the study. Improvements
in the Arthritis Self-Efficacy Scale (p < 0.001) and Joint Protection
Knowledge Questionnaire (p < 0.059) and the affect component of the
AIMS II (p < 0.059) were statistically significant. The improvements
in the VRS (p < 0.078) and EuroQol (p < 0.098) approached but did
not reach statistical significance. CONCLUSIONS: The initial results
suggest that this education programme is of benefit to patients with
RA, in terms of increasing self-efficacy, joint protection knowledge
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
abilities and decreased health care utilisation. Incorporating an
education programme, that is a proven forum to increase a
participants self efficacy, into standard physiotherapy care, needs
to be considered. Continued positive results from arthritis patient
education programmes cannot be ignored and need to be taken
into consideration when developing physiotherapy standards of care
for this patient population. KEYWORDS: RA, education, multi-
disciplinary. FUNDING ACKNOWLEDGEMENTS: Arthritis Ireland.
CONTACT: physiorheumatology@stjames.ie
ETHICS COMMITTEE: SJH/AMNCH Research Ethics Committee,
Tallaght Hospital, Tallaght, Dublin, Ireland
WCPT 2007, Research Reports
Research Report Platform Presentation
2896 Sunday 3 June 15:40
VCEC Exhibit Hall A
PERCEIVED BENEFITS FROM A REHABILITATION PROGRAM –
A STUDY ON PATIENTS WITH BURNOUT
Ahlgren C1 , Stenlund T2,3 , Steinholtz K3 , Slunga-Birgander L3 ,
Fjellman-Wiklund A1 ; 1 Dep Community Medicine and Rehabilitation,
Physiotherapy, Umeå University, Umeå, Sweden; 2 Dep Public
Health and Clinical Medicine, Occupational Medicine, Umeå
University, Umeå, Sweden; 3 Center for Occupational and
Behavioural Medicine, University Hospial, Umeå, Sweden
PURPOSE: One hundred and thirty-nine persons with burnout had
participated in a rehabilitation study for one-year. They had been
randomized to a program with 30 sessions of a cognitive group
treatment and Qigong once a week (REST A) or to a program
with Qigong alone once a week (REST B). The aim of the present
study was to evaluate the programs with respect to the participant’s
subjectively perceived benefits. RELEVANCE: It is important that
rehabilitation programs are based on measures relevant for the
patient group in focus. In order to assure that, it is important to include
participant’s subjective experiences from the program in parallell with
objective measures. PARTICIPANTS: 18 persons with burnout, 5
women and 4 men from each of the programs REST A and REST
B were included. Mean age 45.6±7.4 years. METHODS: Thematic
interviews were conducted with each person. The interviews were
taped and transcribed verbatim. ANALYSIS: The transcripts from
the interviews were analyzed using a qualitative analyze method,
Grounded Theory. In the analysis core concepts and subcathegories
were defined as well as the relation between cathegories. RESULTS:
The overall theme in all interviews regardless of rehabilitation
program was that rehabilitation is an ongoing process with ups
and downs. Persons in the two programs had both similar and
program-specific experiences of benefits from the programs. Core
concepts emerging in the analyses were Recognition and Hope.
The concepts were constructed from slightly different experiences
depending on program attendance. Recognition in REST A was
constructed from shared experiences with other participants and
theoretical explanations given in the cognitive treatment group, while
Recognition in REST B was based on shared experiences with
other participants and bodily reactions during Qigong sessions. The
concept Hope was in both groups constituted of attitude and guidance
from the rehabilitation staff. This, together with program-specific self-
help tools learnt during the rehabilitation, was perceived to give hope
for the future. CONCLUSIONS: Rehabilitation programs for persons
with burnout was perceived as empowering by the participants and
gave them hope for the future. IMPLICATIONS: The use of qualitative
methods in systematic evaluations of treatment programs can give
new and unexpected knowledge. This knowledge can be valuable
in the development of new programs. KEYWORDS: Burnout,
Qualitative method, Interview. FUNDING ACKNOWLEDGEMENTS:
The study was funded by the Swedish Council for Working Life and
Social Research. CONTACT: christina.ahlgren@physiother.umu.se
ETHICS COMMITTEE: The Research Ethics Committee of Umeå
University approved of the study. (Um dnr 02-311)
Research Report Platform Presentation
2849 Sunday 3 June 15:40
VCEC Meeting Rooms 11-12
STEPPING OUT: AN INVESTIGATION INTO THE LEVEL OF
AGREEMENT BETWEEN THREE MEASURES OF STEP COUNT
Baer G1 , O’Loughlin H; 1 Dept of Physiotherapy, Queen Margaret
University College, Edinburgh, Scotland, UK
PURPOSE: This study aimed to investigate the levels of agreement
between three clinical methods of measuring step count. The tools
under investigation were a pedometer (Yamax Digiwalker SW-200),
a new physical activity monitor (ActivPalTM) and video observation
Platform Presentations, Sunday 3 June
(used as the criterion standard). RELEVANCE: Regular physical
activity is associated with improved physical and mental health.
Measures of step count are commonly used to infer levels of
physical activity. One commonly cited recommendation to ensuring
an appropriate level of physical activity is taking 10,000 steps per
day (Hatano et al 1993), however valid and practical methods of
measuring physical activity can be problematic. The step count
measurement methods require to be accurate and robust for
routine clinical use over prolonged periods and for diverse activities.
PARTICIPANTS: Twenty healthy subjects were recruited (4 male, 16
female, mean age 24.8 + 2.6 years). Ethical approval was received
from Queen Margaret University College, Edinburgh. METHODS:
Pilot work was undertaken to determine the study protocol and
exact location of pedometers and activPal. Subjects wore two
pedometers (one on each leg) and an activPal on the dominant
(Dom) leg for one free-living day. During the day each subject
participated in a 30 minute trial of treadmill walking at 2.5 kilometres
per hour(km/h), 5 km/h and jogging at 7.5 km/h. The treadmill trial
was video recorded to provide a criterion measure of step count.
ANALYSIS: Data were checked for normality of distribution using
Shapiro-Wilkes test. Levels of agreement between methods were
assessed using the Bland & Altman method (Bland & Altman 1986),
calculated as the difference in step-count between two methods
plotted against the mean of both. Percentage errors in step count
were also calculated for pedometer and activPal against criterion
video observation. RESULTS: The pedometers demonstrated poor
levels of agreement with observation and large error in step count at
2.5 km/h (mean error (ME) −21% non-dominant (non-Dom) leg, and
ME −33 Dom). Pedometers showed very good levels of agreement
with observation at both 5 km/h (ME +0.8% non-Dom, and ME
+0.18% Dom) and at 7.5 km/h (ME = +0.03% non-Dom and ME
−0.05% Dom). ActivPal had very good levels of agreement with
observation at 2.5 km/h (ME −0.42%) and 5 km/h (ME −0.15%) but
showed poor agreement with observation at the higher velocity of
7.5 km/h (ME +18.2%). CONCLUSIONS: Results indicated that the
Yamax SW-200Pedometer is a suitable tool for measuring step count
in populations that ambulate at >5 km/h or whose activities include
regular jogging at 7.5 km/h. At velocities of 2.5 km/h and 5 km/h
activPal appears a more appropriate means of measuring step count.
Data obtained with the Yamax pedometer at a velocity equivalent
to 2.5km/h and the activPal at velocity of 7.5km/h should however
be viewed with extreme caution. IMPLICATIONS: When measuring
step count as an indication of physical activity, therapists need to
take into account likely walking speed and select the appropriate
measurement tool for the population under investigation. Reference:
Hatano et al 1993 International Council for Health, Physical Education
and Recreation 294-328 KEYWORDS: Pedometer; activity monitor;
levels of agreement. FUNDING ACKNOWLEDGEMENTS: This work
was unfunded. CONTACT: gbaer@qmuc.ac.uk
ETHICS COMMITTEE: Queen Margaret University College, Edin-
burgh, UK
Research Report Platform Presentation
2961 Sunday 3 June 15:40
VCEC Meeting Room 16
RELIABILITY OF FUNCTION, BALANCE, SELF-EFFICACY
AND QUALITY OF LIFE MEASURES IN INDIVIDUALS WITH
PARKINSON’S DISEASE
DalBello-Haas V1 , Klassen L1 , Sheppard M2 , Metcalfe A3 ; 1 School
of Physical Therapy, University of Saskatchewan, Saskatoon, SK
CANADA; 2 Saskatoon Health Region, Royal University Hospital,
Saskatoon, SK, CANADA; 3 Department of Community Health and
Epidemiology, University of Saskatchewan, Saskatoon, SK, CANADA
PURPOSE: To determine the reliability of commonly used measures
in people with Parkinson’s Disease (PD). RELEVANCE: PD, a
neurodegenerative disorder of the basal ganglia, causes gait
disturbances, postural instability, and interference with activities
S95
of daily living (ADL) and psychosocial function. Because random
performance fluctuations are common in people with PD, reliable
measures are necessary to adequately assess physical and psy-
chosocial function in clinical and research settings. PARTICIPANTS:
Six female and 17 male community-dwelling, ambulatory adults
with PD who completed a University of Saskatchewan Biomedical
Research Ethics Board approved consent form participated. Subjects
were 64.13±7.81 years of age, had Mini-Mental State Examination
Scores of 27.43±2.52, had had PD for 4.57±4.41 years, and were
in Stages 1 (n = 13), 2 (n = 6), or 3 (n = 4) of the Hohn & Yahr
Classification of Disability. METHODS: Subjects completed a self-
report demographic and health questionnaire and were evaluated
twice (number of days between Time 1 and Time 2 = 12.92±5.08)
by the same evaluator and at approximately the same time of the
day on the following measures: (1) PD Questionnaire-Short Form
(PDQ-8), an 8-item questionnaire that asks about health status;
(2) The Northwestern University Disability Scale (NUDS), a 5-item
scale that asks about walking, dressing, eating, washing and speech
abilities; (3) the Schwab & England ADL Scale (SE), a scale that
asks the person to rate overall independence in activities from
0% to 100%; (4) The Activities-specific Balance Confidence (ABC)
Scale, a 16-item scale that examines how confident an individual
feels in doing various activities without losing balance or becoming
unsteady; (5) the Timed Up and Go Test (TUG), a timed test that
asks the individual to rise from a chair, walk 3 meters, turn, return
to the chair and sit down; and (6) the Stanford Self-Efficacy for
Managing Chronic Disease 6-Item Scale (SSE), a scale that asks the
person about how well he/she thinks different aspects of a disease
can be managed. ANALYSIS: Descriptive statistics were calculated.
Test-retest reliability coefficients were determined using intraclass
correlation (ICC (3,1)) for the TUG. Spearman rho was used to
determine test-retest reliability for the remaining categorical scales.
Cronbach’s alpha was used to examine internal consistency reliability
of the PDQ-8, NUDS, ABC and SSE. RESULTS: ICC coefficient for
test-retest reliability of the TUG was 0.70, p = 0.00, 95% CI [0.40,
0.86]. Spearman rho correlations for test-retest reliability of the PDQ-
8, NUDS, SE, ABC, SSE were 0.75, 0.75, 0.68, 0.74, and 0.64,
respectively (p = 0.00). Cronbach’s alpha for the PDQ-8, NUDS, ABC,
SSE was 0.78, 0.77, 0.88 and 0.96, respectively. CONCLUSIONS:
Internal consistency of the PDQ-8, NUDS, ABC, and SSE was
good to excellent. Test-retest reliability of the PDQ-8 and NUDS
was good, while TUG, SE, ABC, and SSE test-retest reliability
was moderate. IMPLICATIONS: The high variability of performance
within and between persons who have PD makes assessing
physical and psychosocial function a challenge. The PDQ-8, NUDS,
ABC, SE TUG and SSE are easy to administer and exhibited
moderate to good reliability in our sample. KEYWORDS: Parkinson’s
Disease, reliability,. FUNDING ACKNOWLEDGEMENTS: The Royal
University Hospital Foundation, Saskatoon, SK, Canada. CONTACT:
vanina.dalbello-haas@usask.ca
ETHICS COMMITTEE: University of Saskatchewan Biomedical
Ethics Board
Research Report Platform Presentation
824 Sunday 3 June 16:15
PP Crystal Pavilion A
A TASK-ORIENTED BALANCE PROGRAM FOR OLDER
INDIVIDUALS AND THOSE AGING WITH CHRONIC
DISABILITIES REDUCES FEAR OF FALLING
Perez C1,2 , Lamontagne A1−3 ; 1 Jewish Rehabilitation Hospital,
Laval, Quebec, Canada; 2 Centre de recherche interdisciplinaire en
réadaptation du Montréal métropolitain (CRIR), Montreal, Canada;
3 McGill University, Montreal, Canada
PURPOSE: To study the effects of a ten week exercise program on
balance, mobility, fear of falling and general well being. RELEVANCE:
Balance problems in the elderly and individuals with chronic
neuromuscular conditions such as stroke often lead to decreased
S96
autonomy and falls. Fear of falling can further limit their activities
which contributes to greater functional decline. Evidence shows that
individually-tailored, task-oriented interventions are most effective in
treating balance problems and reducing fall risk yet few hospital-
based programs exist. This study examined the effects of an out-
patient balance program, Programme d’Exercices de la Rééducation
de l’Équilibre (P.E.R.E.), specifically designed for older individuals
aging with chronic disabilities. PARTICIPANTS: 14 subjects (mean
age 70.8) participated in this study. Subjects were either directly
referred to the P.E.R.E. program or screened from an existing
physiotherapy waiting list for treatment of problems of balance or
mobility. METHODS: Treatment was provided bi-weekly for 10 weeks.
This consisted of an individual session which targeted modifiable
factor(s) involved in balance control and a small group class which
trained task-specific skills with focus on sensory challenges. The
Berg Balance Scale (BBS), Timed “up & go” (TUG), comfortable and
fast gait speeds, Falls Efficacy Scale (FES) reflecting fear of falling,
and the SF-36 Health-Related Quality of Life Questionnaire were
administered pre and post intervention. At a 3 month follow-up the
BBS, TUG and gait speed were assessed. ANALYSIS: Descriptive
statistics were used to explore main demographic characteristics.
One-way repeated measures ANOVA for BBS, TUG, and gait speeds
and paired Student t tests for FES and the cumulative SF-36
physical (PCS) and mental(MCS) scores were performed. Statistical
significance was set at alpha (a)  0.05. RESULTS: Comparisons of
post versus pre scores revealed significant improvements in BBS,
TUG, fast gait speed and FES. The average gains ranged from 9%
to 56% with the lowest change in Berg and the highest in FES. No
significant differences between post-treatment and follow-up were
found. Results for the SF-36 revealed a significant positive change
in the MCS. Subject age, gender and baseline measures were not
associated with the magnitude of improvements. CONCLUSIONS:
Aging individuals with chronic disabilities significantly benefit from
a structured balance program. The gains made in balance and
walking abilities were maintained for at least 3 months. The dramatic
reduction in fear of falling is of particular interest as it is a known
risk factor for falls. Additionally, the program led to a significant boost
in the mental well-being of our patients, which may be related to
this decreased level of fear. Providing effective balance treatment
and reducing unhealthy fear is essential to the physical and mental
well-being of older people. IMPLICATIONS: People with balance
problems often develop fear of falling which intensifies with aging.
This leads to enormous functional and emotional consequences.
Clinicians must consider assessing this fear more regularly and
incorporating self-efficacy techniques along side appropriate balance
training. Further research is needed to increase our understanding of
how to enhance balance confidence in patients as well as to study the
impact this improvement may have on falls incidence. KEYWORDS:
Balance, Aging, Fear of falling. FUNDING ACKNOWLEDGEMENTS:
Jewish Rehabilitation Hospital Clinician’s Salary Award. CONTACT:
cperez_hjr@ssss.gouv.qc.ca
ETHICS COMMITTEE: Jewish Rehabilitation Hospital Ethics Com-
mittee and Centre de recherche des institutions de rééadaptation
#CRIR-178-0905
Research Report Platform Presentation
627 Sunday 3 June 16:15
PP Crystal Pavilion B & C
THE EFFECT DIFFERENT ‘UPRIGHT’ SITTING POSTURES HAVE
ON TRUNK MUSCLE ACTIVATION IN PAIN-FREE SUBJECTS
O’ Sullivan P1 , Dankaerts W1,2 , Burnett A1 , Farrell G1 , Jefford E1 ,
Naylor C1 , O Sullivan K1,3 ; 1 School of Physiotherapy, Curtin
University of Technology, Perth, Western Australia; 2 Department
of Rehabilitation Sciences and Physiotherapy, Ghent University,
Ghent, Belgium; 3 Department of Physiotherapy, University of
Limerick, Ireland
PURPOSE: To compare trunk muscle activation in three different
sitting postures: Two different ‘upright’ sitting postures (‘thoracic
WCPT 2007, Research Reports
upright’ and ‘lumbo-pelvic upright’) and slump sitting. RELEVANCE:
Clinical observations suggest that both upright and slump sitting
postures can exacerbate low back pain. There has been substantial
research on the effects of slump sitting on trunk muscle activation.
There has been little research however, investigating the effects of
different upright sitting postures on trunk muscle activation, with
some confusion over whether upright sitting results in increased
muscle activation. PARTICIPANTS: 22 healthy adults (13M, 9F)
with no history of low back pain were recruited from the Perth
metropolitan region for this study. Their mean age was 32 years
(SD ±13 years), mean height 172 cm (SD ±10cm) and mean
weight 71kg (SD ±11 kg). METHODS: A normative within-subjects
single-group study. Spinal-pelvic curvature (Fastrak™) and surface
electromyography (Bortec™) of six trunk muscles were measured
bilaterally in two ‘upright’ (thoracic and lumbo-pelvic) sitting postures
and slump sitting. Trunk muscle activation was normalised to
maximum voluntary isometric contraction. ANALYSIS: One-way
ANOVA’s with repeated measures were used to detect differences
between the three sitting postures (thoracic upright, lumbo-pelvic
upright and slump sitting) in terms of spinal-pelvic curvature, pelvic
angle and trunk muscle activation. Within-subject contrasts were
used to detect further differences. RESULTS: Thoracic upright,
compared to lumbo-pelvic upright, sitting showed significantly greater
thoracic extension (p < 0.001), with significantly less lumbar extension
(p < 0.001) and anterior pelvic tilt (p = 0.03). Further, there was
significantly less superficial lumbar multifidus (p < 0.001) and internal
oblique (p = 0.03) activity, with significantly greater thoracic erector
spinae (p < 0.001) and external oblique (p = 0.04) activity in thoracic
upright sitting. Interestingly, there was no significant difference in
superficial lumbar multifidus activity between thoracic upright and
slump sitting. CONCLUSIONS: Different upright sitting postures
resulted in altered trunk muscle activation patterns. Thoracic upright,
when compared to lumbo-pelvic upright, sitting involved less co-
activation of the local spinal stabilising muscles, such as lumbar
multifidus and internal oblique. IMPLICATIONS: This study helps
explain why ‘thoracic upright’ sitting may be associated with reduced
activation of local spinal stabilising muscles. These results highlight
the need for clinicians to be highly specific when teaching upright
sitting posture in subjects with low back pain if the aim of the
intervention is to facilitate the local spinal stabilising muscles. Further
research is needed to study the responses to these sitting postures
in subjects with low back pain. KEYWORDS: Electromyography,
Lumbar spine, Sitting posture. FUNDING ACKNOWLEDGEMENTS:
None. CONTACT: P.OSullivan@curtin.edu.au
ETHICS COMMITTEE: Ethical approval was obtained from the
Curtin University Human Research Ethics committee, Perth, Western
Australia.
Research Report Platform Presentation
1021 Sunday 3 June 16:15
VCEC Ballroom A
EXERCISE THERAPY IN THE MANAGEMENT OF HIP
OSTEOARTHRITIS: A SYSTEMATIC LITERATURE REVIEW
Simmonds M, Boocock M, McNair P, Larmer P, Steel L; Physical
Rehabilitation Research Centre, AUT University, Auckland, New
Zealand
PURPOSE: The benefits of strength training programmes in
patients with osteoarthritic knees have been well established in the
literature. This support has been extrapolated to the management
of osteoarthritis of the hip, with little documented evidence. The
purpose of this study was to critically review literature evaluating
the effectiveness of exercise therapy in the management of
hip osteoarthritis. RELEVANCE: Osteoarthritis is fast becoming
a significant problem within modern society due to the ageing
population and increasing longevity. Second to the knee, the hip
is the most common large joint affected by osteoarthritis. Within
western populations, estimates place prevalence rates at between
Platform Presentations, Sunday 3 June
3 and 11%. The consequences of this condition are significant,
with sufferers often afflicted by considerable pain, loss of function,
disability and impaired quality of life. Unless effective strategies
for the management of osteoarthritis can be identified, there will
inevitably be an increased burden placed on the health care
system. PARTICIPANTS: not applicable METHODS: An extensive
standardised keyword list was developed and used in a systematic
literature search of fifteen electronic databases. The search identified
interventional studies as well as previous systematic or critical
reviews. The quality of each article was critically appraised according
to the Generic Appraisal Tool for Epidemiology and then graded
according to a modified version of the Cochrane Scoring System.
ANALYSIS: To allow an appreciation of the overall level of evidence to
support specific exercise-based interventions, a ‘pattern of evidence’
approach was used. The overall level of evidence assigned to an
exercise intervention was based upon the number of studies, study
design and the quality rating ascribed to each study. RESULTS: More
than 4000 articles were identified, of which 338 were considered
suitable for abstract review. Following abstract review, 39 studies
were considered suitable for full text review. Only six intervention
studies met the inclusion criteria. No review papers met the
selection criteria as hip data was not analysed independently of
other conditions. CONCLUSIONS: There was a distinct lack of
well-designed studies specifically targeted at the exercise therapy
management. However, some evidence was found to suggest that ex-
ercise therapy can be an effective short-term management approach
for reducing pain levels and improving hip function. Furthermore,
there is some evidence to support the use of manual therapy,
inclusive of joint stretches, manual traction and traction manipulation.
IMPLICATIONS: Traditional exercise approaches, such as strength
training, appear to offer benefits for the short-term management of
osteoarthritis of the hip. However future consideration should be
given to establishing the optimal exercises and levels of exposure
necessary for achieving long term gains, as well as the cost
effectiveness of this type of therapy. KEYWORDS: Hip osteoarthritis,
exercise therapy, rehabilitation. FUNDING ACKNOWLEDGEMENTS:
Nil. CONTACT: marian.simmonds@aut.ac.nz
Research Report Platform Presentation
1459 Sunday 3 June 16:15
VCEC Ballroom B & C
SCALES TO ASSESS THE METHODOLOGICAL QUALITY OF
RANDOMIZED CONTROLLED TRIALS – A SYSTEMATIC REVIEW
Armijo Olivo S1 , Macedo L1,2 , Gadotti I1 , Fuentes J1 , Liddle N1 ,
Magee D1 ; 1 Faculty of rehabilitation Medicine, University of Alberta,
Edmonton, Canada; 2 University of Sydney, Sydney, Australia
PURPOSE: Methodological quality assessment is a topic of great
debate in clinical research and medicine based evidence. The quality
assessment of Randomized Controlled Trials (RCTs) is important
in order to accurately identify the effectiveness of therapeutic
treatments. There are numerous scales that have been used to
evaluate methodological quality in different health areas. However,
the most appropriate scale to evaluate methodological quality in
RCTs in the physical therapy area is still under discussion. The
purpose of this systematic review was to summarize the content,
construction, development, and psychometric properties of scales
used to evaluate the quality of RCTs in health research and identify a
good scale for physical therapy practice. RELEVANCE: Good quality
assessment tools closely related to the physical therapy scope are
needed in order to identify more accurately the efficacy of physical
therapy interventions PARTICIPANTS: Non Applicable METHODS:
Extensive electronic databases searches along with a manual search
were performed. The electronic search included studies from 1965 up
to November 8, 2005 including Medline, Embase, Cinahl, ISI Web of
Science, EMB Reviews-Cochrane Central register of controlled Trials
and Cochrane Library and Best Evidence, CDSR, ACP journal Club,
DARE, CCTR, Global health, and HealthSTAR databases. Key words
S97
used in the search were: scale, critical appraisal, critical appraisal
review, appraisal of methodology, research design review, quality
assessment, randomized controlled trial, and RCT ANALYSIS:
Five independent reviewers screened the publications for inclusion
criteria and extracted data regarding content, construction, special
features and psychometric properties for each scale. All reviewers
critically analyzed and discussed the information provided by the
scales. RESULTS: Twenty nine relevant studies were identified.
These studies accounted for 10 scales (Jadad scale, Cho & Bero
Scale, Reisch’s Scale, Consort Scale, Maastrich Scale, Chalmers’s
Scale, Andrew’s Scale, Pedro Scale, Detsky’s Scale, and OxforPain
Validity Scale (OPVS)) and their adapted scales. Most of the
analyzed scales have not been rigorously developed following the
methodological standards and have not been tested for validity,
responsiveness, and reliability in the areas to which they have
been applied. The most used scales in the physiotherapy area are
Jadad and PEDro scales. However, these scales do not provide
the most comprehensive measure of methodological quality for
physical therapy trials. CONCLUSIONS: Based on the findings of
this systematic review, there are many scales used to evaluate
the methodological quality of RCTs in health research. However,
there are few original scales that have been developed with that
objective. The readers should carefully choose a scale based on
its psychometric properties and its area of development when
assessing methodological quality. IMPLICATIONS: The quality and
development of the scales to assess the methodological quality
of RCT needs to be improved. More standardized and practical
quality assessments tools closely related to the physical therapy
practice are needed. KEYWORDS: Randomized controlled trials,
methodological quality assessment, Physical Therapy. FUNDING
ACKNOWLEDGEMENTS: This study was supported by Alberta
Provincial CIHR Strategic Training Program in Bone and Joint Health,
Izaak Walton Killan scholarship from the University of Alberta,
Physiotherapy Foundation of Canada and MECESUP Government
of Chile Scholarship. CONTACT: sla4@ualberta.ca
Research Report Platform Presentation
643 Sunday 3 June 16:15
VCEC Meeting Rooms 11-12
ELECTROPHYSICAL AGENTS IN PHYSIOTHERAPY PRACTICE
AND EDUCATION: STILL A GOOD IDEA AFTER ALL THESE
YEARS?
Chipchase L1 , Williams M1 , Robertson V2 ; 1 School of Health
Sciences, University of South Australia, Adelaide, SA 5000,
Australia; 2 University of Newcastle, Teaching and Research Unit,
Gosford, NSW 2250, Australia
PURPOSE: To ascertain the views of registered Australian phys-
iotherapists on the role of electrophysical agents (EPAs) in
physiotherapy practice and entry-level education. RELEVANCE:
EPAs are a fundamental clinical physiotherapy management tool
and have long been included in entry-level education programs.
Changes in the global health-care environment including shifts to
evidence-based practice, the emphasis on health promotion and the
emergence of the generic health worker, have led many authors
to question the place of EPAs within contemporary physiotherapy
practice. Changes to professional education with the rapid growth
in scientific knowledge and clinical techniques being used place
strains on ever-expanding entry-level curricula. In relation to EPAs,
the profession appears to be at a cross-road. Should EPAs
remain mainly in the province of physiotherapy practice? Does the
profession want to remove or maintain knowledge of EPAs as a
core foundational skill? PARTICIPANTS: All registered, practicing
physiotherapists, whose names were on a state registration board
in Australia were invited to participate. Physiotherapists who were
retired, working overseas or not practicing physiotherapy were
excluded. METHODS: An observational cross-sectional methodology
was used to survey registered physiotherapists in Australia (a total
S98
of 12893 physiotherapists). The survey was piloted for reliability
and validity. The questionnaire included open and closed-ended
questions. The three page double-sided survey was designed to elicit
information on EPA usage and practice as well as perceptions of its
relevance in current entry-level education. The survey was mailed
to Australian physiotherapists between November 2005 and March
2006. ANALYSIS: Continuous, categorical and nominal data were
analysed using standard descriptive statistics. Open ended questions
were analysed using thematic content analysis. RESULTS: 3538
completed questionnaires were returned (27.4% response rate). The
average age of respondents was 39.4 (SD 10.6) years. Approximately
three quarters of respondents (78.1%) indicated that EPAs should
remain a treatment tool administered primarily by physiotherapists
whereas 21.1% indicated that other professions should be able to
use EPAs. Close to the total sample (98.1%) agreed that EPAs
should remain in the entry-level physiotherapy curriculum. Analysis
of the open-ended question seeking reasons behind this belief
produced several common themes: EPAs usefulness as a treatment
adjunct; common use in clinical practice; perception of efficacy;
community expectation; maintenance of professional boundaries;
safety/medicolegal issues and the belief that knowledge of EPAs
is integral to entry-level physiotherapy education. However, many
respondents indicated that the breadth of EPAs taught should be
reduced and focused on those known to provide clear therapeutic
benefits or commonly used in clinical practice. CONCLUSIONS:
This sample of Australian physiotherapists expressed a strong
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
EPAs should remain a physiotherapy specific tool and that the
teaching should remain within the entry-level curriculum. The results
should be useful to educators and curriculum planners. The results
need to be viewed in light of the response rate which, despite
efforts to maximize, remained low. KEYWORDS: Electrophysical
agents, physiotherapy practice, entry-level curriculum. FUNDING
ACKNOWLEDGEMENTS: No funding was received for this study.
CONTACT: lucy.chipchase@unisa.edu.au
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
1359 Sunday 3 June 16:15
VCEC Meeting Room 16
CONCEPTIONS ABOUT PARTICIPATING IN A CONSTRAINT
INDUCED MOVEMENT THERAPY GROUP IN SUBJECTS WITH
STROKE, AN INTERVIEW STUDY
Kusoffsky A, Biguet G; Karolinska Institutet, Department of
Neurobiology, Caring Sciences and Society, Division of Physiotherapy
PURPOSE: Constraint Induced Movement Therapy (CIMT) has
showed promising training effects regarding the spontaneous use of
the paretic arm and hand in subjects with stroke in some controlled
studies. One difficulty in assessing CIMT lies in identifying which
components are the active or essential elements. Another issue
is that little attention has been given to the patients’ reactions to
this intervention. The purpose of the study was to explore and
describe how subjects with stroke perceive and respond to CIMT
in a group. RELEVANCE: Although research has reported good
rates of compliance, the participants’response to CIMT has not
been studied deeply. PARTICIPANTS: Eleven subjects with stroke,
who participated in a two week CIMT intervention session, were
interviewed. METHODS: The method used was phenomenography.
The focus on the phenomenographic method is to describe different
ways of understanding a phenomenon, in this case the phenomenon
“to participate in CIMT”. It is seen that a phenomenon can
be conceived of, understood or given a meening in different
WCPT 2007, Research Reports
ways. Phenomenography studies the variation of those different
ways. ANALYSIS: The interviews were recorderd and transcribed
verbatim for continued analysis which contained: 1) Familiarisation,
2) Condensation, 3) Compararison,4) Categorisation, 5) Articulation,
6) Assignment of titles, 7) Contrasting. RESULTS: All the informants
stated that they used their paretic hand more in every day life
after the intervention and were positive to group training. All of
them also expressed that the exercises were hard and intense,
and it was mostly a positive experience. Three qualitively different
categories of perceptions of CIMT could be formed: 1) Confrontation
with ambivalence to CIMT, 2) The possibility to accept and adjust
to reality, and 3) The possibility to obtain new personal insights,
leading to the individual taking responsibility for continued training,
self-efficacy in goal-setting and the ability to look forward. Most
informants were found in this last category. CONCLUSIONS: The
study showed that a short and intense training period in a group
could be a source of acceptance and motivation and facilitate
responsibility for continued training. This could contribute to the cost-
effectiveness of CIMT in the long run. IMPLICATIONS: A better
understanding of different ways of responding to CIMT during, as well
as after, the intervention period could be a practical help for adjusting
exercise and coaching individually. KEYWORDS: Stroke, Training,
Interview. FUNDING ACKNOWLEDGEMENTS: The Foundation for
Stroke Research (Sweden). CONTACT: ann.kusoffsky@lsr.se
ETHICS COMMITTEE: Karolinska Institutet, The Research Commit-
tee; Dnr 198/03
Research Report Platform Presentation
1144 Sunday 3 June 16:15
VCEC Meeting Room 17
USE OF THE COMMUNITY BALANCE AND MOBILITY SCALE
AS AN OUTCOME MEASURE WITH PEDIATRIC ACQUIRED
BRAIN INJURY
Brewer K1,3 , Wright V1−3 , Wannamaker E1 ; 1 Bloorview Kids Rehab;
2 Bloorview Research Institute; 3 Department of Physical Therapy,
University of Toronto
PURPOSE: This study evaluated the use of the Community Balance
and Mobility Scale (CB&M) to assess balance in high-functioning
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
Measure (GMFM), a validated outcome measure typically used with
these clients. RELEVANCE: Balance impairments are prevalent
following ABI, and can impact an individual’s ability to access their
community. There are few outcome measures in pediatrics that
address high level balance issues. The CB&M was designed to:
assess the balance of higher functioning adults with ABI; evaluate
the effectiveness of interventions; and identify individuals with limited
community integration due to balance and mobility issues. It is a 13-
item observational measure, scored on a 6-point scale. Although the
CB&M was designed as an adult measure, we wanted to look at its
applicability to pediatrics. From a content perspective, the items of the
CB&M appear suitable for use in pediatrics. PARTICIPANTS: Thirty-
seven children and teens (mean age = 14.7 years) with ABI who were
enrolled in an in-patient pediatric rehabilitation program had CB&M
evaluations by physiotherapists at baseline and discharge. Seventeen
clients also had baseline and discharge GMFM’s. The other 20
children scored 100% on their GMFM at baseline and thus were
not retested on it. METHODS: CB&M and GMFM admission and
discharge scores were collected over a 3-4 year period. ANALYSIS:
Inferential (paired t-tests) and regression analyses were performed
with CB&M and GMFM scores. RESULTS: CB&M mean change for
the entire sample was 17.0% points (SD = 12.2) (mean score = 75.4%
at baseline and 92.4% at discharge) (P < 0.0001). For the 17 clients
with both CB&M and GMFM scores, CB&M mean change was 23.8
points (baseline mean score = 65.1%) while GMFM mean change
was 6.8% points (baseline mean score = 92.8%). CB&M and GMFM
Platform Presentations, Sunday 3 June
baseline and change score correlations were weak (r = 0.34 and 0.14
respectively). CB&M baseline score was a strong predictor of CB&M
change (R2 = 70.2, P < 0.0001). CONCLUSIONS: The CB&M identi-
fied high-level balance issues, and was more sensitive to change in
gross motor abilities than the GMFM. As seen by the high baseline
mean scores for the GMFM (92.8%) and comparatively lower CB&M
baseline scores (62.8%), it is evident that the GMFM failed to detect
balance issues that were present. This is not unexpected since
the GMFM was not designed as a specific measure of balance or
of quality of movement. In contrast, components of performance
quality (e.g., alignment, speed of movement, and co-ordination) are
evaluated in the CB&M’s response scales. IMPLICATIONS: In times
of limited resources, it is critical that we use the most appropriate
tools to measure meaningful outcomes and change in our clients.
The CB&M has proven to be a useful tool for identifying high level
balance issues and indicating change with the school-aged and
adolescent ABI population. Further work is warranted in evaluating its
psychometric properties in this population. KEYWORDS: Pediatric,
Community, Balance. FUNDING ACKNOWLEDGEMENTS: This was
an unfunded project. CONTACT: kbrewer@bloorview.ca
Research Report Platform Presentation
1534 Sunday 3 June 16:35
PP Crystal Pavilion A
THE OTAGO EXERCISE PROGRAMME (OEP): THE
EFFECTIVENESS OF NATIONAL IMPLEMENTATION
Binns E, Taylor D; Physical Rehabilitation Research Centre, AUT
University, New Zealand
PURPOSE: The Otago Exercise Programme (OEP) is a year
long, home based, individually prescribed muscle strengthening and
balance retraining falls prevention programme, developed from four
randomised controlled trials. A meta-analysis of these trials demon-
strated that the OEP reduced falls by a third in older adults. The OEP
has now been implemented throughout New Zealand. AUT University
is evaluating this national programme to assess whether the
reduction in falls observed in a research setting occur in an ordinary
context. RELEVANCE: Falls are the most common form of injury and
major cause of hospitalisation in older adults. Globally the proportion
of older adults in the population is growing. Therefore the prevalence
of falls is likely to increase resulting in a growing public health problem
that is costly on public health resources and on individuals’ functional
independence and quality of life. DESCRIPTION: Older adults are
referred to the OEP by general practitioners, specialists or other
health professionals. There is regional variation as to the inclusion
criteria for the OEP but the programme is designed for community
dwelling older adults with a falls risk. EVALUATION: Therapists and
nurses who deliver the OEP return copies of the assessment forms
to AUT where they are collated into a national database. There is
data received to date for 2154 people, 1680 women and 466 men
(no gender available for 8 people) with a mean age of 86 years and
ranging between 60 and 102 years. Fifty eight percent of participants
had fallen in the 6 months prior to commencing the OEP. In the
first 6 months of the OEP 20% of participants had fallen at least
once and 8% more than once. In the last 6 months of the OEP
26% had fallen once and 4% more than once. CONCLUSIONS:
Participation in the OEP reduces falls in older adults by a third. More
work is needed to address the barriers to implementing community
based falls prevention programmes. IMPLICATIONS: Falls should
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: liz.binns@aut.ac.nz
S99
Research Report Platform Presentation
2082 Sunday 3 June 16:35
PP Crystal Pavilion B & C
PEROMETRY MEASUREMENT OF LOWER LIMB VOLUME: AN
INVESTIGATION OF CRITERION VALIDITY
Bulley C, Coutts F, Grainger A; Queen Margaret University College,
Edinburgh, Scotland
PURPOSE: This study aimed to develop a measurement protocol
for the Perometer (400T) and compare it with the tape measure
method for the calculation of lower limb volume in healthy individuals.
RELEVANCE: A variety of musculoskeletal, vascular and neurolog-
ical conditions impact on limb volume, therefore its measurement
is important in their management. It is frequently measured using
geometric calculations from limb circumferences using a tape
measure (TM). The Perometer (P) optoelectronic imaging device
demonstrates potential to become a gold standard of measurement.
However, there is a lack of standardised protocol and research into its
validity in the lower limb. PARTICIPANTS: Thirty healthy volunteers
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
approved by an ethics committee at Queen Margaret University
College. METHODS: Pilot work was undertaken to establish a
standardised limb position, lower limb landmarks and a percentage
of limb length for measurement. Participants were requested to
avoid vigorous exercise and alcohol consumption 24 hours prior to
testing, and food/fluid intake one hour before. After a 15-minute rest
period with the limb elevated to 90 degrees, standardised reference
marks were placed to indicate the start and end of TM and P
volume calculations. The dominant limb was placed within the P
frame in a standardised position. Three P measurements were taken,
followed by TM measurements at three-centimetre intervals. Volumes
in ml were calculated between the two reference marks using the
P computer software and using the TM Disc model method (Man
et al, 2004: Clinical Physiology and Functional Imaging. 24: 352-
358). ANALYSIS: Statistical analysis involved testing for normality of
distribution before using parametric inferential statistics: an ICC (3,1)
was used to assess the correlation, and limits of agreement were
calculated to assess the degree of agreement, between P and TM
limb volume estimates. RESULTS: Limb volume calculations (mean
of 3 readings) were 8560 ml (P) and 8717 ml (TM), with a difference
of 157 ml. Data were normally distributed (Shapiro-Wilk: p = 0.268 P;
0.602 TM). While the ICC (3,1) indicated good associations between
the two measures (r = 0.952), limits of agreement analysis indicated
that 95% of the time P limb volume estimates will be between 519
ml greater, and 834 ml less than TM estimates, indicating 15.67%
variation, and poor agreement. CONCLUSIONS: Results indicated
poor agreement and therefore measurement methods are not
interchangeable. However, results cannot determine the respective
accuracy of each method. IMPLICATIONS: This was the first study
to calculate limits of agreement between estimates of lower limb
volume using the TM method and upright 400T model of Perometer.
Further work is needed in relation to different aspects of validity and
reliability to determine which method is more accurate and should
therefore be used as a gold standard. KEYWORDS: Perometer; limb;
volume; measurement. FUNDING ACKNOWLEDGEMENTS: Queen
Margaret University College. CONTACT: cbulley@qmuc.ac.uk
ETHICS COMMITTEE: Queen Margaret University College research
ethics committee
S100
Research Report Platform Presentation
1322 Sunday 3 June 16:35
VCEC Ballroom A
EQUATIONS FOR PREDICTING MAXIMAL STRENGTH AFTER
INJURY TO ANKLE PLANTAR-FLEXORS
McNair P, Lovelace C, Reid D; Physical Rehabilitation Research
Centre
PURPOSE: To compare the accuracy of eight 1RM prediction
equations in persons with an injury to the plantar-flexor muscles of the
ankle joint. RELEVANCE: It is important that physiotherapists have
an accurate method for the assessment of plantar flexor strength
in order to appropriately set an individual’s rehabilitation program.
While the 1-repetition maximum (1RM) technique is frequently used
in athletic training, a major limitation in clinical situations is the
chance of re-injury when maximally loading previously injured tissue.
Equations for estimating 1RM from repetitions completed at sub-
maximal loads have been developed. Unfortunately, no research has
been conducted on these prediction equations in persons following
injury. If these prediction methods are an accurate measure of
1RM in persons following injury, they would provide a useful tool
for the prescription of muscle strengthening programs following
injury. PARTICIPANTS: Twenty previously injured subjects with a
background in recreational sports participated. Fifteen of these
subjects had sustained a full or partial tear of the Achilles tendon.
Nine of these Achilles tendon injuries were surgically repaired. Five
subjects had sustained a major strain injury to the plantar-flexor
muscles which was diagnosed by ultrasound imaging. METHODS:
Each subject attended a rehabilitation gym on three occasions; a
familiarisation session, then after randomisation, a session where
the actual or ‘true’ 1RM of the plantar-flexors was established using
a calf raise machine, and a session where the subjects performed
with a load at which they could lift approximately 10 repetitions
before fatiguing. The data from this latter session was used in eight
prediction equations to calculate 1RM strength. Subsequently, these
data were compared to the actual 1RM data. ANALYSIS: A paired
t-test was used to compare the difference scores (predicted 1RM –
actual 1RM) across the injured and control limbs. Data were plotted
using Bland and Altman graphs, enabling an appreciation of the
distribution of error between the 1RM and that predicted by each
equation. Intraclass correlation coefficients (ICCs) between actual
1RM and the respective 1RM prediction methods were calculated.
Typical errors were calculated using the standard deviation of the
difference scores (predicted 1RM – actual 1RM). Significance levels
were set at 0.05. RESULTS: There was a significant deficit in strength
in the injured plantar-flexor muscles compared to the uninjured limb.
There were no significant differences between the predicted 1RM
and actual 1RM values for both control and injured limbs. Bland
and Altman graphs for all equations showed a low level of bias
and random scatter across the range of data. All ICCs were high
(range: 0.95-0.99). However, there were differences in the lower
confidence interval (range: 0.783-0.972). Typical error ranged from
1.7-3.0 percent across the predicted 1RMs. CONCLUSIONS: These
findings show that in patients who have sustained a significant
injury to their plantar-flexor muscles, the accuracy of equations
for predicting 1RM strength is high. IMPLICATIONS: When tissues
cannot be loaded maximally for fear of causing re-injury, prediction
equations are a useful tool for assessment and prescription of
ongoing muscle strengthening exercises in subjects with plantar-
flexor injuries. KEYWORDS: Strength, plantar flexors, rehabilitation,
prediction. FUNDING ACKNOWLEDGEMENTS: Nil. CONTACT:
peter.mcnair@aut.ac.nz
ETHICS COMMITTEE: This work was approved by the Auckland
University of Technology Ethics Committee, Auckland, New Zealand.
WCPT 2007, Research Reports
Research Report Platform Presentation
644 Sunday 3 June 16:35
VCEC Meeting Rooms 11-12
THE VIEWS OF PHYSIOTHERAPISTS: EDUCATION AND NEW
GRADUATE PREPAREDNESS IN ELECTROPHYSICAL AGENTS
Chipchase L1 , Williams M1 , Robertson V2 ; 1 School of Health
Sciences, University of South Australia, Adelaide, SA 5000,
AUSTRALIA; 2 University of Newcastle, Teaching and Research
Unit, Gosofrd, NSW 2250, AUSTRALIA
PURPOSE: This study aimed to determine which electrophysical
agents (EPAs) physiotherapists believed should be included in entry-
level training and, to establish new graduate physiotherapists’ beliefs
regarding their preparedness to use particular electrophysical agents.
RELEVANCE: EPAs remain a core component of many entry-
level physiotherapy education programs. Successive surveys of EPA
usage, however, show professional practice patterns have changed
over the past two decades. This study investigated the views of
physiotherapists as to which EPAs should be included in entry-
level curricula and, the perceptions of new graduates as to their
preparedness in using EPAs in the clinical context. PARTICIPANTS:
All registered, practicing physiotherapists in Australia whose names
were listed on state registration boards were invited to participate
in the study. Physiotherapists who were retired, working overseas
or not practicing physiotherapy were not included. METHODS:
In this observational cross-sectional study, a purpose designed
questionnaire was mailed to registered Australian physiotherapists
(November 2005 and March 2006; to a total 12893 physiotherapists).
Reliability and content validity of the questionnaire were confirmed
prior to the study. All participants were asked to rate how important
they believed 23 different EPAs were within entry level curricula (four
point Likert scale: 1 =”not important” and 4 = “very important”).
New graduate physiotherapists, those who had completed their
training in the last two years, were also asked to indicate how
well prepared they were to use those 23 EPAs (four point Likert
scale: 1 = “not prepared” to 4 = “very prepared”). ANALYSIS:
Results were analysed with SPSS (v 14) using standard descriptive
statistics. RESULTS: 3538 completed questionnaires were returned
(27.4% response rate), 349 (9.9%) of which were new graduates.
Over 75% of all the respondents indicated that learning about
cryotherapy, EMG and pressure biofeedback, hot packs, ultrasound,
sensory electrical stimulation and interferential current was “very
important” or “important” in entry-level curricula. Over 75% also
indicated that shortwave diathermy, ultraviolet light, infrared light
and microwave were “not important” or only “somewhat important”
for inclusion in entry-level curricula. Most new graduates (80%)
reported that they were “prepared” or “well prepared” to clinically
use ultrasound, hot packs, cryotherapy and sensory electrical
stimulation. They reported lower levels of preparedness in using
interferential current, biofeedback and electrical current for motor
stimulation. CONCLUSIONS: New graduates indicated that they
felt well prepared to use only four of the six EPAs selected by
physiotherapists as the most important for inclusion within entry-
level curricula. There is a mismatch between the EPAs selected as
important and new graduates perceived level of preparedness for
clinical practice in using them. IMPLICATIONS: New graduates must
be fully prepared to be safe and effective in a range of EPAs that the
profession considers important for contemporary practice. The results
of this study will provide useful information to educators and curricu-
lum planners of entry-level physiotherapy programs. KEYWORDS:
Electrophysical agents, new graduate preparedness, entry-level
curriculum. FUNDING ACKNOWLEDGEMENTS: No funding was
received for this study. CONTACT: lucy.chipchase@unisa.edu.au
ETHICS COMMITTEE: Ethical approval for this study was obtained
from the University of South Australia’s Human Research Ethics
Committee (15/02/2005)
Platform Presentations, Sunday 3 June
Research Report Platform Presentation
1611 Sunday 3 June 16:35
VCEC Meeting Room 16
BENEFITS OF CONSTRAINT-INDUCED MOVEMENT THERAPY
FOR UPPER EXTREMITY AFTER STROKE- A RANDOMIZED
CONTROLLED TRIAL IN NORWAY
Dahl A1,2 , Askim T3,2 , Stock R4 , Langørgen E4 , Indredavik B1,5 ;
1 The Stroke Unit, University Hospital of Trondheim, Norway; 2 Clinical
Services, University Hospital of Trondheim, Norway; 3 Department
of Community Medicine and General Practice, Norwegian University
of Science and Technology, Trondheim, Norway; 4 Department
of Physical Medicine and Rehabilitation, University Hospital of
Trondheim, Norway; 5 Department of Neuroscience, Norwegian
University of Science and Technology, Trondheim, Norway
PURPOSE: Constraint- Induced Movement Therapy (CIMT) is a
family of therapies that purportedly increase the quality of movement
and amount of use of the hemiparetic upper extremity after stroke.
The benefits of CIMT and the use of valid and reliable outcome
measures are discussed in previous studies. The aim of this study
was to determine the short term and long term effects of CIMT,
and compare its efficacy to traditional rehabilitation in patients
with chronic and sub-acute stroke. RELEVANCE: Patients with
upper limb hemiparesis following stroke often do not integrate their
affected hand in ADL, although they have the potential to do so.
This might reduce independence and increase burden of care.
PARTICIPANTS: The patients were recruited from the Stroke Unit
at the University Hospital of Trondheim and hospitals in central
Norway. 30 patients with upper limb hemiparesis participated; 23
with chronic stroke (more than 26 weeks post-stroke) and seven
with sub-acute stroke (2-26 weeks post-stroke), who fulfilled the
inclusion criteria. METHODS: The patients were randomly allocated
to a experimental group or a control group. The experimental group
consisted of 18 patients who received intensive motor training of
the affected hand for 6 hours daily for the chronic participants and
4 hours daily for the sub-acute participants, for 10 consecutive
weekdays. The unaffected arm was restricted with a mitten during
90% of waking hours. 12 patients were allocated to a control group
receiving standard rehabilitation. Assessments were performed by
blinded assessors at pre-treatment, post-treatment and 6 months
after intervention. Wolf Motor Function Test (WMFT) (performance
time and functional ability) was the primary outcome. Secondary
outcomes, measuring “real world arm use”, were Motor Activity Log
(MAL) (amount of use and quality of movement) and Functional
Independence Measure (FIM). ANALYSIS: Differences in change
between groups were analyzed with independent samples t-test and
with ANCOVA using the pre-treatment test of dependent variable
and time since stroke as covariates. RESULTS: All participants
completed all assessments. The CIMT group showed a statistically
significant greater improvement on both WMFT performance time
(p = 0.047) and WMFT functional ability (p = 0.045), from the pre-
treatment to the post-treatment assessment. There was a trend
towards statistically significant greater improvements in the CIMT
group on both MAL amount of use (p = 0.125) and MAL quality
of movement (p = 0.138), but no such differences on FIM during
the same period. At 6 months follow-up there were no significant
difference between the groups according to any outcome measure.
CONCLUSIONS: CIMT seems to be an effective method to improve
motor function of the hemiparetic hand in the short term, but it does
not seem to have a long term effect. It is yet unclear to what extent
this functional improvement transfer into activities of daily living.
IMPLICATIONS: People with stroke and upper extremity impairments
may benefit from intermittent maintenance sessions of CIMT, in
order to keep their improved motor function and to regain further
ADL function. KEYWORDS: Stroke, Rehabilitation, Hemiparesis.
FUNDING ACKNOWLEDGEMENTS: The Norwegian Fund for Post-
S101
Graduate Training in Physiotherapy. Clinical Services, University
Hospital of Trondheim, Norway. CONTACT: anne.dahl@stolav.no
ETHICS COMMITTEE: The Regional Committees for Medical
Research Ethics, Norway
Research Report Platform Presentation
1714 Sunday 3 June 16:35
VCEC Meeting Room 17
PSYCHOMETRIC PROPERTIES OF THE MUSCULAR
DYSTROPHY FUNCTIONAL RATING SCALE
Lue Y1,2 , Su C2,3 , Yang R4 , Su W2,3 , Lu Y5 , Chen S6 ; 1 Faculty
of Physical Therapy, College of Health Science, Kaohsiung Medical
University, Kaohsiung, Taiwan; 2 Department of Rehabilitation,
Kaohsiung Medical University Hospital, Kaohsiung, Taiwan;
3 Faculty of Occupational Therapy, College of Health Science,
Kaohsiung Medical University, Kaohsiung, Taiwan; 4 Faculty
of Sport Medicine, College of Medical Science, Kaohsiung Medical
University, Kaohsiung, Taiwan; 5 Department of Orthopaedic
Surgery, Kaohsiung Medical University Hospital, Kaohsiung,
Taiwan; 6 Department of Neurology, Kaohsiung Chang Gung
Memorial Hospital, Kaohsiung County, Taiwan
PURPOSE: The purpose of this study was to examine the
reliability, validity and responsiveness of a new disease-specific
measure – the Muscular Dystrophy Functional Rating Scale (MD-
FRS). RELEVANCE: The goals of physical therapy in dystrophic
patients are to maximize functional capacities, improve or maintain
capability for independence and self-care, reduce or prevent
significant deformity, and promote quality of life, a comprehensive
evaluation of the varied clinical problems associated with muscular
dystrophy is of paramount importance to quantify accurately patient’s
functional status and to serve as basis for evidence-based disease
management. PARTICIPANTS: A total of 121 patients age over
6 years and a definite diagnosis of muscular dystrophy confirmed
by two neurologists on the basis of clinical, EMG and muscle
biopsy criteria were recruited into this study. Over half of our pilot
sample was diagnosed with Duchenne muscular dystrophy, followed
by limb-girdle muscular dystrophy, Becker muscular dystrophy, and
facioscapulohumeral muscular dystrophy. METHODS: The internal
consistency of both total and dimension scores of the scale
was examined. Test-retest reliability and inter-rater reliability were
evaluated by administering the test to a group of 51 patients
randomly selected from the total sample. The validity of the
final scale with the Barthel index, the Brooke scale, the Vignos
scale, muscle strength, contracture severity and pulmonary function
was assessed in the same sample for reliability analyses. The
responsiveness of the MDFRS was also examined. ANALYSIS: The
internal consistency was examined using Cronbach’s a coefficient.
Intraclass correlation coefficients were used to measure inter-rater
and test-retest reliabilities. Validity was measured by examining the
relationships the Barthel index, Brooke scale, Vignos scale, muscle
strength, contracture severity, and pulmonary function. In order to
verify the factor structure of the MDFRS, a confirmatory factor
analysis was performed. Standardized response mean was used to
measure responsiveness. RESULTS: Internal consistency reliability
was excellent for all domains of the final 33-item scale, with values
of Cronbach’s alpha ranging from 0.84 to 0.97. Intraclass correlation
coefficients for test-retest and inter-rater reliability were 0.99 for all
domains of the MDFRS. The MDFRS showed moderate to high
correlations with a range of functional rating scales measuring similar
aspects and impairment parameters (Spearman’s rho = 0.65-0.91;
p < 0.001, each). Confirmatory factor analysis supported a unitary
construct of the four-dimensional MDFRS. Sensitivity to change
was confirmed by a large standardized response mean for the
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
S102
patient’s status in the following areas: mobility, basic activites of daily
living, arm function and impairment. KEYWORDS: MDFRS, muscular
dystrophy, functional status. FUNDING ACKNOWLEDGEMENTS:
This work was supported by grants from the National Science Council
(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:
yijilu@cc.kmu.edu.tw
ETHICS COMMITTEE: Kaohwiung Medical University, Chung-Ho
Memorial Hospital
Research Report Platform Presentation
1543 Sunday 3 June 16:55
PP Crystal Pavilion A
MANAGEMENT OF ELDERLY PERSONS WITH FALL-RELATED
INJURIES PRESENTING TO THE EMERGENCY DEPARTMENT
OF A COMMUNITY-BASED TEACHING HOSPITAL
Wightman E1 , Miller E1 , Rumbolt K1 , McConnell S2 , Devereaux M2 ,
Berg K1 , Campbell F; 1 University of Toronto, Toronto, Canada;
2 St. Joseph’s Health Centre, Toronto, Canada
PURPOSE: This study describes the management of elderly persons
with fall-related injuries presenting to the Emergency Department
(ED) of a community-based teaching hospital. It examined the
demographics and fall characteristics of presenting patients and how
these patients were screened, assessed, treated and discharged.
RELEVANCE: Fall management strategies that identify and address
multiple fall risk factors have been shown to reduce recurrent falls
in the elderly. However, it does not appear that such practices are
routinely occurring in the ED. This creates a potential role for physical
therapists in the ED aimed at falls prevention. PARTICIPANTS:
Charts of patients 65 years of age or older who had presented to
the ED of the participating hospital with a fall-related injury between
June 2004 and May 2005 (n=300). METHODS: Following approval
from the Research Ethics Boards from the University of Toronto and
the participating hospital, a retrospective longitudinal chart review
was conducted. A data collection tool was developed and pre-
tested for reliability. ANALYSIS: A univariate analysis was performed
on each variable and bivariate comparisons were conducted for
patients admitted to hospital and patients discharged directly home
from the ED. The statistical analysis was performed using SPSS
software, version 13.0. RESULTS: Of the 300 patients, 81.3%
(n=245) were discharged directly from the ED. Of these individuals,
62.0% (n=152) did not receive a referral for follow-up health care
services. Patients discharged directly from the ED were less likely
to have fall-related risk factors assessed than patients who were
admitted to hospital. For example, walking ability (10.2%, n=25),
balance (4.1%, n=10), lower extremity strength (2.0%, n=5) and
ability to perform activities of daily living (7.3%, n=18) were rarely
documented in the charts of patients discharged directly from the
ED. In the 6 months following the index fall, 8.3% (n=25) of patients
returned to the ED of the same hospital due to a subsequent fall and
17.7% (n=53) returned for a reason other than a fall CONCLUSIONS:
In the ED, functional abilities and fall-related risk factors were not
consistently documented and few patients received multidisciplinary
management. Access to health care professionals such as physical
and occupational therapists should be paired with the piloting
of a screening tool to identify modifiable risk factors and guide
appropriate follow-up health care services. Further investigation is
needed to develop and explore the use of this tool. IMPLICATIONS:
Assessing the risk factors associated with falls is currently within
the scope of practice of both physical and occupational therapists.
Incorporating the staffing of these healthcare professionals within the
ED environment could help to prevent recurrent falls in the elderly
population presenting to the ED with injuries. Prevention of recurrent
falls in our study population alone would have potentially resulted
in over $1 million savings to the hospital system. KEYWORDS:
WCPT 2007, Research Reports
Fall-related injuries, emergency department, elderly. FUNDING
ACKNOWLEDGEMENTS: No funding was received for this study.
ETHICS COMMITTEE: Research Ethics Board, University of Toronto;
Research Ethics Board, St. Joseph’s Health Centre
Research Report Platform Presentation
1348 Sunday 3 June 16:55
VCEC Ballroom A
ANEMIA IMPEDES FUNCTIONAL MOBILITY AFTER HIP
FRACTURE SURGERY
Kristensen M1 , Foss N2 , Kehlet H3 ; 1 Department of Physiotherapy,
Hvidovre University Hospital, Copenhagen DK-2650, Denmark;
2 Department of Anaesthesiology and Orthopedic Surgery,Hvidovre
University Hospital, Copenhagen DK-2650, Denmark; 3 Section of
Surgical Pathophysiology, The Juliane Marie Centre, Rigshospitalet,
Copenhagen DK-2100, Denmark
PURPOSE: The impact of anaemia after hip fracture surgery is
controversial. Moderate anaemia has not been demonstrated to
increase mortality in patients with a hip fracture, but anaemia
will potentially decrease physical performance and thereby impede
postoperative rehabilitation. We therefore conducted a prospective
study to establish whether anaemia affected functional mobility in
the early postoperative phase. RELEVANCE: If anaemia affects
functional mobility for a person with a hip fracture during early
postoperative rehabilitation its essential for the physiotherapists to
take this into consideration when searching for reasons that impede
mobilization. PARTICIPANTS: 487 consecutive patients, median
age 82 admitted to a specialized orthopedic hip fracture unit.
METHODS: All patients were treated according to a well defined
multimodal rehabilitation programme with surgery within 24 hours,
epidural anaesthesia and epidural analgesia, optimized nutrition,
supplemental oxygen, a liberal transfusion threshold and an intensive
physiotherapy programme initiated on the day of operation. Hb was
measured on each of the first three postoperative days; anaemia was
defined as Hb < 100 g/l while functional mobility was measured during
the daily physiotherapy sessions with the Cumulated Ambulation
Score, which allows day to day measurements of functional mobility in
the early postoperative phase. In addition the pre-fracture functional
level, medical conditions, type of surgery, complications, length of
stay and 30-day mortality were recorded. ANALYSIS: Correlations
were tested with Spearman’s rho. Tests for significant differences
between categorical data were performed with the Chi-square
test, for ordinal and continuous data the Mann-Whitney test was
used. Multivariate logistic regression analysis was done to identify
independent factors associated with independent walking. The level
of significance was set at p < 0.05. All data analysis was performed
with SPSS version 10.1. RESULTS: 170, 132 and 116 patients were
anaemic on the first, second an third postoperative days respectively.
A significant association between anaemia and the ability to walk
independently, requiring human assistance or not being able to walk
was present on each of the three days separately (p < 0.05). A
multivariate analysis showed anaemia to be an independent risk
factor for not being able to walk on the third postoperative day (OR
0.41 (0.14-0.73) p = 0.002). 358 patients (74%) were anaemic at
some point and this was associated with increased 30-day mortality
of 12.6% vs. 6.3% (p = 0.049) and increased length of stay: 13
days vs. 8 days (p < 0.001). CONCLUSIONS: Anaemia impedes
functional mobility in the early postoperative phase after hip fracture
surgery and is an independent risk factor for patients not being able
to walk postoperatively, but this study does not allow us to make
conclusions as to the question of whether transfusion in the anaemic
patient will improve her physical and functional capacity, which
requires randomized studies within similar well-defined perioperative
care programmes. IMPLICATIONS: The present data supports the
concept that all available measures should be taken to prevent a
person with a hip fracture in becoming anaemic as a consequence
of the surgical intervention. KEYWORDS: Anaemia impedes mobility.
Platform Presentations, Sunday 3 June
FUNDING ACKNOWLEDGEMENTS: IMK Fonden (Copenhagen,
Denmark). CONTACT: morten.tange.kristensen@hh.hosp.dk
ETHICS COMMITTEE: The study is part of Hvidovre University
Hospitals Hip Fracture Project, which was approved by the local
ethical committee.
Research Report Platform Presentation
2266 Sunday 3 June 16:55
VCEC Ballroom B & C
DOES IT MATTER WHICH PLACEBO CONTROL TO USE IN
PHYSIOTHERAPY TRIALS?
Machado L, Maher C, Kamper S, Herbert R, McAuley J; Back Pain
Research Group, School of Physiotherapy, University of Sydney,
Australia
PURPOSE: To perform a systematic review describing how placebo
controls have been implemented in trials investigating physiotherapy
interventions for low back pain (LBP). RELEVANCE: Inappropriate
placebo choices may introduce bias in randomised controlled trials
(RCTs). Designing a placebo control for a drug trial is usually
straightforward but for physiotherapy interventions this task is more
complex. PARTICIPANTS: Not applicable. METHODS: Studies were
eligible for inclusion if they were randomised, placebo-controlled
trials of physiotherapy interventions for non-specific LBP or sciatica.
MEDLINE, EMBASE, CINAHL and PsychInfo databases were
searched for relevant trials using a search strategy recommended
by the Cochrane Back Review Group. A combination of terms
to limit search results to trials including a placebo control was
also used. Two independent reviewers extracted data on the types
of placebo controls. Trial methodological quality was assessed by
the PEDro scale. ANALYSIS: The adequacy of placebo controls
identified by the structured search was accessed according to 5
criteria believed to be critical to the design of control groups in RCTs:
(1) indistinguishability/structural equivalence between the placebo
and the experimental group; (2) credibility of placebo intervention;
(3) exclusion of patients with previous experience with the therapy
mimicked in the placebo group; and (4) use of a real treatment
in the placebo group. RESULTS: Forty-seven RCTs reporting on
exercises, manual therapy, electrotherapy, acupuncture, heatwrap
therapy, education, neuroreflexotherapy, traction and biofeedback
were retrieved. Most trials were of moderate methodological quality.
The included trials showed an astonishing variety of placebo controls
which were mostly suboptimal when judged against the adequacy
criteria. In only 23.4% of trials were the interventions used in the
placebo and in the experimental groups indistinguishable, whereas
in 76.5% of trials the interventions used were at least structurally
equivalent. Credibility of the placebo intervention was assessed by
different procedures in 25.5% of trials. The same proportion of trials
excluded patients with previous experience with the therapy mimicked
in the placebo group. Finally, 27.6% of trials used placebos which are
contemporary treatments. Potential reasons for inappropriate choices
of placebo controls may be the disagreements about which compo-
nents of the intervention are specific or represent a placebo and the
difficulty in designing placebos which are indistinguishable from the
experimental intervention. CONCLUSIONS: Placebo controls used in
physiotherapy trials for LBP often fail to meet the basic criteria for the
use of this type of control in RCTs. Trial protocols must pay special
attention with choices of placebo interventions which are not inert
and which do not provide a good match for placebo effects in the ex-
perimental group. IMPLICATIONS: RCTs with inappropriate choices
of placebo groups may overestimate or underestimate the effects
of physiotherapy interventions. The development of guidelines with
recommendations on how to design placebo controls in physiotherapy
trials is of high priority. This will allow more interpretable results in
future studies and it will also facilitate the comparison of results
between trials. KEYWORDS: Systematic review, physiotherapy,
placebo effect, blinding. FUNDING ACKNOWLEDGEMENTS: Not
applicable. CONTACT: lmac3689@mail.usyd.edu.au
S103
Research Report Platform Presentation
1721 Sunday 3 June 16:55
VCEC Meeting Rooms 11-12
EFFECTIVENESS OF INTERFERENTIAL CURRENT THERAPY
IN THE MANAGEMENT OF MUSCULOSKELETAL PAIN- A
SYSTEMATIC REVIEW
Fuentes J, Reiko O, David M; University of Alberta. Department
of Physical Therapy
PURPOSE: Successful management of musculoskeletal pain is
one of the major challenges in clinical practice. One of the
electrotherapeutic techniques used for treating musculoskeletal pain
is interferential current therapy (IFT). Even though its widespread use
by physical therapists, there is little and controversial documentation
regarding the scientific evidence supporting the analgesic effects
of IFT. The objective of this study was to evaluate the available
literature regarding the effectiveness of IFT applied alone or as
co-intervention for relieving musculoskeletal pain. RELEVANCE: A
critical analysis of IFT literature regarding its analgesic effectiveness
will help to guide clinicians in their decision making concerning IFT
in musculoskeletal pain conditions and identify potential areas for
further clinical research based on physical therapy evidence-practice.
PARTICIPANTS: Not applicable METHODS: Relevant studies of
IFT in musculoskeletal pain were searched from 1970 up to
and including April 28, 2006. Studies were obtained through an
extensive search of electronic databases including Medline, Embase,
CINAHL, PubMed, Scopus, Cochrane Library, ISI Web of Science,
and PEDro Physiotherapy Evidence Database. The following key
words and their combinations were used in the search: interferential
therapy, interferential current, musculoskeletal pain, electrotherapy,
electroanalgesia, muscle pain, and joint pain. This systematic review
focused only in randomized controlled trials (RCT) using ITF in
musculoskeletal pain conditions such as knee osteoarthritis, jaw
pain, low back pain, and shoulder pain. The main outcome was
pain measurement determined by the use of visual analogue
scale, verbal rating scale, pain rating index, numeric rating score,
and McGill pain questionnaire. Disability/function outcomes were
also considered. ANALYSIS: Two independent reviewers screened
the abstracts and analyzed all papers initially selected by the
abstract or title for the inclusion/exclusion criteria. Each criterion
was graded on a yes/no basis. To evaluate the paper at the next
level, the critical appraisal, the paper had to meet all the inclusion
criteria. The methodological quality of the final selected studies
was analyzed with a methodological scale. This scale considered
nine important methodological issues. RESULTS: A total of 588
articles were found in the database search. Of the 588 articles,
78 were selected as potential studies of interest based on their
abstracts. Only 17 studies actually fulfilled the initial criteria. The
kappa agreement between the reviewers in selecting articles after
applying the inclusion and exclusion criteria was k= 1.0. At the
end of the critical appraisal stage, there was an agreement of k =
0.895. After applying the methodological scale, none article reached
a high methodological quality, just one was of moderate, and 16
were of weak methodological quality. CONCLUSIONS: No definite
conclusions could be drawn about the effectiveness of IFT in reducing
pain in musculoskeletal conditions alone or as a co-intervention,
due to the poor quality of the selected studies. IMPLICATIONS:
With further evidence from high-quality RCTs, it may be possible
to accept the application of IFT in musculoskeletal pain disorders. It
is evident that a need exist for carefully designed and conducted
RCTs in this area with sufficient power to identify clinically
significant effects besides more control of internal and external
validity. KEYWORDS: IFT, musculoskeletal pain, systematic review.
FUNDING ACKNOWLEDGEMENTS: This study was supported by
MECESUP scholarship (government of Chile) and Catholic University
of Maule, Chile. CONTACT: jorgef@ualberta.ca
S104
Research Report Platform Presentation
1893 Sunday 3 June 16:55
VCEC Meeting Room 16
A VIRTUAL REALITY-BASED LOCOMOTOR TRAINING PRO-
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
of Rehabilitation, Laval University, Quebec City, QC., Canada;
2 Centre for Interdisciplinary Research in Rehabilitation and Social
Integration (CIRRIS); 3 School of Physical and Occupational Therapy,
McGill University and CRIR Research Center, Montreal, QC., Canada
PURPOSE: Progressively intense task-oriented practice under
varied environmental and cognitive demands, although known to
promote locomotor recovery after stroke, is often lacking in current
rehabilitation programs. Virtual reality (VR) technology offers new
and safe ways to vary practice of walking tasks with cognitive
demands, under conditions that motivate and empower a person to
re-acquire locomotor skills. The purpose of this study is to report the
feasibility of applying a VR-training program in persons with chronic
stroke. RELEVANCE: A VR-based approach should lead to improved
walking competency in the community by targeting specific practice
of gait speed, changing terrains, endurance, obstacle avoidance
and decision making. PARTICIPANTS: Five persons (4 men and
1 woman) with chronic stroke (34-87 months post stroke) and a
stable cardiorespiratory condition aged 51-76 years, who walked
at free speeds ranging from 49-92 cm/s overground, completed
9 training sessions over 3 weeks. METHODS: Subjects walked,
while using a sliding handrail and a safety harness, on a self-
paced treadmill mounted on a 6-degree-of-freedom motion platform
in virtual environments (VEs). Platform movements were computer
controlled to mimic changes in terrain encountered in the VEs. In
the first 3 VEs (Street Crossing, Corridor Walking, Park Stroll) the
person walked 40m with increasing difficulty (3 levels) related to
time, terrain changes and obstacle avoidance. Animation provided
feedback on successes or failures in timing (all levels) or avoiding
collisions (level 3). Once the first 3 VEs were mastered, the subject
graduated to 2 more complex VEs (Catching a Train, Beach Walking)
that increased the distance walked (90m; 100m) and included time,
multiple terrain and obstacle avoidance constraints. Heart rate and
blood pressure were monitored throughout the program. Pre-and
post-training outcomes included: free and fast 5m walking speeds,
6-minute walk, Balance Scale, Activities-specific Balance Confidence
(ABC) Scale and subjective reports. ANALYSIS: Descriptive statistics
are used to report changes in outcomes. RESULTS: All subjects
adapted to the self-paced treadmill in about 15 minutes and
reported being able to interact meaningfully within the VEs (total
practice time = 110-125 min.). In the VEs they walked 13-43%
(n=5) faster than in the habituation period without VEs, as well
as 14-114% and 3-64%, respectively, faster than their free (n=5)
and fast (4/5) pre-overground speeds. In addition, with practice,
they were able to meet time constraints or to modulate their
speed to adapt to terrain changes and to avoid collisions. Post-
training, the % increase in outcomes was: free walking speed:
2-35% (4/5), fast walking speed: 1-19 (n=5), 6-minute walk: 9-
19% (4/5), Balance Scale: 4-6% (3/5), ABC Scale: 7-14% (3/5).
Subjects reported improvements in walking competency such as:
improved control on slopes, including in a darkened movie theatre,
improved confidence in street-crossing and in avoiding collisions with
persons or wheelchairs. CONCLUSIONS: These preliminary results
demonstrate the feasibility and empowerment potential of this VR-
based locomotor training system to promote walking competency
in the community. IMPLICATIONS: Before it can be recommended,
however, its efficacy must be demonstrated in the randomized
controlled pilot trial currently underway. KEYWORDS: stroke,
virtual reality, locomotor training, walking competency. FUNDING
ACKNOWLEDGEMENTS: This work was supported by the Canadian
Stroke Network for Excellence and the Canada Foundation for
WCPT 2007, Research Reports
Innovation. Carol L. Richards holds a Canada Research Chair in
Rehabilitation. CONTACT: Carol.Richards@rea.ulaval.ca
ETHICS COMMITTEE: Ethics Committee of the Institut de
réadaptation en déficience physique de Québec (IRDPQ)
Research Report Platform Presentation
2091 Sunday 3 June 16:55
VCEC Meeting Room 17
FEASIBILITY AND RELIABILITY OF KNEE MUSCLE STRENGTH
TESTING AND ULTRASOUND IMAGING OF VASTUS LATERALIS
IN 6-12 YEAR OLD CHILDREN
Old S1,2 , Drechsler W1 , Stephensen D1 ; 1 University of East London,
Stratford, London, UK; 2 Northwick Park Hospital, Harrow, UK
PURPOSE: Muscle strength is well established in adults but there
is little evidence in the literature regarding muscle strength in
children. Children need to be considered seperately due to different
physiological characteristics, including skeletal growth and muscle
force. A normative database is required and reliability and feasibility
of muscle strength tests in children needs to be established. Studies
in adults have determined that muscle architecture is an important
feature of muscle strength. Using ultrasound, anatomical cross-
sectional area (ACSA), muscle thickness, pennation angle and fibre
length has been investigated in adults. In children, limited data has
been published investigating the use of ultrasound to determine
muscle architecture and no studies report reliability in children.
Thus, this study aimed to determine the feasibility and reliability of
isometric and isokinetic muscle strength testing of the hamstring
and quadriceps muscle and the feasibility and reliability of using
ultrasound to measure ACSA, muscle thickness, fibre length and
pennation angle in the vastus lateralis (VL) muscle in children.
RELEVANCE: The feasibility and reliability of these measures in
children needs to be established to develop a normative database
and to allow clinicians to gain accurate objective measures when
treating children with a variety of conditions such as cerebral palsy,
arthritis and obesity. PARTICIPANTS: 12 children aged 6-12 years
old with parental consent volunteered from a local primary school
and met the inclusion and exclusion criteria. METHODS: Subjects
were tested twice within a session to determine reliability. Isometric
strength measurements at 60 degrees knee flexion and isokinetic
strength measurements at 180 and 60 degrees/second of the knee
flexors and extensors were recorded. Ultrasound images of VL in the
transverse and longitudinal plane were recorded to determine ACSA,
muscle thickness, pennation angle and fibre length. ANALYSIS:
Mean scores for both tests were determined and a one way ANOVA
was calculated to determine CV and ICC (1,1; 1,2). Pearson cor-
relation coefficients were applied to examine possible relationships
between parameters. RESULTS: Good reliability was determined for
all muscle strength tests. Maximal voluntary isometic contraction
for the knee extensors (MVICE) was the most reliable measure
(ICC 1,2 = 0.98). Good intrarater reliability (ICC 1,1) was determined
for the following ultrasound measures; muscle thickness both in the
longitudinal and transverse plane (0.99 and 0.97 respectively) ACSA
(0.94) and pennation angle (0.72) of VL. Significant relationships
(p < 0.05)existed between MVICE and muscle thickness (longitudinal
plane); MVICE and ACSA; MVICE and pennation angle; ACSA
and pennation angle; ACSA and muscle thickness (longitudinal
and transverse planes); pennation angle and muscle thickness
(longitudinal and transverse plane). CONCLUSIONS: Isometric and
isokinetic strength measurements of the quadriceps and hamstrings
were reliable in children age 6-12 years old and ultrasound
images of VL could be reliably taken in these children. Additionally
correlations were found to exist between the various parameters.
IMPLICATIONS: This research suggests that ultrasound may be
used as a low cost tool to indirectly measure muscle strength in the
clinical setting. KEYWORDS: muscle strength, ultrasound imaging,
children. FUNDING ACKNOWLEDGEMENTS: Paediatric Therapy
Platform Presentations, Sunday 3 June
Department, North West London Hospitals Trust, UK. for funding MSc
in Physiotherapy. CONTACT: samantha.old@nwlh.nhs.uk
ETHICS COMMITTEE: Ethics approval was gained from University
of East London, School of Health and Bioscience Ethics Committee
Research Report Platform Presentation
2007 Sunday 3 June 17:15
PP Crystal Pavilion A
EVIDENCE FROM DEMOGRAPHICS, FUNCTIONAL TASKS,
STRENGTH MEASURES AND SENSORY FUNCTION SUPPORT
SCREENING FOR BALANCE LOSS IN ‘HEALTHY’ COMMUNITY
AMBULANT WOMEN
LowChoy N, Brauer S, Nitz J; The University of Queensland
PURPOSE: The purpose of the research is to inform new initiatives
and strategies towards healthier ageing. This study investigated
differences in demographics, functional measures, strength and
sensory system function of stable, unsteady and unstable categories
of women identified after completion of postural stability tasks.
RELEVANCE: Given the continuing prevalence of falls in the older
person and the escalating costs associated with falls and related
injuries of an ageing Australia and other international countries,
it is important to inform new initiatives and strategies towards
healthier ageing. One option is to identify early those vulnerable
to an increased fall’s risk with age to enable prioritized referral for
education and prevention intervention. PARTICIPANTS: 254 ‘healthy’
women aged between 40 and 80 years. METHODS: Demographics
(age, height, weight, medication use, co-morbidities, fall history and
activity level), clinical balance tests of function, lower limb strength
(quadriceps, hip abductor and adductor muscles), somatosensation
(vibration sensitivity, joint re-positioning error, tactile acuity), gaze
stability and visual acuity were recorded. Women were categorized as
stable (able to complete all trials), unsteady (failed one or two trials)
or unstable (failed all trials) using performances of three 10-second
trials of bilateral stance, foam surface, eyes closed (BS_ foam EC)
and one-legged stance eyes open (OLS_EO). ANALYSIS: ANOVAs
were used to identify differences between categories of women
for recorded measures. RESULTS: Both balance tasks identified
a similar proportion of women from the 50s as unstable (8-9%)
although more women were categorized as unsteady after trials
of BS_foam EC (18%) than OLS_EO (12%). The unsteady and
unstable categories were older, reported more medications and co-
morbidities and less activity. More falls were reported by the unstable
category who failed OLS_EO. Heavier women failed OLS_EO but
not BS_EC. Performances of the unsteady and unstable categories
of women for the step test and the TUG test were inferior to
the stable women (p < 0.001). The unstable group was significantly
weaker (p < 0.01); recorded higher vibration thresholds (p < 0.01)
and greater joint re-positioning error during a weight bearing task
(p < 0.01); and lower scores for edge contrast sensitivity and low-
contrast visual acuity (p < 0.001). Gaze instability was more evident
for unsteady / unstable categories of women. CONCLUSIONS:
These data provide evidence that simple screening tools could be
used to prioritize referral for early prevention intervention for women
from the 40s to minimize falls risk as women age. IMPLICATIONS:
• Simple balance tasks (bilateral stance, foam – eyes closed and
one-legged stance – eyes open) could be used in community
based settings to screen women from the 40s for balance loss as
a low cost initiative towards healthier ageing. • Women who fail
balance tasks (8-9%) should be referred for education and targeted
prevention intervention. Other women identified as ‘unsteady’ need
to be monitored (up to 15%) and referred for prevention intervention
if further reduction in balance occurs. • Physiotherapists and
others engaged in exercise prescription could use the evidence to
address the reduction in strength, visual acuity, gaze stability and
somato-sensory function during the delivery of targeted prevention
intervention programs to maximize the functional ability of women
with ageing. KEYWORDS: Women, balance loss, screening, ageing.
S105
FUNDING ACKNOWLEDGEMENTS: Royal Brisbane and Women’s
Hospital Foundation, Australasian Menopause Society. CONTACT:
n.lowchoy@shrs.uq.edu.au
ETHICS COMMITTEE: Medical Research Ethics Committe at the
university of Queensland and the Royal Brisbane and Women’s
Hospital Research Ethics Committee.
Research Report Platform Presentation
2972 Sunday 3 June 17:15
PP Crystal Pavilion B & C
MUSCLE ACTIVITY ONSET IN ABDOMINAL MUSCLES
RECORDED SIMULTANEOUSLY BY INTRAMUSCULAR
ELECTROMYOGRAPHY AND HIGH FRAME-RATE
ULTRASOUND IMAGING
Vasseljen O1 , Fladmark A1,2 , Westad C1 , Nygaard Ø1,2 , Torp H1 ;
1 Faculty of Medicine, Norwegain University of Science and
Technology, Trondheim, Norway; 2 St Olav University Hospital,
Trondheim, Norway
PURPOSE: The purpose of this study was to investigate whether
high frame-rate ultrasound imaging would yield comparable results
as compared to intramuscular EMG for muscle activity onset in the
abdominal muscles (transversus abdominus, internal and external
obliques; TrA, OI and OE). RELEVANCE: Delayed anticipatory
muscle activity response in deep abdominal and back muscles
has been observed in patients with low back pain, indicative of a
pathological condition. Muscle activity onset is traditionally recorded
by intramuscular electromyography (EMG), but there is a need for
a non-invasive and less cumbersome recording method in large
clinical studies. PARTICIPANTS: Six young to middle-aged healthy
male and females volunteered to the study. METHODS: Muscle
activity onset was recorded simultaneously by ultrasound m-mode
and intramuscular EMG during rapid arm flexions in response to the
flash of a light signal. Ultrasound m-mode with a temporal resolution
of 500 frames per second was used to record rapid movements
caused by muscle deformations in TrA, OI and OE. Alternative
ultrasound techniques based on tissue velocity imaging was included
to explore regional onset variations (strain rate imaging). The latter is
under analyses and will be presented at the congress. ANALYSIS:
Latency time between the light signal and muscle activation onset
was calculated separately for the EMG (volt) and US recordings
(deformation) by visual inspection of time-amplitude displays. Mean
latency differences between the methods were calculated for all three
muscles. RESULTS: High frame-rate ultrasound and intramuscular
EMG recorded muscle onset in TrA and OI with an average
difference between the two methods of less than 10 ms. In OE
muscle onset was on average recorded 42 ms later by EMG than
ultrasound. True activation within the muscle at loci distant to the
site of initial onset, as recorded by EMG, is likely obscured in the
m-mode image by passive tissue deformations. CONCLUSIONS:
Ultrasound m-mode imaging at high time resolution can detect onset
of muscle activity comparably accurate to intramuscular EMG. As
applied, the US m-mode method is not suited to detect regional
onset variations within the muscle occurring after the initial starting
point. Alternative ultrasound applications will be explored in an
attempt to resolve this shortcoming. IMPLICATIONS: The study gives
evidence for an alternative and non-invasive method to intramuscular
EMG for muscle activity onset recordings. KEYWORDS: Muscle
onset, Ultrasound imaging, Electromyography, Low back. FUNDING
ACKNOWLEDGEMENTS: The project received financial support
from The Norwegian Fund for Postgraduate Training in Physiotherapy.
ETHICS COMMITTEE: National committee for research ethics in
Norway (REK IV)
S106
Research Report Platform Presentation
2651 Sunday 3 June 17:15
VCEC Ballroom A
A PERI-OPERATIVE PHYSICAL THERAPY PROGRAM
INCLUDING STRENGTH TRAINING AND ELECTRICAL
STIMULATION MAY HELP COUNTERACT FUNCTIONAL
DECLINE AFTER HIP FRACTURE
Beyer N1 , Albertsen B2 , Bährentz G2 , Rasmussen M2 , Suetta C3 ;
1 Institute of Sports Medicine – Copenhagen & Dept. Physical
Therapy, Copenhagen University Hospital Bispebjerg, Copenhagen,
Denmark; 2 Dept. Physical Therapy, Copenhagen University Hospital
Bispebjerg, Copenhagen, Denmark; 3 Institute of Sports Medicine –
Copenhagen, Copenhagen University Hospital Bispebjerg, Denmark
PURPOSE: It has been shown that functional muscle performance
increased as a result of postoperative resistance training and
electrical stimulation following hip replacement. Moreover, resistance
training markedly reduced length of stay in these patients. The
question is whether peri-operative physical therapy combined with
resistance training and neuromuscular electrical stimulation can help
counteract functional decline in hip fracture patients. RELEVANCE:
Optimising physical therapy programs to counteract functional decline
in hip fracture patients may potentially improve functional ability in
a group of patients where many never recover their pre-fracture
physical function. PARTICIPANTS: 103 patients, aged 60 years
and older, admitted to the Department of Orthopaedics with a
primary hip fracture between October 2004 and June 2006. Pre
fracture all patients were home-dwelling and had independent
walking function. METHODS: Patients who fulfilled the inclusion
criteria were invited to participate in the randomised controlled (non-
blinded) study. On inclusion the patients were randomly allocated
to a standard physical therapy program (SR) consisting mainly
of functional training as part of an accelerated hospital stay or
standard physical therapy combined with resistance training (3/wk)
and neuromuscular electrical stimulation (daily) of the operated
side (RTES). The rehabilitation programmes were commenced the
day after surgery. All patients were tested with the New Mobility
Score (NMS, scores 0-9) to assess pre fracture functional mobility
and Mini Mental State Examination (MMSE) to assess cognitive
function. Three and 10 days post surgery the patients performed
a 10-m walking test (habitual walking speed). ANALYSIS: Data are
presented as median(range). Comparisons between the groups were
calculated with the Mann-Whitney U test. RESULTS: Mean age
was 81.5 yr (60-95)(RTES) and 82 yr (60-99)(SR). The majority
of the participants had a relatively high functional mobility level
pre fracture, NMS=9(2-9)(RTES) and NMS=9(2-9)(SR). MMSE was
performed in 45 patients from both groups and very few were
cognitively impaired, scores were 27(13-30)(RTES) and 28(20-
30)(SR). 35 patients from RTES and 25 from SR were able to
perform the 10-m walking test three days post surgery (29.53s
(15.25-119.53), and 42.17s (16.75-115.00), p = 0.112). Data on 10-
m walking test at three and 10 days post surgery existed in 26
patients from RTES and 19 from SR. Walking time improved in
both groups, however the improvements were significantly greater
in RTES compared with SR (from 27.44s (15.25-107.56) to 18.47s
(11.00-37.00) vs. from 39.18s (16.75- 102.82) to 23.06s (15.00-
123.00), p = 0.008). CONCLUSIONS: More participants in RTES-
group were able to walk 10m three days post surgery and in
those who performed the 10-m walking test three and 10 days post
surgery the participants from RTES had a higher habitual walking
speed than those from SR. Results from this study suggest that
resistance training and neuromuscular electrical stimulation of the
operated side may counteract some of the functional decline seen
in hip fracture patients post surgery. The non-blindedness is the
primary limitation of this study. IMPLICATIONS: An accelerated
hospital stay improves recovery after hip fracture. Implementation
of neuromuscular electrical stimulation and resistance training as
part of the peri-operative physical therapy program may further
improve functional ability in these patients. KEYWORDS: Resistance,
WCPT 2007, Research Reports
NMES, fracture. FUNDING ACKNOWLEDGEMENTS: The study was
partly funded by The Danish Rheumatism Association. CONTACT:
nb01@bbh.hosp.dk
ETHICS COMMITTEE: The regional research ethics committees of
Copenhagen and Frederiksberg
Research Report Platform Presentation
2198 Sunday 3 June 17:15
VCEC Meeting Rooms 11-12
LONG TERM EFFECTS OF REPETITIVE KNEE EXTENSION
INDUCED BY NEUROMUSCULAR ELECTRICAL STIMULATION
(R-NMES) ON MOTOR CORTICAL EXCITABILITY
Tremblay L, Arbour C, Franche M, Major K, Ouellette S; School
of Rehabilitation Sciences, University of Ottawa, Ottawa, Canada
PURPOSE: It has been well established that neuromuscular electrical
stimulation (rNMES) enhances the performance of innervated
muscles for patients with musculoskeletal and neurological disorders.
However, the effects of rNMES on brain excitability is not yet known.
This project investigated the modulation of cortico motor excitability
using modern technology such as transcranial magnetic stimulation
(TMS) during and after prolonged application (30 mins/day X 7 days)
of repetitive NMES inducing knee extension. RELEVANCE: In the re-
education of motor control it is important to know the effects of NMES
on the sensorimotor cortex area of the brain. PARTICIPANTS: 10
healthy male volunteers (median= 21.9±1.4 yrs) from the Faculty of
Health Sciences participated in this project. METHODS: Repetitive
knee extension was induced (90º to full extension without fatigue,
with 10% of maximal voluntary contraction) with rNMES (Response
Select©, 300 msec, biphasic simetrical wave, 15 Hz, duty 8/8 sec,
I at 2.0 X motor threshold) over the femoral nerve with a pair of
rubber carbon silicone electrodes (5X8 cm). Corticospinal excitability
was measured using a TMS stimulator (magstim 200©) connected
to a double cone coil at 10% over motor threshold. Motor evoked
potentials (MEPs) induced by the TMS were recorded (EMG) via
surface electrodes placed over motor points of dominant rectus
femoris muscle (RF). This electrophysiological testing was done
before, immediately after 30 minutes of rNMES (during) and 30
minutes after the end of NMES (post-rNMES) at day 1 and day
7. Voluntary strength (Nicholas hand dynomometer), discomfort
associated to rNMES (VAS) and muscle fatigue (Borg Fatigue
Index) were also measured. ANALYSIS: Repeated non-parametric
measures for a small group of subjects were used (Friedman and
Welcoxon test). RESULTS: 1 session of rNMES induced a late
significant facilitation of primary motor cortex excitability. In fact,
MEPs increased by 77±12% 30 minutes post-rNMES and by 15±9%
immediatly after rNMES compared to control values. However, a
7 day series of rNMES enhanced significantly the facilitation by
33±6% (110 ±14% vs 77±12%) in comparison to a single session of
training. No change was observed immediatly after rNMES sessions
at day 1 and at day 7, (15 ±9% vs. 0±4%). The muscle strength
increased by 15±4% after 7 days of rNMES training. The level of
comfort did not change (VAS= 3.7±0.6 after first training session and
2.8±0.4 after 7 sessions). A similar result was observed with the Borg
Fatigue Index (1.2±1.4 after first training session vs 1.6±0.9 after 7
sessions). CONCLUSIONS: A delayed facilitation of the contralateral
MEPs surpassing the time of application of rNMES and an increase
of muscle strength following rNMES, showed an important long
term effect not only peripherally but also at the sensorimotor
cortex level. This training induced brain plasticity. IMPLICATIONS:
These results suggest a possible implication in rehabilitation for
clients suffering from motor disorders involving poor motor control
and/or muscle weakness. KEYWORDS: Repetitive neuromuscular
electrical stimulation, transcranial magnetic stimulation, motor cortical
excitability. FUNDING ACKNOWLEDGEMENTS: Faculty of health
Sciences. CONTACT: ltrembl@uottawa.ca
ETHICS COMMITTEE: University of Ottawa Research Ethics
Comitee
Platform Presentations, Sunday 3 June
Research Report Platform Presentation
2567 Sunday 3 June 17:35
PP Crystal Pavilion A
RANDOMIZED CONTROLLED TRIAL OF SENSORY-SPECIFIC
BALANCE TRAINING IN OLDER ADULTS: EFFECT ON
PROPRIOCEPTIVE REINTEGRATION AND INCREASED
COGNITIVE DEMANDS
Westlake K, Culham E; Queen’s University, School of Rehabilitation
Therapy, Kingston, Ontario, Canada
PURPOSE: The primary purpose of this randomized controlled trial
was to investigate the postural effects of training on postural recovery
immediately following proprioceptive perturbation both with and
without a concomitant cognitive task in older adults. The secondary
purpose was to determine the effects of the exercise program on
balance performance and confidence. RELEVANCE: Age-related
changes in the ability to adjust to alterations in sensory information
contribute to impairments in postural control and increased fall
risk in older adults. This study represents one of the few studies
that have examined the possibility to enhance sensory integration
through training. PARTICIPANTS: Thirty-six healthy older volunteers.
METHODS: Participants were randomly assigned to an 8-week
balance exercise group (n=17) or a falls prevention education group
(n=19), each led by a physical therapist. Postural recovery following
proprioceptive perturbation through vibration was measured using
center of pressure (COP) velocity change scores. Change scores
were determined using the difference between mean COP velocity
over 45s of quiet standing and the mean of six 5s intervals following
perturbation both with and without a secondary math task. Clinical
measures included lower extremity strength, Fullerton Advanced
Balance (FAB) Scale, and Activities-Specific Balance Confidence
(ABC) Scale. Baseline and post-intervention measurements were
obtained in exercise and education groups. Follow-up measurements
were taken 8-weeks post-intervention only in the exercise group.
ANALYSIS: Analysis of variance (ANOVA) was used to analyze
COP change scores and the effects of the interventions on clinical
measures. Bonferroni correction was applied. RESULTS: COP
velocity change scores decreased by post-intervention in the exercise
group indicating less destabilization, in the first time interval following
perturbation (1-5s) both with and without the secondary task (mean
change score±SD, 1.12±0.58cm/s and 1.31±0.91cm/s) compared
to baseline (1.68±0.96 and 2.23±1.18cm/s) and post-intervention
education group scores (1.71±0.85cm/s and 2.00±1.05cm/s),
p < 0.05. The time to restabilize was also reduced under the
no secondary task condition to 11-15s compared to a baseline
time of 16-20s following perturbation. Changes were not attributed
to increased lower extremity strength. Improvements in postural
recovery were not maintained at 8-week follow-up. Clinical findings
revealed increased post-intervention and 8-week follow-up FAB
scores (35.0±4.06 and 35.27±4.56, respectively) compared to
baseline scores (30.94±4.81) in the exercise group, p < 0.02.
ABC scores decreased in the education group post intervention
(79.06±24.20) compared to baseline scores (87.48±10.71), p = 0.05,
but not in the exercise group. CONCLUSIONS: A sensory-specific
balance exercise intervention resulting in increased short-term
improvements in postural response to the sudden restoration of
proprioception information is supported. IMPLICATIONS: Given that
sensory inputs related to various environmental conditions are
constantly changing, findings that postural adjustments to a change
in sensory information are enhanced with sensory-specific training
are encouraging. Results are expected to lead to more efficient
balance exercise interventions and ultimately, a reduction in fall
risk in older adults. KEYWORDS: Proprioception, Balance, Aging.
FUNDING ACKNOWLEDGEMENTS: Kelly Westlake was supported
by a Canadian Institutes of Health Research Fellowship. CONTACT:
westlake@rrd.stanford.edu
ETHICS COMMITTEE: Queen’s University Health Sciences and
Affiliated Teaching Hospitals Research Ethics Board
S107
Research Report Platform Presentation
3076 Sunday 3 June 17:35
PP Crystal Pavilion B & C
TRAINING AND REHABILITATION IMPLICATIONS FOR THE
TRUNK AND EXTREMITIES WHILE PERFORMING SWISS BALL
AND CONVENTIONAL EXERCISES: AN ELECTROMYOGRAPHIC
ANALYSIS
Escamilla R, Lewis C, Bell D, Bramblet G, Daffron J, Lambert S,
Pecson A, Imamura R, Hreljac A; California State University,
Sacramento, USA
PURPOSE: Test the effectiveness of 13 exercises performed on a
swiss ball and two conventional abdominal exercises (Crunch and
Bent-Knee Sit-up) performed on the ground on activating abdominal
and extraneous musculature. RELEVANCE: While abdominal crunch
and sit-up exercises activate abdominal musculature by actively
flexing the trunk, there are numerous exercises performed on a
swiss ball that activate abdominal muscles either by actively flexing
the trunk or by resisting trunk extension. Abdominal exercises that
actively flex the trunk may be problematic for some individuals with
lumbar disk pathologies due to increased intradiscal pressure and
lumbar spine compression, especially if extraneous muscles are
also active, such as the hip flexors, which may increase lumbar
stress. Individuals with osteoporosis may also not tolerate trunk
flexion due to the risk of vertebral compression fractures. However,
these individuals may be asymptomatic during abdominal exercises
that resist trunk extension and maintain a relatively neutral spine
and pelvis. In contrast, some individuals with facet joint syndrome,
spondylolisthesis, and vertebral or intervertebral foramen stenosis
may better tolerate trunk flexion exercises compared to exercises
that maintain an extended trunk. PARTICIPANTS: A convenience
sample of 18 healthy males and females between 23-45 years old.
METHODS: Surface electrodes were positioned on the subject’s
dominant side over the upper and lower rectus abdominis, external
and internal obliques, rectus femoris, triceps brachii long head,
sternal pectoralis major, latissimus dorsi, and lumbar paraspinals.
EMG data were collected from a Noraxon EMG system during
five repetitions for each exercise. Each repetition was performed
in a slow and controlled manner, taking 3 s to complete followed
by 1 s rest. EMG exercise data were normalized by maximum
voluntary muscle contractions. ANALYSIS: Differences in muscle
activity were assessed by a one-way repeated measures Analysis
of Variance, with Tukey’s post hoc analysis used for pairwise
comparisons. RESULTS: Compared to all exercises: 1) upper and
lower rectus abdominis activity was significantly greater with the
Rollout, Ball Crunch, Double Crunch, Crunch, Pike, and Abdominal
Dips; 2) external and internal oblique activity was significantly
greater with the Pike, Skier, and Knee-up; 3) rectus femoris activity
was significantly greater with the Prone Hip Extension, Knee-
up, Pike, and Sit-up; 4) triceps brachii, sternal pectoralis major,
and latissimus dorsi activity were significantly greater with the
Rollout, Pike, Skier, Decline Push-up, and Prone Hip Extension; 5)
lumbar paraspinal activity was significantly greater with the Side
Crunch. CONCLUSIONS: The Rollout, Pike, Knee-up, and Skier
were not only the best exercises for activating abdominal and
oblique muscles, but they were also the best exercises in activating
extraneous musculature. Interestingly, even the Decline Pushup
was as effective as the Crunch and Sit-up in activating abdominal
and oblique muscles. IMPLICATIONS: Performing exercises with
a swiss ball demonstrated different trunk and extremity muscle
recruitment patterns compared to the conventional crunch and sit-
up. Understanding how different exercises elicit muscle activity from
the trunk and extremities is helpful to therapists in developing
specific abdominal exercises for their patients or clients to facilitate
their rehabilitation or training needs. KEYWORDS: EMG, SPINE,
LUMBAR. FUNDING ACKNOWLEDGEMENTS: None. CONTACT:
rescamil@csus.edu
ETHICS COMMITTEE: California State University, Sacramento
S108
Research Report Platform Presentation
2924 Sunday 3 June 17:35
VCEC Ballroom A
BALANCE CONFIDENCE AND WALKING ABILITY ONE MONTH
AFTER HIP FRACTURE – A RANDOMIZED CONTROLLED
STUDY ON HOME REHABILIATION
Zidén L1,2 , Kreuter M1 , Frändin K1 ; 1 The Sahlgrenska Academy at
Göteborg University Inst. of Neuroscience and Physiology/Physical
Therapy; 2 The Vårdal Institute, Göteborg, Sweden
PURPOSE: The aim of the study was to explore if there was
any difference between an intervention group, receiving home
rehabilitation, and a control group, receiving conventional care,
regarding perceived balance confidence, indoor walking ability and
outdoor walking habits one month after discharge from hospital.
RELEVANCE: Hip fracture is one of the most common causes for
hospital admission among elderly people and the development of
effective rehabilitation programs, as well as evaluation of existing
programs, is essential from a humanistic as well as from an
economical point of view. PARTICIPANTS: Before hip fracture
surgery, 102 persons, admitted to Sahlgrenska University Hospital
in Göteborg, were randomized into two groups, one receiving
home-based rehabilitation after discharge and the other receiving
conventional care and rehabilitation. Inclusion criterias were: Swedish
spoken, at least 65 years old, living in the community in the
central/western parts of Göteborg. Patients with metastatic cancer
or cognitive impairment, persons living in nursing homes and those
who did not give informed consent were excluded. METHODS: In
this ranomized, controlled study the intervention group (IG) (n=48)
received home-rehabilitation including home-visits by physioterapists
(PT, occupational therapists(OT)and occasional nurse visits during
2-3 weeks after discharge. The PT intervention was focused on
supporting and encouraging activity confidence and outdoor walking.
The control group (CG) (n=54) received conventional care. Mean
age of the participants were 81.9 years (IG 81.2, CG 82.5).
The participants in the two groups were similar concerning living
conditions, walking habits and number of medical diagnoses before
the fracture. Primary outcome was balance confidence, measured
by Falls Efficacy Scale (FES), and secondary outcomes were indoor
walking ability, measured by Timed Up and Go (TUG) and outdoor
walking habits. ANALYSIS: T-test was used to compare the two
groups concerning TUG. Non-parametric statistic analyses were
used to compare the two groups; Mann-Whitney U-Test for Falls
Efficacy and Chi Square for independence in outdoor walking.
RESULTS: At the one-month follow up, the participants in the IG
had received in average 2.3 PT, 1.9 OT and 0.25 nurse visits. Total
FES score was significantly higher in the intervention group (mean
rank for IG 65.5 and for CG 35.5, p < 0.001). Mean value for TUG
was significantly lower for the IG (25.1 seconds) compared to the
CG (34.4 seconds, p = 0.018). Also, a significantly greater number of
persons in the IG took outdoor walks regularly compared to the CG
(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
encouraging and supporting activity confidence and outdoor walking,
perceive a higher degree of balance confidence, perform better
on Timed Up and GO and take outdoor walks more often than
those who have received conventional care. IMPLICATIONS: Since
home rehabilitation with the described direction and content seems
to have effect on the participants’ perceived balance confidence,
indoor walking ability and outdoor walking habits it might be a
useful model within this field of geriatric rehabilitation. KEYWORDS:
Hip fracture, home rehabilitation, balance confidence, Timed Up
and Go outdoor walking. FUNDING ACKNOWLEDGEMENTS: The
study was financially supported by the Vårdal Institute, Göteborg
University and Mearchant Hjalmar Svenssons Research Foundation
in Göteborg. CONTACT: lena.ziden@neurophys.gu.se
ETHICS COMMITTEE: The research Ethical Committee of Göteborg,
Sweden
WCPT 2007, Research Reports
Research Report Platform Presentation
2908 Sunday 3 June 17:35
VCEC Ballroom B & C
RESEARCH IN PHYSIOTHERAPY IN SWEDEN AND AUSTRALIA
TODAY – A COMPARISON REGARDING RESEARCH AREA,
STUDY DESIGN AND ICF COMPONENTS
Steding K, Gummesson C; Department of Health Sciences, Divison
of Physiotherapy, Lund University, Lund, Sweden
PURPOSE: The objective was to describe the research presented
at the most recent meetings in physiotherapy in Sweden and
Australia. The aim was to describe the topics, study design used and
which components of the International Classification of Functioning,
Disability and Health (ICF) the study’s outcome measures focused
on. RELEVANCE: Because of increased international exchange,
professional and in the graduate program, international comparison
of research approach within the field is of increased interest.
PARTICIPANTS: The book of abstracts from the Swedish Association
of Registred Physiotherapists annual meeting in 2005 (152 abstracts)
and from the Australian Physiotherapy Associations (APA) Interna-
tional Physiotherapy congress in 2004 (119 abstracts) were included.
METHODS: Abstracts from each meeting were randomly selected.
Sixty-five swedish and 65 australian abstracts were included in
the assessment. Thirty-two abstracts were systematically reviewed
independently by two researchers and the remaining by one
researcher. All abstracts were reviewd twice to ensure consistency
and 28 were selected for test-retest. ANALYSIS: The topics, eg.
Orthopaedics or Neurology, study design such as experimental study
or observational study, and the components of ICF addressed in
the outcome assessment were categorized. An abstract could be
classified into several categories/components. RESULTS: Inter and
intrarater reliability was satisfactory, with only a few differences in the
categorization. The most common area/topic was Orthopaedics. A
quantitative study design was more common than a qualitative design
in both Sweden and Australia. Researchers from both countries
often chose to do observational studies or used an experimental
design/did treatment studies. Among the Australian abstracts, the
studies more often involved the ICF components body structure/body
function compared to the Swedish studies. Among the Swedis studies
activity/participation components were more often focused on than
body structure/body function. CONCLUSIONS: Physiotherapeutic
research in Sweden and Australia both covered many topics,
however similar between the countries. The most common study
design used was a cross sectional quantitative observational study.
IMPLICATIONS: The findings support similarities within the field in
the international perspective. A secondary finding was that the design
of the abstracts affected how difficult the review and categorization
was. Structured abstracts gave the best information and facilitated
the review. This should be encouraged to enhance clarity and offer
readers a better overview of the research. KEYWORDS: Sweden,
Australia, research. FUNDING ACKNOWLEDGEMENTS: None.
Research Report Platform Presentation
2368 Sunday 3 June 17:35
VCEC Meeting Rooms 11-12
ULTRASOUND TREATMENT COMPARED TO ANTIBIOTICS FOR
ACUTE AND CHRONIC SINUSITIS
Høsøien E1 , Lund A2 , Vasseljen O3 ; 1 Røros Physical Institute;
2 Røros Medical Center; 3 NTNU, Norwegian University of Science
and Technology, Faculty of Medicin, Trondheim
PURPOSE: The purpose of the study is to compare therapeutic
ultrasound and antibiotics in the treatment of acute and chronic
sinusitis. An alternative treatment to antibiotics is especially important
for those who are allergic to antibiotics or are pregnant, or for
those who seek alternative treatment. The effect and costs of the
two different methods of treatment will be compared. RELEVANCE:
The prevalence of acute and chronic sinusitis is 5% in the
Platform Presentations, Sunday 3 June
general population. Those who seek medical treatment are normally
prescribed antibiotics. Both WHO and national health plans have as
a goal the reduction of the use of antibiotics. PARTICIPANTS: 44
persons with clinical symtoms of acute or chronic sinusitis and SR
over 10 will be randomly assigned either to ultrasound treatment or
antibiotics. METHODS: 44 persons with clinical symtoms of acute or
chronic sinusitis and SR over 10 will be randomly assigned either to
ultrasound treatment or antibiotics. Patients will complete a 5- item
questionaire on their symptoms on a VAS scale, on the first, fourth
and twenty-first day of treatment. The items are pain and density in
forehead, nose and teeth. In addition, the long-term effect of the two
methods of treatment will be investigated by questionnaire at one-
year follow-up. The ultrasound treatment is applied at 1.0 W/cm2
CW intensity for ten minutes to the forehead, both sides of the
nose and below the eyes for four succeeding days. The antibiotics
treatment consists of Amoxcillin/Imacillin 500mg tablets; one tbl.,
three times a day for ten days. ANALYSIS: Group differences and
changes within groups will be analyzed. RESULTS: The preliminary
results based on the initial three assessments of 26 subjects show a
marked and rapid significant reduction of symptoms on all outcome
variables in both groups, but with no significant difference between
groups. This indicates that ultrasound is as effective as antibiotics
for sinusitis. Complete data and final analyses will be presented
at the Congress. CONCLUSIONS: If the tendency shown by the
questionnaire prevails, the study will be the first to provide evidence
for comparable efficacy of therapeutic ultrasound and antibiotics for
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,
antibiotics. FUNDING ACKNOWLEDGEMENTS: The project got
15.000 Norwegian kroner/ca. 1875 Euro/ca. 2500 US dollars
from Norsk Fysioterapiforbund, avd. Sør-Trøndelag for ultrasound
equipment. CONTACT: eliroros@roros.net
ETHICS COMMITTEE: Medisinsk etisk komite
Research Report Platform Presentation
2344 Sunday 3 June 17:35
VCEC Meeting Room 16
ACUTE CARDIOVASCULAR AND METABOLIC STRAIN DURING
STOCHASTIC RESONANCE THERAPY (ZEPTOR® WHOLE-
BODY VIBRATION PLATE) WITH PATIENTS FOLLOWING A
STROKE
Herren K1 , Hotz-Hängärtner C1 , Oberli A1 , Mathis J2 , Radlinger L1 ;
1 Research Physiotherapy, University Hospital Berne, Switzerland;
2 Department of Neurology, University Hospital Berne, Switzerland
PURPOSE: A treatment with stochastic resonance therapy (srt) on
a Zeptor® vibration plate has been shown to increase force and
power of leg muscles, balance and movement velocity. The aim of
this study was to investigate the physical strain for patients with
a stroke during srt. RELEVANCE: Stroke is the leading cause of
disability among adults. Hypertension is one of the established risk
factors for the occurrence of this disease. This means that one
should avoid strenuous exercises that might increase blood pressure
when treating patients with a stroke in physical therapy. This study
demonstrates the amount of physical strain during srt for these
patients. PARTICIPANTS: 20 patients (15 men, 5 women, 57.8 + 10.5
years) with a recent stroke were included in the study. METHODS:
In a cross-sectional study the patients had to perform a stochastic
resonance therapy with individual sub-maximum vibration-frequency.
Thereby the patients stood on the Zeptor® with slightly bent knees.
The training consisted of 5 series of 1 minute each with 1 minute rest
in between. Blood pressure, heart rate and lactate were measured
before (at rest) and during srt. The study was approved by the ethics
committee of Berne. ANALYSIS: The descriptive statistics and the
nonparametric analysis of variance of the dependant measurements
(Friedman-Test: before therapy and during 5 series) of parameters
S109
were calculated using SPSS. RESULTS: The systolic blood pressure
varied significantly during srt (p = 0.004). Before the therapy it was
at an average of 130.7 mmHg and rose slightly to 140.1 mmHg
after the first series. During the 5 series the systolic blood pressure
varied randomly between 136.0 und 142.1 mmHg. The variation of
the diastolic blood pressure was significant as well (p = 0.033). It
increased from 89.5mmHg, measured before the therapy, to 98.2
mmHg after the first series. During the 5 series diastolic blood
pressure varied between 92.2 and 98.2 mmHg at random. The lactate
varied between 1.9-2.0 mmol/l over all series. In comparison to the
values before the test (1.9 mmol/l) no significant increase could be
detected (p = 0.521). The heart rate varied randomly between 93 and
101 beats/minute (p = 0.131). CONCLUSIONS: During the 5 series
of srt the results showed only a marginal increase in the systolic
and diastolic blood pressure compared with the values before the
test. Lactate and heart frequency did not exceed the measurements
at rest before the therapy. The strain caused by Zeptor-training
is comparable to cardio vascular and metabolic strain between
values during rest and the aerobic threshold. IMPLICATIONS: It
offers a good neuromuscular effect, a minimum training effort and
overall as only a slight strain. For this reason srt on a Zeptor®
vibration plate seems to be very suitable for patients following a
stroke. KEYWORDS: cardiovascular strain, stochastic resonance
therapy, stroke. FUNDING ACKNOWLEDGEMENTS: This survey
was unfunded. CONTACT: kaspar.herren@insel.ch
ETHICS COMMITTEE: local ethical commitee of Berne
Research Report Platform Presentation
3290 Sunday 3 June 17:35
VCEC Meeting Room 17
SENSITIVITY AND SPECIFICITY OF A TWO STEP SCREENING
PROCEDURE FOR FOUR TO SIX MONTH OLD INFANTS
Meade V1 , Sweeney J, Chandler L, Woodward B; 1 Rocky Mountain
University of Health Professions, Provo Utah
PURPOSE: The US federal government has recognized the
importance of early and accurate identification of children with
developmental delay or disability through the Individuals with
Disabilities Education Act (IDEA) which requires states to set up
methods to find eligible children. Eligible children are not always
identified in a timely manner. Current screening relies on either
surveillance or tests for early detection; both strategies are expensive
and may over- or under- identify children. The purpose of this study is
to select infants initially identified by parents concerns and then test
the infants using an observational screening tool requiring parent
participation. RELEVANCE: These two steps will actively involve
parents and result in a more sensitive and specific process of
child find during community surveillance. PARTICIPANTS: Parents
of infants aged 4 to 6 months, living in Houston Co. MN, were
invited to attend a screening clinic in their area. METHODS: This was
an observational screening study. Parent concerns were measured
by attendance at the clinics and answers on the Parent Concerns
Survey. Parents who choose to attend were compared to a random
group of parents who choose not to attend. Step two consisted of
active parent involvement using a structured observational screen,
the Meade Movement Checklist. All infants were independently
evaluated at 6 months using the Bayley Scales of Infant Development
II and the Movement Assessment of Infants. ANALYSIS: Scores on
the MMCL were compared to BSIDII, MAI and parent descriptions
of their infant’s development on the ASQ at 8 to 9 months of
age. Two by two tables evaluated sensitivity, specificity, positive
predictive and negative predictive values of parent concerns and the
MMCL. RESULTS: Of the 213 eligible infants, 55 (25%) attended
one clinic and parents completed the survey and MMCL. Forty
three (78.2%) infants were evaluated by the principle investigator,
who was blind to all screening information. Parents who attended
the clinics had significantly more concerns on the survey than
parents who did not attend. 60% of parents’ concerns included
S110
questions about feeding issues. There were significant correlations
between the MMCL and MAI and BSID II. There was no correlation
between any scores at 4 and 6 months and the pass/fail on the
ASQ between 8 to 9 months. The specificity of the PCS was 81%
and sensitivity 60%. The specificity of the MMCL was 88.2% and
sensitivity was 77.8%; PPV was 63.6% and NPV was 93.8%. When
both BSID scores and medical diagnosis categories were combined
to determine referrals, 15 infants were referred for further evaluation
(27.7%). Referrals represented 7.04% of the 213 invited and 34.8%
of the independent evaluations completed. CONCLUSIONS: Parent
concerns were used in step one to increase specificity and ‘rule
out’ typical infants. An observational screening test was used in
step two to increase sensitivity. Parents with questions about their
infant took the opportunity to have those questions answered.
IMPLICATIONS: Parents’ listed their concerns and identified 25%
of a birth cohort for a second screen. This resulted in both
increased specificity and sensitivity in screening 4 to 6 month old
infants. KEYWORDS: Screen, Infants,Parent concerns, Community
surveillance, Prevention. FUNDING ACKNOWLEDGEMENTS: Grant
support from The Houston County Early Childhood Initiative,
Houston County, Minnesota; Clinic setups and Screening services
through Houston County Interagency Early Intervention Committee,
Early Childhood Family Education in Caledonia, Houston, La
Crescent/Hokah and Spring Grove, Houston County Public Health,
Hiawatha Valley Education District, Houston County, Minnesota,
USA. CONTACT: vickie@vickiemeade.com
ETHICS COMMITTEE: IRB of Rocky Mountain University of Health
Professions, Provo, Utah
Platform Presentations, Monday 4 June
Research Report Platform Presentation
1082 Monday 4 June 08:30
PP Crystal Pavilion A
THE USE OF A CLINICALLY-BASED REFLECTIVE PRACTICE
PORTFOLIO: A SURVEY OF UNDERGRADUATE STUDENT
OPINION
Jones L1,2 , Hammond J1 , Horgan T1 ; 1 School of Physiotherapy,
Faculty of Health and Social Care Sciences, Kingston University
and St. George’s, University of London; 2 Faculty of Medicine,
University of Sydney
PURPOSE: Reflection of clinically-based learning experiences can
be facilitated by the use of a portfolio. Such a portfolio was introduced
into year 2 and 3 of an undergraduate physiotherapy programme.
This study investigated student opinions of the portfolio and its
contribution to their learning experience. RELEVANCE: In the UK,
a profile from a similar reflective practice portfolio will be used as
part of the re-registration requirements with the Health Professions
Council. Therefore students should have a successful and meaningful
introduction to the activity of collecting evidence and using reflection
to construct knowledge, in their training. This study provides some
insight into the acceptance and meaningfulness of a portfolio to
the students. PARTICIPANTS: Undergraduate students who had
completed a portfolio for assessment were asked to participate.
METHODS: A survey by questionnaire (modified from Capstick,
2003) was undertaken, where students were asked to download,
complete and submit responses anonymously at the end of each
academic year to assist review of learning and teaching. The modified
questionnaire consisted of 16 positive statements relating to the ex-
perience of learning, and students were asked whether they thought
the process of completing the portfolio contributed to these. Also
questions were included to identify the perceived clarity of guidelines
and time taken to complete the portfolio. Group email reminders
were given to optimise response rate. ANALYSIS: Analyses were
performed using SPSS including descriptive statistics, Chi-squared
and Fisher’s exact analyses. Comparisons across cohorts were
relevant as the structure and content of the portfolio, and the student
WCPT 2007, Research Reports
guide, have evolved in response to ongoing review. RESULTS: Over
a three year period, 193 questionnaires were returned (128 Year 2
students; 65 Year 3 students). Two cohorts (2002 and 2003) had
completed questionnaires for both Year 2 and Year 3 but these
were not matched due to the anonymity of submission. One cohort
(2004) had only completed Year 2. Descriptive statistics show that
greater than 50% of respondents agreed that the portfolio contributed
to the positive outcomes outlined in 10 of the 16 statements.
The most recent cohorts, 2004 for Year 2 and 2003 for Year 3,
reported completing the portfolio was an ‘effective use of time’,
more than the cohort from the previous year (p = 0.010 and p = 0.044
respectively). Respondents felt that completing a portfolio did not
lead to ‘better marks’ in assignments (86%), ‘better preparation
for assignments’ (73%) nor provided ‘reassurance about course
related concerns’ (73%). On average, students reported spending
1.3 hours per day during their clinical placement on portfolio-
related activity and more than 5%, but less than 10%, of this was
spent in normal work hours. CONCLUSIONS: Students identified
benefits from completing a reflective practice portfolio that extend
to their broader learning experience. There seems to be improving
acceptance of the portfolio from its initial implementation. It is
unclear if this is because of changes to the portfolio requirements
and guidance, or because of the new professional requirements
for CPD and registration. IMPLICATIONS: Clinical-based learning
can be facilitated by a reflective practice portfolio and has the
potential to benefit the broader learning experience of physiotherapy
students. KEYWORDS: portfolio, undergraduate, learning. FUNDING
ACKNOWLEDGEMENTS: Nil. CONTACT: ljones@hscs.sgul.ac.uk
Research Report Platform Presentation
1052 Monday 4 June 08:30
PP Crystal Pavilion B & C
MUSCULAR DISUSE INDUCES MOTOR PERFORMANCE
DISRUPTION AND MUSCLE SPINDLE SENSITIVITY CHANGE IN
PARALLEL
Kaneko F1 , Kizuka T2 , Yamada H3 , Yokoi T1 , Yasojima T4 ,
Masuda T5 ; 1 National Institute of Advanced Industrial Science
and Technology (AIST), Tsukuba, Japan; 2 University of Tsukuba,
Tsukuba, Japan; 3 Tokai University, Hiratsuka, Japan; 4 Kyushu
Kyoritsu University, Kitakyushu, Japan; 5 Tokyo Medical and Dental
University, Tokyo, Japan
PURPOSE: One strategy in motor output modulation is to adjust
the short latency reflex gain and thereby effect changes in the
spinal reflex gain thought to be the possible reason for the disrupted
motor performances after immobilization. The present study was
designed to test whether the spinal level short latency reflex gain
could be changed and, if so, determine where in the circuit of
the short latency reflex it originated as a retrograde adaptation.
RELEVANCE: Muscular disuse, caused by joint immobilization and
bed rest, is frequently encountered in physical therapy. Prevention
measures, matched to the physiological mechanism of the motor
dysfunction following the disuse of muscles, are needed for every
patient. PARTICIPANTS: The lower extremities of nine healthy
males were immobilized for one week using a plaster cast. These
subjects lived at home at night using a bilateral crutch and spent
time every day at our research institute. The study was approved
by the local ethical committee of AIST; all participants gave
informed consent prior to participation. METHODS: Both before and
after the immobilization, the following parameters were measured
while recording an electromyogram of the soleus muscle. The
maximum voluntary contraction (MVC) of the triceps surae and
the variability of the force curve during a force modulation task
were measured as indications of motor performance. In addition,
the short latency stretch reflex (SLSR) of the soleus muscle was
recorded during a ballistic passive ankle dorsiflexion movement.
The passive torque of the triceps surae was measured as an
indication of the mechanical properties of the muscle-tendon complex
Platform Presentations, Monday 4 June
during passive dorsiflexion. The H-reflex was recorded following
electrical stimulation to the posterior tibial nerve in a resting condition.
The H-reflex slope drawn from the H-M curve was adopted as a
parameter that indicates the H-reflex gain. ANALYSIS: To test for
the immobilization effect for each motor performance and the H-
reflex gain, a paired t-test was used. SLSR and passive torque
during ballistic dorsiflexion wer statistically analyzed using a two-
way analysis of variance. RESULTS: The MVC of the triceps surae
significantly decreased and the variability of the force curve during
force modulation task significantly increased after immobilization. The
normalized amplitude and area of the SLSR significantly increased
after immobilization, but there was no significant difference between
the passive torque measured before and after immobilization. The
H-reflex gain was not significantly changed after immobilization
compared with its value before immobilization. CONCLUSIONS: The
new findings in this study were that the SLSR response increased
after immobilization. The mechanical properties of the muscle-tendon
complex did not substantially change. Therefore, some factor other
than the mechanical properties may have caused the enhanced
SLSR response. The absence of a change in the H-reflex gain
after immobilization probably suggests that the enhanced SLSR
after immobilization originates in the muscle spindle sensitivity.
IMPLICATIONS: An intervention to prevent an alteration in the
muscle spindle sensitivity after immobilization that we explored in the
present study may make possible the maintenance of normal motor
performance, even following muscular disuse. KEYWORDS: Disuse,
Immobilization, H-reflex, Stretch reflex, Muscle spindle. FUNDING
ACKNOWLEDGEMENTS: None. CONTACT: f-kaneko@aist.go.jp
ETHICS COMMITTEE: Local ethical committee of AIST
Research Report Platform Presentation
579 Monday 4 June 08:30
VCEC Ballroom B & C
PHYSIOTHERAPY AND INFECTION: COULD THERAPEUTIC
ULTRASOUND UNITS BE A SOURCE OF INFECTION?
Schabrun S1 , Chipchase L1 , Rickard H2 ; 1 School of Health
Sciences, University of South Australia, Adelaide, Australia; 2 School
of Pharmacy and Medical Sciences, University of South Australia,
Adelaide, Australia
PURPOSE: Infections acquired in the healthcare setting are
becoming an increasingly widespread and costly problem. A
significant number of patients now acquire infections linked to
contaminated healthcare equipment, predominantly in the hospital
setting. However, with the current shift towards community-based
care, a larger number of immuno-compromised and high risk
patients are accessing community services, making physiotherapy
equipment, such as therapeutic ultrasound, a potential source of
infection. Despite this, there is a paucity of published research
into contamination levels on physiotherapy equipment with only
one available study into interferential therapy and an absence
of research into therapeutic ultrasound.Thus, the purpose of this
study was to determine the degree of bacterial contamination on
therapeutic ultrasound transducer heads and ultrasound gel after
routine clinical use and to evaluate the efficacy of recommended
infection control procedures in relation to therapeutic ultrasound
equipment. RELEVANCE: Therapeutic ultrasound is the most
commonly used electrophysical agent in contemporary Australian
physiotherapy practice. With the increasing prevalence of multi-
resistant organisms and the high rates of morbidity and mortality
associated with such infections, it is important for physiotherapists
to be aware of any infection risk posed by therapeutic equipment.
PARTICIPANTS: Microbiological cultures were obtained from 44
ultrasound transducer heads and 43 ultrasound gels dispensed via
tubes or bottles. Equipment and gels were drawn from a sample
of convenience encompassing six public hospitals, eight private
practices and three residential disability and aged care facilities in
Adelaide, South Australia. METHODS: Using a prospective cross
S111
sectional design, cultures were evaluated for both the amount
(number of colony forming units (CFUs)) and type of bacteria
present. All samples containing greater than five CFUs per cm2 were
considered contaminated. The 44 ultrasound transducer heads were
then re-evaluated using a repeated measures design for the amount
and type of bacteria present after cleaning with 70 percent alcohol.
ANALYSIS: Due to the observational nature of the measurements
taken in both phases of this study (number of CFUs and type
of bacteria present), statistical analysis was undertaken using
descriptive statistics. RESULTS: 27 percent of ultrasound transducer
heads were contaminated with microorganisms. Organisms isolated
were predominantly those found in normal skin and environmental
flora. By contrast, 28 percent of ultrasound gels were heavily
contaminated (up to 300 CFUs per cm2) with opportunistic and
potentially pathogenic organisms, including Coagulase negative
staphylococci, Stenotrophomonas maltophilia, Staphylococcus au-
reus, Acinetobacter baumannii, and Rhodotorula mucilaginosa. No
multi-resistant organisms were identified. All ultrasound equipment
and gel brands were found to be similarly contaminated. Levels
of contamination on ultrasound transducer heads were reduced by
93.6 percent following cleaning with 70 percent alcohol (p  0.01).
CONCLUSIONS: Therapeutic ultrasound equipment is a potential
source of infection in physiotherapy patients. The risk of infection from
ultrasound transducer heads can be simply and effectively removed
by cleaning with 70 percent alcohol between patients. However,
ultrasound gels also harbour large numbers of potentially pathogenic
organisms, implicating them in the spread of infection. Thus further
research and clearer guidelines on care and maintenance procedures
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
individuals who are immuno-compromised or who have open skin le-
sions. KEYWORDS: Bacterial Contamination, Infection, Ultrasound.
FUNDING ACKNOWLEDGEMENTS: No funding was received for
this study. CONTACT: siobhan.schabrun@adelaide.edu.au
ETHICS COMMITTEE: University of South Australia Divisional ethics
committee (Health Sciences)
Research Report Platform Presentation
734 Monday 4 June 08:30
VCEC Meeting Rooms 11-12
MOTOR IMAGERY TRAINING IMPROVES HAND MOVEMENT IN
PERSONS WITH HEMIPLEGIA
Grabherr L1 , Jola C2 , Berra G3 , Möckli R4 , Theiler R3 , Mast F1 ;
1 Université de Lausanne, Lausanne, Switzerland; 2 University
College London, London, United Kingdom; 3 Stadtspital Triemli,
Zürich, Switzerland; 4 SUVA Rehaklinik, Bellikon, Switzerland
PURPOSE: The objective of this experiment is to investigate whether
repeated imagined hand movements improve motor performance and
thus could be used as an effective rehabilitation technique for persons
with hemiplegia. RELEVANCE: Recent studies using neuroimaging
techniques provide evidence that motor imagery involves some of the
same neural systems engaged while carrying out actual movements.
Such findings have a remarkable potential for application such as
in brain rehabilitation. Even though there is compelling scientific
evidence from the cognitive neurosciences, only a few clinical studies
have adressed the question whether and how motor imagery can
be an effective means to treat persons after a stroke. Until now
only sporadic attempts have been pursued for integrating motor
imagery in cognitive-therapeutic exercises (e.g, Prof. C. Perfetti, Italy).
PARTICIPANTS: 25 participants with hemiplegia (aged between 37
and 92) were recruited from two hospitals. After giving their informed
consent they completed a questionnaire including tests for hemiplegic
status, ideomotor apraxia, sensory body perception, neglect, mental
imagery, and cognitive abilities. The minimum requirements the
participants had to fulfill were the condition of cognitive adequacy
S112
to understand the tasks and to have good postural control (to be
able to sit at a table). They were then assigned to either the IMAG
or the EXEC training group. METHODS: All participants received
6 sessions of training during which the patients were blindfolded.
The participants in the IMAG group had to imagine moving their
hand to a certain position without actually executing the movement
while the participants in the EXEC group were instructed to try to
actually execute the movement. Each training session was followed
by a test session. The task was to rotate the hand around the little
finger as accurately as possible to a predetermined end position. We
designed a special apparatus allowing for controlled execution and
correct measurements of the end position. The deviation (measured
in degrees) between the predetermined and the actual end position
indicates the precision of the hand movement. ANALYSIS: Repeated
measure ANOVAs and Student’s t-tests were used to analyse the
data. RESULTS: Both training groups showed a significant increase
in performance over the 6 test sessions (F(1,23)=19.895; p < 0.001).
The training group (IMAG, EXEC) interacted with the amount of
test sessions (F(1,23)=5.410; p < 0.05) suggesting that the IMAG
group benefited more from the training than the EXEC group. T-Tests
confirmed that the IMAG group was able to perform more precise
hand movements than the EXEC group after the sixth training session
(p < 0.01) while there was no such difference after the baseline test
(p = 0.876) or the first training session (p = 0.969). CONCLUSIONS:
Mental imagery can be an effective means to improve motor
rehabilitation in persons with hemiplegia. Mental rehearsal of a
hand movement improved the accuracy of a motor action more
efficiently than the conventional training. IMPLICATIONS: This study
provides evidence for the benefit of motor imagery training in persons
with hemiplegia and thus suggests the integration of cognitive
training in conventional physiotherapy practice. KEYWORDS: Motor
Imagery, Hemiplegia, Stroke. FUNDING ACKNOWLEDGEMENTS:
This research was supported by SNF Grant 611-066052 (FWM).
CONTACT: gilberto.berra@triemli.stzh.ch
ETHICS COMMITTEE: Approved by two Swiss medical ethic com-
mittees: «SPUK ZH Stadtspitäler» and «Kantonale Ethikkommission
Aargau».
Research Report Platform Presentation
1438 Monday 4 June 08:30
VCEC Meeting Room 16
LEARNING TO BE A PHYSIOTHERAPIST – A LONGITUDINAL
STUDY OF LEARNING FROM A STUDENT PERSPECTIVE
Lindquist I1 , Engardt M1 , Richardson B2 ; 1 Dept. of Neurobiology,
Care Sciences and Society, Division of Physiotherapy, Karolinska
Institutet, Stockholm, Sweden; 2 School of Allied Health Professions,
University of East Anglia, Norwich NR4 7TJ, UK
PURPOSE: To explore the phenomenon of learning to be a
physiotherapist over a three year education programme from a
student perspective. RELEVANCE: Development in physiotherapy
and in learning theories, the new disease panorama and a changing
health care system call for curricular review. The study invites
students to share their experiences of learning. It elucidates students’
views of the role and purpose of physiotherapy and of different
modes of learning. The knowledge will constitute an important basis
in developing curricula for physiotherapy education. PARTICIPANTS:
A strategically selected cohort of twenty-one physiotherapy students
from Sweden and the UK including males and females, mature
students and school-leavers, those with high entry qualifications
and those with low, with and without work experience within
or outside health care. METHODS: A metasynthesis of findings
of four single, earlier studies analysed by a phenomenographic
approach, was used to create a new interpretation and capture
the longitudinal character of variation in learning experience. The
findings of the single studies were drawn from one hundred eleven
interviews of students through the education programme. A question:
“What do experiences described by the physiotherapy students
WCPT 2007, Research Reports
through an education programme reveal about learning to be a
physiotherapist?” was addressed to the findings from four earlier
studies. ANALYSIS: Together the findings constituted the raw data
which would produce new integrative knowledge about the learning
process over time. A phenomenographic approach to analysis
was used to explore differences and similarities with the aim of
describing the phenomenon of learning physiotherapy. RESULTS:
Three patterns of learning range from a cognitive to a cultural
view of learning to be a physiotherapist. The patterns highlight
differences in orientation towards patients, aim and focus of learning,
ways in which the learning activity occurs, and together with whom
and in which context learning takes place. Performing treatment
is learning to cure body structure/function by giving treatment and
instructing patients in an exclusive physiotherapy setting. Solving
problems is learning to solve movement ability problems by educating
clients in a rehabilitation setting and Managing health is learning
to enable individuals to move in an every day life activity by
designing and/or organising activities for them. CONCLUSIONS:
The identified patterns of learning experiences show a variety in
learning focus, in ways of learning and in views of knowledge and
learning and are influenced by the context in which learning occurs
and by learning partners participating in the physiotherapy activity.
IMPLICATIONS: An awareness of different learning patterns in a
student cohort can inform curricula development to ensure that all
students are purposefully exposed to different learning patterns and
different contexts of learning, with guidance of appropriate learning
partners. KEYWORDS: Student learning; physiotherapy education;
qualitative metasynthesis. FUNDING ACKNOWLEDGEMENTS: The
Board of Education, Karolinska Institutet, Sweden and Physiotherapy
Research Foundation, UK,. CONTACT: ingrid.lindquist@ki.se
Research Report Platform Presentation
1835 Monday 4 June 08:30
VCEC Meeting Room 18
PROGNOSTIC INDICATORS FOR SUCCESSFUL PROSTHETIC
REHABILITATION IN OLDER DYSVASCULAR UNILATERAL
TRANS FEMORAL AMPUTEES
Cumming J1,2 , Rome K1,2 , Whittaker V1,2 , Handoll H1,2 ; 1 The
James Cook University Hospital, Middlesbrough, England; 2 The
University of Teesside, Middlesbrough, England
PURPOSE: The aim was to develop profiles of older (over 60
years old) transfemoral prosthetic limb users to inform prosthetic
provision. Relationships between clinical, social and demographic
variables and outcomes including level of mobility and use of
prosthesis were explored. RELEVANCE: New referrals to prosthetics
centres in the UK are assessed for their capabilities for prosthetic
rehabilitation. Evidence is limited underpinning the clinical decision
path and needs development. Transfemoral amputees use 65% more
energy for walking. The low success rate in older transfemoral
amputees in terms of independent mobility and function may be a
reflection of impairment, disability or handicap. PARTICIPANTS: The
entire population of 206 older people (over 60) with transfemoral
amputation referred to the Cleveland Prosthetic Centre between
January 2000 and June 2005 were included in this mixed history
retrospective cohort study. METHODS: Variables of interest included:
co morbidities, sensory impairments, aetiology of amputation,
indicators of pre-amputation and post amputation level of mobility
and function, mobility and limb use at 3 and 6 months post
prosthetic issue, problems associated with the remaining limb,
social circumstances and level of support available or required.
The primary measure of success was based on mobility outcomes
and usage. Data was abstracted from case notes. A customised
data collection form was developed to input data into SPSS
(Statistical Package for Social Sciences) ANALYSIS: Data analysis
was mainly descriptive and comparative. Bi-variate correlations were
used to explore the relationships between aspects of clinical profiles
outcomes. RESULTS: 114/206 referrals (55.34%) were issued with
Platform Presentations, Monday 4 June
a functional prosthesis. 99/114 had a recorded mobility grade at
6 months, 8 (7%) died, 6 (5%)became bilateral. Only 53 (53.33%)
were relatively successful in mobility (independent indoor or outdoor
mobility). Those people who stopped limb wearing at 6 months
(n=38) significant variables (p < 0.05) were co-morbidities: peripheral
vascular disease, ulceration / gangrene other leg, respiratory disease,
arthritis, bladder problems, peripheral neuropathy and total number
of co-morbidities; in addition, no complaint of phantom limb pain,
already dependent on a powered chair, More than 8 medications,
low level mobility 6 months pre-amputation, not independent with
dressing, time to casting >8 weeks, aetiology dysvascularity. Full
time limb wearing at 6 months correlated to fewer comorbidities,
previous mobility level, not having home help and Barthel Index>12
at assessment. CONCLUSIONS: Older people with a transfemoral
amputation have a low success rate (26%) in terms of useful mobility
with a prosthesis. Good pre-amputation mobility, fewer co-morbidities,
low dependence and recovery of independence post amputation are
major positive indicators of success. Particular co-morbidities were
associated with prosthetic mobility failure. Future work should focus
on user satisfaction, perceived exertion, capabilities, comfort and
cosmesis. In addition future work should examine clinical risk of older
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
chairs may offer greater independence and re-integration into
community life. KEYWORDS: transfemoral amputation; older person;
prosthetic rehabilitation. FUNDING ACKNOWLEDGEMENTS: This
project was funded by the Health Foundation, UK. CONTACT:
jane.cumming@stees.nhs.uk
Research Report Platform Presentation
787 Monday 4 June 08:30
VCEC Meeting Rooms 19-20
A CADAVER STUDY TO INVESTIGATE THE LATERAL
DISTANCES OF THE TRANSVERSE PROCESSES FROM THE
SPINOUS PROCESSES OF THE THORACIC SPINE
Geelhoed M, Brewer P, Ortega C, Cervantes G, Cockrum M,
Robbins S; Department of Physical Therapy, University of Texas
Health Science Center at San Antonio, San Antonio, TX, USA
PURPOSE: The purpose of our study is to investigate the lateral
distances of the transverse processes (TPs) from the spinous pro-
cesses (SPs) of the thoracic spine. RELEVANCE: This information
will assist clinicians in locating the TPs using surface palpation.
Many examination and intervention techniques for manual therapy of
the thoracic spine require hand or finger placement over the TPs.
However, surface palpation of the thoracic TPs is difficult due to
their depth relative to more superficial structures. The more easily
palpable SPs provide landmarks to orient clinicians for palpation
of the deeper structures. Our previous investigation proposed a
model to predict the cranial/caudal location of the level of the TPs
of the thoracic spine based on the location of the SPs, and this
study is intended to augment those findings to provide clinicians
with a more complete model for locating the TPs of the thoracic
spine using surface palpation. PARTICIPANTS: We dissected and
measured 12 cadavers. METHODS: We placed the cadavers in
the prone position, and removed as much muscle and connective
tissue as possible from the SPs and TPs to expose them fully for
palpation and measurement. Using the index fingertip, we determined
the most prominent point of the SP and TPs of each thoracic
vertebra and placed pins in them to assist with measurement. Our
previous investigation proposed that the TPs in the thoracic spine
are generally located in a transverse plane at the level of the
most prominent point of the SP of the adjacent cranial vertebra.
Therefore, we chose to measure the lateral distances between
the pins inserted in the most prominent points of the TPs of one
level and the SP of the level above using a digital caliper. We
measured the lateral distances of all 12 thoracic levels on both sides
S113
of the spines of all 12 cadavers. ANALYSIS: We calculated the
mean lateral distances and standard deviations for each thoracic
level. RESULTS: Mean distances for each thoracic level ranged
between 27.1mm and 33.1mm, with an overall mean of 30.1mm
for all cadavers and all thoracic levels. Standard deviations for
each level ranged from 4.1mm to 10.2mm. CONCLUSIONS: The
mean distances demonstrated that the most prominent points of the
TPs of the thoracic spine are generally located approximately 3cm
lateral to the most prominent point of the SP of the adjacent cranial
vertebrae. However, as evidenced by the large standard deviations,
variability of these distances is high, making generalizations about
the exact location of the TPs difficult. The most variability was seen
in the caudal thoracic levels (T11 and T12), which was consistent
with our findings in previous investigations. IMPLICATIONS: This
information should allow clinicians to more accurately locate
the TPs of the thoracic spine using surface palpation of the
SPs, and improve the precision of their examination, differential
diagnosis, and intervention techniques for patients with thoracic spine
dysfunction. KEYWORDS: Thoracic Vertebrae, Palpation, Surface
Anatomy. FUNDING ACKNOWLEDGEMENTS: None. CONTACT:
geelhoed@uthscsa.edu
Research Report Platform Presentation
1083 Monday 4 June 08:50
PP Crystal Pavilion A
A FOCUS GROUP STUDY OF STUDENT PHYSIOTHERAPISTS
PERCEPTIONS OF REFLECTION
Roche A, Coote S; Department of Physiotherapy, University of
Limerick, Ireland
PURPOSE: Reflective practice is a learning strategy that involves
thinking critically about one’s actions (Clouder, 2000). This is
a recognised component of continuing professional development
(CPD), itself fundamental to progressing the physiotherapy pro-
fession. The reflective practice module within the undergraduate
physiotherapy programme at University of Limerick (U.L.) is a
first within physiotherapy curricula in Ireland. However, research
is required to determine how this module influences students’
perceptions of reflection. RELEVANCE: With the present climate of
accountability, physiotherapists have embraced the call for evidence-
based practice (EBP) and clinical effectiveness to underpin their
practice. An essential component of being clinically effective is
critical self-appraisal through reflection. Mandatory documentation
of a chartered physiotherapist’s CPD activities, already exists in
some countries, and is an imminent proposal in Ireland. Therefore
evaluation of a novel educational strategy endeavouring to enable
physiotherapy students to reflect effectively on their practice is of
interest to the profession on an international level. PARTICIPANTS:
20 Year 3 & Year 4 Physiotherapy students at U.L. were randomly
selected. Year 1 & 2 students were excluded as the module is during
Year 3. Students volunteered, gave informed consent and the U.L.
Research Ethics Committee granted ethical approval. METHODS:
A qualitative research design of focus groups was employed. Three
focus groups were held in total; with Year 3 students before and
again after their reflective practice module, examining any change
in their perceptions of reflection. A third was held with Year 4
students, to determine their perceptions a year after completing the
module and with subsequent placement experience. The researcher
led the sessions which all followed a similar questioning structure,
outlined by Krueger (1998, p21). An independent observer noted
group dynamics during each session. ANALYSIS: Sessions were
audio taped, transcribed verbatim and subject to thematic analysis.
Transcripts were examined to identify concepts (such as significant
sentences) and arranged into four major themes by comparing
concepts across each group. The observer’s notes were used to
support the analysis and participants read a descriptive statement
of their session(s) to confirm accurate interpretation. RESULTS:
Students demonstrated a more advanced level of reflective ability
S114
post-module completion, in considering its impact on their future
actions. They perceived personal and professional benefits to
practising reflection, which they felt resulted in a more evidence-
based approach to practice, compared to initial negativity before
the module. They perceived these skills as strategies to continue
in facilitating their CPD. A barrier to reflecting which the students
experienced was the negative attitude towards the concept amongst
some qualified physiotherapists. CONCLUSIONS: The students
involved fully support inclusion of the reflective practice module in
their training and acknowledge its role in improving their confidence,
clinical reasoning and facilitating their CPD once qualified. Negativity
regarding reflective practice amongst clinicians may discourage
reflection in the practical setting. IMPLICATIONS: Further studies
are required, to generalise to a wider population the initial findings
regarding this novel approach to teaching reflective practice.
Investigations to explore why negative attitudes towards reflection
prevails in the clinical setting are also of interest. KEYWORDS:
Reflective Practice, Qualitative Research, Curriculum Develope-
ment, Continuing Professional Development (CPD). REFERENCES:
Clouder, L. (2000) “Reflective Practice in Physiotherapy Education:
a critical conversation”. Studies in Higher Education, 25 (2), 211-
221. Krueger, RA. (1998) “Developing questions for focus groups”.
London: Sage publications. FUNDING ACKNOWLEDGEMENTS:
None. CONTACT: aislingroche007@hotmail.com, susan.coote@ul.ie
ETHICS COMMITTEE: University of Limerick Research Ethics
committee
Research Report Platform Presentation
1200 Monday 4 June 08:50
PP Crystal Pavilion B & C
THE PHYSICAL FITNESS OF CHILDREN BORN EXTREMELY
PRETERM
Danks M1,2, , Burns Y1,2 , Gray P1 , O’ Callaghan M1 , Poulsen L1 ,
Watter P2 ; 1 Growth & Development Research Unit, Mater Health
Services, Brisbane, Australia; 2 University of Queensland, Australia
PURPOSE: The study investigated the physical fitness of extremely
low birthweight and preterm children aged 11-13 years compared
with term controls. Measures of physical fitness and endurance likely
to contribute to fitness and physical abilities of healthy adolescent
school children were investigated to determine which factors were
associated with physical performance. RELEVANCE: Problems of
physical fitness, endurance and motor control at school age have the
potential to adversely affect their health, learning and behavior and
frequently require intervention. PARTICIPANTS: Fifty-six children
who were born 27 gestation weeks or <1000g, who received
care in the Neonatal Intensive Care Unit and are now 11-13 years
of age were included. Children with moderate or severe neuro-
developmental problems or sensory impairments were excluded.The
controls were fifty-five term born children matched for age, sex
and schooling. METHODS: Aerobic fitness was measured by the
standardized 20-meter Shuttle Run Test. Computerised spirometry
was used to measure respiratory function. Functional strength tests of
vertical jump and seated throw were used. Single leg stand measured
stability and motor co-ordination was tested using the Movement
Assessment Battery for Children (MABC). Anthroprometric measures
were collected and the BMI calculated. ANALYSIS: For continuous,
normally distributed outcomes an analysis of variance (ANOVA)
was used to investigate group differences in means. Strength
of association was measured using either correlation coefficients
(Spearman Rank or Pearson as appropriate) or odds ratios.
RESULTS: Significant differences between the groups were found
for measures of weight (p = 0.008), height (p = 0.025), BMI (p = 0.027),
head circumference (p = 0.0001) and functional strength tests (seated
throw p = 0.008; vertical jump = 0.032). The results indicate that
the preterm children performed less well than controls on the
shuttle run (p = 0.0001), single leg stance (p = 0.0001), motor co-
ordination (p = 0.0001) and respiratory function (FVC p = 0.025;
WCPT 2007, Research Reports
FEV1 p = 0.0001; PEF p = 0.001; FEV1/FVC % p = 0.0001). A strong
relationship was evident between performance on the shuttle run and
the test of motor co-ordination (r = 0.64, p = 0.0001 and single leg
stand (r = 0.5 p = 0.0001). Although there was a relationship between
shuttle run and respiratory function measures (r = 0.3-0.34, p = 0.01-
0.04) in the control group, no correlations were found between
these measures in the extremely preterm children. CONCLUSIONS:
Extremely preterm born children without significant disability at the
age of 11-13 years perform less well on tests of motor co-ordination,
balance, functional strength, aerobic fitness and respiratory function
than term born peers of the same age. Despite deficits in respiratory
function in the extremely preterm group, there was no correlation
between respiratory function measures and the aerobic fitness
measure in that group. A major determinant of physical fitness
was motor co-ordination in both groups but particularly in the
preterm children. IMPLICATIONS: Physical therapy for all extremely
preterm born children should be directed towards improving motor
co-ordination, postural stability and balance throughout childhood.
KEYWORDS: Aerobic fitness, motor co-ordination, extreme prema-
turity. FUNDING ACKNOWLEDGEMENTS: Mater Trust. CONTACT:
y.burns@shrs.uq.edu.au
ETHICS COMMITTEE: Mater Hospital Ethics Committee ref no. 449;
University of Queensland, Medical Research Ethics Committee
Research Report Platform Presentation
936 Monday 4 June 08:50
VCEC Ballroom B & C
THE EFFECTS OF LIGHT ENERGY ON WOUND BACTERIA IN
THE RAT: IMPLICATIONS FOR PRACTICE
Nussbaum E1,2 , Lilge L2,3 , Mazzulli T1,2 , Pritzker K1,2 ; 1 Mount
Sinai Hospital, Toronto, Canada; 2 University of Toronto, Toronto,
Canada; 3 University Health Network, Toronto, Canada
PURPOSE: To determine whether laser light (LLLT) improves
healing of infected wounds in the rat by killing bacteria while
simultaneously accelerating host tissue activity. RELEVANCE:
Physical therapists use LLLT to treat chronic wounds. The effect
of LLLT on infected wounds has been inadequately studied despite
its known biomodulatory effects on bacteria in vitro. It appears
possible that irradiation of contaminated wounds might stimulate
bacterial growth, which could further inhibit healing. PARTICIPANTS:
Sprague-Dawley rats (14 per group). METHODS: Dorsal wounds
(1x1cm) were inoculated or sham-inoculated with P. aeruginosa.
Wounds were irradiated or sham-irradiated three times weekly
from Day 1-19 using 635 or 808nm lasers (continuous wave or
3800Hz) at radiant exposures of 1 or 20J/cm2 . Wound area and
bacterial growth were measured three times weekly. ANALYSIS:
Healing over time was analyzed using a linear mixed model from
Day 1-8 and a non-parametric bootstrap method from Day 10-
19 (to account for a change in rate over time). Bacterial growth
was analyzed using a Generalized Estimating Equations model.
Significance was set at a=0.05. RESULTS: Wound Healing Rate
Sham-infected wounds: irradiated versus sham-irradiated controls.
There was no evidence of improved healing over the 19-day period
using any LLLT protocol. Compared with controls, healing was worse
at Day 3 in the 635nm group at high radiant exposure (20J/cm2 ;
p < 0.0001) and in various 808nm groups (1J/cm2 and 20J/cm2 ;
p < 0.0001, p < 0.001), and also from Day 3-10 in the high 808nm
group (20J/cm2 ; p = 0.03). Infected wounds: irradiated versus sham-
irradiated controls. Compared with controls, healing was worse at
Day 3 in the 808nm group at high radiant exposure (20J/cm2 ), and
from Day 3-8 in various 808nm groups (1 and 20J/cm2 ; p < 0.002,
p < 0.002). In contrast, healing improved from Day 3-8 in the 635nm
group at low radiant exposure (1J/cm2 ; p = 0.0002), and from Day 10-
19 in various 808nm groups (1 and 20J/cm2 ; p = 0.0014, p < 0.001
and 3800Hz 1J/cm2 ; p = 0.0172). Bacterial Growth Sham-infected
wounds. Normal flora (alpha- and beta-hemolytic streptococcus,
diptheroid bacteria, Bacillus spp.,) predominated in sham- and
Platform Presentations, Monday 4 June
635nm-treated wounds at 1J/cm2 . In contrast, 635nm irradiation at
20J/cm2 effectively cleared sham-infected wounds of all organisms
from Day 3-19 (<0.0001). Bacteria were also reduced in the early
period irradiating at 808nm (1 and 20J/cm2 ; p < 0.0137, p = 0.0002).
P. aeruginosa infected wounds. In non-irradiated wounds potentially
pathogenic bacteria predominated until Day 8 (S. aureus, coagulase-
negative staphylococci (CNS) and P. aeruginosa) and simultaneously
the presence of normal flora decreased. All bacteria were reduced
at Day 3 using irradiation at 635nm (20J/cm2 ; p = 0.023). Irradiation
at 808nm (1 and 20J/cm2 ) increased bacteria (S. aureus and CNS)
compared with sham-irradiated wounds (p = 0.0014, p < 0.0001), and
reduced the presence of normal flora. CONCLUSIONS: Clearing
wounds of normal flora and increasing growth of staphylococcal
species prolonged healing. Healing improved only when wound
bacterial balance closely matched that of controls. Effects of LLLT
on bacterial growth should urgently be examined in human wounds.
IMPLICATIONS: LLLT that radically alters the normal bacterial
balance in wounds could negatively affect healing. The presence
of normal flora in wounds is important for stimulating granulation
tissue and preventing colonization of the wound surface by bacteria
that cause infection. KEYWORDS: wounds, infection, light therapy.
FUNDING ACKNOWLEDGEMENTS: This work was supported by a
grant from the Canadian Institutes of Health Research.
ETHICS COMMITTEE: Animal Care Committee, Mount Sinai
Hospital Research Institute
Research Report Platform Presentation
1881 Monday 4 June 08:50
VCEC Meeting Rooms 11-12
BILATERAL UPPER LIMB THERAPEUTIC EXERCISE IN ACUTE
STROKE: A RANDOMIZED CONTROLLED TRIAL
Morris J1,3 , Van Wijck F2 , Joice S1 , Ogston S1 , MacWalter R3 ;
1 University of Dundee, Dundee, Scotland; 2 Queen Margaret
University College, Edinburgh, Scotland; 3 Ninewells Hospital,
Dundee, Scotland
PURPOSE: Upper limb (UL) deficits contribute to limitations in activity
and participation for individuals with stroke. Studies conducted in the
chronic post-stroke stage suggest that bilateral therapeutic exercise
(BTE) may improve UL recovery. However effectiveness of this
intervention in acute stroke and responses related to severity of
impairment have not been fully explored. The purpose of this study
was to compare BTE with Unilateral Therapeutic Exercise (UTE) for
UL recovery in the acute post-stroke period and to determine if sever-
ity of initial impairment influences recovery. RELEVANCE: Novel
training approaches for stroke are emerging from developments in
neuroscience and behavioural science. In applying new interventions
to clinical practice, physiotherapy research must determine when and
for whom such approaches are most effective. Here an intervention
previously studied in chronic stroke is examined in acute patients
with differing degrees of severity. PARTICIPANTS: A cohort of
individuals admitted to an acute hospital with acute stroke presenting
with new UL impairment (n=106). Consent was provided within
local ethical guidelines. METHODS: Design: Randomised controlled
trial. Intervention: Participants were randomised to receive BTE or
UTE 2-4 weeks following stroke onset. Both groups participated
in standardised training (20 minutes, 5 days/week, for 6 weeks)
in addition to normal rehabilitation. The BTE group trained both
arms simultaneously but independently; the UTE group trained the
affected arm only. Outcome Measures: Action Research Arm Test
(ARAT), Rivermead Motor Assessment Upper Limb Scale (RMA)
and Nine Hole Peg Test (NHPT), recorded at baseline, 6 weeks
and 18 weeks by a blinded assessor. ANALYSIS: Change scores
(between 0-6 weeks, and 0-18 weeks) were examined using t-tests
and non-parametric equivalents. Three severity sub-groups were
defined from ARAT and NHPT baseline data. Main and interaction
effects of sub-group and treatment allocation were examined using
factorial ANOVA with change on ARAT, RMA and NHPT scores as
S115
dependent variables. RESULTS: No significant baseline differences
existed (p > 0.05). Groups did not differ significantly in mean change
scores between 0-6 weeks on the ARAT (p = 0.68), RMA (p = 0.06),
or NHPT (p = 0.51). Between 0-18 weeks the difference in mean
NHPT change was significant (p = 0.05), with greater improvement
for the UTE group than the BTE group (0.15 pegs/sec + 0.15;
0.10 pegs/sec + 0.03 respectively). No other significant differences
were found. Baseline severity significantly influenced change on
all measures between 0-6 weeks and 0-18 weeks (p < 0.05). This
was not related to treatment allocation. No other interaction effects
existed. CONCLUSIONS: BTE appears no more effective than
UTE for UL recovery in individuals with acute stroke even after
controlling for initial impairment severity. In the long-term, UTE
training appeared most beneficial for dexterity. Some of the selected
outcome measures have been criticised for limited sensitivity,
therefore future research should determine optimal intervention for
BTE training utilising measures more sensitive to improvements.
IMPLICATIONS: This study indicates that there is no advantage in
replacing conventional UTE with BTE in acute stroke for improvement
of unilateral upper limb performance. KEYWORDS: Upper Limb,
Stroke, Therapeutic Exercise. FUNDING ACKNOWLEDGEMENTS:
This work was funded by the Chief Scientist Office, Scottish Executive
Health Department. CONTACT: j.y.morris@dundee.ac.uk
ETHICS COMMITTEE: Tayside Committee on Medical Research
Ethics
Research Report Platform Presentation
1810 Monday 4 June 08:50
VCEC Meeting Room 16
“SELF EVIDENCE OF THE SELF DIRECTEDNESS” –
PHYSIOTHERAPY STUDENTS’ OPINIONS ABOUT SELF DIRECT-
EDNESS AND ITS DEVELOPMENT DURING THE EDUCATION
Helminen E; Jyvaskyla University of Applied Sciences, Jyvaskyla,
Finland
PURPOSE: The first aim of this study is to investigate what is written
to the curriculum about the physiotherapy students self directedness.
The second aim is to study what are physiotherapy student’s
opinions about their self directedness and how it changes during the
education. The third aim is to find out what kind of factors prevent and
promote self directedness in learning. RELEVANCE: One of the most
important goals of higher education is student’s self directedness
according to education legislations of Finland. There have been
conflicts between this goal and the implementation of education.
The concepts of self directedness are complex. PARTICIPANTS:
Physiotherapy Students (n 44) took part of the reseach. METHODS:
This study is qualitative long – term study. The main research method
is theme interview. Other methods are questionaire, self evaluation
and learning diaries. ANALYSIS: Analysing method is content
analysis. RESULTS: Physiotherapy students (n 44) began their
education in 1998 and the last student graduated January 2003. The
curriculum emphasized student’s self directedness and self- direction
in learning, but the students did not understand the language of the
curriculum in the beginning of the education. The comprehension
of the work of the physiotherapist increased through the education.
The level of students self directedness was low in the beginning, but
it developed during the education. Year 1998 students thought that
self- direction means independent decision making. Students found
that student’s own motivation, goal setting and learning atmosphere
promoted self directedness. Restricted factors were other student’s
low motivation and the action of the teacher. The best learning
environment was clinical practice. CONCLUSIONS: One of the
conclusion is that the meaning of students self directedness should
be stated clearly in the curriculum. There should also be more
orientation to the physiotherapist work in the beginning of the
education. Self directedness can be promoted by motivating feedback
from the teacher, permissive learning atmosphere and functional tutor
program. IMPLICATIONS: According these results it is possible to
S116
develop the curriculum, tutor-program, students self direction in learn-
ing and teaching methods. KEYWORDS: Physiotherapy, pedagogic,
self-direction in; learning. FUNDING ACKNOWLEDGEMENTS: The
work was unfunded. CONTACT: eeva.helminen@jamk.fi
ETHICS COMMITTEE: Ethich was not required. Only permission of
the director of our School and the students.
Research Report Platform Presentation
1078 Monday 4 June 08:50
VCEC Meeting Room 17
THE PROVISION OF PHYSICAL THERAPY FOR ELDERLY
NURSING HOME RESIDENTS
Leemrijse C1 , De Boer M2 , Dekker J2 , Ribbe M2 , Van den Ende C3 ;
1 Netherlands Institute for Health Services Research, Utrecht;
2 Institute for Research in Extramural Medicine, VU University
Medical Centre Amsterdam; 3 Sint Maartenskliniek, Nijmegen
PURPOSE: The aim of this study was to investigate how many
residents receive physical therapy in nursing homes. Furthermore,
to analyze factors that contribute to the variation in provision
of physical therapy both between nursing homes and between
residents. RELEVANCE: Physical therapy plays an important role
in improving ADL functioning, discharge rates and survival rates. It
is, however, unclear how many or which nursing home residents
receive physical therapy. Furthermore, there is a lack of insight
into the determinants that influence the decision for treatment.
PARTICIPANTS: A random sample of 600 residents aged 55 years
and older was taken from a random sample of 15 nursing homes.
Residents had to be admitted for either rehabilitative services or
for long term institutional care. METHODS: Data from participating
residents were collected through interviews with the nursing home
physician and the physical therapist. As part of these highly
structured interviews a questionnaire was filled out by the researcher,
in presence of the physician and therapist, enabling them to consult
the medical file of the resident simultaneously. ANALYSIS: Multilevel
analysis was applied because of the intrinsic hierarchical nature of
the data. Multilevel logistic regression analysis was used to define
the variation in the provision of physical therapy between nursing
homes, and the factors that determine whether a resident receives
physical therapy or not. RESULTS: On average, 69% of the 600
residents received physical therapy, but this percentage differed
significantly across nursing homes. Characteristics of the nursing
homes itself, such as the amount of full time equivalents of available
physical therapy, contributed the most to this difference. None of the
residents’ medical diagnoses had a significant influence on referral to
physical therapy, whereas the presence of co-morbidity enlarged the
chance of receiving physiotherapeutic treatment. Residents admitted
for rehabilitation and residents staying at a somatic ward were more
likely to receive physical therapy, as compared to residents admitted
for long term care and residents staying at a psycho-geriatric ward.
Furthermore, as more time had elapsed after admission, the chance
of receiving physiotherapy slightly diminished. Finally, the more full
time equivalents physical therapy present in the nursing home, the
more likely a resident was to receive treatment. CONCLUSIONS:
Physical therapy is most likely provided to residents with good
cognitive functioning, recently admitted for rehabilitation to a nursing
home with a relatively large number of physiotherapists available.
This suggests a potential underuse of physical therapy for long
term residents with cognitive problems. IMPLICATIONS: It is recom-
mended that physiotherapists working in nursing homes reconsider
which residents may benefit from treatment. This may need a shift
in focus of physiotherapists from ‘recovery and discharge’ to ‘quality
of life and well being’ of residents. More insight is needed into the
residents’ needs and into the efficiency of provided care, in order to
establish the optimum amount of physiotherapeutic care for nursing
home residents. KEYWORDS: Nursing homes, elderly. FUNDING
ACKNOWLEDGEMENTS: This project was financed by ZonMw – the
Netherlands Organisation for Health Research and Development.
WCPT 2007, Research Reports
Research Report Platform Presentation
1902 Monday 4 June 08:50
VCEC Meeting Room 18
GRANDSTAND FUNCTION & FEEDBACK – SIT-TO-STAND AS
HOME EXERCISE FOR MOBILITY LIMITED ADULTS OVER 80
YEARS OF AGE
Rosie J, Taylor D; Physical Rehabilitation Research Centre, AUT
University, Auckland, New Zealand
PURPOSE: To investigate the effect of functional home exercise
on strength and performance measures in adults over 80 years of
age with mobility limitations. RELEVANCE: Lower limb weakness is
highly prevalent among older adults and is associated with reduced
functional performance, increased disability and increased incidence
and severity of falls. Low intensity unsupervised progressive
resistance training can be performed safely at home by frailer older
adults, however, studies into the effect of these programmes show
varying results as to their impact on functional outcomes. Little
analysis has been done as to whether functional home exercise,
such as repetitive sit-to-stand training, is an effective alternative to
traditional progressive resistance training for the frailer older adult.
PARTICIPANTS: Community dwelling older adults were invited to
participate, 66 older adults took part in the study. Participants were
80 years of age or older, able to walk 4 metres with or without
an aid, sedentary, and mobility limited. Exclusion criteria included;
currently receiving physiotherapy treatment, medically unstable,
medical conditions that contraindicated participation in a resistance
exercise programme or physical conditions that prevented attempting
either exercise protocol. METHODS: A randomised controlled clinical
trial was conducted to compare repeated sit-to-stand exercises using
the GrandStand with seated knee extensions using ankle weights.
The GrandStand is a simple biofeedback device that is placed in
the participant’s chair providing a visual record of the number of
sit-to-stands completed. Both exercise protocols were performed by
participants daily for 6 weeks. ANALYSIS: Analysis was performed
on an intention to treat basis. Independent sample t-tests were
used to assess any difference between the GrandStand group
and knee extension group at baseline, and any between-groups
change in difference scores following the final assessment. Paired
samples t-tests were used to assess the difference between baseline
and outcome measures within each group. Statistical significance
was accepted if the 2-tailed p value was  0.05. RESULTS:
Results showed no statistically significant differences between the
groups at baseline; there was large variability within each group
in degree of mobility limitation and in baseline measure results.
There was a statistically significant difference at the post-intervention
assessment the Berg Balance Scale mean score for the GrandStand
group alone, indicating an improvement in balance over the 6-
week exercise period (GrandStand group t = −3.624, p = 0.001).
This represents a mean increase of approximately 1.7 points in
Berg Balance Scale score. There was no statistically significant
effect of either intervention on the other outcome measures.
CONCLUSIONS: In a highly variable population of older adults
with mobility limitations, low intensity functional home exercise using
the GrandStand was more effective than low intensity progressive
resistance training at improving Berg Balance Scale score. While
statistically significant, the improvement in Berg Balance Scale score
was modest raising the issue of what extent of change in score is
clinically significant in this population. IMPLICATIONS: The results
indicate a longer duration functional training study may be warranted
based on the improvements over this short programme. Clinically
significant change in Berg Balance Scale score also requires further
investigation in this population. KEYWORDS: older adults, home
exercise, functional training. FUNDING ACKNOWLEDGEMENTS:
Sam Doogue, Whakatane, New Zealand. AUT University, Auckland
New Zealand. CONTACT: juliet.rosie@aut.ac.nz
ETHICS COMMITTEE: Ethical approval was obtained from the AUT
University Ethics Committee
Platform Presentations, Monday 4 June
Research Report Platform Presentation
1401 Monday 4 June 08:50
VCEC Meeting Rooms 19-20
QUALITY OF TRANSVERSUS ABDOMINIS DURING TRAINING IS
ASSOCIATED WITH TEMPORAL CHANGES IN FEEDFORWARD
ACTIVATION
Tsao H, Hodges P; Division of Physiotherapy, The University of
Queensland, Brisbane, Australia
PURPOSE: There is evidence for consistent deficits in feedforward
activity of the deep abdominal muscle, transversus abdominis (TrA)
in people with low back pain (LBP). In a recent study we showed
that training of isolated voluntary contractions of TrA induced
immediate improvements in feedforward activity and this was not
replicated by training that involved general activity of the abdominal
muscles (i.e., sit-up). As individuals vary in their ability to contract
TrA independently from other abdominal muscles, we aimed to
examine the relationship between the quality of isolated training
and changes in timing of feedforward activation. RELEVANCE:
Improved understanding of the relationship between quality of motor
training and changes in timing of muscle activation will aid in
further development of rehabilitation strategies for people with LBP.
PARTICIPANTS: Eleven volunteers with recurrent LBP lasting longer
than three months and of sufficient intensity to limit activities of
daily living were recruited. METHODS: Feedforward control of the
abdominal muscles was assessed during single rapid arm flexion
and extension tasks to perturb the trunk in a controlled manner
before and immediate after motor training. Surface and fine-wire
electromyographic activity (EMG) was recorded from the abdominal,
back and deltoid muscles. Subjects were trained to activate TrA
independently from the other abdominal muscles with feedback of
contraction using real-time ultrasound imaging. TrA EMG activity
was maintained at 5% of the maximum root-mean-square EMG
amplitude. A rating out of ten was given to each subject according
to their ability to contract TrA in isolation, and was determined
through palpation of contraction, observation of ultrasound image
and EMG recordings. This score has been shown previously to be
associated with the functional activity of this muscle. ANALYSIS: The
relationship between changes in onset of TrA EMG following training
and scores for quality of training was examined using Pearson’s
correlation. RESULTS: As expected, activation of TrA was delayed
in all subjects prior to training and the timing of onsets of TrA
EMG was changed by training. There was a significant correlation
between scores of the quality of isolated voluntary training and
changes in onset of TrA EMG for rapid arm flexion and extension
tasks (p<0.05). CONCLUSIONS: These findings suggest that the
magnitude of change in timing of TrA was related to the quality
of training; that is, activation of the TrA with a greater degree
of isolation was associated with greater changes in timing. The
results suggest that mere repetition of TrA contractions without
precision during motor training may not induce similar improvements
in feedforward activation. IMPLICATIONS: The findings provide
evidence that feedforward postural adjustments may be trained in
a patient group with deficits in this coordination, and that changes
not only depend on the manner in which the muscle is trained but
also on the quality of isolated TrA contractions. KEYWORDS: motor
training, low back pain, feedforward postural adjustments. FUNDING
ACKNOWLEDGEMENTS: Funding was provided by the National
Health and Medical Research Council of Australia. CONTACT:
h.tsao@uq.edu.au
ETHICS COMMITTEE: Medical Research Ethics Committee of the
University of Queensland, Brisbane, Australia
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Research Report Platform Presentation
1368 Monday 4 June 09:10
PP Crystal Pavilion B & C
ACUTE CHANGES IN MUSCLE COORDINATION INDUCED BY
EXPERIMENTAL PAIN DO NOT AFFECT CERVICAL MUSCLE
FATIGABILITY DURING SUSTAINED ISOMETRIC CONTRACTION
Falla D1 , Farina D1 , Kanstrup Dahl M2 , Graven-Nielsen T1 ; 1 Center
for Sensory-Motor Interaction (SMI), Department of Health Science
and Technology, Aalborg University, Aalborg, Denmark; 2 Sector
of Anesthesia, Northern Jutland, Denmark
PURPOSE: To investigate whether an acute change in the motor
strategy, induced by experimental neck muscle pain, affects trends
of EMG variables over time during sustained cervical flexion and
extension. RELEVANCE: People with persistent neck pain show
greater cervical muscle fatigue during sustained isometric cervical
contractions compared to healthy individuals. The differences in
myoelectric manifestations of fatigue in people with neck pain with
respect to healthy controls may be due to differences at the muscle
level, in the neural control or both. Experimental muscle pain may
provide a model to help differentiate whether pain-induced alterations
of the control strategy affect muscle fatigability as reflected in the
surface EMG signal. If this hypothesis is rejected then the greater
myoelectric manifestations of fatigue observed in people with chronic
neck pain cannot be solely due to a change in neural control.
PARTICIPANTS: Fourteen volunteers (6 female) participated after
providing informed consent. Participants (age: 26.3±3.6 yr; height:
1.73±0.11 m; weight: 71.9±14.6 kg) were free of neck pain, had
no past history of orthopaedic disorders affecting the cervical spine
and no history of neurological disorders. METHODS: Surface EMG
signals were detected from the sternomastoid and splenius capitis
muscles bilaterally during sustained cervical flexion and extension
contractions at 25% of the maximal force. Measurements were
performed before and after experimental pain by injection of 0.5
ml of hypertonic and isotonic saline into either the sternomastoid
or splenius capitis in two experimental sessions. EMG average
rectified value (ARV) and mean spectral frequency (MNF) were
estimated from consecutive 4-s signal portions throughout the
sustained contraction. ANALYSIS: A three-way ANOVA was applied
to the values of ARV and MNF for the sternomastoid and splenius
capitis muscles with condition (baseline, isotonic and hypertonic
saline), side (ipsilateral and contralateral to injection) and time (5
intervals) as repeated measures. Significant differences revealed by
ANOVA were followed by post-hoc Student-Newman-Keuls pair-wise
comparisons. Statistical significance was set at P < 0.05. RESULTS:
During cervical flexion, injection of hypertonic saline in sternomastoid
or splenius capitis resulted in lower estimates of sternomastoid
ARV on the side of pain (55.1±29.9 mV vs. 42.3±18.9 mV; P < 0.01).
Estimates of sternomastoid MNF during flexion were reduced
bilaterally following noxious stimulation of the sternomastoid (113.5
±19.8 Hz vs. 107.6 ±16.9 Hz; P < 0.05) and splenius capitis (113.8
±20.5 Hz vs. 109.2 ±18.6Hz; P < 0.01). Trends over time of both
sternomastoid and splenius capitis ARV and MNF during sustained
flexion and extension were not changed following hypertonic saline
injection. CONCLUSIONS: Experimentally-induced neck muscle
pain resulted in changed muscle coordination during sustained
cervical contractions in the absence of a change in myoelectric
manifestations of fatigue. IMPLICATIONS: The results suggest that
the greater changes over time of EMG features during sustained
contractions observed in patients with chronic neck pain, more
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
S118
European project “Cybernetic Manufacturing Systems” (CyberManS;
contract nr. 016712). CONTACT: deborahf@hst.aau.dk
ETHICS COMMITTEE: Ethical approval for the study was granted
by Den Videnskabsetiske Komite for Viborg og Nordjyllands Amter
(Approval number: VN 2005/38).
Research Report Platform Presentation
969 Monday 4 June 09:10
VCEC Ballroom B & C
THE EFFECTS OF LOW LEVEL LASER THERAPY (LLLT) ON
HUMAN BREAST CANCER CELL LINES IN VITRO
Laakso L, Powell K, McDonnell A; Griffith University, Brisbane
and Gold Coast, Australia
PURPOSE: This research examined the response of two breast
cancer cell lines (MCF-7 and MB-435) in vitro to a range of laser
doses at two commonly used wavelengths (780nm and 830nm).
RELEVANCE: LLLT is being used increasingly for the management
of post-mastectomy lymphoedema without undisputed evidence of
its effectiveness in this disorder. In particular, information regarding
dose-response relationships and safety (in malignant conditions)
remains elusive. This research set out to clarify dose/response
relationships in cell culture as a starting point towards making
clinical recommendations for use. PARTICIPANTS: In vitro cell cul-
tures. METHODS: Well-differentiated human breast adenocarcinoma
(MCF-7) and less differentiated human breast ductal carcinoma (MB-
435) cell lines were grown and passaged using standard aseptic
tissue culture protocols. 96-well tissue culture plates were seeded
with 1 x 104 cells per well in fresh growth medium, and allowed
to grow for 48-72hrs before exposure to laser. A single dose of
laser was performed at energy densities of 0.5, 1, 2.5, 10 and
12J/cm2 for 780nm laser, and 0.5, 1, 2.5, 10 and 15J/cm2 for 830nm
laser. Cell proliferation was assessed 24hrs after laser treatment
by calorimetric spectrophotometry. ANALYSIS: Percentage growth
differences between treated and control means, and Student t-tests
with 95% confidence limit were calculated. Alpha level was set at
0.05 for all tests. RESULTS: Laser irradiation at 780nm using doses
from 0.5 to 5J/cm2 produced no significant difference in proliferation
of MCF-7 (adenocarcinoma) cells. A positive trend in MCF-7 cell
proliferation was evident at a dose of 10J/cm2 (13.37% mean
percentage increase) becoming significantly increased at 12J/cm2
(p < 0.05). In the MB-435 (ductal carcinoma) cells, laser irradiation
at 780nm (doses from 0.5 to 5J/cm2) also resulted in no significant
difference, but at 10J/cm2 there was a significant increase in cell
proliferation compared to negative controls (p < 0.05). At 830nm, laser
irradiation using doses from 0.5 to 2.5J/cm2 did not affect MCF-
7 cell proliferation, however, at higher doses of 10 and 12J/cm2,
significant increases (p < 0.05) in growth were noted. There were no
effects observed in MB-435 cells after laser irradiation at 830nm for
doses from 0.5 to 10J/cm2, but at 15J/cm2 there was a statistically
significant increase (p < 0.05) in cell proliferation. CONCLUSIONS:
The findings suggest that 780nm and 830nm laser at doses up to
5J/cm2 do not stimulate cell proliferation in the two breast cancer
cell lines studied, however higher doses do appear to stimulate cell
proliferation irrespective of wavelength, and in both human breast
carcinoma cell lines. We plan to investigate further the in vitro effects
of other typical laser wavelengths used in lymphoedema treatment
prior to extending the research to in vivo and clinical models.
IMPLICATIONS: The results of this research imply that low doses of
laser of less than 5J/cm2 at the wavelengths stipulated are potentially
safe for clinical use in the presence of the two types of human breast
cancers studied. Whilst findings from in vitro research cannot be
considered transferable to clinical application, the findings provide
some guidance on targeting potential foci for future work using in
vivo models of treatment and in clinical applications. KEYWORDS:
laser therapy, cancer. FUNDING ACKNOWLEDGEMENTS: Griffith
University. CONTACT: L.Laakso@griffith.edu.au
WCPT 2007, Research Reports
Research Report Platform Presentation
2140 Monday 4 June 09:10
VCEC Meeting Rooms 11-12
EXPLORING THE ATTENTIONAL FOCUS OF FEEDBACK IN
RETRAINING THE HEMIPLEGIC ARM
Durham K, van Vliet P, Sackley C, Badger F; School of Health
Sciences, The University of Birmingham, 52 Pritchatts Road,
Edgbaston, Birmingham, B15 2TT, England
PURPOSE: Movement feedback during physiotherapy for the
treatment of stroke, may positively influence the outcomes of training.
The attentional focus of feedback can be either internal (about
the body) or external (about the effect on the environment). An
external focus of attention is more beneficial to motor learning
in healthy subjects. The purpose of this study was to examine
feedback used in current practice and describe in particular the
attentional focus when training the hemiplegic arm. RELEVANCE:
This study precedes a clinical trial comparing internal and external
focus feedback in training the hemiplegic arm. Together, these studies
will improve outcome for individuals affected by stroke, by first
investigating the feedback physiotherapists currently give in everyday
clinical practice, and then comparing the effectiveness of each
type of feedback. The work will contribute to rehabilitation of older
people with cardiovascular disease. PARTICIPANTS: Four inpatients
and four outpatients with stroke and eight physiotherapists were
purposively recruited from two hospitals. Patients were selected who
scored three to thirteen on the upper limb section of the Rivermead
Motor assessment, who were currently receiving physiotherapy for
their upper limb and gave informed consent. Patients presenting
with severe sensory deficits and receptive speech difficulties were
excluded. METHODS: A triangulated methodology was used, in-
corporating video recordings, interviews and questionnaires. Clinical
data was collected measuring cognition, perception, pain, motor
and sensory impairment. Treatment session(s) were then video-
recorded in the usual neuro-rehabilitation setting. This was followed
by separate interviews with patients and therapists and therapists
also completed a questionnaire. ANALYSIS: All data was collected
by the primary author and transcribed verbatim. An iterative
framework was then developed to analyse the transcripts. Thematic
analysis was conducted independently by the researchers and
concordance was achieved about the emergent themes. Frequencies
of the use of instruction and informative feedback were obtained.
RESULTS: Informative feedback was rarely used. The attentional
focus of instructions and feedback were primarily internal. Statements
that helped to reinforce or provide motivation were evident in
all eight treatments which patients reported as being beneficial.
Verbal instructions were observed more frequently than informative
feedback in all eight treatments. This was often associated with non-
verbal gestures e.g. manual guidance. CONCLUSIONS: The lack
of informative feedback in this sample reflects findings of the small
number of previous studies that have investigated patient/therapist
interactions in stroke rehabilitation. Therapists may be underutilizing
this important resource for facilitating motor learning in the hemiplegic
arm after stroke. Where informative feedback was given to the
patient, the attentional focus was primarily internal. IMPLICATIONS:
This research suggests clinicians may need to increase the use of
informative feedback during motor retraining. Extrinsic feedback can
positively change motor behaviour and is important where intrinsic
feedback systems are compromised. Utilizing this resource through
effective motor retraining could increase the level of skill achieved
and increase the speed of learning. Further work is required to
examine the effects of whether feedback with an internal or an
external focus is more beneficial for stroke. KEYWORDS: Feedback,
attentional focus, upper limb. FUNDING ACKNOWLEDGEMENTS:
This research is supported by The Stroke Association. CONTACT:
k.f.durham@bham.ac.uk
ETHICS COMMITTEE: Sandwell and West Birmingham Local
Research Ethics Committee
Platform Presentations, Monday 4 June
Research Report Platform Presentation
2511 Monday 4 June 09:10
VCEC Meeting Room 16
LEARNERS’ SUGGESTIONS FOR THE TEACHING OF CRITICAL
INQUIRY AND CLINICAL DECISION MAKING
Mabey R; University of North Dakota, Grand Forks, North Dakota,
USA
PURPOSE: Students and graduates of a three-year physical therapy
program were asked to provide insights and suggestions to facilitate
the teaching and learning of critical inquiry and clinical decision
making. RELEVANCE: Physical therapy students are very interested
in coursework tied to hands-on patient/client care; however they
do not always appreciate the role of critical inquiry in clinical
decision making. Linking critical inquiry to clinical decision making
and subsequent patient care is often frustrating to both faculty
and students. The development of effective teaching strategies is
essential and student feedback is part of the development process.
PARTICIPANTS: Students and graduates of the program (n=25)
volunteered to participate in focus group interviews. METHODS:
Interview questions were adapted from those of Steven Brookfield
in ‘The Skillful Teacher.’ Questions addressed the highs and lows
of learning critical inquiry and clinical decision making, teaching
strategies which helped or hindered skill development, and learner
strategies for success. Questions were given to participants prior to
interviews and responses were discussed, clarified, and expanded
during interview sessions. Interviews, scheduled at the participants’
convenience, lasted up to 1.5 hours. Sessions were recorded via
note-taking and audiotape. ANALYSIS: In this qualitative study, notes
and audiotapes were analyzed for emergent themes. Data were
analyzed within and across cohorts, i.e., student level in the program
or graduate status. RESULTS: Three broad categories of results are
addressed: 1.) Responses to interview questions: Learning highs
were related to successes. It ‘just made me feel kind of good
to figure it out that quickly with a limited amount of information.’
‘Intimidated,’ ‘frustrated,’ ‘frazzled,’ and ‘nervous,’ described learning
lows. Helpful strategies included ‘keep it real’ and use active learning.
Learners should ‘Be patient, be curious, be a good listener!’ and
‘Ask for help!’ 2.) Responses related to status in the program:
Students early in the program focused on assignments. Graduates
tended to see the process in a global sense: connections were
made between assignments, courses, academic experiences, and
clinical experiences. Graduates focused on the teaching and learning
as applied to clinical practice. 3.) Responses related to personal
factors: While strategies for teaching and learning were suggested,
some of the challenges and frustrations were addressed by: ‘what
drew me to PT was helping people and working with (patients)
one on one . . . it’s just a personality thing . . . (a reason) why
it’s hard to get people to . . . (perform) research.’ CONCLUSIONS:
Educational experiences associated with critical inquiry and clinical
decision making are similar to those of other subjects. Specific
strategies may be implemented to facilitate the teaching and
learning of critical inquiry and clinical decision making. Resistance to
coursework may be related to personal preferences and motivations.
IMPLICATIONS: While physical therapy students from one site
provided data for this study, educators from other programs may
find this research useful as they promote the development of
critical inquiry and clinical decision making skills in their learners.
KEYWORDS: critical inquiry, clinical decision making, physical
therapy. FUNDING ACKNOWLEDGEMENTS: None. CONTACT:
rmabey@medicine.nodak.edu
ETHICS COMMITTEE: University of North Dakota Institutional
Review Board: IRB #200311-119, Approved 11/18/03; 7/22/04
S119
Research Report Platform Presentation
1685 Monday 4 June 09:10
VCEC Meeting Room 17
DEVELOPING MODELS OF CARE FOR ARTHRITIS: EMERGING
ROLES FOR PHYSIOTHERAPISTS
MacKay C, Veinot P, Devitt R, Badley E; Arthritis Community
Research and Evaluation Unit, Toronto Western Research Institute,
Toronto, Canada
PURPOSE: The goal of this study was to identify the range
of models of service delivery for arthritis incorporating enhanced
roles for physiotherapists. RELEVANCE: With the aging of the
population and concomitant increase in arthritis, there is a growing
care gap between the number of people needing care for arthritis
and access to appropriate services. Shortages in the number of
specialists and geographic variation in their availability indicates
there is a need to explore alternative models of health care delivery
in order to ensure that people with arthritis have timely access
to quality care. Previous research suggests that physiotherapists
in emerging roles can facilitate access to services and provide
quality care for people with arthritis. PARTICIPANTS: A purposive
sample of key informants included health care providers, academics
and administrators who work in the arthritis field from countries
where access to specialists is via physician referral. METHODS:
Semi-structured interviews were conducted either by telephone or
in person using an interview guide. The interviews were taped and
transcribed. ANALYSIS: Qualitative data were analyzed using a
constant comparative approach to identify common types of models
of care and the strengths and challenges of each type of model of
care. RESULTS: Seventy-four key informants were interviewed from
six countries. Four main types of models of care emerged. a) Models
using health care providers in expanded clinical roles utilize the skills
of health professionals such as physiotherapists to increase efficiency
of care by i) assessing patients with musculoskeletal conditions
and referring to the appropriate services including specialist care
or ii) providing ongoing management of patients in collaboration
with a consultant. b) Specialized arthritis programs tend to focus on
delivery of comprehensive, multidisciplinary team care specifically for
arthritis. c) Models promoting remote/rural access include technology
such as telemedicine to improve access to services with a health
professional facilitated clinical examination. d) Community-based
care tends to focus on broader disease populations and offering
community resources and support. Perceived strengths of models
using physiotherapists include decreasing wait times to specialist
care and maximizing the skills of all providers. Challenges identified
for physiotherapists in expanded roles include lack of standardized
training and need for support from professional regulatory bodies
to expand scope of practice. CONCLUSIONS: There was no single
model that was identified by key informants that will work in
all populations and in all circumstances. Alternative models have
emerged internationally in an ad hoc way in part to address
issues in access to care and many include a broadening of skills
within or outside traditional scope of practice. IMPLICATIONS:
Further research is needed to understand the effectiveness and
cost-effectiveness of such models. To advance the development
of models of care using physiotherapists in expanded clinical
roles, a collaborative approach is needed to standardize training,
develop core competencies and address issues in scope of practice.
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.
CONTACT: cmackay@uhnres.utoronto.ca
ETHICS COMMITTEE: University Health Network Research Ethics
Board
S120
Research Report Platform Presentation
1626 Monday 4 June 09:10
VCEC Meeting Rooms 19-20
STRAIN ON THE PECTORALIS MINOR MUSCLE DURING
SHOULDER MOTIONS AND STRETCHING TECHNIQUES: A
CADAVERIC BIOMECHANICAL STUDY
Muraki T1 , Miyamoto S2 , Oshiro S1 , Fujii M1 , Miyamoto H1 ,
Takasaki H3 , Izumi T1 , Hidaka E1 , Uchiyama E4 , Aoki M2 ;
1 Graduate School of Health Science, Sapporo Medical University,
Sapporo, Japan; 2 Department of Physical Therapy, Sapporo
Medical University, Sapporo, Japan; 3 Shinoro Orthopaedic Clinic,
Sapporo, Japan; 4 Department of Anatomy, Sapporo Medical
University, Sapporo, Japan
PURPOSE: Shortening of the pectoralis minor muscle is believed
to limit scapular motions and contribute to shoulder contracture or
impingement syndrome. However, it is unclear how much the muscle
is lengthened during shoulder motions and stretching techniques.
The purpose of this study is to measure strain on the pectoralis
minor muscle in order to determine shoulder motions for stretching
the muscle. RELEVANCE: This study contributes to the development
of stretching exercises of the shortened pectoralis minor muscle.
PARTICIPANTS: Six frozen-thawed transthoracic specimens from six
fresh cadavers were used. Specimens with shoulder contracture were
excluded. METHODS: Strains on medial and lateral fiber groups of
the pectoralis minor were directly measured by precise displacement
sensors (Pulse Coder, LEVEX, Kyoto, Japan) during three passive
shoulder motions, i.e. flexion, abduction, and external rotation at
90º abduction. The strains during three stretching techniques, i.e.
two scapular retraction methods (at shoulder 0º flexion and 60º
flexion) and shoulder horizontal abduction with 90º external rotation
were also measured. ANALYSIS: One-way analysis of variance and
post hoc multiple comparisons tests (Bonferroni and Dunnett) were
used to examine the differences of strain in three different shoulder
motions and stretching techniques. The a level of significance was
set at 0.05. RESULTS: During shoulder flexion and abduction, the
strains on both fiber groups increased linearly in the range of 30
º to 180º and became significantly greater in the range of 60 º to
180º compared to the strain at 0 º. The strain did not significantly
increase throughout external rotation at 90º abduction. Although
mean strains at 180º abduction (56.2±16.5% on lateral fiber and
48.2±15.7% on medial fiber) and 180º flexion (54.9±17.3% on
lateral fiber and 49.0±16.8% on medial fiber) were the greatest
in all shoulder motions, they were not significantly greater than
the strain at external rotation at 90º abduction (40.5±15.1% on
lateral fiber and 33.8±14.3% on medial fiber). In the comparison
of three stretching techniques, scapular retraction at 60º flexion
(52.0±17.2% on lateral fiber and 46.6±14.8% on medial fiber) and
horizontal abduction with 90º external rotation (48.0±14.3% on lateral
fiber and 42.6±14.8% on medial fiber) significantly stretched the
muscle compared to scapular retraction at 0º flexion. However,
mean strains during these two techniques were not greater than
the strain at 180 º of flexion and abduction. CONCLUSIONS: Our
findings indicate that the pectoralis minor muscle was lengthened at
180º shoulder flexion or abduction. The amounts of muscle strains
during three traditional stretching techniques were not greater than
the strain at 180º shoulder flexion and abduction. IMPLICATIONS:
Muscle stretching at 180º shoulder flexion or abduction can be
considered an additional effective stretching technique of the
pectoralis minor muscle. KEYWORDS: Pectoralis minor, Stretch,
Shoulder. FUNDING ACKNOWLEDGEMENTS: No grants or outside
funding were received in support of this research. CONTACT:
tmuraki@sapmed.ac.jp
ETHICS COMMITTEE: Institutional Review Board of Sapporo
Medical University
WCPT 2007, Research Reports
Research Report Platform Presentation
1917 Monday 4 June 09:30
PP Crystal Pavilion A
THE SOCIAL POSITIONING STRATEGIES OF PHYSIOTHERAPY
STUDENTS AND CLINICAL EDUCATORS IN FEEDBACK
SESSIONS
Molloy E1 , Clarke D2 , Webb G, Remedios L; 1 Monash University,
Melbourne, Australia; 2 The University of Melbourne, Melbourne,
Australia
PURPOSE: Face-to-face feedback in clinical education has been
identified as an important but problematic process in aiding student
learning. The health education literature identifies tensions inherent
in the clinical educator’s role as both assessor and mentor, and
highlights the tendency for feedback to elicit negative affective
responses in both students and clinical educators. This study
used a ‘Positioning Theory’ framework to investigate the social
processes, including identity construction and power negotiation,
implicit in feedback sessions. RELEVANCE: Invariably, health
education literature views feedback as a key tool in facilitating
learning. Despite these claims, there is a notable absence of
empirical studies investigating the feedback sessions in situ. An
understanding of how feedback is practised is central to informing
conceptions of ‘effective’ learning practice and, ideally, should
positively influence physiotherapy curriculum design and ongoing
professional development. PARTICIPANTS: Nine students and 12
clinical educators were ‘purposively selected’ to participate in
this in-depth qualitative study. Participants were selected across
three institutions affiliated with the School of Physiotherapy, The
University of Melbourne, and represented three practice domains
of cardiothoracic, musculoskeletal and neurological physiotherapy.
METHODS: Nine student-clinical educator feedback sessions were
videotaped at the half-way point and completion point of the
clinical placement (18 sessions in total). Post-session interviews
were conducted with all participants to elicit their understanding
of the feedback encounters. ANALYSIS: The transcripts from the
18 videotaped sessions and 36 interviews were analysed using
Harre’s (1999) Positioning Theory. This analytical lens was used to
interpret the social dimensions implicit in feedback sessions including
the expectations that both parties carried into the sessions, and
the participants’ responsibilities in feedback as enacted through
the conversation. RESULTS: Both students and clinical educators
colluded to create a feedback culture where educators were
positioned as the authorative ‘diagnosers’ of student performance,
and the students were positioned as ‘attentive listener’. The tendency
for clinical educators to assume the position as ‘diagnoser’ and
‘fixer’ was viewed as ‘the physio way’; an artefact from their clinical
role as physiotherapist. Students identified reasons for resisting
responsibility for self-evaluation including respecting authority, saving
face (minimising risk and exposure) and lacking the skills in self-
diagnosis and self-regulation. CONCLUSIONS: In contrast to the
literature’s support of the importance of two-way feedback for learn-
ing, this study indicated that both students and clincical educators
were responsible for generating a one-way feedback exchange.
The clinical educator was positioned as responsible for ‘diagnosing’
and ‘remedying’ deficits in student performance and students
resisted taking responsiblity for self-evaluation. IMPLICATIONS:
The positioning practices observed across the eighteen feedback
sessions are likely to not only influence students immediate learning
experiences, but may additionally influence their ability to develop
as independent, reflective and self-evaluative practitioners. Changes
in curriculum, and more transparent education of students and
clinical educators is required to encourage students to ligitimately
engage in self-evaluative processes. KEYWORDS: Feedback; Self-
evaluation; Positioning Theory. FUNDING ACKNOWLEDGEMENTS:
The researchers would like to acknowledge the assistance of the
Australian Postgraduade Award (APA) and the Australian and New
Platform Presentations, Monday 4 June
Zealand Association for Medical Education (ANZAME)in funding this
project. CONTACT: Liz.Molloy@med.monash.edu.au
ETHICS COMMITTEE: Ethical approval granted by Human Research
Ethics Committee (HREC) at The University of Melbourne, August
2003
Research Report Platform Presentation
2121 Monday 4 June 09:30
PP Crystal Pavilion B & C
RELATIONSHIP OF PERSONAL CHARACTERISTICS, EXERCISE
ATTITUDES, AND ENVIRONMENTAL FACTORS TO EXERCISE
ACTIVITY IN PERSONS WITH PHYSICAL DISABILITY
John D; Department of Physical Therapy, University of Illinois at
Chicago, Chicago, USA
PURPOSE: Existing evidence points to an epidemic of physical
inactivity in the United States, and illustrates the disparity between
physical activity levels in persons with and without disability.
Research on determinants of physical activity and exercise has
shown that exercise is a complex health behavior inclusive of multiple
factors and levels of influence. Further investigation of these factors
is needed in persons with disabilities. This study addressed this
need by investigating the association of personal characteristics,
exercise perceptions, and environmental factors to exercise activity in
persons with physical disability. RELEVANCE: This study identifies
some of the key factors that are associated with exercise activity
in persons with physical disability and identifies factors that are
barriers to exercise. This knowledge can be used to design exercise
interventions for this population. PARTICIPANTS: Data was collected
with 102 subjects who self-reported physical disability and mobility
impairments, recruited from the community. METHODS: A data
collection instrument was developed which compiled measures of
demographic characteristics, limitations of activities of daily living,
exercise self-efficacy, cognitive-emotional barriers, unmet need for
limitations of activities of daily living, environmental barriers, social
environmental support, physical environmental support, and physical
activity levels. Data was collected in face to face interviews with
each participant. Eleven subjects were selected for follow-up semi-
structured interviews which examined attitudes, and facilitators
and barriers to physical activity. ANALYSIS: Multiple regression
analyses were performed with minutes of weekly exercise activity
as the dependent variable, and self efficacy; perceived barriers,
socio-environmental support; physical environmental supports; levels
of unassisted and assisted ADL limitations; and demographic
characteristics of race, gender, age, income level, and education level
as independent variables. The transcribed semi-structured interviews
were analyzed for key concepts, and these were grouped into related
categories or themes. RESULTS: There were significant associations
to exercise activity at the levels of personal characteristics, exercise
attitudes, and environmental factors. Younger age, lower income,
higher education, higher self-efficacy, lower cognitive-emotional
barriers, and lower environmental barriers were associated with
higher levels of exercise activity in persons with physical disability.
High self-efficacy and motivation for exercise, and the construction
of exercise as a daily routine emerged as key concepts in interviews
with subjects who reported regular exercise. Interview subjects who
reported low of exercise expressed the need for transportation
support, accessible facilities in their communities, and instrumental
support for exercise. CONCLUSIONS: There are some key factors
that are important in promoting physical activity in persons with
physical disability. Those of older age and with lower education may
require additional targeting and support in achieving regular exercise.
Specific strategies that address self-efficacy, cognitive-emotional
barriers, and environmental barriers may be needed. Future
research exploring factors associated with exercise in persons with
disability needs to include larger and more diverse samples across
socioeconomic levels, community locations, and across differing
levels of physical disability. IMPLICATIONS: Physical therapists need
S121
to consider these factors when designing exercise interventions for
persons with disabilities. Additionally, physical therapists need to
adopt an advocacy role for public policies that create environmental
support for physical activity. KEYWORDS: Physical activity; barriers;
self-efficacy. FUNDING ACKNOWLEDGEMENTS: This work was not
funded by an external agency. CONTACT: demetra@uic.edu
ETHICS COMMITTEE: This work was approved by the Institutional
Review Board at the University of Ilinois at Chicago.
Research Report Platform Presentation
1731 Monday 4 June 09:30
VCEC Ballroom B & C
ULTRASOUND PHONOPHORESIS OF PANAX NOTOGINSENG
EXTRACT IMPROVES THE STRENGTH OF REPAIRING
LIGAMENTS
Ng G, Wong R; Department of Rehabilitation Sciences, Hong Kong
Polytechnic University
PURPOSE: This study aimed to examine the combined effect of
therapeutic ultrasound and herbal panax notoginseng extract and
to compare it with the therapeutic ultrasound alone for treating
medial collateral ligament injury in a rat model. RELEVANCE: The
phonophoretic effects of therapeutic ultrasound has been utilized
clinically to facilitate the absorption of topical drugs. Herbal plant
extracts are commonly used in the Chinese community to treat
musculoskeletal problems and panax notoginseng (PN) is a popular
ingredient in many herbal formulae. If the combined treatment effects
of therapeutic ultrasound and PN extract could enhance tissue
healing, it will have a vital impact on the potential application of this
treatment approach in the management of musculoskeletal injuries.
Furthermore, the success of this treatment will be a major step
forward in bridging the eastern and western therapeutic methods.
PARTICIPANTS: Twenty sexually matured male Sparague Dawley
rats were used in this study. METHODS: All the rats received
surgical resection to their left medial collateral ligament (MCL) and
were randomly dividied into 3 groups, namely, Group 1 (combined
ultrasound PN treatment, n=7); Group 2 (ultrasound treatment alone,
n=7); and Group 3 (no treatment control, n=6). On day 3 after the
surgery, the rats were subjected to their respective treatment daily for
6 days a week. Group 1 received 4 minutes of continuous ultrasound
(1 MHz) at the intensity of 1.2 W/sqcm using the contact method with
a coupling gel that contained PN extract. Group 2 received the same
ultrasound treatment but with a normal ultrasonic coupling gel. Group
3 received a placebo treatment similarly to the other two groups but
with the power of the ultrasound machine turned off. ANALYSIS:
On day 17 after surgery, the rats were killed and the MCL on both
legs were mechanically tested with a material testing system for the
ultimate tensile strength. Results of the left side were normalized
against that of the right side for each animal and the normalized data
were compared with a one-way ANOVA at 0.05 level of confidence.
RESULTS: Result of ANOVA showed significant difference (p = 0.022)
among the 3 groups. Post-hoc contrasts revealed that the normalized
tensile strength in Group 1 (74.6 +/− 14.9) was significantly higher
than that of Group 2 (57.5 +/− 14.3) and Group 3 (51.9 +/− 12.0),
whereas no significant difference was found between Group 2 and
Group 3. CONCLUSIONS: We conclude that the combined treatment
of therapeutic ultrasound and PN extract could produce a more
favorable outcome on the strength of the repairing ligament at
2 weeks after injury in rats. IMPLICATIONS: The present study
implies that therapeutic ultrasound application coupled with a gel
that contained a Chinese herbal medicinal extract may produce
more favorable outcome than ultrasound therapy alone on soft tissue
injuries. The efficacy of this combined therapy on human has yet
to be tested. KEYWORDS: Therapeutic ultrasound, ligament, herbal
medication, phonophoresis. FUNDING ACKNOWLEDGEMENTS:
The financial support from Department of Rehabilitation Sciences,
Hong Kong Polytechnic University for this study is acknowledged.
ETHICS COMMITTEE: The Animals Ethics Subcommittee of Hong
Kong Polytechnic University
S122
Research Report Platform Presentation
2897 Monday 4 June 09:30
VCEC Meeting Rooms 11-12
DOES MIRROR THERAPY IMPROVE UPPER LIMB SENSORY
AND MOTOR RECOVERY EARLY POST-STROKE? A
RANDOMISED-CONTROLLED TRIAL
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,
Brisbane, Australia; 3 Oxford Centre for fMRI of the Brain &
Department of Physiology, Anatomy &
PURPOSE: The current study assessed mirror therapy versus sham
therapy on early post-stroke upper limb resting pain and sensorimotor
recovery. RELEVANCE: During mirror therapy participants perform
bilateral limb movements and watch the unaffected hand and its
mirror image, while keeping the affected hand hidden from view
behind a partition. Mirror therapy is hypothesised to either (i)
provide sensory feedback important for sensorimotor integration and
recovery, or, (ii) activate the ipsilateral motor cortex to enhance
sensorimotor recovery. Mirror therapy was associated with improved
motor recovery in a chronic (>6 months) post-stroke population and
improved sensation, function and pain intensity in pain patients.
However, mirror therapy has not been evaluated to determine
its effect on early post-stroke pain and sensorimotor recovery.
PARTICIPANTS: Forty acute (<two weeks) stroke patients were
recruited from an acute rehabilitation hospital. To increase patient
homogeneity, only first-time ischaemic stroke patients participated.
All participants met study inclusion/exclusion criteria. METHODS:
Blinded assessments included a motor assessment (grip strength
and the Motor Assessment Scale (MAS)) and a quantitative sensory
assessment (resting pain intensity, sensory detection, pressure-pain
threshold, and hot/cold sensation). Participants were assessed prior
to treatment, following treatment and one month post-treatment.
Participants were randomly assigned into either mirror-therapy or
sham-therapy (non-reflective surface) for 20 minutes daily for two
weeks, in addition to usual care. Both groups performed bilateral
(as able) simple motor tasks and sensory stimulation progressed
by complexity. Participants in the intervention group watched the
mirror image of the unaffected upper limb during intervention, with
the affected limb hidden from view. Sham group participants were
unable to view the unaffected limb during intervention. ANALYSIS:
Results were analysed on an intention to treat basis. A RM-ANOVA
was used to detect differences between groups (2), times (3), and
sites (4). RESULTS: There were no between-group differences at
baseline. Subjects who underwent mirror therapy demonstrated at
each of the three upper limb sites: improved sensory detection (post:
p < 0.05, follow-up: p < 0.01), pressure-pain threshold (post: p < 0.05,
follow-up: p < 0.01), and hot/cold sensation (post: p < 0.05, follow-up:
p < 0.01); improved grip strength (post: p < 0.05, follow-up: p < 0.01)
and MAS scores (post: p < 0.05, follow-up: p < 0.01); and decreased
resting pain intensity (post: p < 0.01, follow up: p < 0.01) compared
with the sham group post-treatment and at follow-up. There was
no statistically significant change in sensation at the remote (leg)
site. CONCLUSIONS: Mirror therapy was associated with improved
early post-stroke upper limb motor recovery, sensory recovery, and
resting pain intensity. Mirror therapy had no effect on a remote site in
the leg, suggesting that mirror therapy has a local treatment effect.
Further research is needed to determine the optimum frequency
and duration of mirror therapy and if it is equally effective when un-
supervised. IMPLICATIONS: This is the first known RCT of mirror
therapy in a post-stroke population. The results of this study support
the use of mirror therapy in an acute stroke unit. Mirror therapy
was well received by stroke patients and is a simple and cost-
effective intervention that can improve the rehabilitation outcome.
KEYWORDS: Stroke rehabilitation, somatosensation, sensorimotor
integration. FUNDING ACKNOWLEDGEMENTS: NEA is supported
by NHMRC Grant ID 409919 and The Royal Brisbane & Women’s
Hospital Research, Australia. The current research was supported
WCPT 2007, Research Reports
by an APA Neurology-Tagged Grant. GLM is supported by a
Nuffield Oxford Medical Fellowship and is on leave from the School
of Physiotherapy, The University of Sydney, Australia. CONTACT:
nicoleacerra@hotmail.com
ETHICS COMMITTEE: The Royal Brisbane and Women’s Hospital
Human Research Ethics Committee and The University of Queens-
land Medical Research Ethics Committee.
Research Report Platform Presentation
2836 Monday 4 June 09:30
VCEC Meeting Room 16
POSITIONING PRACTICES OF ASIAN-EDUCATED STUDENTS IN
AN AUSTRALIAN PROBLEM-BASED LEARNING CLASSROOM:
ACCESS TO POSITIONS THAT MATTER
Remedios L; University of Melbourne, Melbourne, Australia
PURPOSE: This presentation examines the positioning practices
of Asian-educated students in a small-group learning context.
Positioning Theory (Harre and Van Langenhove, 1991) is a theoretical
framework that used conversation as data for understanding how
individuals negotiate their social context. It is a useful frame
for examining how students experience and shape their learning.
RELEVANCE: Physiotherapy classrooms are cross-cultural learning
contexts and it is important that educators are better informed of
the leaning experience being provided for students from different
cultural and educational backgrounds. PARTICIPANTS: Thirteen
International students who had previously completed the majority
of their pre-tertiary education in East Asia and South-East Asia
were recruited for this study. While these students had shared
regionality and all were from Confucian heritage backgrounds,
there was a marked diversity in cultural, linguistic and educational
backgrounds. Seven students were purposively sampled for closer
examination of positioning practices. METHODS: The data presented
here is drawn from a subset of data taken from a two-year
ethnographic study that examined the experiences and responses of
overseas (Asian) educated students to PBL in the first year of their
undergraduate experience. Participant observation, semi-structured
interviews, video data and video-stimulated recall interviews were the
primary sources of data collection. For this secondary analysis, seven
PBL tutorials were video taped so as to capture the conversational
exchanges between seven Asian-educated students and other group
ANALYSIS: Positioning theory was used as the analytical framework
for examining the positions that were assigned to Asian-educated
students as well as the positions they adopted, accepted and con-
tested. An existed list of positions commonly assigned and adopted
in small group collaborative work among senior school students
(Barnes, 2003) was expanded and modified into a table of positions
commonly seen in PBL tutorials. This classification was used to
examine the positioning of Asian-educated students. RESULTS: Key
findings were that Asian-educated students did not adopt all positions
identified as positions that matter. Further, both tutors and local group
members were found to assign only a limited number of positions to
Asian-educated students and in some cases to even contest their
adoption of key positions. However, despite working within a limited
repertoire of positions, there was evidence of diverse responses
to assigned positions with some students contesting positions
assigned to them. CONCLUSIONS: Positioning practices in PBL
tutorials suggested an embedded power structure that did not allow
Asian-educated students full group membership and opportunity to
negotiate as empowered group members. Further research is needed
to examine tutors’ positioning of students and strategies used by
tutors that actively facilitate students’ access to positions that matter.
IMPLICATIONS: This study foreground factors that limit access some
students have to positions that matter within the PBL context. For all
students to access the learning opportunities available in PBL, tutors
need to scaffold the students’ negotiation of the power structure oper-
ating in small group leaning contexts. KEYWORDS: Asian-educated
students, Positioning Theory, Cross-cultural learning. FUNDING
Platform Presentations, Monday 4 June
ACKNOWLEDGEMENTS: Australian Post-graduate scholarship
(The University of Melbourne). CONTACT: louisajr@unimelb.edu.au
ETHICS COMMITTEE: University of Melbourne, Faculty of Educa-
tion, Human Research Ethics Committee
Research Report Platform Presentation
1994 Monday 4 June 09:30
VCEC Meeting Room 17
COMPARING DISCHARGING POLICY FOR STROKE PATIENTS
BETWEEN THE UK AND JAPAN
Kato G, Takahashi K, Akasaka K, Kurikawa M, Tokita K, Sawada Y;
Department of Physical Therapy Saitama Medical School Junior
Colloge Saitama Prefecture, Japan
PURPOSE: Nowadays, the importance of researching health policy
has been increased because of its characteristic, “health service
is scarce resource” which is influenced by social environment,
such as aging society, economic situation, etc. Moreover, health
staffs have gradually been involved in the health policy making
process. It would be difficult to say that, as a member of medical
staffs, physical therapists sufficiently participate in the policy making
process because not many researches based on policy science have
been achieved by physical therapists have been shown up in Japan.
Therefore, this study aim to study about health policy, and facilitate
puting more physical therapists into the policy process effectively.
RELEVANCE: This study concerns the discharging policy for stroke
patients for following reasons. First, stroke is world-widely known
as a main cause of disability. Second, “bed-blocking”in the UK, and
“socially being inpatient”, a situation that patient have to stay in the
hospital because of their social reasons have been recognized as
a social problem in both countries. Third, many physical therapists
play a strong role in the process of discharging stroke patients.
DESCRIPTION: To achieve understanding discharging policy for
stroke patients, following procedure based on qualitative method was
carried out. First, “Advocacy Coalition Framework”, one of policy
science tools to demonstrate policy, was applied. Secondly, the
data for the framework was collected through databases, Internet
sites, and library catalogue. The key words were ‘stroke’, ‘discharge’,
‘comparative’, ‘policy’, ‘health’, ‘long term care’, ‘continuing care’,
and ‘community care’. Finally, discharging policy for stroke patients
was compared between the UK and Japan to help interpreting the
policy with understanding what is same, and what is different between
them. EVALUATION: This study achieved to illustrate two countries’
discharging policy for stroke patients. By reviewing 50 literature the
framewark was completed. CONCLUSIONS: The comparison carried
out in this study indicates some differences between them. First, the
UK discharging policy intends to control discharging process with the
responsibility set by law, in contrast Japanese one was controlled by
the national insurance schedule. In concrete, if the stroke patients
overstayed in the hospital with social reasons, and then the local
government has to pay for the additional fee in the UK. In Japan,
it is not possible that hospitals receive the normal payment for
overstaying from the Japanese national insurance scheme but may
accept reduction of medical expenditure due to reducing the national
medical care cost. Secondly, the quantity of medical services, such as
the opportunity to access to the hospital beds, computed tomography
scans, Magnetic Resonance Imaging, is more frequently carried
out in Japan. However, there is less quantity of social services in
Japan. On the other hand, in the UK, more multiple professionals are
involved in the discharging process for stroke patients. Particularly the
quantity of social services, such as social works, is higher in the UK.
IMPLICATIONS: Because of lack of medical services, ‘bed-blocking’
tends to be caused in the UK, however ‘socially being inpatient’
in Japan caused by the difficulties happened at the point when
patients discharge from hospital. KEYWORDS: Health policy, Policy
Science, Physical Therapist. FUNDING ACKNOWLEDGEMENTS:
None. CONTACT: goheik@saitama-med.ac.jp
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Research Report Platform Presentation
2321 Monday 4 June 09:30
VCEC Meeting Room 18
ANALYSIS OF THE CLINICAL FACTORS DETERMINING THE
CAPACITY TO PERFORM BRIDGING ACTIVITIES AMONG FRAIL
OLDER ADULTS
Pilon M1,2 , Nadeau S2,3 , Piotte F2 ; 1 CSSS Bordeaux-Cartierville-
St-Laurent, Montréal, Québec, Canada; 2 School of Rehabilitation,
Faculty of Medicine, Université de Montréal, Québec, Canada;
3 Centre de recherche interdisciplinaire en réadaptation du Montréal
Métropolitain, Institut de réadaptation de Montréal, Québec, Canada
PURPOSE: To identify the most important clinical variables de-
termining the execution of bridging activities in frail older adults.
RELEVANCE: Physical therapists often use bridging activities to
assess and train the hip muscle strength and lower-limb motor control
during rehabilitation. These activities have hardly been studied.
PARTICIPANTS: A convenient sample of 30 frail older adults (mean
age ±SD: 80.4 ±7.2) were recruited at a Montreal geriatric health
center. All gave their written consent prior to the assessment.
METHODS: After collecting demographic data, a trained physical
therapist used several clinical tests (e.g. 10 meters walk, Time Up and
Go, Berg balance test, Lower Extremity Coordination Test, Functional
Autonomy Measurement System) to assess the walking ability,
coordination and level of autonomy of the participants. The maximal
static strength of the trunk flexors and extensors, hip extensors,
hip abductors, knee flexors and extensors was assessed using
a hand-held Nicholas dynamometer. The subjects then performed
three different Timed Bridge Tests (TB Tests): 1) a hold test (TB-
Static), 2) a 5-repetitions dynamic test (TB-5rep) and 3) a 60
seconds dynamic test (TB-60s). For all trials, a physical therapist
recorded the height of the bridge with a pelvialtimeter, the duration
(TB-Static and TB-5rep) or the number of repetitions (TB-60s).
ANALYSIS: Descriptive statistics were calculated to establish the
subjects’ characteristics, clinical variables and performance in the
TB Tests. The level of association between the ability to perform the
three TB tests and the clinical variables were first examined with
Pearson’s correlation coefficients then with multiple linear regression
analyses using a stepwise method. RESULTS: Results revealed that
the heights attained in the three bridge tests were related to one
another (r > 0.95) and the duration of execution of the TB-5rep was
significantly associated (r = 0.65) with the number of repetitions of
the TB-60s. Except for the duration of TB-5rep, which showed an
association with the weakest knee extensor strength, there were
no significant associations between the clinical variables and the
TB test parameters, with r values generally lower than 0.30. The
multiple linear regression analyses did not find important predictors
of the TB performance, even with the summation of the muscle
strength for a given muscle. The best models explained 31% of
the variance in the data and were obtained for the heights of the
TB-5rep and TB-60s and for the duration of the TB-Static test.
The variable most often selected was again the strength of the
weakest knee extensor. CONCLUSIONS: The performance of the
TB Tests is poorly explained by the strength of the lower limbs
or the trunk as well as by other clinical variables. Thus, the TB
tests described cannot be used to appreciate the lower-limb muscle
strength at the hip. Further studies are required to identify the
factors that determine the TB test performance. IMPLICATIONS:
Clinicians should not rely on the individual’s performance in a
bridge test to evaluate the strength of the hip muscles among the
geriatric rehabilitation population. KEYWORDS: Elderly, strength,
mobility. FUNDING ACKNOWLEDGEMENTS: This project was
supported by the Ordre professionnel de la Physiothérapie du
Québec and the Fonds de Marie-Anne Lavallée. The authors thank
M. Beaudry and M. Labadie for their technical support. CONTACT:
felisa@sympatico.ca
ETHICS COMMITTEE: CSSS Bordeaux-Cartierville-St-Laurent
ethic’s committee
S124
Research Report Platform Presentation
2436 Monday 4 June 09:30
VCEC Meeting Rooms 19-20
COLLAGEN AND ELASTIN CROSSLINKS IN HUMAN
INTERVERTEBRAL DISCS AND LIGAMENTUM FLAVUM: AGE,
GENDER AND SPINAL LEVEL INFLUENCES
Tan C1 , Kent N2 , Singer K1 ; 1 Centre for Musculoskeletal Studies,
University of Western Australia, Australia; 2 PathCentre, Queen
Elizabeth II Medical Centre, Nedlands, Western Australia
PURPOSE: The objective of the study was to determine the
distribution of collagen and elastin crosslinks in spinal disc and
ligamentum flavum due to age, gender and spinal level influences.
RELEVANCE: Elastic fibers are commonly reported in the matrices
of ligament connective tissues, however the presence of these
tissues in spinal discs is still not fully investigated and determined.
PARTICIPANTS: Tissue samples from cadaveric spinal discs (n=77)
and ligamentum flavum (n=364) were obtained from 24 formalin-
fixed and 2 fresh spines. The mean age of all spines was 57 SD 26
years. METHODS: Spinal ligament and disc samples were harvested
and analyzed for collagen, Pyridinoline, deoxypyridinoline and elastin
crosslinks, isodesmosine and desmosine. Crosslinks were extracted
from hydrolyzed samples by cellulose partition chromatography,
and analyzed by reverse-phase HPLC. ANALYSIS: Results were
quantitative data, analysed using ANOVA and regression analysis
to determine relationships between age, gender, spinal levels and
biochemical parameters. RESULTS: Elastin crosslinks were only
detected in lumbar discs but yielded results in all ligamentum flavum
tissues. The distribution of elastin crosslinks in the ligament was
significantly lower with age (p < 0.05), higher in females (p < 0.05)
and lumbar region (p < 0.01). CONCLUSIONS: The collagen and
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
in human spinal discs compared with spinal ligamentum tissues.
Such data provides clinicians treating spinal patients with information
on the biochemical changes in the soft tissues in relation to age,
hormonal and biomechanical factors. KEYWORDS: Human spinal
discs, ligamentum flavum, collagen, elastin, crosslinks, age, gender,
spinal region. FUNDING ACKNOWLEDGEMENTS: This study was
funded in part through the National Health and Medical Research
Council funding (970244).
ETHICS COMMITTEE: Ethics approval was granted by the Ethics
committe of Curtin University of Technology, Western Australia
Research Report Platform Presentation
2411 Monday 4 June 09:50
PP Crystal Pavilion A
SELF-DIRECTED LEARNING AMONG PHYSIOTHERAPY
STUDENTS
Jeglinsky I; The Faculty of Social and Health care. Arcada, Helsinki,
Finland
PURPOSE: The Physiotherapy education at Arcada is built on
integrative pedagogic to prepare the students for practice in different
contexts. The new curriculum for the physiotherapy degree focuses
on the students’ learning process. Defining learning outcomes and
developing new pedagogic methods have become a challenge for
the teachers. There is a need for developing methods to facilitate
students’ ability to take the initiative to diagnose their learning needs,
formulate learning goals, identify resources for learning, select and
implement learning strategies, and evaluate learning outcomes. The
aim of this project was to investigate the didactic possibilities to
support self directed learning among the physiotherapy students
at Arcada. RELEVANCE: The striving of a common European
area for higher education has put the reforms into an every day
reality for teachers and students. An important part of this Bologna
WCPT 2007, Research Reports
process is student focused education, where learning and especially
learning outcomes are of great importance. A goal for the curricula
is that the student masters the core knowledge of physiotherapy.
Interaction between the core knowledge and pedagogic strategies,
learning environment and the construction of the studies is
essential. DESCRIPTION: This project is a development work
to investigate how physiotherapy students at Arcada experience
their learning through self-directed studies. The data was obtained
through a questionnaire, which consisted of five closed and seven
open questions. Eighty percent of the physiotherapy students at
Arcada (n=56) answered questions about study planning, study
techniques, learning and supervision. The questions were answered
anonymously. The results were analyzed qualitatively according to
categories. EVALUATION: This study showed that reading literature
is the most common activity in self-directed studies. To make
notes, both during independent reading and during lessons is
another method used by students for self-directed studies and
learning. Factors that support self-directed learning are repeating,
time for reflection and a quiet learning environment. Study planning
is facilitated by a structured curriculum and teacher supervision.
Motivated, engaged and competent teachers encourage students
into self-directed studies. CONCLUSIONS: The results show that
physiotherapy students at Arcada concentrate their self-directed
studies on learning theory, but they do not seem to use time in
learning practical skills. Further studies about the students’ ability to
self-reflective and critical thinking in self-directed studies are needed.
IMPLICATIONS: Clearly structured studies combined with support
from the teachers can be used for helping students spend more self
-directed time in learning practical skills. KEYWORDS: Self-directed
studies, learning, didactics. FUNDING ACKNOWLEDGEMENTS:
None. CONTACT: ira.jeglinsky@arcada.fi
Research Report Platform Presentation
3170 Monday 4 June 09:50
PP Crystal Pavilion B & C
SUBJECTIVE AND MUSCULAR FATIGUE IN PEOPLE WITH
PERIPHERAL NEUROPATHY
Graham R1 , White C2 ; 1 Manchester Metropolitan University,
Manchester, UK; 2 King’s College London, London, UK
PURPOSE: The study aimed to examine the complex interaction
between subjective fatigue report and muscular fatigue in people
with peripheral neuropathy. RELEVANCE: Up to 80% of people with
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
to what extent muscle fatigue contributes to this subjective fatigue.
PARTICIPANTS: 13 people with peripheral neuropathy (Diagnoses:
Guillain Barré Syndrome, 4; Chronic Inflammatory Demyelinating
Polyradiculoneuropathy, 7; Multifocal Motor Neuropathy, 1; Parapro-
teinaemic Demyelinating Neuropathy, 1) and 13 healthy volunteers,
aged between 18 and 70 were recruited. METHODS: Subjective
fatigue was evaluated using the Fatigue severity scale, Fatigue impact
scale and Piper fatigue scale questionnaires prior to measurements
of quadriceps femoris muscle performance. These included peak
force, voluntary activation and the response to low and high
frequency electrical stimulation. All participants underwent testing
on two separate occasions at least one week apart. Three muscle
fatiguing protocols were performed to evaluate i) aerobic muscle
metabolism under conditions that broadly mimic daily activity, ii)
the response to a 60 second sustained maximal isometric muscle
contraction, and (iii) decline in force after 3 minutes of intermittent
electrical stimulation. ANALYSIS: 2-tailed independent t tests were
used to assess differences between healthy and PN participants
in subjective fatigue, peak isometric force (MVIC), induced fatigue,
voluntary activation, EMG, response to high and low frequency
electrical stimulation at baseline and after fatiguing protocols.
Pearson product moment correlations were used to examine
Platform Presentations, Monday 4 June
associations between subjective and muscular fatigue measures.
RESULTS: Participants with PN had significantly greater subjective
fatigue (p < 0.05) and were significantly weaker (Mean MVIC force
±SD, NKg−1 : 5.4±2, p < 0.05), than healthy volunteers (7.5±2.2).
However, there was no significant difference between PN and healthy
groups for any measures of muscle performance. PN participants
demonstrated a similar decline in MVIC after a sustained 60 second
isometric contraction (% of initial MVIC force: PN, 60±14% Healthy,
59±18%), comparable decrease in low: high frequency stimulated
force ratio after voluntary fatiguing muscle activity (PN, 0.13±0.18;
Healthy, 0.11±0.15) and a similar decline in initial force following
intermittent electrical stimulation (PN, 60±13% of initial; Healthy,
63±11%).There were no significant associations between measures
of muscular fatigue and subjective fatigue report in either group.
CONCLUSIONS: These results indicate that subjective fatigue is
significantly more severe in people with PN than healthy participants.
However, there is little evidence to suggest that primary muscle
fatigue is responsible for this. IMPLICATIONS: The relationship
between subjective and muscular fatigue in people with PN is unclear.
Future studies should seek to evaluate other causes of subjective
fatigue in this patient group and to examine muscular fatigue relative
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
Foundation for their support of this study.
ETHICS COMMITTEE: Ethical approval was granted by the King’s
College London and Guy’s Hospital Research Ethics committees,
London UK.
Research Report Platform Presentation
2698 Monday 4 June 09:50
VCEC Ballroom B & C
ABIOTIC EFFECTS OF ULTRAVIOLET-C IRRADIATION
ON IN VITRO AND IN VIVO CULTURED BACTERIA:
INTERDISCIPLINARY LABORATORY RESEARCH TO PHYSICAL
THERAPY PRACTICE
Henderson R, Vanik J, Banning J, Han H; Rosalind Franklin
University of Medicine & Science, North Chicago, USA
PURPOSE: The purpose of this study was to investigate the
abiotic effect of Ultraviolet-C (UVC) irradiation on four bacteria
commonly found in infected wounds with an an interdisciplinary
research initiative involving physical therapy and clinical laboratory
science faculty and students. RELEVANCE: Physical therapists use
a variety of interventions to manage infected wounds, including
UVC. However, limited information is available concerning treatment
parameters or the effectiveness of UVC therapy for treatment of
infected wounds in the contemporary clinical setting. Physical therapy
alone lacks the skill set to address these issues which require
an interdisciplinary approach. PARTICIPANTS: Physical therapy
and clinical laboratory science faculty served as research mentors
and interdisciplinary advocates for physical therapy students in this
collaborative laboratory research to address an issue with importance
and implications for physical therapy practice. METHODS: Staphy-
lococcus aureus, Escherichia coli, Pseudomonas aeruginosa and
Klebsiella pneumoniae were irradiated with UVC at two distances and
four different durations for two conditions, In vitro (Plated American
Type Culture Collection organisms) and In vivo (organisms harvested
from infected wounds). Irradiated plates were incubated for 24-48
hours and viable colonies were counted. ANALYSIS: Percent kill
rates were calculated from surviving colony counts. The One-way
Independent ANOVA and Bonferroni t-Test were used to determine
differences between the four irradiation durations at each distance.
The Independent t-Test was used to determine differences between
the two exposure distances and conditions. RESULTS: Mean percent
kill rates ranged from 84-100%. Kill rates were significantly different
between exposure durations at 3 inches (p  0.0001), however, not
S125
at 1 inch (p = 0.87). No differences were found between distances
(p = 0.33) or the In vivo (p = 0.78) or In vitro (p = 0.24) condition.
CONCLUSIONS: The shortest exposure time (5 seconds) was
sufficient to kill bacteria at the closest distance (1 inch). The
collaboration of two health professions resulted in confirmation of
the abiotic effect of UVC and specific recommendations for physical
therapy practice. IMPLICATIONS: Results of this interdisciplinary
research suggest that UVC may provide an effective, safe, and
cost-beneficial alternative to pharmacologic intervention for infected
wounds, particularly important for antibiotic intolerant patients
and antibiotic resistant organisms. It also suggests that UVC is
effective in killing a variety of organisms, possibly simultaneously,
and organisms with different susceptibility patterns. Furthermore,
it appears that multiple exposures to UVC are necessary to
totally eliminate pathogens from an infected wound. This study
also evidences that the roles of health practitioners must expand
and include interdisciplinary research to substantiate and inform
changing clinical practice. If best practice is often interdisciplinary,
education must be as well. KEYWORDS: Ultrviolet-C, Infected
Wounds. FUNDING ACKNOWLEDGEMENTS: None. CONTACT:
roberta.henderson@rosalindfranklin.edu
Research Report Platform Presentation
2986 Monday 4 June 09:50
VCEC Meeting Rooms 11-12
IS NIGHT SPLINTING AS EFFECTIVE AS TILT TABLING AT
PREVENTING ANKLE CONTRACTURE EARLY AFTER STROKE:
A RANDOMISED CONTROLLED TRIAL
Ada L1 , Robinson W2 , Smith R3 , Aung O4 ; 1 University of Sydney,
Sydney, Australia; 2 Bankstown Hospital, Sydney, Australia; 3 Multiple
Sclerosis Centre, Sydney, Australia; 4 St. George Hospital, Sydney,
Australia
PURPOSE: To examine the efficacy of prolonged stretching (via
overnight splinting vs tilt-tabling) in preventing ankle dorsiflexion
contracture early after stroke. RELEVANCE: Calf shortening is a
common problem after stroke. Limitation in ankle range is a major
secondary problem after stroke which leads to reduced mobility
and independence. PARTICIPANTS: 29 stroke patients who were
previously ambulatory, within 2 weeks of a first disabling stroke,
currently immobile but had not already developed contracture in
the affected ankle of greater than 10 degrees compared with the
non affected limb, had no pre-existing skin or circulatory problems
contraindicating application of splints and did not have severe
difficulty in communication participated in the study. The study was
approved by the individual hospital and university ethics committees
and subjects gave informed consent before initial measures were
completed. METHODS: A randomised controlled trial was carried
out in two metropolitan mixed rehabilitation units. The experimental
group had their affected ankle splinted at plantargrade overnight
and the control group were stood on a tilt table with the affected
ankle at maximum dorsiflexion for 30 min. Maximum passive ankle
dorsiflexion and the sit-to-stand item of the Motor Assessment
Scale were measured before and after 4 weeks of intervention,
and after 6 weeks follow up by an assessor blinded to group
allocation. ANALYSIS: Two-way ANOVAs (group x time) were used
to determine whether there was a greater effect of the night
splinting program than the tilt table program on maximum passive
dorsiflexion and sit-to-stand performance. Analysis of data from
Weeks 0 and 4 compared the immediate effect of the splinting
program with the tilt table program while analysis of data from Weeks
0 and 10 determined whether any benefits of the intervention were
maintained. RESULTS: There was no difference in the change in
maximum passive dorsiflexion between the night splinting group
and the tilt tabling group, either by Week 4 (p = 0.61) or by Week
10 (p = 0.75). However, neither group lost range in their ankles
over the intervention period. The experimental group started at
14 deg and finsished at 14 deg which was similar to the control
S126
group who started at 12 deg and finished at 14 deg. Both groups
lost 4 deg in the 6 weeks following the cessation of intervention.
CONCLUSIONS: Night splinting appears to be as effective as titl
tabling at preventing ankle contractures after stroke. IMPLICATIONS:
Clinicians can choose to implement night splinting or tilt tabling
to prevent ankle contracture depending on the requirements of
the individual patient. KEYWORDS: stroke, stretch, contracture.
FUNDING ACKNOWLEDGEMENTS: The Physiotherapy Research
Foundation of Australia. CONTACT: l.ada@fhs.usyd.edu.au
ETHICS COMMITTEE: The Ethics COmmittee for humna research,
the University of Sydney
Research Report Platform Presentation
2930 Monday 4 June 09:50
VCEC Meeting Room 16
OCCUPATIONAL THERAPY AND PHYSIOTHERAPY STUDENTS’
PERSPECTIVES OF PROFESSIONAL ROLE – THERE IS A
DIFFERENCE!
Richardson B, Garnham E; University of East Anglia, Norwich, UK
PURPOSE: To explore perspectives of professional role held by
graduating 3rd year occupational therapy and physiotherapy students
on a shared BSc (Hons) course. RELEVANCE: Shared learning in
health education courses is encouraged to promote inter-professional
team work. Demographic changes and projected increasing inci-
dence of chronic disabilities have led to continuing debate of future
health care needs and the rationale for retaining the individuality
of some health professions PARTICIPANTS: 8 occupational therapy
and 8 physiotherapy students from an education programme with
50% shared courses, were strategically selected from responses
to an open invitation to participate in a study of professional
socialisation. Selection aimed for maximum variation of sex, age,
earlier work experiences, educational background to ensure a rich
diversity of the phenomena. METHODS: A qualitative approach was
taken by three researchers to explore perspectives of professional
socialisation throughout a three year course. A semi-structured
interview of 30-40 minutes was carried out with each participant
by one of the researchers within three months of completing the
course. Each interview opened with the same question “please tell
me about a patient who you have found interesting as an occupational
therapist/physiotherapist”. A commonly agreed interview guide and
a phenomenographic approach was used to explore the varied
conceptions of the role of an occupational therapist or physiother-
apist. ANALYSIS: All interviews were transcribed and analysed
by a phenomenographic method. Reading and familiarisation of
each transcript was carried out by two researchers, independently,
within and across the professions. Interview content was condensed
and relevant statements identified which were summarised and
compared for similarities and differences. The two researchers
then compared and agreed qualitatively different categories across
the summaries which were described and designated with titles.
Finally the categories were contrasted and related to each other.
RESULTS: Complex and varied descriptions of the phenomenum of
professional role emerged. Themes of identification of outcomes and
achieving goals; impact of the context; use of reasoning; continual
learning were identified in which distinct differences in underpinning
health beliefs, styles of reasoning, framing the problem, and
focus of intervention clearly distinguished occupational therapy and
physiotherapy perspectives of professional role. CONCLUSIONS:
Perceptions of the professional role of occupational therapists and
physiotherapists present distinctly contrasting but complementary
views of client centred care which together emphasize a continuum of
health care provision valid to life long client centred care and modern
health care needs. IMPLICATIONS: Distinctly differing perspectives
of occupational therapy and physiotherapy on the focus, reasoning
and rationale for health and social care suggest the importance
of retaining the two professional roles as complementary, but not
WCPT 2007, Research Reports
interchangeable, in providing a full care service in the lifelong man-
agement of chronic disability. KEYWORDS: Occupational therapy
and physiotherapy professional role; health education outcome; phe-
nomenography. FUNDING ACKNOWLEDGEMENTS: Physiotherapy
Research Foundation, Chartered Society of Physiotherapy, UK.
CONTACT: b.richardson@uea.ac.uk
ETHICS COMMITTEE: University of East Anglia, Schools of Health
Ethics Committee
Research Report Platform Presentation
2467 Monday 4 June 09:50
VCEC Meeting Room 17
FACTORS AFFECTING DEMAND FOR REHABILITATION
SERVICES IN ONTARIO, CANADA
Landry M1−3 , Jaglal S1,2,4 , Wodchis W2,4 , Raman J1 , Cott C1−3 ;
1 Department of Physical Therapy, University of Toronto, Toronto,
Ontario, Canada; 2 Toronto Rehabilitation Institute, Toronto, Ontario,
Canada; 3 Arthritis Community Research and Evaluation Unit
(ACREU), Toronto, Ontario, Canada; 4 Department of Health
Policy, Management and Evaluation, University of Toronto, Toronto,
Ontario, Canada
PURPOSE: Demand for health and rehabilitation services often
exceeds supply in an environment of economic scarcity creating
pressure on the health care system. In this research, we explore the
variables that affect demand for rehabilitation services in Canada’s
most populous province of Ontario. RELEVANCE: Rehabilitation
continues to emerge as an essential aspect of health delivery
across the continuum of care. However, many rehabilitation services
(especially outpatient and ambulatory community services) are
generally considered to be beyond the insurable limits of the Canada
Health Act. As a result, outpatient and ambulatory rehabilitation
services are increasingly shifted beyond the publicly funded sector,
and financed through a mix of public and private financing. It
is critical to understand the demand for these services in order
for policy makers to plan and implement appropriate funding and
delivery structures that ensure access to services. PARTICIPANTS:
Informed by the results from a literature and data search, we
conducted a series of 42 key informant telephone interviews between
September 1 and November 18, 2005. A purposive sampling
strategy was used to identify key informants across Ontario. The
sampling frame was selected in order to obtain maximum variation
sampling regarding the dimensions and implications of the issues
being examined. The sampling frame of participants was selected
according to the following criteria: (1) Setting (2) Employment
Type, and (3) Professional Background. Only potential informants
judged to have extensive knowledge and experience in Ontario’s
rehabilitation sector were invited to participate. METHODS: Policy
case study methodology was used, which combined primary (key
informant interviews (N=42) conducted with multiple stakeholders
and secondary (review of publicly available documents) data sources.
ANALYSIS: The transcribed data were entered into a qualitative
data analysis software package (NVivo) for systematic coding.
The research team then performed content analysis to identify
emerging themes that arose form the key informant interviews.
The themes were based on collective perceptions and experiences
of the informants that addressed the issues of demand in the
rehabilitation sector. RESULTS: The demand for rehabilitation is
rising expeditiously, and there are 7 factors identified that will continue
to affect this growing demand. These include (1) an aging population,
(2) increasingly chronic and complex conditions, (3) overall population
growth, (4) increasing public expectations, (5) advances in health
care technology, (6) expanding scope of rehabilitation practice,
and (7) emphasis on health promotion and disease prevention.
CONCLUSIONS: The presence of demand for rehabilitation does
not signal that there is, or will be, sufficient financial and/or human
resources to meet these same demands in Ontario. IMPLICATIONS:
Access to services is increasingly based on eligibility or availability
Platform Presentations, Monday 4 June
of funding rather than demand. Further research is required to
understand the degree to which the presence of unmet rehabilitation
has short and long-term implications at the client and health system
levels. KEYWORDS: Supply, Demand, Rehabilitation. FUNDING
ACKNOWLEDGEMENTS: Ontario Ministry of Health and Long Term
Care (MOHLTC) and the Ontario Neurotrauma Foundation (ONF).
CONTACT: mike.landry@utoronto.ca
ETHICS COMMITTEE: University of Toronto Research Ethics Board
Research Report Platform Presentation
2458 Monday 4 June 09:50
VCEC Meeting Room 18
THE EFFECT ON ADL OF A HIGH-INTENSITY FUNCTIONAL
EXERCISE PROGRAM AMONG OLDER PEOPLE DEPENDENT
IN ADL: A RANDOMIZED CONTROLLED TRIAL
Littbrand H1 , Lundin-Olsson L1 , Gustafson Y1 , Rosendahl E1,2 ;
1 Umeå University, Department of Community Medicine and
Rehabilitation, Geriatric Medicine and Physiotherapy, Umeå,
Sweden; 2 Luleå University of Technology, Department of Health
Sciences, Physiotherapy Unit, Luleå, Sweden
PURPOSE: To investigate if a high-intensity functional weight-bearing
exercise program reduces the dependency in personal care and
mobility among older people dependent in activities of daily living
(ADL), with focus on people with dementia. RELEVANCE: The
number of older people with disability increases. Physical functional
capacity can be improved by high-intensity exercise program, but
there is no strong evidence that physical exercise is an effective
method to reduce disability. PARTICIPANTS: 191 older people
dependent in ADL, living in residential care facilities, and with a Mini-
Mental State Examination (MMSE) score of  10 participated in this
study (the FOPANU Study). Their mean score ± SD of the Barthel
ADL was 13.1±4.2 and 52% of the participants had a diagnosed
dementia disease. METHODS: The participants were randomized to
a high-intensity functional weight-bearing exercise program (the HIFE
Program) or a control activity, including 29 sessions over 3 months.
The Barthel ADL Index, which includes ten items that are summarized
to a total score of 20, was used to assess independency in personal
care and mobility. The assessments were performed, by persons
blinded to the participants’ group allocation, before the intervention,
at 3 months (directly after the intervention period), and at 6 months.
ANALYSIS: Between-group effects on the total score and each item
were analyzed by ANCOVA and by logistic regression, respectively,
using the intention-to-treat principle. RESULTS: When analyzing all
participants, there was no statistical significant difference between
the groups at 3 or 6 months in total score of the Barthel ADL
Index. Analyses for each item revealed that a lower proportion of
participants in the exercise group had deteriorated regarding mobility
indoors (item 7) at 3 and 6 months (4% and 8%) compared to the
control group (16% and 20%), P = 0.01 and 0.03, respectively. Among
people with dementia, there was a significant difference in total score
in favor of the exercise group at 3 months (mean difference 1.1,
P = 0.03), but not at 6 months. CONCLUSIONS: A high-intensity
functional weight-bearing exercise program does not appear to have
an overall effect on ADL according to the Barthel ADL Index among
older people who are dependent in ADL and living in residential
care facilities, but the exercise program seems to have both short-
and long-term effect in maintaining mobility indoors. In the subgroup
of people with dementia, the exercise program seems to have a
short-term overall effect on ADL. IMPLICATIONS: A high-intensity
functional weight-bearing exercise program seems to be a promising
method to reduce disability regarding mobility indoors for older
people living in residential care facilities. For people with dementia,
the exercise program may have an overall effect in personal care
and mobility but continuously training may be needed to maintain
the effect. KEYWORDS: Exercise therapy, Frail Elderly, Dementia.
FUNDING ACKNOWLEDGEMENTS: This work was supported by
grants from the County Council of Västerbotten, the Äldrecentrum
S127
Västerbotten, the Swedish Research Council K2005-27VX-15357-
01A, Erik and Anne-Marie Detlof’s Foundation, the Borgerskapet in
Umeå Research Foundation, and the Dementia Fund. CONTACT:
hakan.littbrand@vll.se
ETHICS COMMITTEE: The study was approved by the Ethics
Committee of the Medical Faculty of Umeå University (§391/01).
Research Report Platform Presentation
2893 Monday 4 June 09:50
VCEC Meeting Rooms 19-20
DOES SUSTAINED LUMBAR ROTATION INDUCE NUCLEUS
PULPOSIS DEFORMATION IN A PREDICTABLE MANNER? – AN
MRI INVESTIGATION
Fazey P1 , Song S2 , Price R3 , Singer K1 ; 1 Centre for
Musculoskeletal Studies, The University of Western Australia, Perth,
Western Australia; 2 Department of Radiology, Royal Perth Hospital,
Perth, Western Australia; 3 Dept of Medical Technology & Physics,
QEII Medical Centre, Perth, Western Australia
PURPOSE: To predict the in vivo effect of sustained lumbar
rotation positions on nucleus pulposis deformation using MRI with
asymptomatic volunteers. RELEVANCE: Physiotherapists commonly
use active and passive non weight-bearing rotation (torsion)
techniques in the management of low back pain. Discogenic low
back pain is common yet the mechanical effect of sustained
lumbar rotation techniques is unknown with respect to the nucleus
pulposis. PARTICIPANTS: 12 subjects comprising: 5 females and
7 males with a mean age of 44 years (range 24-57) were
recruited. Inclusion criteria were: no significant history of back pain
requiring intervention within the previous year and body shape
amenable to positioning within the MRI. Exclusion criteria were
related to the general contraindications to magnetic resonance
imaging. METHODS: Subjects were positioned in a variety of supine
postures including: left lumbar rotation and combinations of flexion,
extension and left rotation, within a 1.5 T magnetic resonance imager
(Siemens, Berlin, Germany). T1 and T2 weighted images were
obtained (TR/TE[5160/102] field of view 210mm, 384x384 matrix).
Flexion to extension range from L1 to S1 was derived from T1
sagittal sequences; T1 coronal images were used to assess direction
and segmental lateral flexion angles; and nucleus hydration patterns
evaluated from mid disc axial T2 weighted images. In this series
30 discs were examined. Acquisition time for each image was 4-6
minutes. ANALYSIS: Selected axial images were post-processed in
Image-J [NIH, Bethesda, USA] to derive average hydration profile
maps of the nucleus. The effect of age on nuclear deformation and
direction was noted. The direction of nuclear deformation, if present,
was subsequently quantified in relation to the associated segmental
lateral flexion. RESULTS: Acceptable intra-observer reliability of
all angular and displacement assessments was achieved with
coefficients of variation <4.5%. Subjects assessed in combined
sagittal and axial plane positions demonstrated an average sagittal
change in range of 44º from extension to flexion between L1 and S1
(range: 18–60º), which resulted in a nuclear displacement of 16% of
disc hydration profile (range: 3.5-19%). On average a 5.5% coronal
displacement of the nucleus was recorded when rotation was coupled
with either flexed or extended positions (range 0.4-15%). In 75% of
discs, a contralateral lateral flexion direction could be predicted from
the nuclear deformation. Subjects assessed in axial plane rotation
only demonstrated an average coronal displacement of 2.3% (range
1.2-6.5%) with variability related to age; older subjects flexed less
and exhibited reduced nucleus deformation. CONCLUSIONS: In
normal discs, sagittal plane postures typically induce a posterior
nuclear migration in flexion and the converse in extension. In
general, these MRI torsion studies of lumbar discs resulted in
nuclear deformation towards the area of least compression relative
to the associated lateral flexion. IMPLICATIONS: The sustained
supine positions adopted for this study preclude extrapolation to
weighbearing postures. However, treatment strategies that assume
S128
the nucleus deforms in a stereotyped manner relative to position
may be cautioned by these data. Further studies with older subjects
with established disc degeneration or with scoliosis are currently in
progress. KEYWORDS: MRI, intervertebral disc, nucleus pulposis.
FUNDING ACKNOWLEDGEMENTS: University of Western Australia
research grant. CONTACT: petefaze@hotmail.com
ETHICS COMMITTEE: Human research and ethics committee, Royal
Perth Hospital, Perth Western Australia
Research Report Platform Presentation
3175 Monday 4 June 10:10
PP Crystal Pavilion B & C
FATIGUE REPORT, ACTIVITY, CARDIOVASCULAR FITNESS AND
ENERGY COST IN PEOPLE WITH PERIPHERAL NEUROPATHY
Graham R1 , White C2 ; 1 Manchester Metropolitan University,
Manchester, UK; 2 King’s College London, London, UK
PURPOSE: The aim of this study was to examine subjective feelings
of fatigue as reported by people with peripheral neuropathy and to
investigate associations with health status, activity, cardiovascular
fitness and energy cost. RELEVANCE: Feelings of fatigue affect up to
80% of people with PN, but factors that contribute to this subjective
fatigue have not yet been established. PARTICIPANTS: 13 people
with peripheral neuropathy (Diagnoses: Guillain Barré Syndrome,
4; Chronic Inflammatory Demyelinating Polyradiculoneuropathy, 7;
Multifocal Motor Neuropathy, 1; Paraproteinaemic Demyelinating
Neuropathy, 1) and 13 healthy volunteers, aged between 18 and
70 were recruited. METHODS: Subjective fatigue and health status
were measured using the Fatigue severity scale (FSS), Fatigue
impact (FIS) and Piper fatigue scales (PFS), and the medical
outcomes short form 36 questionnaire. Resting heart rate and
the energy cost of comfortable walking on a flat surface (EO2 )
was measured. An Actigraph® activity monitor also recorded daily
activity levels over 5 days. ANALYSIS: 2 tailed independent t tests
were used to identify differences between groups and Pearson
product moment correlations were used to determine associations
between subjective fatigue, health status, heart rate, EO2 and
activity. RESULTS: Subjective fatigue was significantly greater in PN
participants on all questionnaires (Mean FSS ±SD: 4 ±1.8, FIS:
22.6 ±21.6, PFS: 2. 7±2.1) when compared to healthy participants
(FSS: 2.3 ±0.8, p < 0.005; FIS: 6.8 ±6.9, p < 0.02; PFS: 1.22 ±1.1,
p < 0.04). Elevated subjective fatigue was significantly associated
with increased limitations in social and physical activities and with
decreased social function and general health perception in people
with PN (r>0.6 for all, p < 0.05). They also had higher resting
heart rates (79 ±11 beats per min) than healthy participants
(72±8 beats per min, p < 0.04). Additionally, participants with PN
were less active (p < 0.03) and used more energy whilst walking
(Mean EO2 ±SD:16.5 ±7 ml m−1 ) than healthy volunteers (11.1
±2.3 ml m−1 , p < 0.02). However, no significant associations were
demonstrated between these factors and levels of subjective fatigue.
CONCLUSIONS: The current study indicates that subjective fatigue
is a significant problem for people with PN that adversely affects
health status. Despite no significant relationships between subjective
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.
IMPLICATIONS: This study indicates that subjective fatigue should
be considered in the assessment of people with PN as it is associated
with reduced health status. Larger studies are now necessary to
confirm these results and to investigate other possible contributors to
subjective fatigue in this patient group. KEYWORDS: Fatigue, quality
of life, peripheral neuropathy. FUNDING ACKNOWLEDGEMENTS:
We wish to acknowledge Guy’s, King’s and St Thomas’ Charitable
Foundation for their support of this study.
ETHICS COMMITTEE: Ethical approval was granted by the King’s
College London and Guy’s Hospital Research Ethics committees,
London, UK.
WCPT 2007, Research Reports
Research Report Platform Presentation
3280 Monday 4 June 10:10
VCEC Meeting Rooms 11-12
IMPLIMENTATION OF A RANDOMIZED CONTROLLED TRIAL OF
VERY EARLY MOBILIZATION DOES NOT CHANGE STANDARD
STROKE UNIT CARE
Collier J1 , Thrift A1 , McQuinn A2 , Fu C2 , Grealy S2 , Bernhardt J1−3 ;
1 National Stroke Research Institute, Melbourne, Australia; 2 School
of Physiotherapy, Univerity of Melbourne, Australia; 3 School of
Physiotherapy, La Trobe University, Melbourne, Australia
PURPOSE: During 2001/2, we found that 58 stroke patients spent
more than 50% of the day resting in bed and only 13% of the day
engaged in activity likely to aid their physical recovery. This study
aimed to investigate whether the levels of patient physical activity
changed in response to stroke unit participation in A Very Early
Rehabilitation Trial (AVERT). RELEVANCE: When therapy research
trials are performed within a stroke unit, researchers need to evaluate
the impact of the experimental intervention on standard care. If
standard care is contaminated by the experimental intervention, the
trial methodology is compromised. PARTICIPANTS: Patients were
recruited from Austin Health and St. Vincents Hospital stroke units.
These centres were participating in AVERT Phase II, 2004/5. Patients
less than 14 days post stroke were eligible. Patients receiving
pallative care were excluded, as well as those patients recruited
to AVERT. METHODS: Behavioural mapping was undertaken to
determine the activity levels of acute stroke patients. Ten-minute
observations were conducted between 0800 to 1700 over one day
with patient activity documented. Whole body movements were
grouped into five activity categories to reflect the degree of physical
work during these activities. These were: no activity (asleep, inactive),
non-therapeutic activity (eating, watching TV in bed), minimal
activity (transfer by hoist, sit in chair), moderate activity (standing,
sitting unsupported) and high activity (walking, stairs). The primary
contamination outcome was the level of high activity. The secondary
outcome was the level of non theraputic activity and no activity.
ANALYSIS: Stepwise binomial logistic regression was used to
assess differences in activity between time periods (2001/2, 2004/5)
controlling for differences in patient characteristics. RESULTS: 53
stroke patients (mean age 74.7 years, 49% male) were recruited.
Thirteen one day observations were completed. Patients spent 9%
of the day in standing and walking activities and 65% of the day in
bed involved in non therapeutic activities. No statistical differences
between time periods were found (standing and walking: OR=0.980,
p = 0.159; bed: OR=1.004, p = 0.608). CONCLUSIONS: No change
in the level of physical activity of stroke patients was found. We are
confident that measures taken in the AVERT intervention protocol to
limit contamination of standard care are effective. IMPLICATIONS:
The AVERT intervention protocol limits contamination of standard
care and can be used to evaluate the efficacy of a very
early mobilisation intervention. KEYWORDS: contamination, stroke,
randomized controlled trial. FUNDING ACKNOWLEDGEMENTS:
None. CONTACT: j.bernhardt@unimelb.edu.au
ETHICS COMMITTEE: Human Ethics Committee, Austin Health;
Human Ethics Committee, St. Vincent Hospital
Research Report Platform Presentation
3235 Monday 4 June 10:10
VCEC Meeting Room 16
POST-QUALIFYING EDUCATION: FINAL YEAR PHYSIOTHERAPY
STUDENTS’ KNOWLEDGE AND OPINIONS OF MASTER’S
LEVEL STUDY
Gray H, Kerr C; Glasgow Caledonian University, Cowcaddens
Road, Glasgow, G4 OBA, Scotland, UK
PURPOSE: The aim of this study was to investigate final year
Physiotherapy students’ knowledge and opinions of Master’s level
study and their intentions towards its undertaking. The study
Platform Presentations, Monday 4 June
particularly explored whether there was any relationship between
levels of perceived knowledge of and intentions to undertake this
type of post-qualifying education. RELEVANCE: Postgraduate study
is the fastest growing sector within higher education in the United
Kingdom, particularly amongst the allied health professions. This is
partially due to the growing number of specialist posts within the
National Health Services (NHS), and has resulted in a rising demand
for Master’s level courses in Physiotherapy. To date, studies that have
investigated Physiotherapists’ opinions of post-qualifying education
have focussed on qualified practitioners, and have not considered
the views of undergraduate students. PARTICIPANTS: All final year
Bachelor’s degree Physiotherapy students (n=146) in Scotland were
invited to participate in the survey based study. Students were
recruited in lectures/ tutorials at the universities during visits by the
researcher. There was a 93.8% response rate (n=137), with 89.1%
female and 10.9% male participants. The majority (83.9%) of the
students were in the 20-24 years age banding, with 9.5% in the 25-29
banding, 5.1% between 30-34, and the remaining 1.4% were aged 35
years and above. METHODS: A self-administered questionnaire was
designed and piloted by the researchers prior to distribution using
a group-administered method. The questionnaire covered four main
areas: demographics; perceived knowledge of Master’s level study;
intentions to undertake Master’s level study; and perceived barriers
and benefits of Master’s level education. ANALYSIS: A descriptive
approach to data analysis was adopted, including frequency tables.
Chi-square tests were carried out to determine the relationships
between the nominal and ordinal level data. RESULTS: The key
findings of this study were that the participants perceived they
had little knowledge of Master’s level study, which then correlated
significantly with their intentions to commence it (p = 0.03). Only
29.9% of students planned to participate in Master’s level education,
29.2% did not intend to, and 40.2% were unsure. The main perceived
benefits to undertaking postgraduate study were: increased level
of knowledge (25.5%); improved skills (24.8%); and better career
prospects (20.4%). The main barriers identified were lack of:
funding (49.6%); time (21.9%); and motivation (11.7%). Interestingly,
there was no significant correlation between the student’s age
and their intention to undertake postgraduate study (p = 0.295).
CONCLUSIONS: It appears that the students who felt that they were
informed about the nature and benefits of Master’s level study were
more likely to consider it favourably and planned to undertake it at
a later date. Future work could be undertaken to investigate in more
detail the main motivations and barriers to undertaking postgraduate
qualifications. IMPLICATIONS: It appears that higher education
institutions and professional bodies should market the benefits of
post-qualifying education to undergraduate Physiotherapy students in
order to promote their ambitions towards obtaining a higher degree.
Gaining a Master’s qualification is not only beneficial to the individual
Physiotherapist for career advancement, but also to the Health
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: h.gray@gcal.ac.uk
ETHICS COMMITTEE: Glasgow Caledonian University’s School of
Health & Social Care’s Research Ethics Committee
Research Report Platform Presentation
2605 Monday 4 June 10:10
VCEC Meeting Room 18
THE EFFECTS OF AN EARLY HEALTH
PROMOTION/REHABILITATION INTERVENTION IN AN
OLDER ADULT HOME CARE POPULATION
Wishart L1 , Richardson J1 , Roberts J1 , Browne G1 , Gafni A1 ,
Wilkins S1 , Henderson S2 ; 1 McMaster University, Hamilton,
Canada; 2 Community Access Centre of Halton, Burlington, Canada
PURPOSE: The purpose of this study was to evaluate the effective-
ness of a home health promotion/ rehabilitation intervention designed
S129
to promote behaviours that optimize autonomy. RELEVANCE: Older
adults who experience a change in health status and require
hospitalization are at risk for a long-term deterioration of functional
status. These individuals may benefit from home rehabilitation
services on discharge from the acute setting to prevent this loss
of deterioration. PARTICIPANTS: Two hundred and one clients,
aged 60 years and older, referred to home care services including
homemaking and/or nursing (but not rehabilitation services) following
an acute hospital admission were selected. METHODS: In this
clinical trial, participants were randomized to receive either the
occupational and physical therapy intervention focused on health
promotion/ rehabilitation in addition to the usual home care, or
the usual home care services. The health promotion/ rehabilitation
intervention consisted of an average of 4 visits and follow up
phone calls by the therapy teams who helped the participants and
informal caregivers with problem solving skills related to setting
and implementing health promotion/ rehabilitation goals. The study
participants were evaluated by independent blinded evaluators at
baseline and 3 and 6 months after the start of the intervention
for perceived health state as measured by the General Health
Perception and Physical Functioning subscales of the Short Form
36 (SF 36 Version 2). Other measures included cognitive screen,
physical functioning, coping and caregiver stress. ANALYSIS: All
analyses were intent-to-treat. Analysis of co-variance was used to
assess the effect of the intervention on the general health and
physical functional subscales of the SF36. RESULTS: There was
no overall benefit of the therapy intervention for the 161 participants
who completed all follow up evaluations on the primary outcomes,
the SF 36 Physical Functioning or the General Health Perception
index at 3 months or 6 months or on any of the other outcome
measures. However, when examining planned interactions at 6
months, the younger-old adults (mean=71 years,sd=4.6) who had
fewer problem solving coping skills, and older adults (mean=82 years,
sd=4.6) with greater problem solver coping skills benefited from
the intervention as indicated by the SF 36 General Health Index
(p = 0.02). CONCLUSIONS: The intervention was not effective for all
participants; however, a subgroup of younger-old adults who were low
problem solvers and a subgroup of older adults with higher problem
solving benefited from the addition of the OT/PT health promotion/
rehabilitation intervention. IMPLICATIONS: The findings from this
research will assist health providers to identify older adults who will
benefit from a proactive health promotion intervention focused on
optimizing independent living. These findings also provide evidence
to support an expanded interprofessional role for physical therapists
in the community. KEYWORDS: health promotion, rehabilitation, ag-
ing, interprofessional. FUNDING ACKNOWLEDGEMENTS: Health
Transition Fund, Health Canada. CONTACT: wishartl@mcmaster.ca
ETHICS COMMITTEE: McMaster University, Faculty of Health
Science, Ethics Committee
Research Report Platform Presentation
3110 Monday 4 June 10:10
VCEC Meeting Rooms 19-20
PARTICIPANT PERCEPTION OF MOVEMENT ABILITY ACROSS
SIX DIMENSIONS WITH AND WITHOUT PHYSICAL THERAPY
INTERVENTION: TESTING THE EXTENDED MOVEMENT
CONTINUUM THEORY
Allen D1−3 ; 1 Health and Disability Research Institute, School of Public
Health, Boston University, Boston, MA, USA; 2 University of California,
Berkeley, CA, USA; 3 Samuel Merritt College, Oakland, CA USA
PURPOSE: The purpose of this study was to test two hypotheses:
participants will perceive differences across six dimensions of move-
ment ability associated with 1) having a diagnosed movement disor-
der, and 2) receiving physical therapy intervention. RELEVANCE:
These hypotheses arose from the Movement Continuum Theory
(MCT). Proposed as a grand theory of physical therapy, the
MCT links the scientific basis of movement with physical therapy
S130
principles and the effect of physical therapy in improving current
movement capability. Subdividing the MCT’s unified construct of
movement into multiple dimensions extends the MCT. If movement
is composed of multiple dimensions, different disorders should affect
designated movement dimensions in predictable ways. Furthermore,
patients should improve in affected dimensions upon successful
completion of physical therapy intervention. PARTICIPANTS: 69
volunteers participated in the study. 35 adults having diagnosed
movement disorders (from post-operative musculoskeletal and pain
syndromes) and beginning outpatient physical therapy formed the
intervention group (mean age 47, range 19-85, 25 females). Adults
without diagnosed movement disorders formed the 34-person no-
intervention group (mean age 54, range 19-78, 17 females).
METHODS: A 24-item self-report questionnaire based on the
extended MCT assessed perceived movement ability across six
dimensions: flexibility, strength, accuracy, speed, adaptability, and
endurance. The intervention group responded at the beginning of
and about two weeks into an episode of outpatient physical therapy
as prescribed by the attending clinician. The no-intervention group
responded twice with approximately two weeks between exposures.
ANALYSIS: Item response theory methods allowed estimation of
participant locations on each of the dimensions at baseline and
two weeks, anchoring item parameters on the same calibration for
comparability. Multiple regression controlled for baseline differences
while examining significance of group membership on two-week
data. Paired t-tests across times, effect sizes, and minimal clinically
important differences (MCIDs) were examined for each dimension.
RESULTS: The intervention group perceived lower movement
ability at baseline compared to the no-intervention group. At two
weeks, the intervention group had increased in their perception
of movement ability in all dimensions; the no-intervention group
perceived no change. When controlling for differences in baseline
data between groups, group membership was significant only for
strength and speed dimensions (p = 0.002 and 0.013 respectively).
Effect sizes were highest for strength and speed, at 0.42 and
0.39 and with 63% and 57% of participants over the calculated
MCID post-intervention, respectively. CONCLUSIONS: Having a
diagnosed movement disorder and receiving intervention were both
associated with perceived differences in dimensions of movement
ability. Participants in the intervention group perceived greater change
in strength and speed than in other dimensions after two weeks
of intervention when controlling for baseline status. Effect sizes
were moderate for these dimensions after only two weeks. Evidence
for the alternative hypothesis of a unified construct of movement
consists of significant increase in all dimensions with intervention
for this sample. IMPLICATIONS: Physical therapy management and
research can benefit from a well-supported theory linking movement
and clinical practice. The extended MCT provides a potential basis
for focusing on specific movement dimensions affected by particular
disorders. KEYWORDS: theory testing; research implementation;
outcomes research. FUNDING ACKNOWLEDGEMENTS: Post-
doctoral Fellowship from the National Institute on Disability and
Rehabilitation Research, Grant number H133P0001. CONTACT:
allendianed@gmail.com
ETHICS COMMITTEE: Exempt status was given by the Committee
for the Protection of Human Subjects, University of California,
Berkeley, USA
WCPT 2007, Research Reports
Research Report Platform Presentation
2003 Monday 4 June 10:45
PP Crystal Pavilion A
PREVALENCE OF DEPRESSION IN PATIENTS ADMITTED IN
INTERMEDIATE CARE UNIT
Yohannes A1 , Baldwin R2 , Connolly M3 ; 1 Department of
Physiotherapy, Manchester Metropolitan University, Manchester, UK;
2 Department of Old Age Psychiatry, Manchester, UK; 3 Department
of Geriatric Medicine, Auckland, New Zealand
PURPOSE: Intermediate care provides a wide range of services
intended to reduce possible hospital admission or readmission
and to provide further rehabilitation as a temporary transition from
hospital to home. Older patients with acute medical illnesses may
take longer period to regain full functional recovery compared to
younger patients and hence they are most likely to use more hospital
beds. RELEVANCE: Depression is very common in acutely ill older
patients with medical problems and its prevalence ranges from 20
to 40%. To date no studies have investigated the prevalence of
depression and its predictors in older patients with chronic medical
illnesses admitted for further rehabilitation in intermediate care.
PARTICIPANTS: Consecutive series of older patients with chronic
medical illnesses aged >60 years referred for further rehabilitation
primarily for physiotherapy treatment from hospital or directly from
their General Practitioners to intermediate care. Patients were
excluded from the study because of terminal illness, refusal or written
informed consent, psychotic disease, dysphasia severe enough to
prevent questionnaire completion or severe cognitive impairment.
METHODS: Depression was assessed using the Hospital Anxiety
Depression scale (HAD). Patients self-completed the Nottingham
Extended Activities of Daily Living Scale (NEADL) to assess physical
disability. Cognitive impairment was examined using the Mini Mental
State Examination (MMSE). All the scales were administered by the
research physiotherapist who also extracted the sociodemographic
characteristics after a few days stay in the intermediate care unit.
The study was approved by the local research ethics committee.
ANALYSIS: Descriptive statistics were used to determine the
prevalence of HAD depression >8 which is recommended as
clinically relevant with depressive symptoms. To examine factors that
predict depression a forward multiple regression analysis was used.
Significance was set at p < 0.05. RESULTS: Eighty patients (male
28) mean age 80 years, range (60-97 years) were recruited. 29
(36%) of the subjects had a HAD depression score >8. Predictors of
depression in patients with chronic medical illnesses are: NEADL [t=
−2.6, p < 0.009], number of falls in the past year [t= 2.24, p = 0.02],
pack years [t= 2.24, p = 0.03]. Total R2 = 0. 15. Further analysis
revealed 8% of the variance was contributed by physical disability,
3% by frequency of falls and 2% by pack years. The MMSE was not
a predictor of depression. CONCLUSIONS: Depression is common
in older patients with chronic medical diseases. Depression was
associated with physical disability, frequency of falls in the past year
and number of cigarette smoked in pack years. IMPLICATIONS:
Healthcare professionals including physiotherapists should be aware
of the high prevalence of depression in this patient group, and its
possible management in older patients with a history of falls admitted
in intermediate care unit. KEYWORDS: Depression, Intermediate
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:
A.yohannes@mmu.ac.uk
ETHICS COMMITTEE: The Wigan Research Ethics Committee
reviewed the study
Platform Presentations, Monday 4 June
Research Report Platform Presentation
1988 Monday 4 June 10:45
PP Crystal Pavilion B & C
TEMPORAL PROFILE OF THE RECOVERY IN SHOULDER
STRENGTHS AFTER REPETITIVE EXERCISE
Takemoto Y, Miyashita K, Urabe Y, Ijiri T; Hiroshima University
PURPOSE: Acute fatigue of shoulder muscles is usually caused by
repetitive movements without adequate rests during sports activities
and/or manual labors. The influence of muscle fatigue may last for
several days. However, there was little research in the recovery of
shoulder strength from muscle fatigue. Therefore, the purpose of this
study is to demonstrate the temporal profile of shoulder strengths
after muscle fatigue caused by repetitive shoulder abduction exercise.
RELEVANCE: This result would provide new insight in preventing
chronic muscle fatigue caused by repetitive sports activities or
manual labors and help us to establish more effective exercise
protocol. PARTICIPANTS: Twenty four healthy females who had no
musculoskeletal problem on the shoulder joint were recruited for this
study. METHODS: Right shoulder and left shoulder were determined
as the exercise side and non-exercise side, respectively. A dumbbell
of 5% of their maximum isometric shoulder abduction strength was
used for the exercise. Shoulder abduction at the seated position was
performed in three sets of 50 repetitions through the range form 0
to 90 degree. Isometric strength of Abduction(ABD), Flexion(Flex),
External rotation(ER), and Internal rotation(IR) were measured by
a hand held dynamometer before, immediately, one day, two days,
and three days after the exercise. Muscle strength was expressed as
the relative value to the muscular strength in the first measurement.
ANALYSIS: One way ANOVA was used to compare muscle strengths
obtained by each measurement. Scheffe correction was applied.
P < 0.05 was considered statistically significant. RESULTS: In the
exercise side, the mean ± SD of the ABD strengths were 83.7±8.3,
90.9±9.2, 93.2±11.0 and 98.6±10.5 immediately, one day, two days,
and three days after the exercise, respectively. The Flex strengths
were 83.5±9.0, 92.2±10.5, 94.3±11.1 and 97.6±10.9. The ER
strengths were 94.7±8.7, 97.4±8.7, 100.4±11.6 and 103.8±9.6. The
IR strengths were 93.1±9.9, 91.9±10.4, 94.3±11.4 and 98.2±8.5.
The ABD strengths were significantly decreased immediately, one
day, and two days after the exercise. The Flex and IR strengths
were significantly decreased immediately, one day and two days
after the exercise. However, no change was observed in the ER
strength of the exercise and all strengths in the non-exercise side.
CONCLUSIONS: This study shows that significant loss of muscle
strength was caused by the repetitive exercise with light load. The
shoulder abduction exercise decreased not only the ABD strength
but also the Flex and IR strength. The decreased muscle strengths
were not fully recovered until three days after the exercise. In future
study, we need to investigate what interventions are more effective
to fasten the recovery time from the fatigue. IMPLICATIONS: This
result will enhance the knowledge of chronic injury prevention caused
by repetitive activities. KEYWORDS: Repetitive exercise, Shoulder
strength, Muscle fatigue. FUNDING ACKNOWLEDGEMENTS: This
study was not supported by any grant or commercial resource.
CONTACT: tyukiko77@hiroshima-u.ac.jp
ETHICS COMMITTEE: The Ethics Committee of Hiroshima Univer-
sity
S131
Research Report Platform Presentation
529 Monday 4 June 10:45
VCEC Meeting Rooms 11-12
THE EFFECTIVENESS OF COMMUNITY PHYSIOTHERAPY AND
ENHANCED PHARMACY REVIEW FOR KNEE PAIN IN OLDER
ADULTS: A RANDOMISED CLINICAL TRIAL
Foster N1 , Hay E1 , Thomas E1 , Phelan M1 , Yates H1 , Peat G1 ,
Blenkinsopp A2 , Sim J1 ; 1 Primary Care Musculoskeletal Research
Centre, Keele University, Keele, Staffordshire, UK; 2 Medicines
Management, Keele University, Keele, Staffordshire, UK
PURPOSE: This study tested the effectiveness of two primary
care treatment strategies for older adults with knee pain, enhanced
pharmacy review and community physiotherapy and compared
these with a control of advice only. RELEVANCE: Knee pain is
the most common cause of chronic musculoskeletal pain in older
adults, affecting approximately 25% of people aged over 55 years.
Guidelines for the management of knee pain and osteoarthritis
recommend both non-pharmacological and pharmacological ap-
proaches. The traditional general practitioner / family doctor led
service is increasingly unsustainable, and alternative models, utilizing
the skills of other members of the healthcare team, need to be
evaluated. PARTICIPANTS: 325 participants aged 55 years and over
consulting their general practitioner with knee pain were recruited
(mean age 68 years) from 15 general practices. Exclusion criteria:
potentially serious pathology such as inflammatory arthritis, previous
or planned knee replacement, recent physiotherapy or intra-articular
injection to the knee. In total, 91% reached 6 month follow-up
and 88% reached 12 month follow-up. METHODS: This pragmatic,
multi-centre, randomized clinical trial randomly assigned participants
to enhanced pharmacy review (n=108), community physiotherapy
based on exercise (n=109), or a control (advice only) (n=108). The
primary outcome was change in the Western Ontario and McMaster
Universities Osteoarthritis Index (WOMAC) pain scale (range 0 to 20)
and function scale (range 0 to 68) at 3, 6 and 12 months. Secondary
outcomes included patients’ global assessment of change, the
internationally agreed Outcome Measures in Rheumatology Clinical
Trials (OMERACT) clinical responder criteria, medication intake and
further GP consultations over the follow-up period. ANALYSIS:
Analysis was by intention to treat. RESULTS: Baseline WOMAC
pain scores (mean (sd)) were 9·1 (3·7) and function scores were
29·9 (12·8). At 3 months the mean reductions in pain scores were
0·41 (2·8) for control, 1·59 (3·2) for pharmacy and 1·56 (3·4) for
physiotherapy, and for function were 1·02 (8·2); 2·61 (9·8) and 4·79
(10·8). Compared with control, mean differences in change scores
(95% CI) were: pain 1·15 (0·2, 2·1), function 3·77 (1·0, 6·6) for
physiotherapy; and pain 1·17 (0·3, 2·1), function 1·58 (−1·0, 4·2) for
pharmacy. At 3 months, there were significantly larger improvements
in pain (p = 0.014) and function (p = 0.008) for the physiotherapy
group and in pain for the pharmacy group (p = 0.08), compared
with control. More of the physiotherapy group (40%), compared with
the pharmacy (33%) and control groups (19%) were classified as
treatment responders at 3 months. Similar trends were observed at
6 and 12 months but were not statistically significant. Significantly
fewer participants in the physiotherapy group reported consulting
their GP for knee pain in the follow-up period and non-steriodal anti-
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: n.foster@keele.ac.uk
ETHICS COMMITTEE: The North Staffordshire Research Ethics
Committee, UK
S132
Research Report Platform Presentation
1296 Monday 4 June 10:45
VCEC Meeting Room 16
CHANGES IN LEVATOR ANI ANATOMICAL CONFIGURATION
AFTER PHYSIOTHERAPY IN STRESS URINARY INCONTINENT
WOMEN: AN MRI STUDY
Dumoulin C1 , Peng Q2 , Stødkilde-Jørgensen H3 , Shishido K4 ,
Constantinou C2 ; 1 School of Rehabilitation, Faculty of Medicine,
University of Montreal; 2 Urology Depart, Stanford University School
of Medicine; 3 MR Research Centre, Institute of Clinical Medicine,
Arhus University; 4 Urology Depart, Fukushima Medical College
PURPOSE: This study seeks to quantify the effect of pelvic floor
muscle (PFM) training on the anatomical configuration of levator
ani using magnetic resonance imaging (MRI). RELEVANCE: PFM
training has proven to be effective in reducing stress urinary
incontinence and mixed urinary incontinence in women. However,
the underlying mechanism by which PFM training prevents urine
leakage is not fully understood. PARTICIPANTS: Five women with
urodynamically proven stress urinary incontinence participated in
this study after giving informed consent. The participant’s mean
age was 45.8 + 9.47 years; the mean BMI was 26.67 + 3.53
and mean parity was 2.2 + 0.44 babies. METHODS: This is an
institutional review board-approved, quasi-experimental pre-test/post-
test design study, examining pre- and post-treatment MRI data. All
image data were acquired with a General Electric SIGNA twin-speed,
1.5 Tesla magnet. With subjects in the supine lying position, A PA
torso coil tuned for PFM imaging was centered at the symphysis
pubis. A spoiled gradient sequence of T1-weighted images was
used with the following parameters: TR= 70 ms, TE min full,
flip angle = 60º, field of view (FOV) 24 cm, slice thickness 3
mm, 0.5 mm gap, matrix 256 x 256, NEX two, scan time 36 s.
Eight axial images were acquired for two different conditions, at
rest and during a PFM voluntary contraction. Source images were
manually segmented and surface modeling was applied to build a
3-dimensional model of the levator ani. Models were measured to
determine the levator ani surface area and encircled volume at rest
and during a voluntary contraction in addition to the percentage
of levator ani retractions and bone movements during voluntary
contractions prior to and after PFM training. ANALYSIS: Pre- and
post-treatment mean values of the five parameters were compared
with paired t-tests to evaluate the changes. Two-sided P values
<0.05 were considered significant. All analyses were carried out
using SPSS for Windows (version 11.0) software. RESULTS: After
PFM training, the levator ani surface area at rest was significantly
smaller than before, decreasing from 144.45 + 9.60 mm2 to 132.37
+ 7.71 mm2 (P = 0.04). The relative reduction in volume encircled
by the levator ani during contraction increased significantly, from
−11.65 + 3.31 mm3 to −26.02 + 6.04 mm3 (P = 0.04). The percentage
of levator ani surface retraction during a voluntary contraction was
significantly increased from 65.61% to 81.70% (P = 0.02). Pubic
movement during PFM contraction was significantly reduced, from
1.45 + 0.59 mm to 0.44 + 0.27 mm (P = 0.05). CONCLUSIONS:
To our knowledge, this is the first study using MRI to describe
changes in muscle morphology after PFM strength training. Evidence
is provided to demonstrate that PFM training results in anatomical
changes of the levator ani and reduce pubic movement. These result
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: chantal.dumoulin@umontreal.ca
ETHICS COMMITTEE: Institutional Review Board, Arhus University
WCPT 2007, Research Reports
Research Report Platform Presentation
860 Monday 4 June 10:45
VCEC Meeting Room 17
THE EFFECTS OF NON-PHARMACOLOGICAL INTERVENTIONS
ON FATIGUE IN FOUR CHRONIC ILLNESS CONDITIONS: A
CRITICAL REVIEW
Smith C1 , Hale L234 ; 1 DipPT UK; 2 PhD; 3 MSc (physiotherapy);
4 BSc (physiotherapy)
PURPOSE: The purpose of this study was to identify and critically
review studies which investigated the effectiveness of non pharmaco-
logical interventions used in physiotherapy practice to alleviate fatigue
in four chronic health conditions: multiple sclerosis (MS), Parkin-
son’s disease (PD), cancer, and human immunovirus/autoimmune
deficiency syndrome (HIV/AIDS) RELEVANCE: This review explores
the evidence for the effects of non pharmacological interventions
on fatigue including aerobic and resistance exercise, energy
management strategies and complementary and alternative thera-
pies. PARTICIPANTS: Not applicable METHODS: AMED, CINHAL,
EMBASE, Ovid MEDLINE, PsycINFO and Cochrane database of
systematic reviews were searched (1966 to 2006) using search
terms: multiple sclerosis, cancer, Parkinson’s disease, HIV/AIDS,
fatigue, physiotherapy, physical therapy, aerobic, exercise, resistance,
energy management, energy conservation, acupuncture, Tai Chi,
complementary medicine, alternative medicine and yoga. Selection
criteria included all study designs investigating effectiveness of
interventions which are used (frequently or occasionally)in physio-
therapy practice, and which included a scale or subscale measuring
fatigue as an outcome measure ANALYSIS: Critical evaluation
of each included study was conducted according to established
critical appraisal guidelines. RESULTS: Twenty seven studies which
fulfilled the selection criteria were included in the review: these
studies investigated aerobic exercise, resistance exercise, energy
management, acupuncture, Tai Chi and yoga.Of the twenty seven
studies, there were 13 RCTs, 7 pilot studies, 3 pre/post test studies,
1 cohort, 1 case series, 1 case study, and 1 qualitative study. Analysis
showed promising evidence for the effects of aerobic and resistance
exercise on fatigue in the cancer population; however, there was
less evidence for exercise intervention in MS, PD and HIV/AIDS.
There was limited evidence for energy management of fatigue in
MS and cancer. There was little evidence found for the effects of
complementary and alternative interventions on fatigue in all popu-
lations, and no evidence for the effect of any non pharmacological
intervention on fatigue in PD. CONCLUSIONS: The results of this
study have highlighted a dearth of evidence for the effectiveness of
most non pharmacological interventions used for treatment of fatigue
in most of the conditions under review. IMPLICATIONS: Many of
these interventions are frequently utilized by physiotherapists when
treating individuals with chronic illness.The results from this study
may inform the physiotherapy profession in several ways; by providing
an overview of current available evidence, to inform future clinical
case reports, especially in those areas where no evidence is currently
available, and to clarify future direction for research therapists
when planning trials. KEYWORDS: Fatigue, illness, intervention, non
pharmacological. FUNDING ACKNOWLEDGEMENTS: This review
was conducted as part of the requirements for entry into a University
of Otago Physiotherapy Masters degree (by thesis). CONTACT:
cath.smith@otago.ac.nz
Platform Presentations, Monday 4 June
Research Report Platform Presentation
1723 Monday 4 June 10:45
VCEC Meeting Room 18
BELIEFS REGARDING THE PATHOBIOLOGICAL BASIS OF
PAIN INFLUENCE THE LEVEL OF PAIN DURING A CLINICAL
PROVOCATION TEST
Coppieters M, Hodges P; Division of Physiotherapy, School of
Health and Rehabilitation Sciences, The University of Queensland,
St Lucia (Brisbane), Australia
PURPOSE: This study investigated whether beliefs about the source
of symptoms, together with background knowledge of diagnostic
tests, influences pain perception during clinical tests. RELEVANCE:
With medical information on clinical tests and diagnoses widely
available to patients, clinicians are often confronted with patients
who have expectations about the outcomes of clinical tests and have
formulated their own diagnosis. The impact of this on pain provocation
during clinical tests to diagnose musculoskeletal conditions is
unclear. PARTICIPANTS: Fifteen asymptomatic and naive volunteers
participated in this study (9 females, 6 males; age, weight and height
(mean (SD)): 22 (6) years, 66 (12) kg, 172 (10) cm). METHODS:
Experimental muscle pain was induced by infusion of hypertonic
saline in the thenar muscles of the right hand. Pain intensity and
size of the painful area were evaluated in 5 different arm positions
with a different amount of nerve bed elongation. The arm positions
corresponded with 5 stages of the neurodynamic test for the median
nerve. All participants received identical information regarding the
biomechanics of the median nerve and the concept of differential
diagnosis via mechanical provocation of sensitised structures. Based
on additional information gathered from an information sheet, half of
the participants believed that infusion of hypertonic saline induced
local muscle pain (‘muscle group’) and half of the participants
believed nerve pain was induced (‘nerve group’). Consequently,
participants in the ‘muscle group’ anticipated no changes in pain
with elongation or shortening of the nerve bedding in the five
upper limb positions, whereas participants in the ‘nerve group’
anticipated changes in pain perception consistent with the amount
of nerve bed elongation. The volunteers were randomly assigned
to the ‘nerve’ and ‘muscle’ groups. ANALYSIS: Pain intensity and
size of the painful area were compared with a two-way analysis
of variance, with one group factor and one repeated-measures
factor. The level of significance was set at p < 0.05. RESULTS:
Although the induced pain was of muscular origin in all participants,
participants in the ‘muscle’ and ‘nerve group’ responded differently
to changes in the length of the nerve bed (p < 0.00001). Participants
in the ‘muscle group’ demonstrated no change in pain perception
with the test (p  0.38), whereas pain varied significantly in the
‘nerve group’ (p  0.001). The increase and decrease in pain in the
‘nerve group’ corresponded with an increased and decreased loading
of the nervous system. CONCLUSIONS: Previous research has
demonstrated that, when participants are not aware of the origin of
the induced pain, experimental muscle pain does not change during
the neurodynamic test for the median nerve, slump test or straight leg
raising test. Findings of this experiment suggest that the perception
of pain during a clinical provocation test is not only influenced by
the pathobiological processes in operation, but also by the patient’s
beliefs and expectations. IMPLICATIONS: The findings demonstrate
that a patient’s beliefs regarding the pathobiological process
in operation should be considered when interpreting subjective
responses during clinical tests. It also suggests that misjudgements
by a patient about his or her condition may hinder accurate diagnosis.
KEYWORDS: Diagnosis; patient’s beliefs, clinical test. FUNDING
ACKNOWLEDGEMENTS: PH is supported by the National Health
and Medical Research Council of Australia (NHMRC). CONTACT:
m.coppieters@uq.edu.au
ETHICS COMMITTEE: Medical Research Ethics Committee, The
University of Queensland
S133
Research Report Platform Presentation
638 Monday 4 June 10:45
VCEC Meeting Rooms 19-20
ON CALL COMPETENCE – DEVELOPING A TOOL FOR SELF
ASSESSMENT
Thomas S1 , Broad M2 , Cross J3 , Gough S4 , Harden B5 , Ritson P6 ,
Quint M7 ; 1 University of the West of England, Bristol, UK; 2 Cardiff
and Vale NHS trust, Cardiff, UK; 3 University of East Anglia,
Norwich UK; 4 Manchester Metropolitan University, Manchester, UK;
5 Winchester and Eastleigh Health trust, Winchester, UK; 6 Royal
Liverpool Childrens Hospital, Liverpool, UK; 7 Queen Alexandra
Hospital, Cosham, UK
PURPOSE: To develop and validate a self-evaluation tool (ques-
tionnaire) to identify perceived competence and confidence felt
by physiotherapists undertaking emergency duty. RELEVANCE:
Physiotherapists in the UK may be required to undertake Emergency
Duty (On Call respiratory care) with little or no opportunity to
work with patients with respiratory problems during their working
week. This poses a challenge for therapists who need to maintain
and demonstrate their competence in this area. Emergency duty
guidelines (EDG) were published in 2002 and this self-evaluation
tool is being developed to help individuals identify specific learning
needs based on these guidelines. The tool supports the reflective
approach to competence advocated by the Chartered Society of
Physiotherapy and could be used to provide evidence of continuing
professional development as required by the Health Professions
Council. PARTICIPANTS: 180 Senior respiratory physiotherapists
attending ‘On course for on call’ conferences in Autumn 2005.
METHODS: A questionnaire for rating self perceived competence
was developed from criteria in the Emergency duty guidelines (EDG).
A triangulation approach was used to evaluate content validity.
Respiratory experts completed the questionnaire and gave written
feedback and 15 particpated in semi-structured follow up telephone
interviews. An initial pilot led to item refinement resulting in 12
assessment, 10 treatment and 5 confidence items, and 10 additional
range items addressing perceived competence in different situations.
Likert scales were used to rate each item. Ethical approval for the
study was obtained from Southmead Research Ethics committee.
ANALYSIS: Descriptive statistics were compiled for each item.
Internal consistency was analysed using Cronbach’s alpha. Total
competence scores for each section were calculated. Themes were
derived from open questions and interviews (analysed separately
by two reviewers) using content analysis. RESULTS: There were
143 responses (74% response rate) Over 90% of participants
either ‘agreed’ or ‘strongly agreed’ (that they were competent)
for all assessment and treatment items.The mean competence
score was 91% (median 93.8%). Cronbach’s alpha demonstrated
strong internal consistency between items .965 (assessment)
.976 (treatment) .925 (range) and .909 (confidence). Participants
supported the competencies but requested additional items and
clearer instructions. The importance of current, regular clinical
experience in determining competence was highlighted. Experience,
self-confidence, and attitude to on-call may affect competence rating,
and therefore the reliance on self-evaluation to assess competence
was questioned. CONCLUSIONS: Respiratory experts supported
the development of this tool to help therapists identify their on-
call learning needs and facilitate transferability between trusts.
Content validity of scale items was demonstrated through the
consistency of responses from senior respiratory clinicians. Further
research is needed to assess repeatability prior to undertaking
a national survey. The tool is now ready for use to support
reflective practice but further work is needed before recommended
competence scores can be agreed for summative assessment
purpopses. IMPLICATIONS: A national tool is now available for
therapists to identify their learning needs and support their reflective
practice.The items were written for those working mainly with adult
patients and may need adapting for paediatric physiotherapists. The
tool is based on core respiratory competencies and could potentially
S134
be adapted for use with students or staff working in respiratory
care. KEYWORDS: Competence, Self-assessment, Emergency
duty physiotherapy. FUNDING ACKNOWLEDGEMENTS: Unfunded.
CONTACT: sandy.thomas@uwe.ac.uk
ETHICS COMMITTEE: Southmead Research Ethics Committee
Research Report Platform Presentation
2403 Monday 4 June 11:05
PP Crystal Pavilion A
THE EFFECT OF FOOT FUNCTIONS ON BALANCE AND GAIT
IN OLDER PEOPLE
Ersoy A, Can F
PURPOSE: Foot problems are commonly seen in older people and
may lead to foot dysfunction. Foot in a neutral position has been
clinically observed to facilitate ambulation and prevent disability. Gait
abnormalities and falls might be resulted from foot problems and
dysfunctions. The aim of this study to investigate the influence of
foot functions on balance and gait abnormality which is causative
factor for falling in older people. RELEVANCE: The risk factors
for falling in older people are loss of posture and balance, gait
abnormalities and foot problems. Prevention of falls could be provided
by restoring balance and gait, and also improving foot functions.
Detailed evaluation of foot functions which could be correlated with
balance and gait must be important for older people. Improving foot
functions could be an effective prosedure to enhance balance and
gait parameters in geriatric rehabilitation. PARTICIPANTS: A total
of 60 older people (35 females and 25 males) living in Nursing
home included in the study. Their mean age was 77.07±6.83
ranged between 65-93 years. The subjects who have severe
neurological deficits or ortopaedic and rhematological diseases,
ortopaedic surgery, loss of vision, major foot deformities can cause
limping or disability were excluded of the study. METHODS: Minor
foot problems such as pes cavus, pes planus, plantar keratosis
were recorded by inspection. Foot deformity Scale and Maryland
Foot Scoring Scale were used for assesing foot problems and foot
functions. Balance and gait were measured using Berg’s Balance
Scale and Gait Abnormality Scale. ANALYSIS: All the datas were
analized using SPSS for Windows Release 11.5 packed program.
Pearson’s Correlation Coefficient Test was used to find out the
relationships between the parameters. The significance level was
set at p < 0.05 and p > 0.01. RESULTS: Their foot deformity scale
was 4.97±2.95 points (1-11 points). 83.3% of hallux valgus, 25% of
painful heel, 97% of plantar keratosis and 76.7% of one toe deformity
were observed. Their mean foot function score was 85.52±8.9
according to Maryland Foot Scale. Their Gait Abnormality Scale
was 14.43±6.31 points (between 4 to 28 point). There was a high
correlation between foot problems and foot functions (r: −0.496,
p < 0.01). Foot function was highly correlated with gait abnormality
(r: −0.424, p < 0.01), while there was a positive relationship between
foot function and balance (r: 0.317, p < 0.05). CONCLUSIONS: It
has been concluded that balance and gait can be influenced by
foot problems and foot functions. As foot functions improve, balance
and gait parameters could be more stable and get into normal
limits in older people. If causative factors like foot problems for
fall could be improved or treated, prevention of fall, gait training
and effectiviness of rehabilitation may be higher in older people.
IMPLICATIONS: In geriatric rehabilitation, the physical therapist
must be taken account the detailed assesment and treatment of
foot problems and foot functions before balance and gait training
of older people. KEYWORDS: Balance, Gait, Older People, Foot,
Berg’s Balance Scale. FUNDING ACKNOWLEDGEMENTS: None.
CONTACT: filizcan2002@yahoo.com
ETHICS COMMITTEE: Hacettepe University Ethics Commitiee
WCPT 2007, Research Reports
Research Report Platform Presentation
2634 Monday 4 June 11:05
PP Crystal Pavilion B & C
NEURAL COORDINATION BETWEEN ANTAGONIST MUSCLES
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
by many different neural structures. One of them is the control that
happens in the spinal cord by means of inhibitions and facilitations
between antagonist or synergist muscles. The main pathways
involved are associated with presynaptic inhibition and reciprocal
inhibition. These may be verified non-invasively in the soleus and
tibialis anterior by conditioning the H reflex with stimulation to a nerve
to the antagonist muscle (activating Ia fibers). It is also possible to
verify these inhibitions during movements and comprehend better
the associated motor control. RELEVANCE: A good knowledge of
these spinal controls can give more comprehension about different
injuries, as tendonitis, as it could make possible the creation
of different exercises for therapy. PARTICIPANTS: 16 subjects.
METHODS: The soleus H reflex was obtained by stimulation of
the tibial nerve in the fossa poplitea, and it was conditioned by a
stimulus to the common fibular nerve in subjects at rest and during
dorsiflexion and plantarflexion. The conditioning stimulus preceded
the test stimulus by either 15 or 100ms. These differences in the
time intervals determine which pathway will be evaluated. All the
subjects stayed seated with the right foot fixed onto a pedal with
a torque meter, and they realized 20% of the maximum voluntary
contraction, with visual feedback. ANALYSIS: The amplitudes of
the H reflexes were used to compute the percent of inhibition
for each pathway, with 15 and 100ms between the stimuli. The
obtained values were compared with one-way ANOVA, using the
Tukey post-test to compare the three conditions: at rest and during
the two contractions. RESULTS: The medium latency conditioning
(15ms) of the H reflex caused similar levels of inhibition in the
resting state (32.73% ±4.18) and during dorsiflexion (31.92% ±5.96),
this difference being not significant (p = 0.84). During plantarflexion
the inhibition was 15.09% (±2.34) while at rest it was 30.01%
(±5.56). This 50% decrease in inhibition was statistically significant
(p < 0.05). The long latency conditioning caused (five subjects) at
rest 20.22% ±3.83 of inhibition and in dorsiflexion it caused 34.43%
±7.90. This 70.31% increase in inhibition during dorsiflexion was
statistically significant (p < 0.05). During plantarflexion the mean level
of inhibition was 53.26% (±5.29) while at rest it was 77.63% (±5.50)
(p < 0.005). CONCLUSIONS: Neural circuits of the spinal cord are
modulated during muscle activation by descending pathways and
by afferent inputs from muscle receptors. IMPLICATIONS: These
neurophysiological findings are useful for a better understanding
of mechanisms behind normal and pathologic motor behaviors.
More refined therapeutic approaches may rely on such knowledge
and provide treatment for different neurological and orthopedic
diseases. KEYWORDS: H reflex, neural inhibition, motor control.
FUNDING ACKNOWLEDGEMENTS: CNPq and Capes. CONTACT:
eugenia@leb.usp.br
ETHICS COMMITTEE: Ethics Committee from Psicology Institute of
Univesity of São Paulo
Research Report Platform Presentation
1330 Monday 4 June 11:05
VCEC Meeting Rooms 11-12
EFFECTS OF A PHYSIOTHERAPY PROGRAM ON
SYMPTOMS AND FUNCTION IN INDIVIDUALS WITH SEVERE
OSTEOARTHRITIS OF THE KNEE JOINT
McNair P, Simmonds M, Collier J; Physical Rehabilitation Research
Centre, AUT University
PURPOSE: To investigate the effects of a six week physiotherapy
program on pain, impairments and function in individuals with
Platform Presentations, Monday 4 June
osteoarthritis of the knee joint. RELEVANCE: With a growing
elderly population, osteoarthritis is becoming an increasing burden
upon health care resources. Limited attention has been given to
programs that might improve symptoms and function in individuals
with severe osteoarthritis of the knee joint. PARTICIPANTS: Subjects
(N=47, mean age 72 years) who were scheduled to have a total
knee joint replacement within six weeks were randomly assigned
to physiotherapy and “normal care” groups. METHODS: A single
blinded randomized trial design was implemented. Subjects in the
physiotherapy group attended a program three times per week for
six weeks. Each session involved a combination of land and water
based exercises, and included a circuit type design that incorporated
strengthening, walking and stepping activities. The program was
progressed each week according to performance and symptoms.
Subjects in the “normal care” group received a standardized home
program. This program was typically prescribed for patients in the six
weeks prior to total knee joint replacement. It involved instructions
concerning exercises that would be beneficial for improving strength
and function. Both groups provided information concerning their
activity levels during the time of the study. The following variables
were examined prior to and after the interventions: quadriceps
and hamstring muscle strength during a maximal effort isometric
contraction at 90 degrees of knee flexion, a 6 RM for a dynamic
leg press exercise; walking performance (timed 10 meter walk and
ascending and descending stairs); pain, stiffness and perceived
ability to undertake activities of daily living as measured using the
subsections of the WOMAC Knee and Hip Osteoarthritis Index.
ANALYSIS: To compare the groups across time, a 2-factor (groups
and time) repeated measures ANOVA was utilised. The alpha level
was set at 0.05. RESULTS: The findings showed that muscle strength
was significantly improved (p < 0.05) in the quadriceps muscles of the
physiotherapy group only. Furthermore, in this group only, walking
performance was also significantly increased (p < 0.05), as was
perceived ability to undertake activities of daily living (p < 0.05). No
significant improvements (p > 0.05) were noted in hamstring muscle’s
strength, knee joint pain or stiffness in either group. CONCLUSIONS:
These findings provide support for a short term physiotherapy
program in the treatment of severe osteoarthritis of the knee joint.
IMPLICATIONS: The findings indicate that even when individuals
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
ACKNOWLEDGEMENTS: Arthritis New Zealand; New Zealand
Society of Physiotherapists. CONTACT: peter.mcnair@aut.ac.nz
ETHICS COMMITTEE: This work was approved by the Northern
Regional Ethics Committee, Auckland, New Zealand.
Research Report Platform Presentation
1479 Monday 4 June 11:05
VCEC Meeting Room 16
EFFECT OF PELVIC FLOOR MUSCLE DYSSYNERGIA, MET IN
DYSSYNERGIC DEFECATION, ON SEVERE PERINEAL TEAR
DURING DELIVERY
Marchand M1 , Corriveau H1 , Watier A2 ; 1 University of Sherbrooke;
2 Centre Hospitalier Universitaire de Sherbrooke
PURPOSE: The study’s objective was to determine if dyssynergic
defecation was associated with an increased risk of third- and fourth-
degree perineal tear during a first vaginal delivery. RELEVANCE:
Perineal tearing often occurs during the second stage of labour.
These muscular lesions cause some discomfort after childbirth, such
as urinary incontinence, which is a symptom treated with a perineal
approach by a physical therapist. Many risks factors are associated
with perineal tearing. Nevertheless, some studies have suggested
that lack of coordination of the pelvic floor, present in dyssynergic
defecation, could be present during the second stage of labour and
cause perineal tearing. PARTICIPANTS: 317 primiparas (27.72±4.15
years of age) with a vaginal delivery between May 1, 2005 and
S135
June 1, 2006 who experienced no complications during pregnancy or
childbirth participated in this study. Participants were recruited from
one hospital in Québec in 2006 with medical charts in the obstetrics
department. METHODS: A case-control study was conducted. The
Knowles-Eccersley-Scott Symptom score, sent by mail after delivery,
made it possible to identify participants with dyssynergic defecation.
A review of the medical/obstetric charts revealed the degree of
perineal tear as well as other risk factors, such as the mother’s age,
gestational age, length of the second stage of labour, use of forceps,
vacuum extraction, episiotomy, anaesthesia, and newborn’s weight.
ANALYSIS: Univariated and multiple logistic regressions were used
for analysis with odds ratio as the association measure. RESULTS:
55 primiparas had a severe perineal-muscle tearing and 262
primiparas had tearing equal to or less than a second-degree tear. 88
participants (28.1%) had constipation and 31 were of the dyssynergic
type (9.8%). Of the women with dyssynergic defecation, 10 had
severe perineal tearing. The presence of dyssynergic defecation
triples the risk of a third- or fourth-degree perineal tear (OR: 3.44;
95% CI: 1.29–9.15), median episiotomy doubles it (OR: 2.62; 95% CI:
1.30–5.30), the use of forceps triples it (OR: 3.61; 95% CI: 1.76–
7.37) and the newborn’s weight increases it by a factor of 1.50 for
each 250 g (OR: 1.50; 95% CI: 1.21–1.86). Pelvic-floor training is a
protective factor, reducing the risk of perineal tear by half (OR: 0.46;
95% CI: 0.21–0.98). CONCLUSIONS: This exploratory study led to
the hypothesis that the presence of dyssynergic defecation increases
the risk of severe perineal tearing. Indeed, it would be important
to conduct a prospective study with the objective of evaluating the
relationship between lack of pelvic-floor muscle coordination with
dyssynergic defecation and severe perineal tearing. IMPLICATIONS:
This study has helped identify a modifiable factor (dyssynergic
defecation) in the prevention of severe perineal tearing. In particular,
physical therapists may develop a specific pelvic-floor exercise
program for the treatment of dyssynergic defecation and help prevent
discomfort due to urinary incontinence after delivery. KEYWORDS:
Severe perineal tear, Dyssynergic defecation, Urinary incontinence.
FUNDING ACKNOWLEDGEMENTS: This work was funded by the
Centre de Recherche sur le vieillissement de Sherbrooke.
ETHICS COMMITTEE: The ethics committee on human research in
the Centre Hospitalier Universitaire de Sherbrooke
Research Report Platform Presentation
1877 Monday 4 June 11:05
VCEC Meeting Room 17
RESPONSE TO EXERCISE IN PEOPLE WITH BOTH DIABETES
AND STROKE
Kluding P, Tseng B; University of Kansas Medical Center, Kansas
City, KS, US
PURPOSE: This pilot project sought to examine the influence of
Type 2 diabetes mellitus in people with chronic stroke. We compared
body mass index (BMI), measures of function, cardiorespiratory
fitness, and muscle strength between people with both stroke and
diabetes (SD) and subjects with stroke alone (SA) at baseline and
following an exercise program. RELEVANCE: Diabetes is known to
be a contributing factor to the cause of stroke, but the influence of
diabetes on function after stroke has not been specifically examined.
Although it is generally accepted that physical exercise is beneficial
for people who have had a stroke, the presence of diabetes and
diabetic complications may limit an individual’s tolerance for exercise
and their ability to benefit fully from it. PARTICIPANTS: Ten subjects
(4 SD, 6 SA) have enrolled in this project to date, with a mean age
of 62.9±8.7 years and mean time since stroke of 53.3±34.7 months.
Two subjects dropped out during the intervention phase (1 SD, 1
SA) and 2 subjects have not yet completed the intervention, so only
baseline data are presented for these 4 subjects. METHODS: All
subjects participated in a supervised program of aerobic and lower
extremity muscle strengthening exercise three times each week for
12 weeks. The intensity of aerobic exercise was determined by a
S136
graded maximal exercise test and progressively increased. Outcome
measurements include BMI, functional measures (Stroke Impact
Scale (SIS), Fugl-meyer, gait velocity), cardiorespiratory fitness
(VO2peak, MET level, and duration of exercise test), and muscle
strength (measured with a hand-held isometric dynamometer).
ANALYSIS: An independent t-test was used to examine differences
in baseline measurements between the SD and SA groups. A paired
t-test was used to compare measurements before and after the
exercise program in the 6 subjects who completed the intervention.
Significance level was set at 0.05. RESULTS: At baseline, a
significant difference between the groups was found for percent
recovery on the SIS (37.5% for SD, 65.83% for SA, p = 0.021).
The SD subjects also had higher BMI, decreased function (SIS
score, Fugl-Meyer), decreased VO2peak, and decreased strength
of all extremities compared to the SA subjects, although none of
these differences were significant. For the 6 subjects who completed
the intervention (3 SD, 3 SA), significant improvements were found
in VO2peak (11.8 vs 14.5 ml/kg/m, p = 0.046), MET level (3.4 vs
4.2, p = 0.41), and duration of test (9.1 vs 12.9 minutes, p = 0.037).
CONCLUSIONS: Subjects with both stroke and diabetes rated their
level of recovery from stroke lower than subjects with stroke alone,
and demonstrated generally lower levels of function. Following the
intervention, significant improvements in cardiorespiratory fitness
were noted even in this small sample. We have identified feasibility
issues related to recruitment and a 20% drop out rate that will
need to be addressed in future studies. IMPLICATIONS: This
preliminary work indicates a need for future study with a greater
number of subjects to determine if there is a difference in outcome
between the two groups. The mechanism behind these hypothesized
differences will be explored in the future. KEYWORDS: diabetes,
stroke, exercise. FUNDING ACKNOWLEDGEMENTS: This work was
supported by a Mary Switzer Fellowship award from the National
Institute of Disability and Rehabilitation Research through the US
Department of Education. CONTACT: pkluding@kumc.edu
ETHICS COMMITTEE: Human Subjects Committee of the University
of Kansas Medical Center
Research Report Platform Presentation
1811 Monday 4 June 11:05
VCEC Meeting Room 18
NOXIOUS HEAT DISCRIMINATION ABILITY IN PERSONS WITH
CHRONIC PAIN: A PSYCHOPHYSICAL STUDY
Tan C1 , Roche P1 , Martin D2 , Palmer S3 ; 1 Queen Margaret
University College, School of Health Sciences, Edinburgh, United
Kingdom; 2 Sheffield Hallam University, Centre for Health & Social
Care, Sheffield, United Kingdom; 3 University of the West of
England, Faculty of Health & Social Care, United Kingdom
PURPOSE: To compare the noxious thermal discriminative ability
and decision-making bias of persons with chronic pain to pain-
free individuals. RELEVANCE: Studies have indicated that persons
with chronic pain (CP) demonstrated higher experimental pain
thresholds (pressure and thermal) compared to pain-free individuals
(PF). However it has not been clearly established the extent to
which physiological and cognitive-decisional influences contribute
to the elevated pain threshold. This information is important for
understanding the effect of chronic pain on behavioural responses
and the underlying neurophysiological processes of chronic pain.
In particular, secondary hyperalgesia which is a consequence of
central sensitisation. PARTICIPANTS: Thirty-three persons with
chronic low back pain and twenty-nine pain-free individuals took
part. They were recruited from an outpatient physiotherapy clinic
and community centres. The mean age for CP was 54.7 (S.D. =
13.9) years and PF was 57.8 (S.D. = 16.7) years. The average
length of low back pain experienced was 15.1 (S.D. = 10.3)
years. METHODS: Noxious thermal stimuli were administered to
the participant’s dominant forearm using a Peltier thermode with a
surface area of 25 mm × 50 mm (Somedic AB). Three blocks of paired
WCPT 2007, Research Reports
temperatures were presented (45ºC and 46ºC, 46ºC and 47ºC, 47ºC
and 48ºC). Participants were required to determine the higher of
the paired temperature using a 6 category confidence rating scale.
ANALYSIS: The sensitivity (da, perceptual accuracy at the task)
and response bias (ca, tendency to choose a particular rating) of
the participants were calculated (Macmillan and Creelman, 2005).
One way repeated ANOVA with Group (CP vs. PF) as a between-
subject factor was performed on the sensitivity and response bias
data. RESULTS: CP were better at discriminating between the paired
noxious temperatures than the PF as noted by their higher sensitivity
scores (p = .027). There were no significant differences between the
participant’s ability to discriminate for the higher temperatures pairs
as opposed to the lower temperature pairs (p = .311). No significant
interaction effects between Group and the temperature pair (p = .642).
CP held the same decision criteria compared to PF when asked
to choose the scale ratings (p = .24). CONCLUSIONS: Interestingly,
the CP group was better at discriminating noxious thermal stimuli
than PF. The response biases of both groups were similar. This
finding suggests that the perceptual accuracy of CP, compared to
PF, in performing thermal discriminatory tasks may be enhanced.
There is a current lack of models explaining this phenomenon and
the relationship between pain threshold and noxious discrimination
ability. However, central sensitisation of the nervous system is
a potential explanatory model. IMPLICATIONS: Elucidating the
processes underlying chronic pain may guide healthcare profes-
sionals in focusing their treatment and rehabilitation strategies
(physical, psychological or cognitive). KEYWORDS: Chronic, pain,
psychophysics. FUNDING ACKNOWLEDGEMENTS: This study was
funded by the Queen Margaret University College PhD studentship
programme. CONTACT: ctan@qmuc.ac.uk
ETHICS COMMITTEE: Queen Margaret University College Ethics
Committee; Lothian Research Ethics Committee (National Health
Service, Edinburgh)
Research Report Platform Presentation
1474 Monday 4 June 11:05
VCEC Meeting Rooms 19-20
EXPERIENCES OF CAREGIVERS TO PATIENTS WITH
AMYOTROPHIC LATERAL SCLEROSIS REGARDING
NON-INVASIVE POSITIVE PRESSURE HOME VENTILATION
Sundling I1 , Ekman S2 , Weinberg J3 , Klefbeck B4,5 ; 1 Stockholms
Sodra Geriatriska Klinik, Sjukgymnastikenheten, Stockholm,
Sweden; 2 Division of Gerontological Caring Science, Department
of Neurobiology, Health Care Sciences and Society, Karolinska
Institutet, Stockholm, Sweden; 3 Department of Clinical
Neuroscience, Karolinska University Hospital, Huddinge, Sweden;
4 Division of Physiotherapy, Department of Neurobiology, Health
Care Sciences and Society, Karolinska Institutet, Stockholm,
Sweden; 5 Department of Physical Therapy, Karolinska University
Hospital, Huddinge, Sweden
PURPOSE: The purpose of this study was to investigate the
experiences of caregivers to patients with Amyotrophic Lateral
Sclerosis (ALS), regarding non-invasive positive-pressure ventilation
(NPPV) at home. RELEVANCE: Although strong evidence underlines
the importance of treating sleep disordered breathing to improve
quality of life for patients with ALS, most patients underutilize
treatment. Research on quality of life during end-of-life care is sparse
and interviews with caregivers may be the only source of information
when patients cannot be interviewed. Little is known about the impact
on the caregiver’s life when a family member is provided with non-
invasive positive-pressure home ventilation and no study using a
qualitative approach on the experiences of caregivers to patients
with ALS on home ventilation was found. PARTICIPANTS: Eight
caregivers to patients with ALS were selected for their ability to
provide information for the study. The caregivers were 40-74 years
of age. All were spouses to patients with ALS, living at home.
The patients had been on non-invasive ventilation at home for a
Platform Presentations, Monday 4 June
period of 3-15 months using the ventilator daily for 2 hours up
to 24 hours. METHODS: The research interviews were conducted
as conversation about the home ventilation. Each interview started
with the open-ended question: Please tell me in what way your
spouse benefits from the home ventilation? Follow up questions
were asked to encourage informants to explain or deepen their
stories. Interviews were taped and transcribed in full. ANALYSIS:
The text was analysed for major content themes using a qualitative
content analysis method and coded in meaning units in light of the
purpose of the study. RESULTS: Content emerged that referred to
the three main themes “Getting to know the ventilator”, “Embracing
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
caregiver’s need for active support from a multi-professional team
and suggest that the caregiver’s experiences be included in the
technical development of NPPV equipment. The results also show
the caregiver’s ability to provide information on how NPPV affects
the quality of life of patient’s with ALS. IMPLICATIONS: This new
information provides the physiotherapist with the knowledge of how
to take an active role in supporting both caregivers and patients.
It enables the physiotherapist to be “a step ahead” when periods
of more active support will occur. Further studies are suggested to
focus on caregiver’s to patients with ALS need for support during
the ventilator period and also on how a multi-professional team
can meet the caregiver’s changing need for support throughout the
ventilator period. KEYWORDS: Caregivers, Non-invasive ventilation,
Qualitative content analysis. FUNDING ACKNOWLEDGEMENTS:
The Swedish Association of Persons with Neurological Disabilities
provided funding for the study. CONTACT: ing-mari.sundling@sll.se
ETHICS COMMITTEE: The Ethics Committee at Huddinge University
Hospital, Stockholm, Sweden
Research Report Platform Presentation
2643 Monday 4 June 11:25
PP Crystal Pavilion A
SHOE CHARACTERISTICS AND POSTURAL STABILITY IN
OLDER WOMEN ATTENDING A GERIATRIC DAY HOSPITAL
Crehan F1 , Curran M2 , Barrett E3 , Moore A, Donegan C, Horgan F;
1 Royal College of Surgeons in Ireland, Dublin, Ireland; 2 Dept
of Physiotherapy, Beaumont Hospital, Dublin, Ireland; 3 Dept of
Medicine for the Elderly, Beaumont Hospital, Dublin, Ireland
PURPOSE: This study examined the effects of footwear on balance
in a sample of older women attending a day hospital. RELEVANCE:
The causes of falls in older people are multi-factorial and include
intrinsic factors and environmental hazards such as unsafe footwear.
Footwear is a potentially modifiable factor but has been little
studied to date. PARTICIPANTS: 100 elderly females attending a
geriatric day hospital took part. Inclusion criteria included being
over 60 years of age, having an AMTS of 6 or over- being
able to understand simple instructions and being able to stand
independently. METHODS: Demographic data and a brief falls
history were recorded. Participant’s footwear was assessed using
a Footwear Assessment Form. A Berg Balance Score (BBS) was
completed under two conditions-shoes on and shoes off. Ethical
approval was granted by the hospital Research Ethics Committee.
ANALYSIS: Repeated measures ANOVA for shoe effect and linear
regression for baseline predictors of shoe effect were applied.
RESULTS: Participants’ mean age was 82 years (s.d. 6.5) with a
mean Abbreviated Mental Test Score of 8.2 (s.d. 1.9). 51% were living
alone and 80% had a history of falls. The mean BBS was 39.07 (s.d.
9.14) with shoes on and 36.54 (s.d. 10.39) with shoes off (p < 0.0001).
Wearing their own footwear significantly improved a participant’s
balance compared to being barefoot. The greatest benefit of footwear
was seen in participants who were independently mobile with the
poorest balance. CONCLUSIONS: This is the first study to look
S137
at the effects of usual footwear on the balance of frail patients
attending a day hospital and identifies that there is a significant
benefit. Further studies should investigate whether particular types
of footwear are associated with greater benefit. IMPLICATIONS:
An increased understanding of the effect of usual footwear and
slippers on balance will allow physiotherapists to advise regarding
safe footwear and falls prevention. KEYWORDS: footwear, balance,
falls. FUNDING ACKNOWLEDGEMENTS: RCSI Summer student
grant (2005). CONTACT: fionacrehan@hotmail.com
ETHICS COMMITTEE: Beaumont Hospital Ethics (Medical Re-
search) Committee.
Research Report Platform Presentation
3072 Monday 4 June 11:25
PP Crystal Pavilion B & C
INVESTIGATION OF CHANGES IN OXYGENATION OF HUMAN
QUADRICEPS FEMORIS DURING ISCHAEMIA AND FATIGUING
MUSCLE CONTRACTIONS
Mead D, Culpan J, Cramp M; University of East London, London, UK
PURPOSE: Near infrared spectroscopy (NIRS) provides a non
invasive method of analysing muscle metabolism and response to
stress in human muscle, normally under ischaemic conditions. This
study examines the feasibility of using NIRS during muscle fatigue
as a basis to explore tissue oxygenation and muscle performance in
those with metabolic problems. RELEVANCE: Metabolic problems,
such as diabetes, are associated with obesity and increased risk
of significant cardiovascular diseases. Their impact on muscle
performance is an important consideration in the implementation of
rehabilitation programmes. PARTICIPANTS: A convenient sample of
10 healthy adults (5M, 5F) mean age 36 (SD 7) years with no known
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
Deutschland GMBH) were placed over both quadriceps femoris
muscles. Responses of the right limb to (A) proximal limb occlusion
with a thigh cuff pressure of 100 mmHg greater than systolic
pressure for 15 minutes, (B) percutaneous stimulation at 40Hz
for 250 ms every second for 3 minutes (modified Burke fatigue
protocol) and (C) proximal limb occlusion for 5 minutes applied
immediately after muscle fatigue were recorded. Anthropometric
details including skinfold thickness were also recorded. ANALYSIS:
Preliminary analysis of changes in oxyhaemoglobin (DO2Hb) and
deoxyhaemoglobin (DHHb) during the first 3 minutes of each
condition has been conducted. Repeated measures ANOVA was
performed to determine possible significant differences between
conditions A, B, and C and post-hoc t-tests were conducted as
appropriate. The relationship with anthropometric characteristics was
also examined using Pearson’s correlation coefficients. Statistical
significance was defined as p < 0.05. Mean ± SEM are reported.
RESULTS: As expected, measures DO2Hb and DHHb were related
to skin fold thickness (r = −0.677 to −0.783, p < 0.05). For conditions
A, B and C, absolute values for DO2Hb were 133±50 mM, 194±67 mM
and 214±60 mM respectively and for DHHb were 158±40 mM,
260±39 mM and 154±65 mM respectively. Significant differences were
observed in DO2Hb (ANOVA: F2 = 8.975, p < 0.01) and DHHb
(ANOVA: F2 = 7.448, p < 0.05). Post hoc analysis confirmed that
change in DO2Hb levels was significantly less in condition A (p < 0.05)
whereas change in DHHb levels was significantly greater during
condition B (p < 0.05). CONCLUSIONS: Differences in the response
of DO2Hb and DHHb during ischaemia in a fresh and fatigued
state and during fatiguing muscle contraction support the feasibility
of the procedure but unresolved issues include the effectiveness
of lower limb occlusion and potential localised volume changes
in the lower limb distal to the cuff. The negative correlation
between skinfold thickness and measures of DO2Hb and DHHb
suggests that skinfold thickness may account for the large observed
variability. IMPLICATIONS: Further investigation is required before
S138
application to a population with metabolic problems. KEYWORDS:
Muscle fatigue, Tissue oxygenation, Metabolic diseases. FUNDING
ACKNOWLEDGEMENTS: The Wellcome Trust Vacation Scholarship
Scheme. CONTACT: m.c.cramp@uel.ac.uk
ETHICS COMMITTEE: School of Health and Bioscience Research
Ethics Committee, University of East London
Research Report Platform Presentation
1570 Monday 4 June 11:25
VCEC Meeting Rooms 11-12
A NEW APPROACH TO ANTERIOR KNEE PAIN: BOTULINUM
TOXIN TYPE-A INJECTION OF VASTUS LATERALIS TO
RESTORE KNEE EXTENSOR BALANCE
Singer K1 , Singer B1 , Silbert P2 , Song S3 ; 1 Centre for
Musculoskeletal Studies, University of Western Australia, Perth,
Australia; 2 Department of Neurology, Royal Perth Hospital, Perth,
Australia; 3 Department of Radiology, Royal Perth Hospital, Perth,
Australia
PURPOSE: Persistent anterior knee pain [AKP] is a prevalent
musculoskeletal disorder, frequently presenting in women, and may
be associated with considerable morbidity and reduced quality of
life. Many interventions for AKP have been investigated, including:
taping, biofeedback, muscle stimulation, foot orthoses and specific
stregthening regimes, often without universal success. Botulinum
toxin Type-A [BTXA] has proven successful in situations where
moderation of muscle over-activity is indicated. BTXA provides a
localised transient denervation of muscle confering a dose-related
opportunity to improve function and control of local muscle systems.
The role of BTXA in cases of chronic AKP has not been established.
RELEVANCE: The aim of this original study was to investigate
whether selective weakening of the distal third of vastus lateralis
[VL] muscle following BTXA [Dysport® ] intramuscular injection, in
conjunction with an exercise programme to strengthen the knee
extensor system, would confer sustained functional improvements
in subjects with chronic AKP dysfunction. PARTICIPANTS: Eight
female subjects were referred into this open-label trial by orthopaedic
surgeons, sports medicine physicians or local physiotherapists.
The average age was 29 years, all presenting with a history of
symptoms>1 year. Strict entry criteria were met; none had prior
surgery and all had deem to ‘fail’ conservative management, with
most being considered for a surgical opinion. All subjects had a
normal patello-femoral joint according to radiology evaluation from
CT examinations. METHODS: Each subject underwent repeated
baseline assessment prior to Dysport® injection into the distal
third of Vastus Lateralis muscle, performed by an experienced
neurologist under EMG guidance. Quantitative static knee extensor
force production at 30º knee flexion and a timed stair task,
and qualitative (self reported pain and disability) measures were
performed at baseline and 6 weekly intervals to 24 weeks post-
injection. Cross sectional area of the knee extensor musculature
from the distal third to joint line was evaluated from computed
tomography [CT] at baseline and 12 weeks post-injection. During the
post-injection period, all subjects undertook a home-based daily knee
extensor strengthening programme. ANALYSIS: Repeated measures
ANOVA with planned comparisons across time intervals was used
to test for significant changes. RESULTS: No adverse events were
encountered. Most subjects reported meaningful improvements in
knee pain and symptoms, and increased participation in sporting and
daily living activities. Performance on a timed stair task improved in
all subjects (p < 0.01). Isometric knee extensor force was improved
(p < 0.001) despite localised atrophy of the distal Vastus Lateralis in
the treated limb. The greatest change occurred between baseline and
six weeks post-injection, however improvements were maintained
at 24 week and 12 month follow-up. CONCLUSIONS: These data
provide preliminary evidence for the role of BTXA injection as an
adjunct to rehabilitation of indivduals with chronic AKP dysfunction.
Functional improvements were sustained at longer term follow-up.
WCPT 2007, Research Reports
Randomised placebo controlled studies are currently in progress
to investigate the efficacy of this intervention. IMPLICATIONS: In
cases of persistent anterior knee pain unresponsive to rehabilitation,
a single injection of BTXA into the distal third of the Vastus
Lateralis muscle may confer a temporal opportunity to restore
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
Australia. CONTACT: kps@cms.uwa.edu.au
ETHICS COMMITTEE: Royal Perth Hospital Ethics C’tee
Research Report Platform Presentation
1598 Monday 4 June 11:25
VCEC Meeting Room 16
WHICH WOMEN DO PELVIC FLOOR MUSCLE EXERCISES SIX
MONTHS POSTPARTUM?
Bø K1 , Owe K1 , Nystad W2 ; 1 Norwegian School of Sport Sciences,
Department of Sports Medicine; 2 Norwegian Institute of Public
Health, Division of Epidemiology
PURPOSE: In 1947 Kegel advocated pelvic floor muscle training
(PFMT) after childbirth to prevent and treat urinary and fecal
incontinence and sexual dysfuntion. Todate randomized controlled
trials have demonstrated that such exercises are effective. However,
there is scant knowledge about how many and which women are
doing the exercises. The aim of this study was to estimate the
association between PFMT and several demographic and health
related factors that may influence PFMT 6 months postpartum.
RELEVANCE: Knowledge about which women are performing PFMT
may help targeting the health services for postpartum women.
PARTICIPANTS: This analyses include the first 17978 women
enrolled in the Norwegian Mother and Child Cohort Study (Moba)
who answered questions about PFMT (N= 17744). METHODS:
Pregnant women are recruited to the study through a postal invitation
after they have signed up for the routine ultrasound examination in
their local hospital.The study has been approved by the regional
committee for ethics in medical research and the Data Inspectorate.
ANALYSIS: Logistic regression analyses were used to estimate the
association between doing regular PFMT 6 months post partum
and several factors that may influence PFMT. The results are
presented in terms of crude and adjusted odds ratios (aOR) with 95%
confidence intervals (95% CI). RESULTS: Six months postpartum,
78.3% reported doing at least occasional PFMT. Of all women, 58.3%
did PFMT regularly  once a week and 27.6% did PFMT  3 times
a week. Women doing regular PFMT were more educated, likely to
participate in general fitness activities and had more children. Women
experiencing urinary leakage and pelvic girdle pain postpartum
were also more likely to do PFMT (aOR=1.26, 95% CI 1.18-1.35;
aOR=1.31, 95% CI 1.23-1.39). Those who smoked daily, or were
delivered by cesarean, were less likely to do PFMT (aOR=0.81,
95% CI 0.72-0.91; aOR=0.56, 95% CI 0.51-0.61). CONCLUSIONS:
Women that did regular PFMT had more children, were significantly
more educated, and were more likely to participate in general fitness
activities 3 times a week. Women experiencing urinary leakage
and pelvic girdle pain were also more likely to do PFMT regularly. In
contrast, women that smoked daily or were delivered by cesarean
were less likely to do PFMT regularly. IMPLICATIONS: When
recommending PFMT, special attention should be directed towards
those less educated KEYWORDS: pelvic floor muscle training,
postpartum, prevention,. FUNDING ACKNOWLEDGEMENTS: The
study is supported by The Norwegian Ministry of Health, NIH/NIEHS
(grant no. N01 – ES – 85433), NIH/NINDS (grant no. 1 UO1
NS 047537-01) and Norwegian Research Council/FUGE (grant no.
151918/S10). CONTACT: kari.bo@nih.no
ETHICS COMMITTEE: The regional medical ethics committe of
Norway (RekSør)
Platform Presentations, Monday 4 June
Research Report Platform Presentation
2039 Monday 4 June 11:25
VCEC Meeting Room 18
DOES HYDROTHERAPY RELIEVE PAIN? A SYSTEMATIC
REVIEW OF THE LITERATURE
Swinkels A1 , Hall J2 , Briddon J1 , McCabe C3 ; 1 University of
the West of England, Bristol, UK; 2 Royal National Hospital for
Rheumatic Diseases, Bath, UK; 3 University of Bath, UK
PURPOSE: Pain relief is a common therapeutic aim when refer-
ring patients with neuromusculoskeletal disease for hydrotherapy
(exercise in warm water). This is based on the popular belief
that hydrotherapy relieves pain, but what is the evidence for this?
This systematic review considers the question “Does hydrotherapy
relieve sensory pain in adults with neuromusculoskeletal disease”?
RELEVANCE: The International Association for the Study of Pain
identifies the relief of pain as a priority in the delivery of healthcare
and this presents a growing challenge in an aging population.
Hydrotherapy is an expensive modality which is under threat in
the current economic climate. Systematic reviews of randomised
controlled trials (RCTs) play a critical role in informing decisions
on the clinical effectiveness of health care delivery. No previous
reviews have specifically focused on the question of whether
hydrotherapy relieves pain in adults with neuromusculoskeletal
disease. PARTICIPANTS: N/A METHODS: Fourteen electronic
databases were searched for RCTs on hydrotherapy for patients
with neuromusculoskeletal disease compared to other physiotherapy
interventions or no treatment controls. A process of consensus
was adopted in accepting papers for the review following a tiered
approach in which titles, abstracts and full papers were screened
independently by two reviewers. ANALYSIS: Papers accepted for
the review were subjected to descriptive data extraction and quality
assessment using a modified Scottish Intercollegiate Guidelines
Network (SIGN) checklist and the Cochrane criteria for internal
validity in RCT’s. Within and between group effect sizes for sensory
pain outcome measures were calculated. RESULTS: 705 citations
were retrieved, of these 19 RCTs were selected for inclusion. These
incorporated 670 patients with rheumatic disease, low back pain,
multiple sclerosis and fibromyalgia. Patients received between 4-84
hours of hydrotherapy (mean 26.2 hours) over a period ranging from
4-52 weeks. Within group effect sizes following hydrotherapy were
equivocal. Between group effect sizes showed little evidence in favour
of hydrotherapy versus the control group interventions of immersion
and land based exercise. CONCLUSIONS: There is currently little
substantive evidence that hydrotherapy relieves pain in adults with
neuromusculoskeletal disease or that it relieves pain more effectively
than other modalities such as immersion. However, many of the
studies reviewed were methodologically flawed and failed to meet
key criteria for internal validity. In addition, reporting issues such as
the omission of information on water temperature and the aim, type
and intensity of the exercise intervention detracted from the quality
of some reports. IMPLICATIONS: At present there is little evidence
to support the use of hydrotherapy in the relief of pain. Further
randomised controlled studies of good quality are needed to provide
a robust evidence base on pain relief in hydrotherapy. Developments
in understanding of the potential mechanisms of pain relief in
hydrotherapy may help to target treatment at those populations most
likely to benefit. KEYWORDS: Hydrotherapy, pain, systematic review.
FUNDING ACKNOWLEDGEMENTS: Funding for this systematic
review was provided by Donated Funds, Royal National Hospital for
Rheumatic Diseases, Bath, UK and the Faculty of Health and Social
Care, University of the West of England, Bristol, UK. CONTACT:
annette.swinkels@uwe.ac.uk
S139
Research Report Platform Presentation
2053 Monday 4 June 11:25
VCEC Meeting Rooms 19-20
LONG-TERM EFFECTS OF GLOSSOPHARYNGEAL INSUFFLA-
TION IN PERSONS WITH CERVICAL SPINAL CORD INJURY
Nygren-Bonnier M1,2 , Wahman K3 , Lindholm P4 , Markström A5 ,
Westgren N6 , Klefbeck B1,2 ; 1 Division of Physiotherapy,
Department of Neurobilogy, Care Sciences and Society, Karolinska
Instiutet, Stockholm Sweden; 2 Department of Physical Therapy,
Karolinska University Hospital, Huddinge, Sweden; 3 Division of
Neurorehabilitation, Department of Neurobiology, Care Sciences
and Society, Karolinska Institutet Stockholm, Sweden; 4 Section
of Environmental Physiology, Department of Physiology and
Pharmacology, Karolinska Institutet, Stockholm, Sweden;
5 Respiratory Unit, Department of Anaesthesia and Intensive
Care, Karolinska Institutet, Danderyd Hospital (KIDS), Danderyd,
Sweden; 6 Spinalis Clinic and Research Unit, Karolinska University
Hospital, Stockholm, Sweden
PURPOSE: To evaluate the immediate and long-term effects
of glossopharyngeal insufflation (GI) on lung function, ability to
cough and chest expansion in persons with cervical spinal cord
injury. RELEVANCE: Persons with cervical spinal cord injury have
severe inspiratory and expiratory muscle weakness, which leads to
diminished tidal volumes, sighs, and cough flows, resulting in reduced
chest wall and lung expansion. The cause of death for these persons
with a reduced vital capacity (VC) is often due to pneumonia as a
consequence of a decreased ability to cough. Earlier studies have
shown that GI can help the patient to take deeper breath to improve
coughing effectiveness and to prevent pneumonia. An important
treatment goal for these patients would be to improve ability to cough,
ventilation, and chest wall range of motion. PARTICIPANTS: Twenty-
seven subjects, 21 men and six women, mean 47 (range 21-70)
years of age, with cervical spinal cord injury, in Stockholm community
were included. METHODS: The subjects performed 10 repetitions
of GI four times a week during eight weeks. Pulmonary function,
peak cough flow (PCF), functional residual capacity (FRC) (measured
with nitrogen washout) chest expansion and maximal inspiratory and
expiratory mouth pressure (MIP and MEP) were measured before
and after the eight weeks. ANALYSIS: Descriptive statistics are
presented as mean ± standard deviation (SD) and range. Student’s
paired t-test was used, and a value of p < 0.05 was accepted as
being statistically significant. RESULTS: Seven of the 27 subjects had
difficulty performing GI and were excluded from the analysis. After
eight weeks of training the subjects had significantly increased their
VC (p < 0.001) with 0.3 l, and FRC 0.7 l (p < 0.0001). The subjects
inhaled with GI, 0.9 l on top of their VC. Chest expansion increased
significantly by GI. There was no change in PCF, MIP and MEP.
CONCLUSIONS: By using this technique, GI, for a period of eight
weeks the subjects who could perform GI were able to increase their
VC and FRC. Further studies are needed to investigate if the use
of GI can prevent pulmonary complications. IMPLICATIONS: These
new results show that it is possible to increase VC and FRC with GI
in the long-term. This could be of value for physiotherapists to teach
patients with cervical spinal cord injury and other neuromuscular
disorders, and might slow the progressive decrease in lung volume
that is caused by the disorders. The technique is easy to perform,
it is not time-consuming, and it may be useful as a complement
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-
bonnier@karolinska.se
ETHICS COMMITTEE: The regional Research Ethics Committee,
Nord, Karolinska Institutet, Stockholm, Sweden, Dnr: 04-1071/1
S140
Research Report Platform Presentation
2786 Monday 4 June 11:45
PP Crystal Pavilion A
INTER-RATER RELIABILITY OF FOUR FALLS RISK
ASSESSMENT TOOLS FOR RESIDENTIAL AGED CARE
Barker A1 , Nitz J1 , Haines T1,2 ; 1 Division of Physiotherapy, The
University of Queensland, Brisbane, Australia; 2 Princess Alexandra
Hospital, Brisbane, Australia
PURPOSE: The aim of this study was to undertake the first step
towards validating four falls risk assessment tools by determining
the level of reliability between three raters in the use of the
Peninsula Falls Risk Assessment Tool (PFRAT), Melbourne Falls Risk
Assessment Tool (MFRAT), Falls Assessment Risk and Management
(FARAM) and the Queensland Falls Risk Assessment Tool (QFRAT).
Specifically, the reliability of (1) overall scores obtained, (2) risk
factors identified and (3) to define limits for the smallest change
that indicates real changes in falls risk scoring. RELEVANCE: Falls
risk assessment tools are widely used by physiotherapists to assess
the falls risk of people living in residential aged care, despite a
paucity of evidence to support their efficacy. Investigations into
the validity of falls risk assessments have been few, and their
results poor. The use of instruments which do not have known
clinometric properties is an issue of effective resource utilisation.
Further investigation into the validity of falls risk assessments used by
physiotherapists is needed. PARTICIPANTS: Twenty-eight residents
(mean age 83.75 years, SD 8.73) from two residential aged care
facilities in metropolitan Australia were assessed by the three raters.
METHODS: A cross-sectional reliability study involving concurrent,
blind assessment by three raters: a physiotherapist experienced in
aged care, a physiotherapist and a final-year physiotherapy student
was conducted. ANALYSIS: The intra-class correlation coefficient
(ICC; two-way random effects, absolute agreement model) was used
to assess correlation on overall and item scoring between the three
raters. The mean and standard deviations (SD) of each rater’s scores
were calculated to detect the presence of systematic differences.
The standard error of measurement (SEM) and minimal detectable
change (MDC) were calculated for the total scores to assess the
error in measurement between raters. As the tools had varying
total scores the MDC% was calculated to allow for comparisons
between tools to be made. The MDC% = (MDC/total score) X 100.
RESULTS: Intra-class correlation coefficients of 0.77, 0.57, 0.75 and
0.77 for the PFRAT, MFRAT, FARAM and QFRAT were obtained.
The MDC was 5.06, 5.05, 7.46 and 4.87 points, representing a
change of 25.32, 16.82, 37.29 and 13.53 percent of the total scores
before change can be interpreted as a real change in scoring.
Over 50% of items on the PFRAT and QFRAT showed high (0.75-
1.00) ICC scores, compared with 17% or less of individual items
on the FARAM and MFRAT. CONCLUSIONS: The QFRAT is a
reliable measure of falls risk. The MFRAT, FARAM and the PRAT
demonstrated inconsistent levels of reliability. IMPLICATIONS: The
finding that three out of four commonly used and endorsed falls
risk assessments have poor inter-rater reliability raises questions
about the expenditure of often limited resources on completing
these assessments. KEYWORDS: Accidental falls, risk assess-
ment, residential facilities. FUNDING ACKNOWLEDGEMENTS: Nill.
CONTACT: a.barker@shrs.uq.edu.au
ETHICS COMMITTEE: Ethical clearance was obtained from the
University of Queensland Medical Research Ethics Committee.
WCPT 2007, Research Reports
Research Report Platform Presentation
3267 Monday 4 June 11:45
PP Crystal Pavilion B & C
MULTI LEVEL PREDICTORS OF WOMEN’S PHYSICAL
ACTIVITY BEHAVIOUR FOLLOWING PARTICIPATION IN AN
EXERCISE-BASED PRIMARY PREVENTION PROGRAM
Landry M1 , Brooks D2 , Grace S3 , Thomas S3 ; 1 Women’s College
Hospital, Toronto, Ontario, Canada; 2 University of Toronto, Ontario,
Canada; 3 York University, Toronto, Ontario, Canada
PURPOSE: Physical activity is well established as a health promotion
and cardiovascular disease prevention behavior. Despite this, over
55% of Canadians do not participate in regular physical activity.
Women have lower rates of participation in leisure time physical
activity than men and have also been studies to a lesser extent than
men. The predictors of adherence and maintenance to moderate
intensity physical activity have not been thoroughly investigated,
especially in a group of women at risk for cardiovascular disease,
after participation in a primary prevention program. This study will
provide important information on the assessment of physical activity
among women and the results can be used to help develop more
effective interventions for women at risk for cardiovascular disease.
RELEVANCE: Few studies have examined the determinants of
PA in different contexts. Factors that contribute to maintenance of
recommended PA guidelines in women, at moderate-to-high risk
for CVD, following an exercise based risk modification intervention
have not yet been explored. PARTICIPANTS: A convenience sample
of subjects who have enrolled in the PP program at the Women’s
Cardiovascular Health Initiative (WCHI) was targeted for recruitment.
METHODS: This study is a retrospective cohort study designed to
determine predictors of PA maintenance 6 to 36 months following
participation in a PP program. Data was collected through database
files and self-administered survey questionnaire. The dependant
variable was PA (via the International Physical Activity Questionnaire
(IPAQ), the Duke Activity status Index (DASI) score and the total
Kaiser Physical Activity Scale (KPAS) score) measured 6 to 36
months post discharge from the PP program ANALYSIS: Bivariate
analysis was conducted using the IPAQ, KPAS, and DASI as
dependant variables. Independent variables found to have significant
correlations the bivariate analysis were put in a regression model to
determine the effect. RESULTS: Of a total of 168 women Information
letters were sent out in September 2005 to 115 eligible participants.
A total of 73 completed surveys were received for a 74.5% response
rate. Approximately 82% of the respondents were categorized on the
IPAQ as being “sufficiently active” or “health enhancing physically
active”, with a mean expenditure of 2068 METmin/week. Age and
HADS score were both found to be significantly inversely related
to the DASI score(p = 0.02). The SF-36 PCS was also significantly
correlated with DASI(p < 0.0001). Analysis of the separate indepen-
dent variables in the regression model for the KPAS was significant
for employment and PA Plans. Unemployed or retired participants
scoredless on the KPAS total score (p = 0.0004). CONCLUSIONS:
Some of the factors that may predict physical activity participation
are potentially modifiable, such that improved maintenance rates
could be achieved with a better understanding of PA patterns and
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: mireille.landry@wchospital.ca
ETHICS COMMITTEE: Ethics approval from the Toronto Academic
Health Sciences Council Ethics Review Board and from the University
of Toronto was obtained.
Platform Presentations, Monday 4 June
Research Report Platform Presentation
2864 Monday 4 June 11:45
VCEC Meeting Rooms 11-12
QUADRICEPS ACTIVITY AND MOVEMENT IN RESPONSE TO UN-
PREDICTABLE SAGITTAL SUPPORT-SURFACE TRANSLATIONS
Stensdotter A1 , Grip H, Hodges P, Häger-Ross C; 1 Department
of Community Medicine and Rehabilitation, Physiotherapy, Umeå
University, Umeå Sweden
PURPOSE: The aim of this study was to determine whether
activity of vastus medialis obliquus (VMO) is delayed and/or
reduced in response to unpredictable perturbations in persons with
patellofemoral pain (PFP) and if there is a relationship between whole
body kinematics and muscle activity. RELEVANCE: PFP may be
related to unfavorable knee joint loading. Delayed and/or reduced
activity of VMO and altered kinematics have been identified in people
with PFP in some studies, whereas others have failed to show a
difference compared to healthy individuals. Earlier studies have in
general investigated anticipatory muscle activity in different voluntary
tasks without reference to movement strategies. No previous study
has investigated both muscle activity and whole body kinematics in
postural responses to unpredictable balance perturbations in PFP.
To guide the physiotherapy management of PFP it is important
to understand the association between quadriceps coordination
and movement strategies and to understand why VMO activity is
sometimes altered in PFP. PARTICIPANTS: 17 women with PFP
(age 27.7±6.6 years) who were pain-free at the time of testing
and 17 matched healthy controls (age 26.0±4.6 years) participated.
METHODS: Whole body three dimensional kinematics and surface
EMG of quadriceps muscles were studied during the postural
response to unpredictable support surface translations. ANALYSIS:
Onset of EMG activity was determined by a computer algorithm
which served as a guide for manual inspection and correction. Data
were presented to the examiner without reference to muscle or
order of repetition. A six degree of freedom segment model was
created to identify movements. Anterior/posterior linear shift velocity
of the body’s center of mass (COM) was calculated and angular
movement and velocity were determined for the trunk, hip and knees
in three dimensions. Statistical analyses were performed with a
three-way repeated-measures- ANOVA with kinetic chain, group and
muscle as factors. RESULTS: Unexpectedly, onset of VMO EMG
was earlier relative to the other parts of the quadriceps in PFP.
This was associated with changes in kinematics including greater
trunk and hip flexion in response to anterior platform translation in
the PFP subjects. No differences were found between groups for
joint angular movement and velocity or linear shift and velocity of
COM. No differences between groups were found in response to
posterior translations. CONCLUSIONS: The relative timing between
the portions quadriceps muscles may be task specific. The earlier
activity of VMO and greater trunk flexion (which may reduce the
load on the knee by shifting the COM forwards) may be part of
an adapted postural response in attempt to 1, reduce knee joint
loading; 2, compensate for reduced quadriceps strength; 3, protect
the affected knee; and/or 4, compensate for reduced balance control.
IMPLICATIONS: Attention should be directed toward task specific
compensatory strategies and that these may persist even in the
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: Ann-Katrin.Stensdotter@hist.no
ETHICS COMMITTEE: Umeå University Medical Research Ethics
Committee, Umeå Sweden. (§245/01, dnr 01-166)
S141
Research Report Platform Presentation
2294 Monday 4 June 11:45
VCEC Meeting Room 16
INDIRECT TRAINING OF THE PELVIC FLOOR MUSCLES VIA
TRANSVERSUS ABDOMINIS FOR FEMALES WITH URINARY
INCONTINENCE: A RANDOMIZED CONTROLLED TRIAL
Hung H, Tsauo J; School and Graduate Institute of Physical Therapy,
College of Medicine, National Taiwan University, Taipei, Taiwan
PURPOSE: The treatment effects of pelvic floor muscle training
for urinary incontinence have been proven by many randomized
controlled trails. But there is no evidence to describe the effect
of indirect training of pelvic floor muscles (PFM) via transversus
abdominis (TrA). Does it work for female urinary incontinence? Does
the treatment effect come from the functional improvement of PFM?
This study aimed to answer these questions. RELEVANCE: This
study provides information about clinical management of female
urinary incontinence. PARTICIPANTS: Seventy-one women with
urinary incontinence were recruited in this study. METHODS: All
subjects were randomized to intervention (48.6±6.4 y/o) or control
group (48.9±6.4 y/o) and evaluated pre- and post- the 4-month
intervention by a physical therapist blinded to the randomization. The
demographic data, related urogynaecological history, self-reported
severity, leaking frequency during 3-days diary, leaking amount
during 1-hr and 20-mins pad test, strength of PFM, vaginal squeeze
pressure and time, and quality of life were collected and analyzed.
Women in the control group learned correct contraction of PFM in the
first evaluation and received customary information of PFM exercise.
The executer asked them to perform PFM exercise everyday but not
contact with them by phone or other way. The intervention group
followed a specially designed exercise course including diaphrag-
matic breathing, tonic activation, muscle strengthening, functional
expiratory patterns and impact activities. They were individually
trained by a physical therapist for 30-60 minutes eight times during
the intervention period. ANALYSIS: A two-way mixed analysis of
variance (ANOVA) and Wilcoxon signed-rank test were used to
assess possible differences between pre- and post- intervention and
two groups. The Chi-square and Mann-Whitney rank-sum tests were
used to assess the discrete dependent variables. RESULTS: The
self-reported incontinence severity, self-reported stress incontinence
severity, leaking frequency during 3-days diary, leaking amount during
1-hr pad test and 20-mins pad test were significantly improved in
the intervention group (p < 0.0005, p < 0.0005, p = 0.042, p = 0.013,
p = 0.006 respectively) but not in the control group. The self-reported
incontinence improvement rate and stress incontinence improvement
rate of the intervention group was significantly better than the control
group (p = 0.006–0.002). The quality of life was significantly improved
in more items for intervention group compared to control group.
There was no difference of change of strength and endurance
of PFM between two groups. The endurance was significantly
improved when the data of two groups were pooled to analyze,
but strength not. CONCLUSIONS: The training of PFM via TrA
could improve the urinary incontinence, but the treatment effect may
not come from improvement of strength of PFM. Further studies
about the mechanism are needed. IMPLICATIONS: Findings suggest
that the women with urinary incontinence may be trained via TrA.
KEYWORDS: Pelvic floor muscles, Transversus abdominis, Urinary
incontinence. FUNDING ACKNOWLEDGEMENTS: National Science
Council of Taiwan. CONTACT: r93428006@ntu.edu.tw
ETHICS COMMITTEE: Ethics committee of NTUH, No: 9461700665
S142
Research Report Platform Presentation
2353 Monday 4 June 11:45
VCEC Meeting Room 18
EXPERIENCES OF MOVING WITH PERSISTENT PAIN-A
QUALITATIVE STUDY FROM A PATIENT PERSPECTIVE
Lundberg M1 , Styf J1 , Bullington J2 ; 1 Division of Occupational
Orthopaedics, Sahlgrenska University Hospital & Göteborg
University, Göteborg, Sweden; 2 Ersta & Sköndal University College,
Stockholm, Sweden
PURPOSE: The aim of the present study was to explore how patients
with persistent musculoskeletal pain experienced moving with pain.
RELEVANCE: For the patient with persistent pain, movement is
often accompanied by pain. During the past decade there has been
focus on the negative impact of fear of movement on the patient
with persistent pain. Physical therapists have a unique position in
the health care system, since we focus on achieving health through
movement. We need, however, a language that gives meaning to
pain and describes the general bodily experience without resorting
to terms that indicate disease. One methodology that enables us
to explore the lived experience is phenomenology, which has been
recommended as an “alternate research paradigm” to positivism for
physical therapy research. New knowledge can be acquired by asking
the patients about their experiences regarding moving with pain.
PARTICIPANTS: The sample was purposive and consisted of 10
Swedish outpatients with heterogeneous non-malignant persistent
musculoskeletal pain. The patients took part in individual rehabilita-
tion at two different physical therapy departments. Informed consent
was obtained prior to participation, and the study was approved by
the Ethics Committee at the University of Göteborg. METHODS: In-
depth interviews were performed by a physical therapy researcher
with many years’ experience with the rehabilitation of patients with
persistent musculoskeletal pain. The interviews were audio-taped
and lasted for 1-1.5 hours. All interviews were performed by the same
researcher. Open-ended questions were used in order to stimulate
detailed accounts of the patients’ experience. The guiding question
was “How do you experience moving with pain?” ANALYSIS: The
interviews were analyzed according to a qualitative method known
as the Empirical Phenomenological Psychological (EPP) method.
This approach consists of focusing on the individual’s experience
of the phenomenon. The EPP-method is a descriptive idiographic
qualitative methodology that aims to describe the meaning structure
of a psychological phenomenon. RESULTS: The experience of
moving with pain implied much more than pure physical movement.
Pain was a threatening challenge to the informants’ existence and
identity. The results were coded, analyzed and described in three
typologies; Failed adaptation, Identity restoration and Finding the
way out. CONCLUSIONS: In conclusion, to move with persistent
pain was described by the informants as having deep existential
impact on the individual’s life. It was also evident that all of
the informants experienced a dramatic change in their identity.
These experiences would most likely affect the patients’ chances
of recovery. IMPLICATIONS: By helping patients to move and by
confronting them with their fear of movement we also touch their
feelings and self image. We need to extend our knowledge about
what it means to the patient in an existential context to be unable
to move as before, in order to enable a successful rehabilitation
process. KEYWORDS: chronic pain, fear of movement, identity,
movement, phenomenology. FUNDING ACKNOWLEDGEMENTS:
This study was supported by grants from the Health and Medical
Care Executive Board of the Region Västra Götaland. CONTACT:
mari.lundberg@orthop.gu.se
ETHICS COMMITTEE: Göteborg University
WCPT 2007, Research Reports
Research Report Platform Presentation
2468 Monday 4 June 11:45
VCEC Meeting Rooms 19-20
AN OBSERVATIONAL COHORT STUDY OF PHYSICAL
RECOVERY AT THREE AND SIX MONTHS AFTER A
PROLONGED STAY IN INTENSIVE CARE
Salisbury L1 , Walsh T2 , Hope D2 , Bateman A2 ; 1 Centre for
Integrated Healthcare Research, School of Health Sciences,
Edinburgh University, Medical School, Teviot Place, Edinburgh, EH8
9AG, Scotland; 2 Intensive Care Unit, Edinburgh Royal Infirmary,
51 Little France Crescent, Edinburgh, EH16 4SA, Scotland
PURPOSE: To investigate the physical profile of recovery in persons
who have suffered a prolonged stay in intensive care (>48 hours).
RELEVANCE: While medical interventions in Intensive Care Units
(ICU) continue to save lives, the long term physical, psychological
and nutritional effects are poorly understood or evaluated (Combes et
al, 2003). Research of physical rehabilitation following intensive care
is limited (Jones et al, 2003). This study investigated the physical
recovery profile of patients following a prolonged stay in intensive
care. PARTICIPANTS: A total of 68 persons who had suffered a
prolonged stay in intensive care (>48 hours) were recruited into
the study. Thirty-five participants completed the study protocol and
returned at 3 and 6 months post discharge from ICU. Of the remaining
33 participants 9 died, 19 were lost to follow-up and 5 withdrew
from the study. METHODS: This observational cohort study was
carried out at Edinburgh Royal Infirmary, Scotland, with approval of
the Multi-Centre Research Ethics Committee. Informed consent was
obtained from either the participant or their welfare guardian if the
participant was unable to give informed consent. At 3 and 6 months
post discharge from intensive care participants were assessed using
a battery of physical outcome measures including a six minute
walk test (6MWT), the SF-36 and SF-36 physical component score,
the Frenchay Activities Index (FAI), the Euroquol thermometer of
health and visual analogue scales (VAS) of fatigue (0 indicating
no fatigue to 10 indicating worse fatigue), pain (0 indicating no
pain to 10 indicating worse pain), and appetite (0 indicating no
appetite to 10 indicating best appetite). ANALYSIS: All data was
tested for normality using a Shapiro-Wilks test. Data demonstrating
normal distribution was presented using mean ±SD. All other data
was presented with medians and IQR. RESULTS: For all outcome
measure two values are presented the first represents the score
at 3 months and the second the score at 6 months. Euroquol
Thermometer (61±21.56; 64±19.92); FAI (34±10.65; 37±10.06);
VAS of fatigue (4.89±2.6; 4.74±2.5); VAS of pain (4(0.5-6); 5(1.5-7));
VAS of appetite (8(3.5-9.5); 8(5.5-9.5)); SF-36 (42 (28-56); 45(28-
68)); SF-36 Physical Component Score (34(20-45); 38 (23-56)).
Only 17 participants were able to undertake the 6MWT at 3 and
6 months (354±149; 452+174). CONCLUSIONS: At 3 months post
discharge from intensive care the participant’s outcome measures
demonstrated ongoing physical deficits. At 6 months the scores
showed minimal improvement from the 3 month scores with the
exception of the 6MWT. Persons who have undergone a prolonged
intensive care stay demonstrate ongoing physical deficits after
discharge from ICU. IMPLICATIONS: These physical deficits indicate
that this group have ongoing rehabilitation needs that are currently
not being met. As a result a research study has been developed to
investigate the provision of multi-disciplinary rehabilitation, including
physical therapy, immediately after discharge from intensive care
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.
CONTACT: Lisa.Salisbury@ed.ac.uk
ETHICS COMMITTEE: Multi-Centre Research Ethics Committee,
United Kingdom
Platform Presentations, Monday 4 June
Research Report Platform Presentation
3116 Monday 4 June 12:05
PP Crystal Pavilion A
THE EFFECTS OF AGE AND FALL HISTORY ON THE
STEADINESS OF FORCE GENERATION IN THE QUADRICEPS
Newham D1 , Perry M1,2 , Carville S1,3 ; 1 Division of Applied
Biomedical Research, King’s College London, UK; 2 Current Address:
School of Physiotherapy, Curtin University of Technology, Perth,
Australia; 3 Current Address: Aacademic Dept of Rheumatology,
King’s College London School of Medicine, London, UK
PURPOSE: To compare the steadiness of quadriceps force in healthy
young and older people and also to investigate whether older
people with a history of medically unexplained falls generate less
steady force than those without a history of falling. RELEVANCE:
A decreased ability to generate smooth and controlled muscle force
(i.e. decreased steadiness) has been reported in older people, mainly
during isometric contractions. This may be a cause of medically
unexplained falls in older people, but has not been studied. Safe
posture and controlled movement requires the generation of steady
forces during dynamic contractions as well as isometric ones and
older people often report particular difficulty in controlling movements
that predominately involve eccentric contractions. We studied force
steadiness during static and dynamic contractions of the quadriceps
in healthy young and older people. The latter group included people
with and without a history of falls. PARTICIPANTS: We studied 44
young (aged 18-40 years) and 78 older (aged>70 years) people. In
the latter group 34 people had a history of falling (fallers) and 44
did not (non-fallers). The study had the approval of the local ethics
committee. METHODS: Steadiness during isometric steadiness was
measured during contractions at 10, 25 and 50% maximal voluntary
force (MVC). The subjects were given visual targets and asked to
maintain force as steadily as possible for 10s. The coefficient of
variation (CoV) of the force trace was measured over the middle
6s. Anisometric steadiness was measured by the standard deviation
of acceleration during concentric and eccentric contractions against
two external loads (1 & 5 kg) at the ankle. Subjects were asked
to bend and straighten their knee as smoothly as possible over
a joint range of 30-90 degrees of flexion. Each contraction lasted
6s. A 1 min rest period elapsed between each of the contractions.
ANALYSIS: ANOVA and post hoc t-tests were used. RESULTS:
The younger subjects tended to be most steady and the fallers the
least but the differences were not consistently significant. During
isometric contractions the fallers were less steady (P < 0.001) than
both the young and non-fallers, who had similar values. Isometric
steadiness was unaffected by force in all three subject groups.
Steadiness during dynamic contractions in all groups steadiness was
similar for both of the two external loads and types of contraction.
During concentric and eccentric contractions the older subjects were
less steady than the younger ones (P < 0.002). The only differences
between the two older groups was that the fallers were less steady
than the non-fallers by 31% (P = 0.013). CONCLUSIONS: These data
indicate ageing affects the steadiness of dynamic contractions more
than isometric ones. The decreased steadiness during eccentric
contractions in the fallers could be an important mechanism of
medically unexplained falls. IMPLICATIONS: These data support
the subjective reports of older people that they have more difficulty
controlling eccentric force generation. It has been reported that
practice improves the steadiness of force generation and this should
be considered when working with older people, particularly those at
risk of falling. KEYWORDS: Ageing, muscle force, steadiness, falls.
FUNDING ACKNOWLEDGEMENTS: We are grateful for support
from the EU Better Ageing project (QLRT 2001 00323) and the
Charitable Foundation of Guy’s and St Thomas’, UK. CONTACT:
di.newham@kcl.ac.uk
ETHICS COMMITTEE: King’s college London
S143
Research Report Platform Presentation
3105 Monday 4 June 12:05
VCEC Meeting Rooms 11-12
UNDERSTANDING THE MECHANISMS OF PAIN IN KNEE
OSTEOARTHRITIS
Maly M1 , Costigan P2 , Olney S3 ; 1 School of Physical Therapy,
The University of Western Ontario; 2 School of Kinesiology & Health
Sciences, Queen’s University; 3 School of Rehabilitation Therapy,
Queen’s University
PURPOSE: We aimed to identify whether mechanical charac-
teristics could explain variance in pain intensity in people with
knee osteoarthritis (OA). RELEVANCE: We know little about the
determinants of pain due to knee OA and therefore, our strategies
to target pain may not be optimal. Little work has investigated the
role of mechanical characteristics though medications change both
pain intensity and knee mechanics. If mechanics are related to
pain, mechanical interventions could be useful to pain management.
PARTICIPANTS: Participants had physician-diagnosed, radiographic
knee OA (n=54, age 68.3 ±8.7 years; 32 were women). Participants
had an average of 2.5 comorbidities (conditions that required
treatment for>3 months). METHODS: Pain intensity was reported
on the Western Ontario McMaster Universities Osteoarthritis Index
(WOMAC-Pain). Body Mass Index (BMI) was calculated from
measured height and weight. Quadriceps strength was the mean
peak extensor torque (QUAD) of 5 maximum-effort 60º/s trials
on an isokinetic dynamometer. Static varus-valgus angle (VAR)
was measured from weight-bearing radiographs. Three-dimensional
gait analysis was conducted to compute the peak knee adduction
moment (ADD MOM) and dynamic range of knee motion about
the sagittal (ADD RNG) and coronal (FLEX RNG) axes. The study
was approved by the Queen’s University Research Ethics Board.
ANALYSIS: Pearson Correlation Coefficients (r) were calculated
and deemed significant if p < 0.002 (2 tailed Bonferroni correction,
6 comparisons, a = 0.01). A step-wise linear regression was
performed with the WOMAC-Pain as the dependent variable and
the mechanics as independent variables. RESULTS: Participants
reported 30 ±19 (out of 100) on WOMAC-Pain. Data from one
participant was removed (n=53) because her pain score was an
outlier. BMI (28 ±5 kg/m2 ) and VAR (−0.8±4.6º) suggested that
the 53 participants had mild disease. Peak QUAD was 64 ±29 Nm.
Gait analysis included ADD MOM (0.44 ±0.15 Nm/kg), ADD RNG
(8.8±3.4º) and FLEX RNG (60±9º). Correlations with the WOMAC-
Pain subscale (n=53): BMI (kg/m2 ): 0.41*; QUAD (Nm): −0.03;
VAR (º): 0.10; ADD MOM (Nm/kg): 0.10; ADD RNG (º): −0.04;
FLEX RNG (º): −0.41*. A model explaining variance in WOMAC-Pain
showed that greater dynamic knee range of flexion-extension related
to a lower pain score (slope coefficient −2.9 ±0.9, Adj R2 0.18). Added
to that, lower BMI related to lower pain intensity (slope coefficient
6.4±2.1, Adj R2 0.29). CONCLUSIONS: These findings apply to a
high functioning group with knee OA. Dynamic range of motion and
body mass explain variance in pain intensity, providing evidence that
mechanical variables are important to understanding pain in people
with knee OA. IMPLICATIONS: Because this study does not provide
insight into cause and effect, future research should investigate
whether dynamic knee range of motion and obesity are sources of, or
the result of, pain. Interventions aimed at range of motion and obesity
could address, in part, the causes of pain. Physical therapists can
play a critical role in studying and implementing such programs to
manage pain due to knee OA. KEYWORDS: arthritis, biomechanics,
pain. FUNDING ACKNOWLEDGEMENTS: Canadian Institutes for
Health Research (#99034), Toronto Rehabilitation Institute, Natural
Sciences and Engineering Research Council of Canada. CONTACT:
mmaly@uwo.ca
ETHICS COMMITTEE: Queen’s University Research Ethics Board
S144
Research Report Platform Presentation
2564 Monday 4 June 12:05
VCEC Meeting Room 16
EFFECT OF COMPARTMENTAL PELVIC FLOOR MUSCLE
CONTRACTION ON URETHROVESICAL STRUCTURES USING
REAL-TIME ULTRASOUND – A PILOT STUDY
Crotty K1 , Bartram C1 , Pitkin J2 , Cairns M3 , Taylor P3 , Dorey G4 ;
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
PURPOSE: Pelvic Floor Muscle Contraction (PFMC) can be isolated
anterially, posterially or in combination. However, instructions for
PFMC with respect to continence are inconsistent in scientific
and lay publications. Study purpose is to investigate which
compartmental PFMC produces greatest change in urethrovesical
structures as seen on 2-D Real-time Ultrasound (2D-RTUS), and
validate 2D-RTUS for this purpose. RELEVANCE: Whilst studies
have investigated exercise regimes and interventions, none have
addressed compartmental PFMC. Currently therefore, treatment
outcomes may be sub-optimal due to this gap in the evidence
base. It is also difficult to compare research studies, and women’s
health information in lay publications is confusing. PARTICIPANTS:
A convenience sample of 38 continent, nulliparous, pre-menopausal
women were recruited from one UK hospital and physiotherapy
clinic. Twenty completed the study, and 17 sets of 2D-RTUS data
were usable. METHODS: Participants were taught anterior, posterior
and combined PFMCs by a specialist physiotherapist, practiced
three PFMCs in each compartment twice daily for two weeks, and
completed an exercise diary. Surface Electromyography confirmed
ability to distinguish between compartments. Three PFMCs in each
compartment were imaged in random order using perineal 2D-RTUS
in supine and standing by a Professor of Radiology, and repeated
after 10 minutes. Measurements of angle of urethral inclination (AUI)
and angle of bladder neck rotation (ABNR) were read twice by
one rater and once by a second rater. ANALYSIS: Best of three
images in each compartment were used for analysis. Preliminary
analyses are presented (n=17) for average compartmental AUI,
where smaller angles correspond to optimal activity. Analyses of
ABNR, repeatability, intra and inter-reader reliability, and image
clarity for validity of 2D-RTUS are ongoing. RESULTS: For test
one supine, smallest AUI in each compartment was achieved using
posterior PFMC in 8/17 (47.05%), [average AUI 47.4º (SD: 9.9)];
combined PFMC in 6/17 (35.3%) [average AUI 49.0º (SD: 10.3)],
and anterior PFMC in 2/17 (11.8%) [average AUI 50.6º (SD:10.3)].
In 1/17 (5.9%) poor image clarity prevented comparison. For test
one standing, smallest AUI in each compartment was achieved using
combined PFMC in 7/17 (41.1%) [Average AUI 58.1º (SD: 11.7)];
posterior PFMC in 6/17 (35.3%) [Average AUI 56.7º (SD: 11.3)],
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:
The preliminary results from this pilot study suggest that anterior
PFMC instructed as “contract as if stopping the flow of urine”
is less useful than posterior or combined PFMC in respect to
AUI. This is relevant because large AUI is related to incontinence.
Furthermore, anterior PFMC is widely taught by non-specialist
practitioners and promoted in lay publications. Continued analyses of
these results and future studies in non-symptomatic and symptomatic
populations are planned and will inform which compartmental PFMC
effects greatest change in urethrovesical structures. IMPLICATIONS:
Results suggest that standardizing technique to either a posterior
or combined PFMC may optimize AUI and thus have potential
for improving treatment outcomes for incontinent women. Findings
may also aid comparison of research studies, and objectively
inform advice given in lay publications. KEYWORDS: Continence,
Imaging, Pelvic floor muscle. FUNDING ACKNOWLEDGEMENTS:
With thanks to the following providers: Visus Medical 44803 Bochum,
Germany: JiveX reader software. Neen Health Care, Oldham OL1
WCPT 2007, Research Reports
4AY,UK: Periform Electrodes. Verity Medical, Lightwater GU18
5WW,UK: Neurotrac 5 EMG. CONTACT: k.crotty@herts.ac.uk
ETHICS COMMITTEE: Harrow Local Research and Ethics Commit-
tee (LREC) UK. LREC NUMBER:04/QO/405
Research Report Platform Presentation
2251 Monday 4 June 12:05
VCEC Meeting Room 17
EFFECTS OF ENDURANCE EXERCISE ON MOTOR COORDINA-
TION, AMBULATORY AND STEREOTYPIC BEHAVIOR, AND PAIN
THRESHOLD IN STREPTOZOTOCIN INDUCED DIABETIC RATS
Ghosh P1 , Czekajewski J2 ; 1 Maryville University, St. Louis,
Missouri, USA; 2 Columbus Instruments, Columbus, Ohio
PURPOSE: Diabetes mellitus is a worldwide problem and can
gradually affect the whole body system in chronic conditions.
The aim of the present study was to delineate the effects of
endurance exercise training on motor coordination, stereotypic
and ambulatory behavior, pain sensation, and blood glucose
concentration in streptozotocin-induced diabetic rats RELEVANCE:
Substantial evidence suggests a decline in neuromuscular junction
activities and development of neuropathy in patients with diabetes
mellitus and these changes affect the quality of life. PARTICIPANTS:
Twenty male Wister rats (170-200 g) were used for the experiment.
METHODS: Diabetes was induced by intravenous injection of
streptozotocin (6 mg/100 g body wt)through tail vein. Blood glucose
levels were monitored by glucose oxidase method 3 days post-
injection, and the animals with blood glucose exceeding 250 mg/dL
were considered diabetic. Only 16 rats out of 20 fell into this criteria.
They were divided into two groups. One group of rats was used
for exercise training while the other group of rats remained in the
cage without any exercise. Exercise training consisted of treadmill
running with a horizontal floor moving at a constant speed of
20 meter/min for 30 min twice a day for 5 days a week. Motor
coordination, pain threshold, stereotypic and ambulatory behavior,
and blood glucose concentration were assessed at 7-day intervals
for 28 days.- ANALYSIS: The statistical analysis was carried out
using student’s t-test. RESULTS: The results show that endurance
exercise significantly increases both stereotypic and ambulatory
behavior, improves pain threshold, and increases motor coordination
in diabetic rats when compared with non-exercised diabetic rats.
CONCLUSIONS: It is concluded that endurance exercise training can
prevent the decline in motor coordination, stereotypic and ambulatory
behavior, and pain threshold in diabetic rats IMPLICATIONS: The
outcome of the study may add to the existing knowledge on the
effects of exercise on diabetes. KEYWORDS: Diabetes, endurance
exercise, motor coordination. FUNDING ACKNOWLEDGEMENTS:
This work was not supported by research fund.
Research Report Platform Presentation
2385 Monday 4 June 12:05
VCEC Meeting Room 18
LIVING WITH LONG-TERM PAIN: A PHENOMENOLOGICAL
SEARCH FOR MEANING
Hassenkamp A; St Georges/University of London and Bournemouth
University
PURPOSE: Whilst chronic pain has been the focus of much research
attention, the experience for the person living with it, remains
predominantly unchanged. Often this group of patients is labelled
as difficult, demanding and manipulative. Using a phenomenological
approach this study aimed to explore the deeper meaning of what it
is like to live with long-term pain as an older person. It sought to elicit
insights that might enable the therapist to develop new avenues of
interactions with the patient. RELEVANCE: Physiotherapy’s model
of practice is based on communication- and movement science.
Focussing only on these during the assessment and examination
Platform Presentations, Monday 4 June
process can miss out on tapping into the the patient’s rich experience
in perceiving the world through an altered body. Rather than
bringing meaning to this situation, this may be created from it.
PARTICIPANTS: 12 physiotherapy patients over the age of 60
who had lived with unremitting pain for more than 10 years were
recruited to the study. All responded to a flyer in a physiotherapy
department of a large nationally renowned teaching hopsital in the
UK. METHODS: A phenomenological paradigm with an embodied
life-world perspective based on the philosophy of Merleau-Ponty was
chosen with its emphasis on experiencing the world through the body.
In-depth interviews lasting about 1 hour explored what it is like to live
with chronic pain. The interviewer sought to elicit rich descriptions
focussed on the participants’ bodily awareness of the world, any
alterations in these and relevant interactions. Alongside this, memos
relating to non-verbal observations as well as reflections on the
interactions were used. ANALYSIS: All interviews were audiotaped
and transcribed. The qualitative analysis was iterative. Meaning units
were recognized, themes and finally patterns identified while keeping
in mind the sense of the whole. The researcher used imaginative
variation seeing all possible perspectives and finally constructed an
overall description of the essence of the experience while at the
same time taking a reflexive stance throughout the whole process.
RESULTS: Inbued with the demands and feedbacks of the scientific
world from which they had sought help, the participants all identified
watershed insights leading them to deconstruct their adherence to the
biomedical interpretation of their experiences. All participants stated
that only the recognition of dissonance with the accepted concepts
helped them to move on. Pain was described as ‘isolating’, a ‘conduit
for hence unknown experiences both enhancing and damaging’ while
the altered bodies were described as ‘a barrier to the ‘normal’
world’ and ‘a supertuned instrument’. All reported a ‘before and
after’ (ie the onset of pain) time concept which they linked to a new
vulnerability and at times an enhanced creativity. CONCLUSIONS:
A phenomenological, embodied stance elicited themes in this group
of needing to unburdening themselves of their assumed and re-
inforced biomedical beliefs before being able to make sense of
living in their world with altered bodies. IMPLICATIONS: There
might be a need to challenge some of the assumptions of a
reductionist, hypothetico-deductive paradigm in physiotherapy and
replace it with a more interpretative stance in this group of patients.
KEYWORDS: phenomenology; Merleau-Ponty; life-world paradigm.
FUNDING ACKNOWLEDGEMENTS: No funding has been received.
CONTACT: ahassenk@hscs.sgul.ac.uk
ETHICS COMMITTEE: Royal National Orthopaedic Hospital LREC,
London, UK, December 2005
Research Report Platform Presentation
2711 Monday 4 June 12:05
VCEC Meeting Rooms 19-20
ISSUES THAT INFLUENCE THE FEASIBILITY OF TECHNOLOGY-
BASED EXERCISE EDUCATION AND MONITORING IN PATIENTS
WITH CARDIOVASCULAR DISEASE
LaPier T, Wilson B; Eastern Washington University, Department
of Physical Therapy, Spokane, WA, USA
PURPOSE: The purpose of this study was to describe how often
patients with cardiovascular disease had access to and comfort with
using home technology, health monitoring, and exercise equipment.
RELEVANCE: Recently a National Heart, Lung, and Blood Institute
Working Group recommend that, “Research support should be
directed to evaluate the effectiveness of advanced interactive
technologies and systems that incorporate not only instruction but
also ongoing monitoring and corrective feedback.” Several studies
have reported positive in patients with cardiovascular disease
using Internet-based instruction technologies. For computer-based
instruction to be used in post-hospital education delivery, patients
must have access to and be competent using the necessary
technology. PARTICIPANTS: This study included 50 patients who
S145
were admitted to the hospital for a CVD related diagnosis. Patients
who could not understand English, were not cognitively intact, or
had undergone cardiac transplantation or a ventricular assist device
placement were excluded. METHODS: This prospective descriptive
study used a sample of convenience recruited from a regional
medical center. Patient background and medical information was
obtained through chart review and interview. Patients completed a
questionnaire that included items about what types of resources
for education, self-monitoring, and exercise they had available to
them after discharge from the hospital. ANALYSIS: Descriptive
statistics and frequencies were calculated for all of the data collected
in this study. RESULTS: We found that the type of technology
equipment most often available was a video-cassette recorder
(93%) and least available was the Internet (58%). Furthermore,
only 42% of study participants had access to and competence
with using both computers and the internet. We found that the
type of health monitoring equipment most often available was
a thermometer (90%) and least available was a blood pressure
monitoring device (59%). We also found that the type of exercise
equipment most often available at home was an exercise bike (32%).
In addition, we found that 88% of the study participants reported
having easy access to a safe place, most often outside to walk
regularly. CONCLUSIONS: We found in this population of patients
that less than half could easily participant in an Internet-based
education and or monitoring program after hospital discharge. In
addition, many study participants were not able to self-monitor vital
signs and did not have home exercise equipment. Taken together
this data suggests that, although technology-based education and
monitoring may be efficacious and provide optimal remote interaction
between healthcare providers and patients, it may not be feasible in
many practice areas and settings. Although most study participants
reported having access to a place for walking outside, depending
on the climate walking may not consistently be an exercise option.
IMPLICATIONS: Patient education is a key intervention for facilitating
secondary prevention of cardiovascular disease through risk factor
reduction. Use of newer technologies may provide another method
of delivering information to enhance patient self-management of
cardiovascular diseases but access to and competence with these
tools may be a limiting factor, especially in less developed and
rural areas. KEYWORDS: patient education, exercise, cardiovascular
disease. FUNDING ACKNOWLEDGEMENTS: None. CONTACT:
tlapier@ewu.edu
ETHICS COMMITTEE: Spokane – IRB
Research Report Platform Presentation
2709 Monday 4 June 12:45
PP Crystal Pavilion B & C
A COMPARISON OF KNEE JOINT LAXITY AMONG
SNOWBOARDERS BEFORE AND AFTER SNOWBOARDING
Wade J, Henderson R; Department of Physical Therapy, Rosalind
Franklin University of Medicine and Science, North Chicago, Illinois,
USA
PURPOSE: Snowboarding has evolved into one of the world’s most
popular winter sports. Little evidence exists to explain injury trends
among snowboarders in the recreational setting. The aim of this
study was first, to evaluate the difference in anterior knee joint
laxity between the leading and trailing legs of snowboarders before
and after activity; second, to evaluate the difference in anterior
knee joint laxity within each leg among snowboarders before and
after snowboarding activity; and third, to compare anterior knee
joint laxity results with various snowboarding habit patterns reported
on a participant questionnaire. RELEVANCE: Knee injuries are
common among snowboarders. The leading leg is injured significantly
more often than the trailing leg. This study investigates how knee
responds to snowboarding activity, both within and between lower
limbs. PARTICIPANTS: Twenty-seven male (77.14%) and eight
female participants (n=35), ranging in age from 18 to 56 years
S146
(mean=22, SD=7.14 years), voluntarily participated in the study at
Alyeska Ski Resort in Girdwood, Alaska. Participants met criteria
for inclusion if they were 1) recreational snowboarders, 2) non-
beginners, 3) 18-65 years, and 4) without history of knee injury.
METHODS: Participants completed a 13-item questionnaire detailing
their snowboarding habit patterns. Participants were instructed to
engage in 3-hours of normal recreational snowboarding activity.
Knee joint laxity was measured using the MEDmetric KT-1000
Arthrometer before and after activity in both the leading and trailing
legs. Approval for this study was obtained from the IRB at Rosalind
Franklin University of Medicine and Science. ANALYSIS: Unpaired
t-tests were used to compare between leg differences before and
after snowboarding. Paired t-tests were used to compare within leg
pre- versus post-snowboarding differences. Participant questionnaire
responses were analyzed using paired t-tests, unpaired t-tests
and the One-Way ANOVA. RESULTS: No statistically significant
differences (p < 0.05) were found when the leading leg was compared
to the trailing leg, either before or after snowboarding activity. When
Pre-snowboarding was compared to Post-snowboarding, significant
differences (p < 0.05) were found in both the leading and trailing
legs. The only snowboarding habit pattern from the participant
questionnaire to demonstrate significant differences (p < 0.05) was
stance pattern. CONCLUSIONS: Snowboarding activity does result
in an increase in knee joint laxity within both legs; however, this
increase is not different between legs. There is some evidence
to suggest that the change in knee joint laxity is associated with
a snowboarders stance pattern. IMPLICATIONS: These findings
suggest that the normal repetitive stresses occurring at the knees
are not likely to account for the leading versus trailing leg injury
discrepancy experienced by snowboarders. It is more likely that
this discrepancy is attributable to biomechanical forces acting on
the knees during turning, jumping, landing, or falling. KEYWORDS:
Snowboarding, Knee, Laxity. FUNDING ACKNOWLEDGEMENTS:
None. CONTACT: jack@aptak.com
ETHICS COMMITTEE: Institutional Review Board at Rosalind
Franklin University of Medicine and Science
Research Report Platform Presentation
897 Monday 4 June 12:45
VCEC Ballroom B & C
LOWER EXTREMITY BIOMECHANICAL AND NEUROMUSCULAR
ACTIVATION COMPENSATIONS FIVE YEARS FOLLOWING ACL
RECONSTRUCTION
Nyland J, Caborn D; Division of Sports Medicine, Dept. of
Orthopaedic Surgery, University of Louisville, Louisville, KY, USA
PURPOSE: Bilateral lower extremity biomechanical and neuromus-
cular activation characteristics were compared during maximal effort
single leg jumps. Our hypothesis was that the ACL reconstructed
lower extremity would display differences compared to the non-
involved lower extremity. RELEVANCE: Long-term biomechanical
and neuromuscular activation changes may remain following ACL
injury, surgical reconstruction, and rehabilitation. PARTICIPANTS:
70 subjects with bilaterally equivalent active knee mobility and
laxity within 2 mm of the non-involved knee were evaluated at
a mean of 5 years (range = 2-10 years) post-unilateral ACL
reconstruction. METHODS: Subjects completed the 2000 IKDC
Knee Survey. EMG (1000 Hz), vertical ground reaction force (500
Hz) and two dimensional sagittal plane kinematic (60 Hz) data
were collected as subjects performed 3 sets of 3 consecutive
maximal effort single leg countermovement jumps with each lower
extremity. Gluteus maximus, vastus medialis, medial hamstring and
gastrocnemius EMG amplitudes were standardized to levels attained
during performance of single repetition, maximal volitional effort
isometric contractions (%MVIC) using standard manual muscle tests.
Ground reaction force magnitudes were standardized to bodyweight
(BW). ANALYSIS: Paired t-tests were used to compare mean side-
to-side differences (P < 0.05). RESULTS: 66% of subjects displayed
WCPT 2007, Research Reports
normal or nearly normal survey scores. Peak bilateral lower extremity
joint displacement did not differ at the hip (53.9 ±15º vs. 53.4 ±15º),
knee (54.9 ±12º vs. 53.8 ±12º) or ankle (20.5 ±6º vs. 20.2 ±5º).
Single lower extremity vertical jump height did not differ (31 ±11 cm
vs. 31.3 ±11 cm). Vertical ground reaction forces (1.86 ±.23%BW
vs. 1.87 ±.21%BW) and power (25.9 ±6 W/kg vs. 25.4 ±5.8 W/kg)
during propulsion did not differ. Vertical ground reaction forces during
single leg jump landing were decreased at the surgical side (3.2
±.5%BW vs. 3.3 ±.5%BW, P = 0.009), however power during landing
did not differ (−44.9 ±12 W/kg vs. −46.6 ±14 W/kg). Standardized
EMG amplitudes were decreased at the vastus medialis muscle (1.4
±.65%MVIC vs. 1.6±0.85%MVIC, P = 0.03) and increased at the
gluteus maximus muscle (1.05±0.79%MVIC vs. 0.81±0.38%MVIC,
P < 0.0001) of the involved lower extremity during propulsion.
Standardized EMG amplitudes were also decreased at the vastus
medialis muscle (1.2±0.63%MVIC vs. 1.31±0.69%MVIC, P = 0.04)
and increased at the gluteus maximus muscle (1.18±1.1%MVIC vs.
0.88±0.4%MVIC, P < 0.0001) of the involved lower extremity during
single leg jump landing. Medial hamstring and gastrocnemius muscle
standardized EMG amplitudes did not display significant side-to-side
differences. CONCLUSIONS: Despite predominantly satisfactory
knee survey scores evidence of biomechanical and neuromuscular
activation differences at the involved lower extremity were observed.
Decreased landing forces, decreased vastus medialis muscle activa-
tion and increased gluteus maximus muscle activation amplitudes
at the involved lower extremity suggest long-term compensatory
changes toward a hip joint bias to decrease knee joint loading
forces. IMPLICATIONS: ACL reconstruction corrects ligamentous
laxity, however compensatory biomechanical and neuromuscular
activation changes still occur. KEYWORDS: ACL Reconstruction,
Patient Outcome, Allograft, Compensatory Changes. FUNDING
ACKNOWLEDGEMENTS: Fischer-Owen Fund Educational Grant.
CONTACT: john.nyland@louisville.edu
ETHICS COMMITTEE: University of Louisville Medical Institutional
Review Board
Research Report Platform Presentation
934 Monday 4 June 12:45
VCEC Meeting Rooms 11-12
DEVELOPMENT AND EVALUATION OF THE GERMAN VERSION
OF THE “PAIN ATTITUDES AND BELIEFS SCALE FOR
PHYSIOTHERAPISTS (PABS-PT)”
Laekeman M1 , Sitter H2 , Basler H3 ; 1 Physiotherapy, Medical Faculty
of Philipps-University Marburg, Germany; 2 Institute of Theoretical
Surgery, Philipps-University Marburg, Germany; 3 Department of
Medical Psychology, Philipps-University Marburg, Germany
PURPOSE: Recent studies discussed Fear-Avoidance-Beliefs
(FABs) as a high risk factor for chronic low back pain. The aim of
this study was to develop and evaluate a scale (German version) for
the assessment of attitudes and beliefs of physiotherapists towards
the treatment of back pain. RELEVANCE: FABs can be influenced
by the attitudes and beliefs of physical therapists. PARTICIPANTS:
In a cross-sectional study a questionnaire was sent out, to which 280
out of a total of 424 physiotherapists (response rate 66%) answered,
part of them being a representative sample of German physiotherapy
practitioners (n = 353), and a smaller sample consisting of students in
a bachelor course for physiotherapy (n= 71) with previous experience
in physiotherapy practice. METHODS: The questionnaire included
the “Pain Attitudes and Beliefs Scale” for physiotherapists (PABS-
PT) (Dutch original version), which has been translated into German
following a forward-backward procedure. Further instruments were
the adapted version of the Tampa Scale of Kinesiophobia (TSK-DE)
and a translated version of patient vignettes (originally in English).
ANALYSIS: To determine psychometric properties of the PABS,
we employed a principal component factor analysis in addition to
item- and regression analyses. RESULTS: Factor analysis of the
German version corroborated the structure of the original version
Platform Presentations, Monday 4 June
with a biomedical factor explaining 21.5% of the total variance
and a psychosocial factor explaining 3.6% of the variance. The
respective subscales depict an internal consistency of Cronbach’s
a = 0.77 (scale 1) and 0.58 (scale 2). Retest-reliability in a smaller
sample of n = 79 amounts to r = 0.83 and r = 0.70 respectively.
Physiotherapy students scored significantly higher on scale 2 after an
introduction into biopsychosocial model of treatment for pain. Validity
was supported by substantial correlations between both subscales
and the scores in the TSK and the patient vignettes, especially
with regard to given recommendations for activity and return to
work (r values between 0.72 and 0.37). CONCLUSIONS: The
German version of the PABS-PT appears to be a reliable and valid
instrument for the assessment of attitudes towards treatment options
for low back pain in physiotherapy. IMPLICATIONS: Reliability of
the psychosocial scale may improve by an increase of the number
of items. KEYWORDS: low back pain – physiotherapy – treatment
orientation. FUNDING ACKNOWLEDGEMENTS: this work was
unfunded. CONTACT: m.laekeman@cityweb.de
ETHICS COMMITTEE: Ethics commission, Medical Faculty of
Philipps-University, Marburg, Germany.
Research Report Platform Presentation
730 Monday 4 June 12:45
VCEC Meeting Room 18
UNDERSTANDING PARTICIPATION ISSUES IN WOMEN LIVING
WITH HIV
Solomon P, Wilkins S; McMaster University, School of Rehabilitation
Science, Hamilton, Canada
PURPOSE: This study examined the experiences of women living
with HIV focussing on what helps and hinders women from
participating fully in their community. RELEVANCE: In developed
countries HIV has become an increasingly chronic and episodic
illness. With this shift, the role of rehabilitation in management of HIV
related disability has increased. The World Health Organization has
developed the International Classification of Functioning, Disability
and Health (ICF) to assist in understanding how contextual factors,
such as environment and personal factors, relate to leading a
full life. Increased understanding of the barriers and facilitators to
participation will enable physiotherapists to provide care that will
meet the needs of a vulnerable population. PARTICIPANTS: 23
women (mean age =40) who had been living with HIV for an average
of 9.5 years. 61% of the women rated their health as very good
to excellent; 13% rated their health as fair to poor. 83% of the
women had children. 65% had an annual income in the range
of CAN$10,000–19,000. METHODS: This study used qualitative,
phenomenological methods. Purposeful recruitment identified diverse
community participants across Canada. Women were interviewed in
person or telephone using open-ended, semi-structured questions.
Use of the ICF as a framework ensured a variety of environmental
and personal factors were examined. ANALYSIS: Interviews were
audiotaped and transcribed verbatim. Initially both investigators
coded 7 transcripts to develop the coding system. Summaries of
each woman’s story were completed. Categories and overarching
themes were developed using a qualitative software program (N6).
RESULTS: Although women were living with a variety of disabilities
and activity limitations these were secondary in importance to the
daily need to cope with multiple life stressors. Overarching themes
related to participation included fearing disclosure, experiencing
discrimination, managing participation on a daily basis, coping
positively with HIV, fostering supportive networks and living in poverty.
One group of women was participating to the extent to which they
desired; this group was able to identify and mobilize multiple social
and health supports. A second group was isolated, depressed and
experienced major challenges to participation. Children were a major
motivation to participate in all women’s lives. For those participating
fully, children provided a sense of involvement which lead to a
more fulfilling life. For those experiencing difficulty, children were
S147
the sole source of motivation for participation. CONCLUSIONS: The
findings revealed the complexity of ways in which women managed
their participation. This supports the notion that rehabilitation efforts
be multifaceted including the development of social and health
care support and promotion of policies which promote participation.
IMPLICATIONS: The findings highlight the importance of a holistic
team approach in the management of HIV related disability.
Although physiotherapy has the potential to assist women with self-
management strategies related to the chronic nature of the illness,
this was not a priority in these women’s lives. Physiotherapists
need to work with others to provide consultation and advocacy
so that women can be involved with rehabilitation strategies to
improve their quality of life. Future work will focus on identifying
predictors of participation and the physiotherapy role in managing
HIV related disability and promoting participation. KEYWORDS: HIV,
participation. FUNDING ACKNOWLEDGEMENTS: This research
was funded by the Canadian Institutes for Health Research.
ETHICS COMMITTEE: McMaster University Research Ethics Board
Research Report Platform Presentation
2827 Monday 4 June 13:05
PP Crystal Pavilion B & C
KNEE SPRAIN EFFECTS ON KNEE FUNCTION AFTER AN
EARLY PHYSIOTHERAPY INTERVENTION
Ylönen J1 , Lundberg M1 , Tollbäck A2 ; 1 Karolinska University
Hospital, Stockholm, Sweden; 2 Karolinska Institute, Stockholm,
Sweden
PURPOSE: The aim of this study was to evaluate effects of an
early physiotherapy intervention after knee sprains. RELEVANCE:
Knee sprains are one of the most common knee injuries in leisure
activities and sports. The subsequent discomfort and soft tissue
damages can lead to negative inactivity effects. It is important
that the rehabilitation process is individually adapted and adjusted
to the extent of the injury, the symptoms and to the goal of the
rehabilitation. This process needs to be started shortly after the
injury. PARTICIPANTS: 48 patients, 19 women and 29 men, (17-
55 years of age), were consecutively recruited from the Emergency
Room, at the Karolinska University Hospital, Huddinge. METHODS:
The patients were randomly allocated to an intervention- or a control
group. All patients received written instructions including a simple
training program made by a physical therapist. The patients in the
intervention group were also scheduled for a visit to a physical
therapist... During the visit, the patient received information about
the injury mechanisms and factors that influence injury healing.
The patients had the opportunity to ask questions and receive
answers and explanations and to discuss fears and expectations.
They were also given an individualized treatment program. The
patients graded their knee function with KOOS (Knee injury and
Osteoarthritis Outcome Score) two and six weeks after the knee
injury. Six weeks after the injury, knee range of motion, effusion
measured as knee girth and thigh girth were measured in all
patients. Ethical approval for performing the study was obtained
by the Ethics Committee at the Karolinska University Hospital in
Stockholm. ANALYSIS: Non-parametric statistical methods were
used. The Mann Whitney U-test was used to assess differences
between the groups. The Wilcoxon Sign Rank Test was used to
assess differences within the groups. P < 0.05. RESULTS: Six weeks
after the knee injury, the increase in patient estimated knee function
(KOOS) was higher in the intervention group compared to the control
group. There were no significant differences in active knee range of
motion, effusion or thigh girth, between the groups. CONCLUSIONS:
Patients with knee sprains receiving early treatment intervention
with one visit to a physical therapist estimate their knee function
higher six weeks after injury compared to patients who did not
receive an early physical therapy intervention. Furthermore, in this
study, objective measurements of active knee range of motion,
effusion and thigh girth, did not reflect knee function. Thus, these
S148
results reflect a substantial individual benefit from the visit to the
physical therapist. IMPLICATIONS: Early, individualized physical
therapy intervention in addition to written information improve patient
rated knee function to a higher degree than written information only.
KEYWORDS: Intervention, knee sprain, physical therapy. FUNDING
ACKNOWLEDGEMENTS: This study was supported by grants from
the Swedish Research Council, Karolinska Univerity Hospital.
ETHICS COMMITTEE: Ethics Commintee at the Karolinska Univer-
sity Hospital, Stockholm, Sweden
Research Report Platform Presentation
905 Monday 4 June 13:05
VCEC Ballroom B & C
KNEE FLEXOR TORQUE DEFICITS TWO YEARS FOLLOWING
ACL RECONSTRUCTION WITH SEMITENDINOSUS-GRACILIS
AUTOGRAFT: COMPARISON WITH ALLOGRAFT AND
NON-IMPAIRED GROUPS
Nyland J, Elmlinger B, Tillett E, Caborn D; Division of Sports
Medicine, Department of Orthopaedic Surgery, University of
Louisville
PURPOSE: This study compared the isometric knee flexor torque of
subjects who were two years status-post ACL reconstruction using
autogenous semitendinosus-gracilis (STG) grafts with subjects who
were two years status-post ACL reconstruction using allograft tissues
and with a non-impaired control group. Our hypothesis was that
subjects with autogenous STG grafts would display greater involved
side knee flexor torque deficits compared to the other groups.
RELEVANCE: The graft that is selected for ACL reconstruction is an
important surgical decision since options have differing advantages
and disadvantages. Autogenous tissue harvest is known to impair
knee joint function during the early stages of rehabilitation following
ACL reconstruction. PARTICIPANTS: Three groups of 20 subjects
(STG autograft group = 13 males, 7 females, 27.1 ±7.6 years of
age; allograft group = 8 males, 12 females, 31.8 ±11 years of age;
and control group = 13 males, 7 females, 29.4 ±10 years of age)
participated in this study. The STG autograft group was 2.3 ±.4
years status-post ACL reconstruction with a mean 2000 IKDC Knee
Evaluation Survey score of 86.4 ±11. The allograft group was
2.4 ±.5 years status-post ACL reconstruction with a mean 2000
IKDC Knee Evaluation Survey score of 80.5 ±13. All subjects who
underwent ACL reconstruction were compliant with rehabilitation
program recommendations. METHODS: Handheld dynamometry
of bilateral knee flexor torque was performed with subjects in
a prone position with the test knee positioned at 90º flexion.
Measurements were performed twice and the mean values were
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
between group involved – noninvolved side isometric knee flexor
torque differences (P < 0.05). RESULTS: The STG autograft group
displayed greater involved side knee flexor torque deficits (−17±14
Nm) compared to the allograft group (−0.81±8.9 Nm) and compared
to the control group (−0.75±14.2 Nm) (P = 0.001). The allograft group
did not display statistically significant differences with the control
group. CONCLUSIONS: Long-term knee flexor torque deficits exist
at two years following ACL reconstruction when autograft STG tissue
was used despite patient compliance with rehabilitation program
recommendations. IMPLICATIONS: A modified rehabilitation pro-
gram may help to reduce the knee flexor torque deficits observed
among patients who undergo ACL reconstruction using an STG
autograft. KEYWORDS: Patient Outcome, Allograft, Rehabilitation.
FUNDING ACKNOWLEDGEMENTS: Fischer Owen Orthopaedic
Fund. CONTACT: john.nyland@louisville.edu
ETHICS COMMITTEE: University of Louisville Medical Institutional
Review Board
WCPT 2007, Research Reports
Research Report Platform Presentation
970 Monday 4 June 13:05
VCEC Meeting Rooms 11-12
SELF-REPORT OUTCOME MEASURES FOR LOW BACK
PAIN – SEARCHING FOR INTERNATIONAL CROSS-CULTURAL
ADAPTATIONS
Costa L, Maher C, Latimer J; Back Pain Research Group, School
of Physiotherapy, The University of Sydney, Australia
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.
RELEVANCE: Self report measures are commonly used in clinical
practice and in research studies. Most existing questionnaires were
developed in English and it is not clear how many have been adapted
to other languages. PARTICIPANTS: Not applicable METHODS: Two
different searches on MEDLINE, EMBASE, CINAHL and LILACS
were performed. The first search identified questionnaires specifically
designed for patients with LBP. The second search combined the
name of the questionnaire with 35 different languages in order to
locate cross-cultural adaptations of the questionnaire. ANALYSIS:
Data on the psychometric testing of the translated questionnaires
were extracted. Additionally psychometric properties were rated by
the Quality Criteria for Psychometric Properties of Health Status
Questionnaires with the evaluation restricted to the subset of items
relevant to cross-cultural adaptation. RESULTS: 40 questionnaires
were identified of which only 15 had been adapted to a new
language. Only 19 of the 35 different languages we searched for were
represented in the search results. From 1400 possible adaptations,
only 61 have been completed. Psychometric testing of the adapted
questionnaires was quite variable and in general sub-optimal with
testing usually restricted to an assessment of reliability and construct
validity. CONCLUSIONS: There are insufficient cross-cultural adap-
tations for self-report outcome measures for LBP patients; the pattern
of results suggests that there is no relationship between the number
of people who speak a language and the number of adaptations
to that language. Major differences in sample sizes, test-retest
periods, statistical analysis and benchmarks considering reliability
and validity were found. IMPLICATIONS: There is a clear need for
further cross-cultural adaptation of LBP self report measures and for
greater attention to the quality of psychometric evaluation of adapted
questionnaires. Without appropriately adapted measures the clinical
management of LBP patients who do not speak English is potentially
compromised. KEYWORDS: Outcome assessment, psychometric
properties, low back pain. FUNDING ACKNOWLEDGEMENTS:
Leonardo Costa is a PhD student supported by CAPES – Ministério
da Educação – Brazil; Christopher Maher holds a research fellowship
funded by the National Health and Medical Research Council of
Australia. CONTACT: Leonardo Costa – lcos3060@usyd.edu.au
Research Report Platform Presentation
2958 Monday 4 June 13:05
VCEC Meeting Room 17
A DAILY PHYSICAL ACTIVITY AND DIET INTERVENTION FOR
INDIVIDUALS WITH TYPE 2 DIABETES MELLITUS
Van Rooijen A1 , Viviers C2 ; 1 Dept of Physiotherapy, Faculty of
Health Sciences, University of Pretoria; 2 Div of Human Nutrition,
Faculty of Health Sciences, University of Pretoria
PURPOSE: The aim of this study was to establish the efficacy of
a holistic approach: i.e. daily walk and diet intervention program
as well as compliance to medicine use to decrease HbA1c over
a period of 4 months in subjects with limited financial resources.
Secondary outcomes that were investigated were body mass index,
blood pressure, lipid profiles, waist circumference, Health-related
quality of life and walking distance. RELEVANCE: Evidence suggests
that populations in Africa develop Type 2 diabetes mellitus (DM) at an
increasing rate as they reject their traditional lifestyles. Diabetes is the
Platform Presentations, Monday 4 June
tenth most common cause for total life years lost in females in South
Africa. Physical activity is under-used in the management of type
2 DM in South Africa. PARTICIPANTS: The study was conducted
at the New Pretoria Academic Hospital, in the Gauteng Province of
South Africa. The study participants were men and women of all
races between the ages of 40 and 65, with Type 2 DM and a known
duration of the disease for at least one (1) year and a HbA1c of
>8-9.5%. METHODS: A randomised controlled clinical trial design
was used for the study. For the walk program participants in the
experimental group each received a pedometer as a motivational and
monitoring tool. The dietary programme provided the participants with
the knowledge, skills and motivation to incorporate self-management
into their daily lifestyles.The control group received the usual care
and was wait-listed for an intervention similar to the experimental
group. ANALYSIS: An analysis of repeated co-variance (ANCOVA)
was used to compare the experimental and control groups with
respect to changes in HbA1c, in BMI, waist circumference, health-
related quality of life and lipid profiles using the baseline values as
covariate. A p-value <0.05 was regarded as statistically significant.
RESULTS: The preliminary baseline adjusted mean HbA1c change
from baseline in the exercise group after 12 weeks was −0.39%
(95% CI −0.8 to 0.02). The difference in the baseline adjusted mean
walking distance change from baseline in the exercise group (36.20
to 57.32) was significantly different (p < 0.01) from the baseline in
the control group (12.07 to 33.33).The difference in the change from
baseline health perception in the exercise group (67.9 to 85.19)
was not significantly different (p = 0.86) from baseline in the control
group (69.16 to 85.37). However, the change from baseline within the
experimental and the control groups, both with p < 0.01, respectively,
was significant. Cronbach’s alpha coefficient (0.74) indicates a good
internal consistency. CONCLUSIONS: The decrease in HbA1c levels
of 0.39% in this study must be viewed against the decrease of
1% to 2% with medication, which is seen as clinically significant.
IMPLICATIONS: The exercise interventions together with the use
of medication and correct diet may contribute to the achievement
of a HbA1c level of lower than 7.5% and thus reduced morbidity.
KEYWORDS: Type 2 diabetes mellitus, exercise, nutrition, health-
related quality of life. FUNDING ACKNOWLEDGEMENTS: This
study was funded by the Medical Research Council of South
Africa, and by the South African Sugar Association. CONTACT:
tania.vrooijen@up.ac.za
ETHICS COMMITTEE: Pretoria Academic Hospital Ethics Review
Board
Research Report Platform Presentation
1390 Monday 4 June 13:05
VCEC Meeting Room 18
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 ;
1 Centre for Research on Inner City Health, St. Michael’s Hospital,
Toronto, ON, Canada; 2 Department of Health Policy, Management
and Evaluation, University of Toronto, Toronto, ON, Canada;
3 University Health Network, Toronto Western Hospital, Toronto,
ON, Canada; 4 Centre for Addiction and Mental Health, Toronto, ON,
Canada; 5 Department of Psychiatry, University of Toronto; 6 School
of Human Kinetics, Laurentian University, Sudbury, ON, Canada
PURPOSE: The purpose of this research was to describe factors
that influence the experiences of “disability” from the perspective of
adults living with HIV/AIDS within a larger conceptual framework.
RELEVANCE: HIV increasingly is perceived as a chronic illness in
developed countries. Individuals may be experiencing the long-term
health-related consequences of HIV and potentially adverse effects
of treatment; often termed “disability”. However, the nature and extent
of these consequences from the perspective of adults living with
HIV/AIDS are unknown. PARTICIPANTS: Men and women (18 years
S149
and older) living with HIV/AIDS. METHODS: We conducted focus
groups and interviews with adults who experienced an “episode”
of illness attributed to HIV. We asked participants to describe their
health-related challenges, the physical, social and psychological
areas of their life affected, and the impact of these challenges on
their health. ANALYSIS: We used grounded theory techniques to
develop a conceptual framework that described the consequences
of living with HIV. Within this framework, we focused on factors that
influenced how these consequences were experienced by adults
living with HIV. RESULTS: We recruited 38 participants (21 men,
16 women, 1 transgendered person) for 4 focus groups and 15
face-to-face interviews. Participants had a median time since HIV
diagnosis of 9 years (interquartile range: 5-9); 25 (66%) were
taking antiretrovirals and 19 (50%) had a nadir CD4 count <200
cells/mm3 . Participants conceptualized “disability” as episodic in
nature, characterized by unpredictable periods of wellness and illness
due to HIV and its treatments. “Disability” included four dimensions:
symptoms / impairments, difficulty carrying out day-to-day activities,
uncertainty resulting in worrying about the future and challenges of
social inclusion. Four main factors influenced these dimensions of
“disability”. Level of support (e.g. practical and emotional support
from friends, family, and partners, support from health care personnel
and services, and income support) and stigma were classified as
extrinsic factors. Living strategies (e.g. seeking social interaction
with others, maintaining sense of control over life and their illness,
and attitudes and beliefs) and aging were classified as intrinsic
factors that could exacerbate or alleviate “disability” experienced by
adults living with HIV/AIDS. CONCLUSIONS: Influential intrinsic and
extrinsic factors are a key component of the overall conceptualization
of “episodic disability”. Level of support, stigma, living strategies
and aging may exacerbate or alleviate dimensions of “disability”.
These factors provide a more comprehensive understanding of
how “disability” is experienced by adults living with HIV/AIDS.
IMPLICATIONS: Existing disablement frameworks have not taken
into account the episodic nature of “disability”, nor acknowledged
the factors that can alter experiences of “disability”. These factors
are integral to understanding how “disability” is experienced and
perceived by adults living with HIV/AIDS. These factors should
be considered by providers in clinical practice and in the future
measurement of “disability” for adults living with HIV/AIDS. This
research also may be applicable to individuals living with other
episodic and chronic illnesses. KEYWORDS: Disability, HIV/AIDS.
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: kelly.obrien@utoronto.ca
ETHICS COMMITTEE: Ethics approval was obtained from the St.
Michael’s Hospital, Research Ethics Board.
Research Report Platform Presentation
3304 Monday 4 June 13:25
PP Crystal Pavilion B & C
A SURVEY OF CURRENT METHODS OF TREATMENT OF THE
FEMALE ATHLETE TRIAD BY PHYSICAL THERAPISTS IN THE
US
Pantano K; Cleveland State University, Cleveland, Ohio, USA
PURPOSE: Restriction of dietary intake and/or over-exercising
in young women can lead to athletic amenorrhea and early
development of osteoporosis. Known as the Female Athlete Triad,
this condition may be prevalent in sports that emphasize a lean body
appearance. Greater opportunities and increased sports participation
for women has lead to greater competition and a need to excel
for the female athlete. The Female Athlete Triad, as a result, has
become a growing concern among health professionals. Methods of
prevention and treatment in early stages are necessary if long-term
detrimental effects are to be avoided.The goal of this self-report is
to describe the current methods of treatment and prevention used
S150
by physical therapists in the U.S for women having symptoms of, or
increased susceptibility to, the Female Athlete Triad. RELEVANCE:
Understanding the current methods of treatment and prevention for
the female ahtlete triad will help others identify the current strategies
to implement so that the devastating effects of osteoporosis can
be prevented in the young female athlete. PARTICIPANTS: 500
physical therapists currently practicing in the U.S. were randomly
selected from the Sports or Orthopedic Physical Therapy Sections
of the APTA. METHODS: A survey was developed to assess current
methods used by physical therapists in the U.S. to treat and/or
prevent the Female Athlete Triad. A prototype survey was sent to
a panel of 20 experts to establish content and construct validity
of the self-report. The revised questionnaire was then randomly
sent to 500 physical therapists practicing in the U.S. ANALYSIS:
Descriptive statistics were used to provide demographic information
about the population studied and to determine the frequencies with
which physical therapists refer to other health care professionals for
treatment of the disorder. Descriptive information about treatment
and preventive measures were compiled and described in narrative
form. RESULTS: One hundred and seventy-nine physical therapists
responded to the mailed survey (36% response rate). Of the 179
participants, 25% (44) stated that they currently employ specific
methods of treatment. Sixteen of those respondents (36%) reported
that they currently use preventative strategies, but only 16% (7)
are involved athletic screening for the disorder. The methods of
treatment, prevention and frequency at which physical therapists use
a multidisciplinary team approach are described. CONCLUSIONS:
The results suggest that for the population of physical therapists
targeted in this study, more therapists may be knowledgeable in
the treatment of the Female Athlete Triad than in its prevention.
A greater focus on education for the treatment and prevention of
the Female Athlete Triad could assist in decreasing the prevalence
of this disorder. IMPLICATIONS: Understanding and learning more
about the prevention of the female athlete triad can empower
the physical therapist to be educational leaders to other other
professional, coaches and parents that are involved in the care
of the female athlete. KEYWORDS: Female athlete, osteoporosis,
exercise. FUNDING ACKNOWLEDGEMENTS: None. CONTACT:
k.pantano@csuohio.edu
ETHICS COMMITTEE: Drexel University IRB
Research Report Platform Presentation
913 Monday 4 June 13:25
VCEC Ballroom B & C
A RANDOMIZED CLINICAL TRIAL COMPARING THE
EFFECTIVENESS OF FUNCTIONAL KNEE BRACE TO
NEOPRENE SLEEVE USE FOLLOWING ANTERIOR CRUCIATE
LIGAMENT RECONSTRUCTION
Birmingham T1,2 , Bryant D1,2 , Giffin R1 , Kirkely A1 , Kramer J2 ,
Litchfield R1 , Fowler P1 , Donner A3 ; 1 Fowler Kennedy Sport
Medicine Clinic, University of Western Ontario; 2 School of
Physical Therapy, University of Western Ontario; 3 Department
of Epidemiology and Biostatistics, University of Western Ontario
PURPOSE: The primary objective of this study was to compare post-
operative outcomes in patients using an anterior cruciate ligament
(ACL) functional knee brace and patients using a neoprene knee
sleeve during rehabilitative exercises and physical activities after
ACL reconstruction. RELEVANCE: Various types of knee orthoses
are commonly used by patients during rehabilitation and return to
physical activities after ACL reconstruction. PARTICIPANTS: 150
patients who were undergoing ACL reconstruction using a hamstring
autograft were recruited from a tertiary care sport medicine clinic.
METHODS: In this two-group parallel design randomized controlled
trial, patients were randomized to receive an ACL functional
knee brace (n=76) or a neoprene sleeve (n=74) at their 6 week
postoperative visit following primary ACL reconstruction. Patients
were instructed to wear the knee orthosis during participation in all
WCPT 2007, Research Reports
physical activities, including rehabilitation exercises, with the potential
of adding substantial strain to the knee (i.e. running, jumping, twisting,
cutting, pivoting, quick stop/starts, or activities on uneven ground). All
patients and physical therapists were instructed to follow guidelines
from a standardized postoperative ACL rehabilitation protocol used
at this centre. Patients were assessed preoperatively, 6 weeks, 6, 12,
18 and 24 months postoperatively. ANALYSIS: Outcome measures
included disease-specific quality of life (ACL QOL), Knee arthrometry
(KT 1000) and single limb forward hop test administered by a
blinded research assistant. 1 and 2-year outcomes were compared
after adjusting for baseline scores. A priori directional subgroup
hypotheses based on time from injury to surgery, preoperative KT
1000 scores, and 1 and 2-year compliance scores for brace or
sleeve use were evaluated using tests for interactions. Analyses
followed the intention-to-treat principle. RESULTS: There were no
significant between-group differences for any of the outcomes
at 1 and 2-year follow-ups. Mean between-group differences at
2 years were: 2.87% (95% CI: −3.85–9.60) for the ACL QOL,
0.07mm (95% CI: −0.80–0.93) for KT 1000 side-to-side difference,
and 2.64% (95% CI: −4.57–9.85) for hop limb symmetry index.
There were no significant subgroup findings and adverse events
were similar between groups. CONCLUSIONS: Confidence intervals
for between-group differences are narrow and exclude clinically
important differences. These findings suggest a functional knee brace
does not result in superior outcomes over a neoprene sleeve following
ACL reconstruction. IMPLICATIONS: There is lack of scientific
evidence to support the recommendation of using an ACL functional
knee brace over a neoprene sleeve after ACL reconstruction.
KEYWORDS: Randomized Clinical Trial, Anterior Cruciate Ligament
Reconstruction, Knee Brace. FUNDING ACKNOWLEDGEMENTS:
This research was undertaken thanks to funding from the Canadian
Institutes of Health Research, Smith & Nephew Canada, and the
Canada Research Chairs Program. CONTACT: tbirming@uwo.ca
ETHICS COMMITTEE: University of Western Ontario Research
Ethics Board for Heath Sciences Research Involving Human Subjects
Research Report Platform Presentation
2303 Monday 4 June 13:25
VCEC Meeting Rooms 11-12
TWO-DAY REPRODUCIBILITY OF FUNCTIONAL CAPACITY
EVALUATION IN SUBJECTS WITH EARLY OSTEOARTHRITIS
OF HIP AND/OR KNEE
van Ittersum M1 , Bieleman A2 , Groothoff J3 , Oosterveld F2 ,
Reneman M3 , van der Schans C1 ; 1 Hanze University of Applied
Sciences, Groningen, The Netherlands; 2 Saxion University of
Applied Sciences, Enschede, The Netherlands; 3 University Medical
Centre Groningen, The Netherlands
PURPOSE: In a spin-off study of the Cohort Hip and Cohort Knee
(CHECK) project, functional capacity is evaluated using a protocol
based on the Isernhagen Work Systems (IWS). Test-retest reliability
of lifting and carrying was published as good in healthy subjects
and in subjects with chronic nonspecific low back pain. However,
no data are available concerning two-day reproducibility in patients
with osteoarthritis (OA). The purpose of this study is to assess
the reproducibility of lifting and carrying of FCE in subjects with
early OA of the hip and / or the knee on two consecutive days.
RELEVANCE: The reliability of FCE as an outcome measurement
instrument for early OA was assessed. PARTICIPANTS: 92 Subjects
with early OA of hip and / or knee were evaluated, of which 86%
were female. Mean age of the patients was 57 years, with 13%
of the subjects having complaints of hip, 24% complaints of knee
and 63% of both joints. METHODS: A two-day protocol based on
the IWS FCE was applied. Most tests of this Functional Capacity
Evaluation (FCE) consist of stepwise increments of physical loading.
The tests for lifting low, lifting overhead and carrying were repeated
on the second day. ANALYSIS: Differences between the two days on
weight lifted and carried were calculated using paired samples t-tests.
Platform Presentations, Monday 4 June
Intraclass Correlation Coefficients (ICC) were calculated to analyze
association between day 1 and day 2. Bland and Altman analyses
were performed to assess limits of agreement. No criteria for limits
of agreement were available. However, smaller limits of agreement
indicate more stability because it indicates that the natural variation
is small. RESULTS: Mean (sd) scores of the two days for lifting low,
lifting overhead and carrying on day 1 and day 2 are as follows: Lifting
low (kg) 19.7(9.2)-19.5(9.4) (p = 0.15); Lifting overhead (kg) 9.8(5.1)-
9.3(4.5) (p = 0.16); Carrying (kg) 20.0(9.2)-20.2(8.9) (p = 0.64). ICC
values were respectively: r = 0.89, r = 0.75 and r = 0.88. Limits
of agreement for the different tests were: lifting low 6.4 kg; lifting
overhead 5.2 kg; and carrying 6.4 kg. CONCLUSIONS: There were
no statistically significant differences between the test performances
on both days. All three tests show good two-day test reproducibility
based on ICC values. We found acceptable stability for lifting low
and carrying. The need for a two-day test protocol could not be
confirmed. However, the natural variation of lifting overhead should
be taken into account when using the test clinically. IMPLICATIONS:
In the CHECK study a one-day test protocol will be used. However,
the natural variation of lifting overhead should be taken into account
when using the test clinically. KEYWORDS: FCE; Osteoarthritis;
Reliability. FUNDING ACKNOWLEDGEMENTS: The CHECK cohort
is financed by the Dutch Arthritis Association. The study was co-
financed by the Stichting Nuts-Ohra and the ‘Mobiliteitsfonds van het
HBO’. CONTACT: m.w.van.ittersum@pl.hanze.nl
ETHICS COMMITTEE: Medisch Spectrum Twente, Enschede, The
Netherlands
Research Report Platform Presentation
3295 Monday 4 June 13:25
VCEC Meeting Room 17
FUNCTIONAL OUTCOMES AFTER TOTAL JOINT
ARTHROPLASTY: COMPARISON OF PATIENTS WITH AND
WITHOUT DIABETES
Amusat N1 , Jones A1 , Beaupre L2 , Scot S3 , Warren S1 ; 1 Faculty
of Rehabilitation Medicine, University of Alberta; 2 Orthopedic
Research, Capital Health, Edmonton; 3 Faculty of Pharmacy &
Pharmaceutical Sciences, University of Alberta
PURPOSE: Current rates of Total Joint Arthroplasty (TJA) are
increasing among the elderly; as is the prevalence of diabetes
mellitus (DM). The effect of DM on short-term function after TJA
has not been clearly elucidated. The aim of this study was to
evaluate the effect of DM on 6-month functional outcomes in a
patient population who received TJA. RELEVANCE: Dysfunction is
one of the primary clinical problems for patients with TJA. Diabetes
has been associated with dysfunction in the general population,
but this relationship has not been established in patients with TJA.
PARTICIPANTS: Seven hundred and fifteen patients who received
primary elective total hip (n = 307) or knee arthroplasty (n = 408).
METHODS: This is a secondary analysis, which was part of a
larger prospective longitudinal study. Patients were evaluated within
a month prior to surgery and 6-months after receiving TJA. Self
reported function was measured using the function subscale of the
Western Ontario and McMaster Universities (WOMAC) Osteoarthritis
Index. ANALYSIS: Student t-tests (both independent and paired)
were used to compare WOMAC 6-month function between patients
with and without diabetes. Multiple regression analysis was used
to assess impact of diabetes status on function controlling for
relevant medical characteristics (joint pain and function, co-morbidity,
Body Mass Index (BMI), in-hospital complications, depression and
type of joint operation). RESULTS: The mean age for the 82
patients who had diabetes was 67 years (SD 9.5) and 53% were
female. There were no differences in demographics, baseline joint
pain and function, and overall post-operative complications between
patients with and without DM. There were more DM patients with
hypertension (70% vs. 44%), circulatory (20% vs. 13%), heart (26%
vs. 21%), kidney (8.5% vs. 3%) and eyes problem (31% vs. 35%).
S151
Patients with DM had more co-morbid conditions (mean 3.55, SD
2.0), higher BMI (mean 34.2, SD 6.4), and fewer were discharged
home (52%). The mean (SD) baseline WOMAC function was 51.9
(17.4) and 49.1 (17.5) respectively for patients with and without DM
(P>0.05). All patients irrespective of diabetes status had significant
improvement (29%) in WOMAC function (P < 0.001). Function at
6-months was significantly lower for patients with diabetes (mean
23.9, SD 17.5) than patients without diabetes (mean 18.5, SD
14.3), but the difference was not clinically meaningful. Diabetes
status was not significant in explaining 6-month WOMAC function
after adjusting for relevant medical characteristics (P = 0.16, R2
= 0.12). CONCLUSIONS: Although patients with DM had more
co-morbid conditions, it did not appear to influence their baseline
or postoperative function when compared with patients without
DM. Diabetes status was not a significant determinant of short-
term functional outcome after TJA in this community-based cohort.
IMPLICATIONS: Diabetes status alone is not a reason to expect
poor functional outcomes when planning rehabilitation care after
TJA. KEYWORDS: WOMAC Function, Total Joint Arthroplasty,
Diabetes Mellitus. FUNDING ACKNOWLEDGEMENTS: This study
was funded by the Alberta Heritage Foundation for Medical
Research, Royal Alexandra Foundation, University of Alberta Hospital
Foundation, and the Edmonton Orthopaedic Research Trust.
ETHICS COMMITTEE: Health Research Ethics Board of the
University of Alberta.Canada.
Research Report Platform Presentation
1431 Monday 4 June 13:25
VCEC Meeting Room 18
EXPERIENCES AND PERCEPTIONS OF SEXUALITY AND
HIV/AIDS AMONG YOUNG PEOPLE WITH PHYSICAL
DISABILITIES IN A SOUTH AFRICAN TOWNSHIP
Wazakili M, Mpofu R, Devlieger P
PURPOSE: The purpose of this study was to explore the experiences
and perceptions of sexuality and HIV/AIDS among 15-24 year-old
young people with physical disabilities in a South African Township
characterised by high unemployment rates and lack of social
services. RELEVANCE: Disabled young people are a key group that
is being left out the global fight against HIV/AIDS, yet they are as
vulnerable as their non-disabled peers to HIV risk (Groce, 2003).
Physiotherapists need to be aware of the HIV prevention needs of
this population. They also need take an active role as HIV/AIDS
educators for the disabled young people with whom they work.
PARTICIPANTS: Ten young people with physical disabilities and ten
parents of children with disabilities participated in the study. Parents
were asked to participate because of their experience in looking after
children with disabilities as well as to stand in for the young people
who were not able to pariticipate. METHODS: Qualitative research
methods were employed for the study. Respondents participated in
multiple individual in-depth interviews. They also participated in 4
focus group discussions of 4-10 participants each. Parents signed
consent forms for the 15-18 year olds and the 19-24 year olds signed
their own after the aim of the study was explained. Demographich
data, consent procedures, interviews and focus group discussions
were all audio-taped and transcribed verbatim. Transcripts were
read back to the participants for verification or additional ideas.
ANALYSIS: Data analysis involved reading and re-reading transcripts
to gain understanding of the subject under study. Transcripts were
then sorted into broad content categories. Each response was
summarised and pattern coded. Codes were compiled to record
the experiences and perceptions of young people with physical
disabilities within the context of their environment. RESULTS:
The results indicate that young people with physical disabilities
have limited factual knowledge about sexuality and HIV/AIDS.The
decisions and choices they make about sexual behaviour are not
informed by what they know; rather, they are part of their whole life
situation in the township. They consider their need to be loved and
S152
accepted, need for job security and family life, to be more important
than practicing safe sex.They likened the threat of HIV/AIDS to having
no food and living in shacks, therefore, no need to treat HIV/AIDS
differently. CONCLUSIONS: Young peoople with physical disabilities
are at increased risk for every known risk factor for HIV/AIDS.
There is need for sexuality and HIV/AIDS programme developers
to take into account the experiences and perceptions of this target
population and to include them in mainstream HIV/AIDS prevention
programmes. IMPLICATIONS: Physiotherapists, especially those in
Africa need to be equipped with relevant sexuality and HIV/AIDS
information so they can participate in reaching out to young
people with disabilities with whom they work. KEYWORDS: Young
people with physical disabilities, sexuality, perceptions, HIV/AIDS,
experiences. FUNDING ACKNOWLEDGEMENTS: I am grateful to
the UWC/VLIR – Dynamics of Building a Better Society (DBBS)
Programme for sponsoring my PhD studies under the Youth Wellness
Project. CONTACT: 9915769@uwc.ac.za
ETHICS COMMITTEE: The University of the Western Cape Senate
Research Report Platform Presentation
758 Monday 4 June 14:00
PP Crystal Pavilion A
THE COMMUNITY BALANCE AND MOBILITY SCALE: AN
OUTCOME MEASURE FOR HIGH FUNCTIONING INDIVIDUALS
WITH TRAUMATIC BRAIN INJURY
Howe J1,2 , Inness L1−3 , Niechwiej-Szwedo E3 , Jaglal S1−3 ,
McIlroy W1−3 , Verrier M1−3 ; 1 Toronto Rehabilitation Institute;
2 University of Toronto, Department of Physical Therapy; 3 University
of Toronto, Graduate Department of Rehabilitation Science
PURPOSE: To further examine the validity of the Community Balance
and Mobility Scale (CB&M) building on previous research which
explored the measurement properties of the scale. RELEVANCE:
Problems with balance are reported to be a longstanding concern
post-traumatic brain injury (TBI) even for community ambulators.
Previously existing balance measures were unable to evaluate these
ambulatory individuals without a ceiling effect. The CB&M was
developed to enable physiotherapists to evaluate change in the
balance and mobility skills of the higher functioning patient with
TBI who is re-integrating into the community. PARTICIPANTS: A
sample of convenience of ambulatory individuals with TBI was
recruited from in-patient and out-patient settings within Toronto
Rehab and two private community clinics. Twenty-three and 27
patients patients participated in sensitivity and validity studies,
respectively. METHODS: Sensitivity was evaluated using the CB&M
and Berg Balance Scale (BBS) change scores between admission
and discharge. Validity was evaluated by examining the relationship of
the CB&M total scores with laboratory measures of postural sway and
spatiotemporal characteristics of gait (GAITRite™), the Community
Integration Questionnaire (CIQ) and the Activities-Specific Balance
Confidence Scale (ABC). ANALYSIS: Standardized response means
(SRMs) of the BBS were compared with the CB&M. Spearman
Rank Correlation Coefficients between CB&M scores and postural
sway, gait measures (velocity, the mean and variability of step
width, step time, step length) and questionnaires were evaluated.
RESULTS: The SRMs for the BBS and the CB&M were 0.54 and
1.26, respectively. Correlations between the CB&M total scores and
static measures of postural sway were low and not statistically
significant. The majority of correlations with spatiotemporal measures
of gait were significant and of a moderate to high magnitude.
The relationship between the CB&M and preferred walking velocity
was demonstrated by a correlation of r = 0.68 (p < 0.00). Individuals
walking at velocities>1.0 m/sec, however, demonstrated a wide
range of CB&M scores. Greater variability in step length and time
was associated with lower CB&M total scores (r=-.51, p = 0.0063
and r = −0.68, p < 0.0001, respectively). Pooled data across CB&M
studies (n=47) demonstrated a significant correlation between CB&M
and CIQ scores (r = 0.54, p < 0.0001). A significant correlation also
WCPT 2007, Research Reports
existed between the CB&M and ABC scores (r = 0.52, p = 0.03).
CONCLUSIONS: The CB&M enables the physiotherapist to better
evaluate change in the high-functioning individual with TBI than an
existing clinical balance measure. The strong relationships of the
CB&M and gait variability, a marker of postural instability, indicate that
the CB&M evaluates high level dynamic balance. The relationships
of the CB&M with the ABC and CIQ demonstrate that patients’
perceptions of balance self-efficacy and community integration are
aligned with CB&M total scores. IMPLICATIONS: This current phase
of research further supports the validity of the CB&M by establishing
relationships with other measures of dynamic stability, community
integration and self-efficacy. Therefore, the CB&M is useful for the
physiotherapist in their clinical practice. This research also suggests
that for the higher-functioning patient the CB&M may be more
sensitive in capturing deficits than the surrogate measure of walking
velocity. KEYWORDS: Outcome measure, High level balance,
Traumatic brain injury. FUNDING ACKNOWLEDGEMENTS: Ontario
Neurotrauma Foundation. CONTACT: inness.liz@torontorehab.on.ca
ETHICS COMMITTEE: Toronto Rehab Research Ethics Board
(REB), University of Toronto REB
Research Report Platform Presentation
657 Monday 4 June 14:00
VCEC Ballroom A
ADHERENCE TO LOW BACK PAIN CLINICAL PRACTICE
GUIDELINES AND THE EFFECT OF ADHERENCE ON PATIENT
OUTCOME
Rutten G, Degen S, Oostendorp R; Centre for Quality of Care
Research (WOK), Radboud University Nijmegen Medical Centre,
Nijmegen, the Netherlands
PURPOSE: This study assessed both the degree of adherence
of private practice physiotherapists to the Dutch guidelines for the
diagnosis and management of non-specific low back pain and
the correlation between this adherence to said guidelines and
patient outcome. RELEVANCE: Patients with non-specific low back
pain make up 20% of the patients presenting to private practice
physiotherapy in the Netherlands. Clinical guidelines potentially
enhance quality and efficacy of care. Adherence to these guidelines
has appeared to be moderate thereby complicating an evaluation
of the impact of these guidelines on the quality and efficacy of the
care process. PARTICIPANTS: 442 private practices were invited by
mail and physiotherapists of 122 practices attended an instructional
session. 233 therapists registered for participation, of which 41% (n =
96) recorded requested patient data. The average age of participating
therapists was 41.2 years (SD = 9.9) and 26.1% were female.
Therapists were encouraged to randomly select their patients by
asking every first appropriate patient that presented for treatment
each week. METHODS: 96 therapists recorded the diagnostic and
treatment process data on 242 patients with non-specific low back
pain by means of a web-based recording system. We used an iterated
consensus procedure to establish both care process indicators
and patient outcome measures based on the Dutch physiotherapy
guidelines for low back pain. We also formulated algorithms to extract
data from the recording system with regard to said indicators and
measures. Therapists encouraged their patients to complete outcome
measures for pain (Visual Analogue Scale – VAS) and function
(Dutch version of the Patient-Specific Functional Scale (PSFS-Dutch)
and Quebec Back Pain Disability Scale – QBPDS). In addition, we
recorded the number of treatment sessions. ANALYSIS: We used
descriptive statistics to express the degree of adherence both with
the guidelines overall and for the distinct components of the care
process. We used correlation and multiple regression analyses to
determine the relationship between adherence to the guidelines
and patient outcome measures. RESULTS: Overall adherence with
the guidelines was 65.7%. Adherence to distinct components of
the care process ranged from 1.2% for indicators concerning the
physicians’ prescription to 96.5% for the assessment of the patient
Platform Presentations, Monday 4 June
profile. Pre to post-treatment differences in QBPDS-score correlated
with the initial QBPDS-score, patient age, therapist adherence to
the guidelines, and living environment (R2 = 0.187). The number
of treatment sessions correlated negatively with adherence to the
guidelines, previous physiotherapy treatment, a previous episode
of low back pain less than half a year ago and being a (post)
secondary student (R2 = 0.186). CONCLUSIONS: This study showed
an overall therapist adherence to clinical guidelines for non-specific
low back pain of 65.7%. Adherence with the guidelines was related
to better short-term outcomes with regard to patient function as
measured by the QBPDS and a lesser number of treatment
sessions. IMPLICATIONS: The results indicate that a higher degree
of adherence to the clinical guidelines for non-specific low back
pain may enhance the efficacy of the physiotherapeutic process.
KEYWORDS: Clinical Guidelines; Therapist Adherence: Patient Out-
come. FUNDING ACKNOWLEDGEMENTS: This study was funded
by CZ-Actief in Gezondheid. CONTACT: g.rutten@kwazo.umcn.nl
Research Report Platform Presentation
568 Monday 4 June 14:00
VCEC Exhibit Hall A
STUDENT PERCEPTIONS OF NETWORK TECHNOLOGIES
INCORPORATED INTO A TRADITIONALLY-TAUGHT
PHYSIOTHERAPY MODULE
Finlay J; Glasgow Caledonian University, Glasgow, Scotland
PURPOSE: Computer advances have fuelled Internet use in
Higher Education (HE) so that network technologies (NT) are now
frequently embedded within teaching and learning (T&L) strategies
of traditionally-taught university modules. Despite a strong educa-
tional rationale for their use, evaluation of these blended-learning
environments is criticised for being predominantly quantitative and
tutor-focussed so that the true impact of NT from the student’s
perspective is unknown. This research was designed to address
this gap by evaluating physiotherapy student perceptions of optional
bespoke web-based materials (film-clips, quizzes, lecture-notes and
e-mail) on the Blackboard Virtual Learning Environment (VLE),
which were developed as additional support for classroom-based
instruction in a first-year anatomy/manual therapy module. Generated
data had the dual purpose of guiding local developments and
providing qualitative evidence for the wider educational debate.
RELEVANCE: Government initiatives regarding computer and life-
long learning skills, combined with drives from educational or-
ganisations have caused a shift towards blended-learning in HE
despite limited evaluative work, which has resulted in an urgent
need for rigorous qualitative research of student perspectives of
these changes. PARTICIPANTS: Thirty physiotherapy students were
recruited through individual written invitations forming one pilot
group (n=10 second-year students) and two main groups (n=20
first-year students, representing 26% of this intake), from which
twenty-seven finally participated. A purposeful stratified sampling
procedure (based principally on Blackboard usage, gender and age)
ensured proportional representation of these student characteristics.
METHODS: A qualitative research design using a hermeneutical
phenomenological approach was selected to explore student experi-
ences. A moderator (who was unfamiliar to participants) conducted
three homogenous focus groups using a semi-structured questioning
route and audio-recording of data. Field-notes were taken by the
researcher. ANALYSIS: Data were transcribed verbatim by the
researcher and analysed using Ritchie and Spencer’s five-stage
framework. To enhance analytical rigour, debriefing, reflexivity, field-
journal completion and person, investor and analysis triangulation
were incorporated. RESULTS: Three themes emerged: “Blackboard
is beneficial to me” encompassed markedly positive attitudes,
emphasising NT provide an essential student support system through
their role in communication facilitation and information retrieval.
Strong emotional benefits emerged here, which were previously
unreported in the literature. “Promoting my Blackboard use” explored
S153
motivations to using NT where tutor influences, usefulness of material
and the VLE structure were important motivators. “Enhancing
my Blackboard experience” emphasised student endorsement of
NT benefits by focussing on potential solutions to problems that
hampered their use. CONCLUSIONS: This rigorous qualitative
study addressed criticisms of current evaluative literature and found
physiotherapy students strongly endorsed the incorporation of NT
into a traditionally-taught module, where positive effects on personal
well-being, learning and computer skills were indicated. Benefits
outweighed drawbacks indicating motivation to utilise NT was high,
despite access being optional. Further qualitative work is required to
substantiate these exploratory findings, and to explore their impact
on clinical practice. IMPLICATIONS: Such strong student support,
coupled with existing sound educational rationale, suggests NT
enhance the academic experience of undergraduate physiotherapy
students. Removing these opportunities may be detrimental and
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
learning. FUNDING ACKNOWLEDGEMENTS: Glasgow Caledonian
University. CONTACT: j.finlay@gcal.ac.uk
ETHICS COMMITTEE: School of Health and Social Care Ethics
Committee, Glasgow Caledonian University; Queen Margaret Uni-
versity College Ethics Committee
Research Report Platform Presentation
2262 Monday 4 June 14:00
VCEC Meeting Rooms 1-3
THE CLINICAL ENCOUNTER EXPERIENCES OF PATIENTS
WITH NASOPHARYNGEAL CARCINOMA
Lee E1 , Twinn S2 , Moore A3 , Jones M4 ; 1 Physiotherapy
Department, Prince of Wales Hospital, Shatin, Hong Kong SAR;
2 The Nethersole School of Nursing, Chinese University of Hong
Kong, Hong Kong SAR; 3 Clinical Research Centre for Health
Professions, University of Brighton, United Kingdom; 4 School of
Engineering, University of Brighton, United Kingdom
PURPOSE: Health-care professionals and patients with cancer have
different perspectives on treatment priorities and clinicians often
underestimate patients’ preferences for care in the treatment. The
objective of this study was to identify factors that contribute to a
therapeutic clinical encounter experience from the perspectives of
nasopharyngeal carcinoma (NPC) survivors. RELEVANCE: NPC
is a commonly occurring cancer among Chinese, especially in
a relatively young population group. Since the disease carries
a favourable prognosis, sequelae following treatment become an
important concern for these patients. In recent decades, the call for
holistic patient focused and patient involvement rehabilitation prevails,
which is in contrast to the predominant biomedical model currently
operating in Hong Kong. PARTICIPANTS: Patients with their cancer
in remission were referred by the oncologists when musculoskeletal
symptoms in the neck were identified. Those reluctant to express
their experiences, or had signs of active metastases were excluded.
32 patients in total were invited to participate and one patient
refused. METHODS: The study objective required the adoption
of a qualitative approach. Semi-structured in-depth audio-taped
interviews in Cantonese were conducted in a regional teaching
hospital in Hong Kong. Sampling was continued until the point of
saturation at which the addition of new data from participants did not
provide additional information about the health-care experiences and
expectations of physiotherapy service. ANALYSIS: Data collection
and analysis using a grounded theory approach were concurrently
conducted. Peer review and respondent validation were carried
out to assure the study trustworthiness. RESULTS: Among the 31
participants, there were 18 males and 13 females with a mean age
of 50.4 years old. Radiotherapy remained the primary treatment
and 14 participants had radiotherapy as their sole treatment. Six
S154
participants had experienced a recurrence for their cancer with
operative treatment received. Average post radiotherapy completion
time was 64.2 months (range: 6-151 months). The participants
articulated the context they inhabited was one of illness, rather
than health. Patients expressed an un-equal power base between
themselves and clinicians and requested clinicians to listen to
them. The patient-clinician relationship was mainly an affective
orientation. Therapeutic alliance throughout the rehabilitation process
such as setting the treatment goal and fulfilling their functional
roles was expected. Putting the patient first, value-for-money
treatment, and appointment flexibility were key features of a quality
rehabilitation service. CONCLUSIONS: Three main themes were
identified: patient-clinician relationship, participation in therapeutic
alliance, and quality rehabilitation service provision. These, together
with the identified needs of the participants, contributed to the
participants’ perceived health-related quality of life. A constructive
clinical experience was perceived when their needs were met.
IMPLICATIONS: The findings highlight the importance of patient-
centeredness in treatment delivery in order to better meet the needs
of patients. A multifaceted role of clinicians exhibiting therapeutic
skills, critical appraisal skills, reflective skills, communication shills,
interpersonal skills, and educational skills is demanded. The findings
also facilitate the development and prescription of a multimodal
treatment relevant to the multiple realities of the participants.
KEYWORDS: nasopharyngeal carcinoma; qualitative study; health-
care experience. FUNDING ACKNOWLEDGEMENTS: The study
was funded by Sir Robert Black Trust Fund Postgraduate Scholarship.
CONTACT: edwinlee@cuhk.edu.hk
ETHICS COMMITTEE: Joint the Chinese University of Hong Kong –
New Territories East Cluster Clinical Research Ethics Committee
Research Report Platform Presentation
1591 Monday 4 June 14:00
VCEC Meeting Rooms 8&15
THE EFFECT OF A HOME STIMULATION PROGRAMME ON THE
NEURODEVELOPMENTAL STATUS OF CHILDREN INFECTED
WITH HIV IN SOWETO, SOUTH AFRICA
Potterton J1 , Stewart A2 , Cooper P3 ; 1 University of the
Witwatersrand, Johannesburg, South Africa; 2 University of the
Witwatersrand, Johannesburg, South Africa; 3 University of the
Witwatersrand, Johannesburg, South Africa
PURPOSE: The purpose of this study was to establish whether a
basic home stimulation programme would have an effect on the
neurodevelopmental status of young children infected with HIV living
in Soweto, South Africa. RELEVANCE: Paediatric HIV is a global
health concern. South Africa has more HIV infected children than any
other country in the world.HIV is neuropathic and has the potential
to cause a significant encephalopathy with resultant developmental
delay.All facets of development are affected. Physiotherapists in
South Africa have not been involved in the long term management
of children infected with HIV.No physiotherapy intervention studies
have been done on children with HIV and developmental delay.
PARTICIPANTS: 122 children under 2.5 years of age were recruited
for this study. All children had a confirmed diagnosis of HIV and
were cared for by a primary, adult caregiver.The caregivers of
consecutive children attending a paediatric HIV clinic, at Chris Hani
Baragwanath hospital in Soweto, who met the inclusion criteria were
asked to participate in the study. METHODS: This study was a
longitudinal, randomised clinical trial. 122 children were randomised
into either the experimental or control group.The children in the
experimental group received a home stimulation programme which
was updated every three months at a routine clinic visit.The children
in the control group received no intervention. All children were
assessed using the Bayley Scales of Infant development at baseline,
six months and twelve months.The Mental Developmental Index
(MDI)and Motor Developmental Index (PDI) were calculated for
each child at each visit.Ethical clearance and informed consent
WCPT 2007, Research Reports
were obtained prior to data collection. ANALYSIS: Demographic
data were summarised using descriptive statistics.Change in the
developmental status of the two groups over time was assessed using
ANOVA.Step wise multiple regression analysis was used to identify
predictors of developmental status as well as factors predictive of
improvement in developmental status over time. RESULTS: The
two groups were well matched for all variables at baseline.At
baseline 52% of the children had severe mental delay and 72%
had severe motor delay.The children in the experimental group
showed significantly greater improvement in MDI(p = 0.01) and
PDI (p = 0.02)scores over time. Weight-for-age and CD4 counts
were predictive of developmental status. CONCLUSIONS: Children
infected with HIV in South Africa are at risk of severe developmental
delay. A basic home stimulation programme resulted in sinificant
improvements in mental and motor development in young children
infected with HIV. IMPLICATIONS: Physiotherapist need to be
aware of the impact of HIV on the developing central nervous
system. Developmental assessment and management should be
an integral part of services for children infected with HIV.The long
term rehabilitation needs of children infected with HIV need to be
investigated. KEYWORDS: HIV, neurodevelopment, encephalopathy,
children. FUNDING ACKNOWLEDGEMENTS: Medical Research
Council of South Africa. AIDS Research Institute, University of the
Witwatersrand. CONTACT: Joanne.Potterton@wits.ac.za
ETHICS COMMITTEE: The Committee for Research on Human
Subjects, University of the Witwatersrand. (Certificate no: M03-05-
68)
Research Report Platform Presentation
883 Monday 4 June 14:20
PP Crystal Pavilion A
HIGH-LEVEL MOBILITY OUTCOMES FOLLOWING TRAUMATIC
BRAIN INJURY AND STROKE
Williams G; Epworth Hospital, Melbourne
PURPOSE: To evaluate the effectiveness of a high-level mobility
program for people with traumatic brain injury (TBI) and stroke.
RELEVANCE: High-level mobility is important for many employ-
ment, social, leisure and sporting roles, and quality of life in
general, particularly for the younger survivors of TBI and stroke.
PARTICIPANTS: Thirty-four consecutive referrals to the ‘Running
Group’. All participants were, or had been, receiving rehabilitation
following a neurological injury. Twenty-eight participants attended
the program. Sixteen had sustained a TBI, seven had suffered a
CVA, two were undergoing rehabilitation following neurosurgery for
brain tumours, two had suffered a hypoxic brain injury, and one
participant had multiple sclerosis. Participants were predominantly
male (20 males/8 females) and their average age was 33.2 years
(range 16-72 years). Time post-incident ranged from 4-207 months
(median 25 months) for the people with TBI and 1-110 months
(median 10 months) for non-TBI. All except two of the participants
had sustained an extremely severe TBI (post-traumatic amnesia >28
days, range 1-153 days). METHODS: Data were collected from 34
consecutive referrals to the ‘Running Group’. The primary outcome
measure was the high-level mobility assessment tool (HiMAT), and for
a smaller number of participants the Illinois Agility Test was also used.
Participants were reassessed following participation in a 3 month
high-level mobility program conducted twice weekly. ANALYSIS:
To investigate the effectiveness of the high-level mobility program,
individual and group change scores on the HiMAT were calculated.
The minimal detectable change (MDC) score for improvement on
the HiMAT (maximum score 54) has been established at 4 points.
The proportion of participants who exceeded the MDC was also
calculated. RESULTS: Six participants did not attend following their
initial assessment or dropped out after only a few weeks. HiMAT
scores for the remaining 28 participants on referral ranged from 6-
44 points (mean 20.3). The 3 month follow-up scores ranged from
12-51 points (mean 29.2). The mean HiMAT score change ranged
Platform Presentations, Monday 4 June
from 2-20 points (mean 8.9). Results also indicated that 92.9%
(26/28) of participants exceeded the MDC, demonstrating a clinically
significant change during the 3 month program. CONCLUSIONS:
Significant late-term recovery in high-level mobility was achieved
during a 3 month program. All except two participants demonstrated
clinically and statistically significant improvements. These results also
demonstrate that the HiMAT is responsive to change in mobility
limitations in chronic TBI and non-TBI populations. IMPLICATIONS:
High-level mobility is important for many people with neurological
impairments. Participation in many employment, social, leisure
and sporting activities requires mobility skills beyond independent
level walking. This study shows that significant high-level mobility
improvements can be achieved beyond the traditional acute recovery
phase. This program assists people with neurological impairments
to achieve better rehabilitation outcomes, and positively impacts
on societal participation and quality of life. KEYWORDS: traumatic
brain injury, mobility, therapy. FUNDING ACKNOWLEDGEMENTS:
This work was funded by Epworth Hospital, Melbourne, Australia.
CONTACT: gavin.williams@epworth.org.au
Research Report Platform Presentation
716 Monday 4 June 14:20
PP Crystal Pavilion B & C
THE INFLUENCE OF A CLINICAL MASTERS COURSE
IN MANUAL THERAPY ON THE UK CAREERS OF THE
PHYSIOTHERAPY POSTGRADUATES
Green A, Perry J, Harrison K; Physiotherapy & Dietetics
Department, Coventry University, Coventry, UK
PURPOSE: To explore the career pathways of a group of postgrad-
uate manual therapists and to identify the influence of the Masters’
education on those careers. RELEVANCE: Over the last decade in
the UK, there has been potential for manual therapists to extend
their roles and develop their careers in response to the new career
framework that has developed within the National Health Service
(NHS). The clinical masters’ programme at Coventry is designed to
enable the development of senior practitioners into specialist roles
within clinical practice, research and educational environments and
therefore it is of interest to explore whether they have met their
potential. PARTICIPANTS: All the postgraduates from the masters’
programme from 1994 to 2005 were invited to complete a postal
questionnaire (response rate 62.3%,n=48, with representation from
each year). METHODS: Survey methodology was used. The first
section of the questionnaire asked about the participants’ current
role and career pathway since their initial physiotherapy qualification.
The second section explored Masters’ education and its influence
on their current roles. ANALYSIS: Quantitative data was analysed
by Statistical Package for Social Scientists software and open ended
questions were categorised and quantified in terms of frequency of
response by two researchers independently and then consensus was
reached. RESULTS: All respondents are physiotherapists and the
majority remain in clinical practice (83%) with 14.5% within education
and 2% in research. Within the NHS career framework 6.2%
achieved Consultant Therapist roles, 14.4% were in Extended Scope
Practitioner posts and 16.6% were working as Clinical Specialists.
The mean time taken to achieve their current posts since completion
of the MSc., was 8.7 years for the Consultants, 1 year prior to
completion for the Clinical Specialists, at completion for the Extended
Scope Practitioners and 2.4 years for Lecturers. Positive contributions
from Masters’ education were identified and the most frequently
cited were improved confidence in self and confidence in practice
(n=24), the status of the qualification (n=23) and improved clinical
skills (n=20). Negative factors that were most frequently cited were
‘less clinical hands on’ within their roles (n=9), more management
responsibilities (n=5) and an increase in expectations from others of
the individual (n=4). CONCLUSIONS: Findings suggest that Masters’
education has enabled the participants to take on new specialist
roles and they are ‘fit for purpose’ in the new career framework.
S155
Extended Scope Practitioner and Clinical Specialist roles are usually
achieved during the programme which suggests that the taught and
clinical elements provide the essential attributes for these roles, whilst
Consultants and Lecturers complete the research project before
attaining their posts. As the first Consultant posts were created
in 2002, it may be that these posts will be achieved sooner after
completion of postgraduate programmes in the future. Factors that
encourage and discourage progress have been identified and further
work planned using focus group methodology will explore these
factors in greater depth. IMPLICATIONS: This research will enable
managers to offer opportunities and adequate support mechanisms
for these groundbreaking specialists who value clinical contact.
For educationalists, this research provides evidence that clinical
masters’ programmes prepare physiotherapists for advanced clinical
roles. KEYWORDS: manual therapy, physiotherapy careers, post-
graduate education. FUNDING ACKNOWLEDGEMENTS: Centre for
Higher Education Development at Coventry University. CONTACT:
a.green@coventry.ac.uk
ETHICS COMMITTEE: Coventry University Ethics Committee
Research Report Platform Presentation
689 Monday 4 June 14:20
VCEC Ballroom A
PHYSIOTHERAPY GUIDELINES FOR THE MANAGEMENT OF
OSTEOPOROSIS WHO IS USING THEM AND WHAT ARE THE
BARRIERS TO IMPLEMENTATION?
Donaghy M1 , Bulley C1 , Dow C2 ; 1 Queen Margaret University
College Edinburgh UK; 2 Stirling University Stirling UK
PURPOSE: Evidence based clinical guidelines are an important
route to ensuring the transfer of evidence into practice but are
physiotherapists using them? While scientific rigour underpins the
development of clinical guidelines the awareness, use or clinical
impact of physiotherapy clinical guidelines has not been evaluated.
This study aimed to find answers to the following questions; who has
access to and who is using the Chartered Society of Physiotherapy
osteoporosis guideline in the UK? How is it being implemented?
What are the perceived barriers to implementation? RELEVANCE:
Developing guidelines is costly. This study identifies barriers to their
use and makes recommendations for an action-research based
process of implementation and evaluation. PARTICIPANTS: 243
physiotherapists working in the National Health Service, independent
hospitals and private practice across the UK. METHODS: Survey
methodology enabled the collection of numerous responses from a
wide variety of geographical and clinical contexts. All aspects of the
study were informed by an advisory group including representation
from the National Osteoporosis Society and service users. The 26-
item questionnaire was developed from the literature and piloted in
three clinical sites. Closed and open questions addressed availability
and use of the guideline, implementation strategies and barriers.
Stratified sampling was conducted from strategic health authorities or
health boards throughout the UK, and from lists of 31 independent
hospitals and 102 private practitioners. Of a total random sample
of 558 services, 25% responded. ANALYSIS: Descriptive analysis
was performed using the SPSS version 12 and Excel. RESULTS:
62% of services had access to the guideline but only 35% were
using it. Physiotherapists most frequently using the guideline included
osteoporosis services (65%), specialist older people’s falls services
(50%) and rheumatology services (45%). Less than 18% of physio-
therapists working in out-patients, the community, and independent
hospitals used the guideline. Implementation strategies were under-
used, when employed, the most successful were education, local
opinion leaders and concensus projects. Perceived barriers to
implementation were lack of resources, training, time involvement,
and inapplicability to individual patients. CONCLUSIONS: Despite
a relatively low response rate, results from 243 sites indicate poor
awareness and use of the osteoporosis guideline throughout the UK.
The lack of implementation strategies suggests that physiotherapists
S156
and users need to develop a sense of ownership in their service,
with time to discuss and plan adaptations to practice where
appropriate, and to provide feedback into guideline review processes.
A deeper understanding of the implications of the guideline is
required, especially in services such as outpatients where the direct
relevance or recommendations to their clients may be less obvious.
IMPLICATIONS: This survey has highlighted a problem, but the
information supplied by questionnaire responses are limited in depth,
making it difficult to fully understand the reasons for poor guideline
implementation. An action research approach would enable the
integration of implementation strategies into a cycle of investigation
and change. As guidelines are integrated into practice, discussion
should identify and resolve problems. There should be input from
both users and non-users of clinical guidelines, and from clients
affected by their use. This information could be collected using focus
groups and individual interviews. KEYWORDS: Clinical guideline,
osteoporosis, physiotherapy. FUNDING ACKNOWLEDGEMENTS:
This study was funded by the Chartered Society of Physiotherapy
UK. CONTACT: mdonaghy@qmuc.ac.uk
ETHICS COMMITTEE: The study was approved by the Multiple Site
Research Ethics Committee
Research Report Platform Presentation
826 Monday 4 June 14:20
VCEC Exhibit Hall A
USING COMPUTERIZED ADAPTIVE TESTING TO IMPROVE THE
EFFICIENCY OF OUTCOMES DATA COLLECTION
Hart D1 , Mioduski J1 , Werneke M2 , Stratford P3 ; 1 Focus On
Therapeutic Outcomes, Inc.; 2 CentraState Medical Center;
3 McMaster University
PURPOSE: To describe development of a computerized adaptive
test (CAT) for patients with lumbar spine syndromes, determine
precision, discriminant validity and sensitivity to change of CAT
measures of functional status (FS), and compare efficiency of CAT
administration with an instrument containing all items. RELEVANCE:
Collecting outcomes data in a busy clinic can be time-consuming and
costly, but advances in computer technology have reduced patient
burden with little loss of measurement precision. PARTICIPANTS:
To develop the CAT, we analyzed retrospective data from 1,285
patients (46±16 yrs, min 14, max 100, 41% male) who were treated
for their lumbar syndromes in 56 outpatient clinics in 18 US states
and who completed 16 physical functioning (PF) items and 12 Back
Pain Functional Scale (BPFS) items. We implemented the CAT and
analyzed retrospective data from 5,971 patients (48±17 yrs, min 18,
max 92, 40% male) who were treated for their lumbar syndromes in
275 outpatient clinics in 30 US states and who routinely completed
the CAT during treatment. Project had formal IRB approval. All clinics
participated with Focus On Therapeutic Outcomes, Inc. METHODS:
In both data sets, patients entered FS data at intake and discharge
(self-report surveys). Data set 1: items were computer administered
in the same format as paper surveys. Data set 2: items were
administered using the CAT. ANALYSIS: Data set 1: intake data
were analyzed using Item Response Theory methods employing
a rating scale model (RSM) to test item unidimensionality, local
independence, differential item functioning (DIF) and fit. A CAT was
developed that selected items with maximum information given the
patient’s estimated level of FS and stopped when measurement
precision was high. Data set 2: intake and discharge CAT generated
FS measures were analyzed using: 1) global rating of change data
and receiver operating characteristic analyses to assess CAT FS
measure sensitivity to change; 2) ANCOVAs to test CAT FS measures
ability to discriminate patients by symptom acuity, gender, age
and surgical history. RESULTS: Data set 1: unidimensionality, local
independence and negligible DIF of 25 items were supported. RSM
fit the data well. The lumbar specific CAT used on average 7 items
(72% more efficient than using all items) to estimate FS measures.
Intake CAT FS measures discriminated patients by surgical history.
WCPT 2007, Research Reports
CAT FS measures were as precise as FS measures using all items.
Data set 2: a CAT FS change score of 7 out of 100 represented
clinically important change. CAT FS change scores discriminated
patients by acuity, age and surgical history. CONCLUSIONS: Results
supported: strong psychometric qualities of the item pool and validity
of CAT FS measures; the CAT process was more efficient than
using all items; the CAT could be implemented in a variety of
outpatient clinics; and CAT FS measures were responsive to clinical
change and had good discriminant validity. IMPLICATIONS: CATs
are being used to produce precise measures of FS in an efficient
way in busy outpatient clinics. As computer item banks expand,
more precise measures should evolve. Recognized gain in data
collection efficiency will facilitate assessment of more constructs
without undo patient burden. KEYWORDS: computerized adaptive
testing, item response theory, functional status, patient-reported
outcomes. FUNDING ACKNOWLEDGEMENTS: None. CONTACT:
dsailhart@verizon.net
ETHICS COMMITTEE: Focus On Therapeutic Outcomes, Inc.
Research Report Platform Presentation
2181 Monday 4 June 14:20
VCEC Meeting Rooms 1-3
LYMPHEDEMA THERAPY IN BREAST CANCER PATIENTS WITH
LYMPHEDEMA; A SYSTEMATIC REVIEW
Kärki A1 , Anttila H2 , Rautakorpi U2 ; 1 Satakunta University of Applied
Sciences, Pori, Finalnd; 2 National Research and Development
Centre for Welfare and Health (STAKES)/Finnish Office for Health
Technology Assessment (Finohta), Helsinki, Finland
PURPOSE: To review systematically the effects of lymphedema
therapy. RELEVANCE: Breast cancer treatments may disturb the
lymphatic drainage of the upper limb causing lymphedema. Lym-
phedema therapy methods are various, and national guidelines are
needed to support the use of the effective methods. PARTICIPANTS:
Operated breast cancer patients with upper limb lymphedema.
METHODS: Medline, Cinahl, DARE, HTA database, PEDro and the
Cochrane Library were searched for systematic reviews, guidelines
or HTA reports. We updated the latest review by a literature
search from January 2004 to May 2006 for controlled trials with
or without randomization. ANALYSIS: Two authors selected the
trials, three performed the final selection and two extracted the
data. Three authors assessed the methodological quality for studies.
Disagreements were solved by consensus. We used a list developed
by van Tulder (2003), 11 equally weighted criteria (yes=1, no=0,
don‘t know=0), resulting 0-11 points. From studies that had been
assessed in the earlier high quality reviews (Pecino 2004, Kärki
2001) we adopted the quality assessments. We also aimed to pool
the data of the trials. Synthesis: We were not able to pool any
studies because of clinical heterogeneity and lacking data. We made
a qualitative synthesis taking into account the methodological quality
of the studies, number of studies, type of design (RCR, CT), type
of outcome measure, statistical significance and consistency of the
findings. We applied a rating with five levels of evidence by van
Tulder (2000): 1. Strong evidence: generally consistent findings in
multiple (2) high quality RCTs. 2. Moderate evidence: generally
consistent findings in one high quality RCT and multiple (>2) low
quality RCTs. 3. Limited evidence: one RCT or generally consistent
findings in multiple RCTs or CTs. 4. Conflicting evidence: inconsistent
findings in multiple RCTs or CTs. 5. No evidence: no RCTs found
or just one CT. RESULTS: We identified 10 systematic reviews
and 18 trials (12 randomized). One high quality RCT compared
manual lymph drainage (MLD) with compression garments (CG)
to CG alone, and reported similar reduction of lymphedema in
both groups after 4 weeks, the greatest reduction in the first 2
weeks. Other studies were moderate to low quality, compared MLD
vs. simplified MLD (3 studies), MLD vs. compression sleeve (CS)
(2 studies), MLD vs. compression pump (3 studies), CS vs. no
treatment (1 study), CG vs. CS (1 study), resisted training vs. no
Platform Presentations, Monday 4 June
training (1 study), and 3 studies on devices (mechanical pressure
device, lower-level laser and ultrasound compared to self massage
and CS, placebo, and compression pump, respectively). CG or CS
was used as an add-on treatment in 14 studies. These studies
reported no differences between groups, but a 4-60% reduction of
lymphedema was found in all groups. MLD or compression pump
alone, lower-level laser or ultrasound had no effects on lymphedema.
CONCLUSIONS: CG are effective in reducing lymphedema. MLD
seems to have no additional effects when combined with CG
(2=Moderate evidence). Evidence of the effectiveness of other
lymphedema therapy methods was insufficient (5=No evidence).
IMPLICATIONS: CG or CS should be introduced to daily use
immediately in case of post-treatment lymphedema in breast cancer
patients. KEYWORDS: breast cancer, lymphedema, lymph ther-
apy, systematic review. FUNDING ACKNOWLEDGEMENTS: The
research project was funded by National Research and Development
Centre for Welfare and Health (STAKES)/Finnish Office for Health
Technology Assessment (Finohta). CONTACT: anne.karki@samk.fi
ETHICS COMMITTEE: Ethical committee in National Research and
Development Centre for Welfare and Health (STAKES)have approved
our study in 2006.
Research Report Platform Presentation
1787 Monday 4 June 14:20
VCEC Meeting Rooms 8&15
DISABILITY PREVALENCE AMONG A COHORT OF INPATIENTS
ADMITTED TO CHRIS HANI BARAGWANATH HOSPITAL SOUTH
AFRICA
Myezwa H1,2 ,
Stewart A1,2 ,
Nesara P1,2 ; 1 University
of the
Witwatersrand,Johannesburg, South Africa; 2 Chris hani
Baragwanath Hospital, Johannesburg, South Africa
PURPOSE: This study was conducted to gain insight and under-
standing of the prevalence of disability among people with HIV
using the ICF checklist with the overall aim to obtain a relevant
functional and participation picture of people living with HIV/AIDS
in South Africa RELEVANCE: In south Africa, HIV/AIDS places
a major burden on the health services. Physiotherapists already
treat people living with HIV/AIDS.The interventions thus far not
been informed by a relevant analysis of the impairments,activity
limitations and participation problems experienced by this population
of patients. PARTICIPANTS: A cohort of eighty in-patients admitted
to Chris Hani Baragwanath Hospital South were approached by
the clinical team and assessed by the research team. Fifty seven
female patients were assessed and 23 male patients. METHODS: A
cross sectional study was conducted. On admission and confirmation
of HIV status patients were approached by the clinical team.
Patients who consented were assessed using the ICF Checklist
with sub assessments using goniometry, dynamometry, and mini
mental test questions. ANALYSIS: Data was entered into the EPI
info programme. univariate analysis was conducted for frequencies
and bivariate analysis was conducted to determine associations.
RESULTS: The patient assessments presented a varied picture of
the different domains. The impairments of body functions showed
mild to complete impairments in the mental functions-73% (n=58)
with high numbers in the sub domains of emotion 61% (n=49),
energy 75% (n=60), disturbed sleep 71% (n=57). Eighty four percent
(n=66) had problems with sensory functions with the most problems
in the sub category of pain 81% (n=65). Impairments were also
high in the domains of cardiovascular, haematological, immunological
83% (n=67) and respiratory function domains-73% (n=58). Seventy
four percent (n=59) had impairments in neuro-musculoskeletal and
movement related functions with muscle power presenting as the
domain with the most problems 76% (n=61). Structural changes were
high in the respiratory structures 66% (n=53) and in structures of
the nervous system 49% (n=39). Other categories assessed were
the activity and participation in a number of life areas. Difficulties
were evident in over 60% of patients assessed in general tasks and
S157
demands, mobility, domestic life and in life areas involving society
and community life. Associations between the different categories
of health related states were found. Pain, respiratory functions,
functions of the digestive system, and neuromuscular and movement
related functions showed strong association with various activity
and participation restrictions. Some examples in brief are pain and
general tasks (p = 0.00), pain and mobility (p = 0.001), respiratory and
general tasks (p = 0.00), neuromuscular and domestic life (p = 0.02)
Strong associations are evident between impairments of mental
functions as a barrier to environmental factors such as support
and relationship in general (p = 0.04) with acquaintances (p = 0.007)
and to attitudes with various players such as health workers friends
and family (p = 0.05). CONCLUSIONS: Impairments related structural
changes and activity and participation limitations have been outlined.
Associations between the different domains are evident and can
be used to determine different support services and rehabilitation
programmes for PLWA IMPLICATIONS: A clear picture of the
functional limitations that PLWA present with has implications for
physiotherapists in service delivery and education. KEYWORDS:
HIV/AIDS, ICF, impairments, activity limitations and participation
restrictions. FUNDING ACKNOWLEDGEMENTS: Medical research
Council of South Africa (MRC); Carnegie Foundation. CONTACT:
hellen.myezwa@wits.ac.za
ETHICS COMMITTEE: Human research Ethical Committee (Medi-
cal) University of Witwatersrand
Research Report Platform Presentation
2071 Monday 4 June 14:40
PP Crystal Pavilion A
THE EFFICACY OF TWO COMMUNITY-BASED EXERCISE
PROGRAMS IN ADULTS WITH A TRAUMATIC BRAIN INJURY:
A RANDOMIZED CONTROLLED TRIAL
Hassett L1,2 , Moseley A2 , Tate R3 , Harmer A2 , Fairbairn T4 ,
Leung J5 ; 1 Brain Injury Rehabilitation Unit, Liverpool Health
Service, Sydney, Australia; 2 School of Physiotherapy, University of
Sydney, Sydney, Australia; 3 Rehabilitation Studies Unit, University
of Sydney, Sydney, Australia; 4 Brain Injury Rehabilitation Unit,
Westmead Hospital, Sydney, Australia; 5 Brain Injury Rehabilitation
Unit, Royal Rehabilitation Centre Sydney, Australia
PURPOSE: The primary objective of this study was to compare
the effectiveness of a supervised fitness centre-based exercise
program to an unsupervised home-based exercise program on
cardiorespiratory and psychosocial outcomes in adults who have
sustained a traumatic brain injury (TBI). The secondary objective
was to compare the compliance rates between groups to determine if
one program is superior in increasing physical activity. RELEVANCE:
TBI is the leading cause of long-term disability in children and
young adults. Previous research has shown that people who have
sustained a TBI are less physically active and more deconditioned
than the normal population. Exercise programs are prescribed
by physiotherapists to reverse deconditioning; however there is
uncertainty about the effectiveness of these exercise programs. The
results of this study will provide physiotherapists with high-level
external evidence to guide the prescription of exercise programs
for people with TBI. It will also allow funding bodies to fund
interventions that have been rigorously examined. PARTICIPANTS:
Sixty two participants were recruited from three Sydney metropolitan
brain injury rehabilitation units. Inclusion criteria were: very severe
or extremely severe TBI; ability to walk at a speed exceeding
1m/s; and hospitalisation for at least 1-month. Participants were
predominantly young (mean age=34yr), deconditioned (mean level
achieved on modified 20-metre shuttle test=6), males (85%) who
had sustained extremely severe injuries (mean length posttraumatic
amnesia=43 days) an average of 3-months before entry into the
study. Almost half of the participants sustained their injury from a
road traffic accident (48%). METHODS: A multi-centre, assessor-
blinded, parallel group, randomized controlled trial was conducted.
S158
Participants were randomly allocated to one of two groups: the
experimental group participating in a 12-week supervised fitness
centre-based exercise program, and the control group participating in
a 12-week unsupervised home-based exercise program. ANALYSIS:
Analysis of covariance was used to analyze the difference between
groups. The primary outcome was a measure of cardiorespiratory
fitness, the modified 20-metre walk/run shuttle test. Compliance
rates were determined by the number of sessions completed in
accordance with training logs. Paired t-tests were used to analyze
factors influencing compliance. RESULTS: The fitness centre-based
group was significantly more compliant than the home-based group in
completing the 12-week exercise program. Participants in the home-
based group were more likely to be compliant if they were more
physically impaired, had slower processing speed or had a history
of exercising in the home environment. CONCLUSIONS: People
who have sustained a TBI are likely to be more physically active
if prescribed a fitness centre-based exercise program rather than a
home-based exercise program on discharge from hospital. Future
research is needed to examine if a fitness centre-based program
increases physical activity in other domains (e.g. occupational)
in the short and long-term. IMPLICATIONS: TBI rehabilitation
services should develop links with local fitness centres to facilitate
effective community-based exercise programs. Physiotherapists can
play an active role in establishing these programs through edu-
cation and liaison with personal trainers and fitness centre staff.
KEYWORDS: Fitness Exercise; Traumatic Brain Injury. FUNDING
ACKNOWLEDGEMENTS: Motor Accidents Authority of NSW; Sir
Robert Menzies Memorial Scholarship in Allied Health. CONTACT:
leanne.hassett@sswahs.nsw.gov.au
ETHICS COMMITTEE: Sydney South West, Western Sydney, the
University of Sydney and Royal Rehabilitation Centre Sydney Human
Research Ethics Committees
Research Report Platform Presentation
943 Monday 4 June 14:40
VCEC Ballroom A
AWARENESS: A KEY DETERMINANT OF GUIDELINE
IMPLEMENTATION? RESULTS OF A THEORY-BASED
CROSS-SECTIONAL SURVEY IN THE NETHERLANDS
Rutten G, Rutten S, Kremers S, Harting J; Faculty of Health
Sciences, Department of Health Promotion and Health Education,
Maastricht University, the Netherlands
PURPOSE: This study aimed to assess physiotherapists’ adherence
to the Dutch guidelines for non-specific low back pain, ascer-
taining which determinants were related to guideline adherence,
and analysing the role of physiotherapists’ awareness of their
performance in this relationship. RELEVANCE: Guideline adherence
has been found to be only moderate. This may negatively influence
the quality of care. Interventions to enhance adherence have been
found to be of limited effectiveness. This might be due to the absence
of a theoretical framework. Such a framework should at least include
“awareness”, as for other complex behaviours this determinant has
been shown to be a major influence. PARTICIPANTS: At random,
1,500 primary care physiotherapists were invited to participate
(response rate 31.5%). Respondents’ mean age was 42.3 years (SD
= 8.9), 49.3% were female, and years of working experience ranged
from under five to over 30 years (median category 16-25 years).
METHODS: Through a cross-sectional survey, guideline adherence
was objectively measured by means of validated clinical vignettes
and subjectively by asking about the physiotherapists’ perceived
level of adherence. A theoretical framework combining Rogers’
Innovation Decision Process and Weinstein’s Precaution Adoption
Process Model guided the measurement of adherence determinants,
which resulted in internally consistent scales. ANALYSIS: Descriptive
statistics were used to express objective and perceived guideline
adherence. Cross-tabulations of both measures showed whether
or not physiotherapists’ perceptions of adherence were realistic
WCPT 2007, Research Reports
(i.e., “aware”). Multiple linear regression analyses determined the
factors related to adherence for all respondents, and, separately,
for physiotherapists with realistic perceptions of adherence. Similar
regression analyses established the determinants associated with
this awareness of adherence. RESULTS: The average guideline
adherence rate was 50.4% (SD = 16.8). Only 38.5% of the physio-
therapists held realistic perceptions of their personal adherence. For
all respondents, adherence was related to the amount of attention
paid to the guidelines and to the perceived relative advantage
(R2 = 0.06). For physiotherapists with realistic perceptions (i.e.,
who were “aware”), adherence was again related to the amount of
attention paid and to a greater extent to the relative advantage,
but also to the presence of so-called facilitators (R2 = 0.31). In
turn, awareness of adherence was most strongly associated with the
perceived social norm. CONCLUSIONS: This study illustrates the
benefits of the application of a theoretical framework in guideline
adherence studies. From the differences in explained variance of
adherence between all physiotherapists and those who were “aware”
(D = 25%), we conclude that awareness of adherence is a key
factor in guideline implementation. More realistic perceptions may
be achieved by influencing the physiotherapists’ response to the
opinions of others (social norm). However, the interpretation of
our findings may be limited because of the cross-sectional design
and the moderate response rate. IMPLICATIONS: To enhance the
implementation of guidelines, interventions should first of all take
into account physiotherapists’ awareness of personal adherence.
Suggestions for future implementation studies include using a
longitudinal design to ascertain the determinants that actually predict
adherence. In doing so, the use of an extended theoretical framework
is strongly recommended. KEYWORDS: clinical guidelines; guideline
adherence; awareness. FUNDING ACKNOWLEDGEMENTS: The
work was unfunded. CONTACT: g.rutten@kwazo.umcn.nl
Research Report Platform Presentation
2202 Monday 4 June 14:40
VCEC Meeting Rooms 8&15
THE EXTENT OF DELAY OF LANGUAGE, MOTOR AND
COGNITIVE DEVELOPMENT IN HIV POSITIVE INFANTS
Baillieu N, Potterton J; University of the Witwatersrand
PURPOSE: To determine the extent of delay in acquisition of lan-
guage, cognitive and motor skills in HIV positive infants. Secondary
objective: to determine the skill which is most adversely affected by
HIV. RELEVANCE: It has been found world-wide, that HIV-positive
children have significantly greater neurological dysfunction than their
HIV negative counterparts. There has been very little research
carried out on this subject in Africa and developing countries, where
the HIV pandemic is critical, and intervention is greatly needed. It
is necessary for education regarding the developmental problems of
HIV, and therefore the structuring of policy regarding management of
such patients. PARTICIPANTS: A power calculation revealed that a
sample of 40 infants was needed. The infants were aged between 18
and 30 months, and were antiretroviral naive. The sample was one of
convenience from a paediatric HIV clinic at Chris Hani Baragwanath
Hospital in Soweto, Johannesburg. METHODS: The infants were
assessed using the Bayley Scales of Infant Development II (BSID
II). The facet scores of the BSID II were used for descriptive analysis
of language, cognitive and gross and fine motor function. The mental
and psychomotor indices of the BSID II were used to determine the
extent of delay of mental and motor development. A standardized
socioeconomic questionnaire was administered to evaluate the
socioeconomic backgrounds of the infants. ANALYSIS: A T-test was
used to compare chronological age and developmental age (as
determined by the BSID II) in both mental and motor development.
Descriptive analysis of gross and fine motor development, as well as
global language development was carried out. The BSID II mental
and motor scale scores were used to determine the severity of mental
and motor delay. Socioeconomic questionnaires were descriptively
Platform Presentations, Monday 4 June
analysed. RESULTS: Both cognitive and motor development were
found to be significantly delayed, with motor development being
the skill most adversely affected by HIV, and more specifically
gross motor function. Global language development was delayed
in 82.5% of the sample. The socioeconomic status of the sample
was low, which has an added negative effect on neurodevelopment.
CONCLUSIONS: Neurodevelopment is affected in infants with HIV.
Motor development is the skill most adversely affected by the disease,
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
up once a diagnosis has been made. They may benefit from early
intervention, specifically by physiotherapists with regards to their
delay in gross motor function. KEYWORDS: HIV, Neurodevelopment,
Infants. FUNDING ACKNOWLEDGEMENTS: Medical Research
Council of South Africa; Aids Research Institute, University of the
Witwatersrand. CONTACT: nicole.baillieu@wits.ac.za
ETHICS COMMITTEE: Obtained from the Human Ethics Research
Committee of the University of the Witwatersrand
Research Report Platform Presentation
2276 Monday 4 June 15:00
PP Crystal Pavilion A
SERIAL CASTING FOR THE TREATMENT OF ELBOW
CONTRACTURES IN ADULTS WITH TRAUMATIC BRAIN
INJURY: A RANDOMIZED CONTROLLED TRIAL
Moseley A1 , Hassett L1,2 , Leung J3 , Clare J4 , Herbert R1 ,
Harvey L5 ; 1 School of Physiotherapy, University of Sydney,
Sydney, Australia; 2 Brain Injury Rehabilitation Unit, Liverpool
Health Service, Sydney, Australia; 3 Brain Injury Rehabilitation
Unit, Royal Rehabilitation Centre Sydney, Sydney, Australia; 4 Brain
Injury Rehabilitation Unit, Westmead Hospital, Sydney, Australia;
5 Rehabilitation Studies Unit, Northern Clinical School, Faculty
of Medicine, University of Sydney, Sydney, Australia
PURPOSE: The aim of this randomized controlled trial was to
compare serial casting with 1 hour of daily stretch for the treatment
of elbow flexion contracture after traumatic brain injury (TBI).
RELEVANCE: Contracture, or loss of joint mobility, is a common
problem after TBI. Physical therapists treat contracture with passive
stretch. The effects of stretch have been investigated in two
systematic reviews and a modest number of randomized controlled
trials, but the results of these trials and reviews are not conclusive.
Serial casting has not been compared to stretch of shorter duration.
This comparison is of importance because physical therapists are
often faced with a choice between these two treatment alternatives.
PARTICIPANTS: Twenty-six adults with elbow flexion contracture
after TBI participating in multidisciplinary inpatient rehabilitation.
All subjects completed the study. METHODS: Participants were
randomized to receive either serial casting or a program of 1 hour
of daily stretch for 2 weeks. Outcomes were measured at baseline,
after 2 weeks, then 1 day and 4 weeks later. The primary outcome
was passive elbow extension using a torque-controlled procedure.
ANALYSIS: All analyses were by intention-to-treat. Between-group
differences were examined with analysis of covariance using a linear
regression approach. RESULTS: At 2 weeks, serial casting reduced
contracture by an average of 22 degrees (95% CI 13 to 31) compared
to the stretch group. One day later this effect had decreased to 11
degrees (95% CI 0 to 21 degrees). The effect had almost completely
disappeared at the 4-week follow-up (mean 2 degrees, 95% CI −13
to 17). CONCLUSIONS: Serial casting produces greater short-term
reductions in elbow flexion contracture than a program of 1 hour of
stretch per day in adults with TBI. These effects are not sustained.
Future research could determine if administration of a more
aggressive stretching protocol in the period following cast removal
could maintain the increase in joint range. IMPLICATIONS: Serial
casting induces transient increases in range of motion. Intensive
S159
prolonged stretches and motor training after casting are probably
required to maintain these gains. KEYWORDS: traumatic brain
injury, stretching, contracture. FUNDING ACKNOWLEDGEMENTS:
Motor Accidents Authority of New South Wales, Australia. CONTACT:
amoseley@mail.usyd.edu.au
ETHICS COMMITTEE: University of Sydney, South Western Sydney
and Western Sydney Area Health Services, Royal Rehabilitation
Centre Sydney and Princess Alexandra Hospital
Research Report Platform Presentation
1862 Monday 4 June 15:00
PP Crystal Pavilion B & C
COMMENCING TAUGHT POST-QUALIFYING EDUCATION:
BARRIERS FACING PHYSIOTHERAPISTS
Glover P1, , Bulley C2 ; 1 NHS Lanarkshire, Glasgow, Scotland,
United Kingdom; 2 Queen Margaret Uiversity College, Edinburgh,
Scotland, United Kingdom
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
(MLS). RELEVANCE: With rapidly increasing knowledge there is
a requirement for continuing professional development to enable
evidence-based practice. Taught MLS provides guidance in this
development; greater understanding of barriers facing physiother-
apists in undertaking MLS will enable facilitation in clinical and
educational environments. PARTICIPANTS: A purposive sample of
9 volunteers (8 female, 1 male, mean age: 36 ±7.29) was recruited.
Participants were: engaged in part-time taught MLS; registered with
the United Kingdom’s professional regulatory body; working within
the National Health Service, and possessed a minimum of four
years clinical experience. METHODS: A qualitative, interpretative,
phenomenological study was undertaken with the assumption that
reality is individual and all viewpoints are valid. Following ethical
approval, individual, semi-structured interviews (mean time: 67 min-
utes) were conducted using an interview schedule. Questions were
derived from a literature review and two developmental interviews
with Master’s graduates. ANALYSIS: Interviews were transcribed
verbatim and a summary was member-checked to ensure that
initial interpretations were appropriate. Data analysis was conducted
using the framework of interpretative phenomenological analysis.
This focuses on analysis and interpretation of the participants’
words in context to gain deeper understanding of their experiences.
Quotations that communicated similar meanings and ideas were
grouped to form themes. Where conceptual links were identified, key
themes emerged. Peer verification of this analysis was conducted
to increase rigour and involved reflexive discussions with an
experienced qualitative researcher. RESULTS: Three key themes
emerged that described the barriers to MLS in different environments:
educational, working, and social. There were several barriers
associated with the educational environment; participants frequently
expressed self-doubt regarding academic abilities, often related
to past educational experiences. They also described negative
emotions due to unfamiliarity with the environment and content of
MLS. These seemed particularly strong amongst participants who
were only qualified to diploma level, as they felt their previous
education did not prepare them for MLS. Barriers associated with the
working context included a lack of professional support, especially in
relation to funding and study leave. These led to social barriers as
clinicians were anxious about having insufficient time and finances
to fulfil their social roles. CONCLUSIONS: The experiences of this
group of post-qualifying students suggest that clinicians who have
not previously studied at degree level may face greater barriers to
commencing MLS than those with a degree, due to self-doubt and
unfamiliarity with higher education. Prior to commencing their study
participants had perceived the experience of MLS as potentially
threatening, and were concerned about the time and financial
resource implications. Further exploratory research into how to
S160
effectively address the barriers highlighted in this study is required.
IMPLICATIONS: The perceived barriers to MLS communicated by
this group of physiotherapists may be reduced by improving links
between clinical and educational environments, thereby increasing
familiarity and enabling discussion of the resources required for MLS.
This may lead to greater professional and financial support for qual-
ified physiotherapists who wish to commence MLS. KEYWORDS:
Barriers, Master’s Education. FUNDING ACKNOWLEDGEMENTS:
Unfunded. CONTACT: peter.glover@lanarkshire.scot.nhs.uk
ETHICS COMMITTEE: Queen Margaret University College Research
Ethics Committee, Edinburgh, Scotland, United Kingdom. NHS
Lanarkshire Research Ethics Committee, Scotland, United Kingdom.
Research Report Platform Presentation
1357 Monday 4 June 15:00
VCEC Ballroom A
ADVICE FOR THE MANAGEMENT OF LOW BACK PAIN: DO
RANDOMISED CONTROLLED TRIALS REFLECT CURRENT
CLINICAL GUIDELINES?
Liddle S1 , Gracey J2 , Baxter D3 ; 1 Health and Rehabilitation
Sciences Research Institute, University of Ulster, Shore Road
Newtownabbey, Co. Antrim, BT37 0QB, Northern Ireland; 2 School
of Physiotherapy, University of Ulster, Shore Road Newtownabbey,
Co. Antrim, BT37 0QB, Northern Ireland; 3 School of Physiotherapy,
University of Otago, Dunedin, New Zealand
PURPOSE: To synthesise evidence from randomised controlled trials
(RCTs) relating to the effectiveness of advice for low back pain
(LBP), to compare the advice being offered to people with acute,
subacute and chronic LBP, and to evaluate the extent to which this
is congruent with current clinical guidelines. RELEVANCE: Advice
is one of the principal ways that physiotherapists communicate
with patients, and is recognised as playing an important role in
the management of LBP. More information is needed about the
effectiveness of advice as it is given, and how this is reflected
in current clinical guidelines. PARTICIPANTS: Thirty-nine RCTs,
involving 7,347 participants, qualified for inclusion based on their
methodological quality. METHODS: Systematic review of RCTs using
advice, either alone or with another intervention, in accordance
with the QUOROM guidelines and the Cochrane Collaboration Back
Review Group Guidelines for Systematic Reviews (1997; 2003):
methodological assessment identified RCTs of ‘high’ or ‘medium’
methodological quality, based on their inclusion of at least 50%
of the specified internal validity criteria. Outcome measures were
analysed based on five recommended core outcome domains.
ANALYSIS: Statistical pooling of results was not appropriate due
to the heterogeneity of trials. An intervention was considered
positive if there was a significant difference (p < 0.05), in one of
the recommended categories of outcome measure post-treatment,
when compared to other interventions provided in the trial. For
those trials using no outcome measures within the recommended
categories, a significant difference in two other outcome measures
was stipulated. RESULTS: Twenty three percent of trials investigating
acute LBP had a positive outcome, compared to 86% and 74% of
subacute and chronic LBP trials respectively. Advice as an adjunct
to exercise was the most common form of treatment for acute and
chronic LBP. Advice as part of a back school was most commonly
used for subacute LBP; these trials generally demonstrated long-
term positive results. A wide variety of outcome measures were
used, making comparisons between treatment outcomes difficult.
CONCLUSIONS: The type pf advice provided to people with LBP
within RCTs varies considerably depending on symptom duration.
This has important implications for clinical practice, and for the design
of further clinical trials in this area. Findings from this review support
current recommendations that advice to stay active is sufficient for
acute LBP; however it appears that RCTs do not commonly reflect
these recommendations. IMPLICATIONS: The results of this review
tentatively support the use of advice as part of a back school
WCPT 2007, Research Reports
approach for subacute LBP, however trials in this area are limited and
generally of poor quality. Given that the effectiveness of treatment for
subacute symptoms can directly influence the likelihood of chronicity,
these results would suggest that education and awareness of the
causes and consequences of back pain may be a valuable treatment
component for this patient subgroup. For chronic LBP there is strong
evidence to support the use of advice to remain active in addition to
individually tailored advice relating to the most appropriate exercise,
and/or functional activities to promote active self-management.
KEYWORDS: Advice, low back pain, randomised controlled trials.
FUNDING ACKNOWLEDGEMENTS: This project was funded as
part of a PhD studentship by the Department for Employment and
Learning (Northern Ireland). CONTACT: SD.Liddle@ulster.ac.uk
Research Report Platform Presentation
1208 Monday 4 June 15:00
VCEC Exhibit Hall A
IMPLEMENTING AN INTEGRATED ELECTRONIC OUTCOMES
AND ELECTRONIC HEALTH RECORD PROCESS TO CREATE
A FOUNDATION FOR CLINICAL PRACTICE IMPROVEMENT
Deutscher D1 , Hart D2 , Horn S3 , Dickstein R4 , Gutvirtz M1 ;
1 Maccabi Healthcare Services – HMO, Tel-Aviv, Israel; 2 Focus On
Therapeutic Outcomes, Inc., White Stone, VA, USA; 3 Institute for
Clinical Outcomes Research, Salt Lake City, Utah, USA; 4 University
of Haifa, Mount Carmel, Haifa, 31905, Israel
PURPOSE: Clinical practice improvement (CPI) processes are
dependent on routine collection of clinical outcomes, process and
patient characteristics. Our purposes were to 1) describe the
integration of electronic functional status (FS) outcomes into an
electronic health record (EHR); 2) examine the applicability of on-
going outcomes data collection in a large physical therapy service in
relation to patient and clinic burden; and 3) examine the potential
for using the FS/EHR database in CPI projects. RELEVANCE:
The conceptualization of functioning as described in the Guide to
Physical Therapist Practice appears consistent with ICF’s definition
of activities and participation. Therefore, functioning, as described
by a patient’s ability to perform activities, appears important when
establishing treatment goals in physical therapy. However, for
patients with neuro-musculoskeletal disorders, integration of routine
measures of FS and EHR data in physical therapy settings are
uncommon. PARTICIPANTS: Data were examined from 21,523
consecutive adult patients (mean age=50.6, SD=16.3, range=18-99,
58.9% women) referred to physical therapy for treatment of functional
deficits secondary to neuro-musculoskeletal disorders. METHODS:
Process and patient characteristic data were entered into the EHR.
Outcomes data were collected using computerized adaptive testing
technology in 11 outpatient clinics and were integrated into the EHR.
Participation rate (percent of all episodes of care entered into the
EHR with FS intake data) and completion rate (percent of episodes
with FS intake data that also had FS discharge data) were calculated.
Time required to enter FS data by the patient and administrative
time required to manage the patient during FS data collection per
episode were collected. ANALYSIS: Descriptive statistics were used
for analyses. RESULTS: After one year, average participation rate per
clinic reached 79.8% (range=52.7%-100%) and average completion
rate per clinic reached 45.1% (range=19.3%-64.7%). Average survey
entry time per patient was 03:37 minutes (SD=02:19). Maximum
estimate of average administrative time per patient was 9.6% of
overall episode time. The integrated FS/EHR database contained
data from 5,039 episodes of care for 4,845 patients with both intake
and discharge FS data including EHR patient demographic and
treatment process data. CONCLUSIONS: The results indicate that
the collection of routine outcomes measurements in a large public
physical therapy service is realistic. Participation and completion
rate goals of 90% and 65%, respectively, appeared feasible.
Improving completion rates through clinician’s education of clinical
use of outcomes, and if needed, by linking outcomes and provider
Platform Presentations, Monday 4 June
payment, seems promising. Integrated EHR/outcomes data produced
a valuable CPI platform for service evaluation and outcomes
research. Additional variables needed for more comprehensive
CPI analyses were identified. IMPLICATIONS: The electronic
environment used to register health records and measure outcomes
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
practice, so educational processes can be applied to improve clinical
outcomes. KEYWORDS: Clinical Practice Improvement, Outcomes,
Functional Status, Electronic Health Record, Computerized Adaptive
Testing. FUNDING ACKNOWLEDGEMENTS: The work not funded.
CONTACT: dandeuts@netvision.net.il
ETHICS COMMITTEE: IRB, Maccabi Health Care Services – HMO,
Tel-Aviv, Israel
Research Report Platform Presentation
2283 Monday 4 June 15:20
PP Crystal Pavilion A
ECOLOGICAL VALIDITY OF CLINICAL GAIT ASSESSMENT IN
ADULTS WITH TRAUMATIC BRAIN INJURY
Moseley A1 , Canning C1 , Tate R2 , Wong D3 ; 1 School of
Physiotherapy, University of Sydney, Sydney, Australia;
2 Rehabilitation Studies Unit, Northern Clinical School, Faculty
of Medicine, University of Sydney, Sydney, Australia; 3 Brain Injury
Rehabilitation Unit, Liverpool Health Service, Sydney, Australia
PURPOSE: To evaluate the ecological validity of clinical gait
assessments that use a dual-task performance paradigm in adults
with traumatic brain injury (TBI). RELEVANCE: After TBI, walking is
generally slower than in the able-bodied population. An important
focus of physiotherapy intervention is to re-establish a more
efficient gait that can meet the demands of everyday environments.
Physiotherapists need ecologically valid gait tests that can predict
and provide information about a person’s ability to walk in a
real-life environment. Agreement between three commonly used
gait tests (comfortable and fast pace over a 10-m distance and
a 6-min walk test) and walking in real-life environments has
previously been reported to be poor. PARTICIPANTS: Forty-eight
adults with traumatic brain injury participating in multidisciplinary
inpatient rehabilitation, including physiotherapy gait training and an
occupational therapy shopping group. METHODS: Walking speed
was measured in the clinic using four comfortable 10-m walk tests
(walking alone, walking while performing a concurrent cognitive
task, walking while performing a concurrent manual task, and
walking while performing both the cognitive and manual tasks
concurrently). Walking speed was also measured covertly in three
real-life environments (ie, a corridor in the rehabilitation unit, a car
park of a metropolitan shopping centre, and inside a metropolitan
shopping centre). ANALYSIS: A matrix of intraclass correlation
coefficients (ICC; type 1, 1) was calculated to determine the
agreement between the speed in the clinical gait tests and in the real-
life environments. RESULTS: Highest agreement occurred between
walking while performing a concurrent cognitive task and walking
in the real-life environments (ICC 0.50 to 0.71). CONCLUSIONS:
Clinical gait tests that involve walking while performing concurrent
tasks have higher ecological validity than walking alone. These tests
may better mimic the processing demands of walking in real-life
environments, where the person with TBI needs to monitor and
respond to the movement of other people and objects in addition
to attending to their walking. IMPLICATIONS: Clinical gait testing
should include a concurrent task component as this may better
simulate the requirements needed in functional walking. Furthermore,
practice in real-life environments should be incorporated into a
walking training program for people with TBI. KEYWORDS: traumatic
brain injury, walking, validity. FUNDING ACKNOWLEDGEMENTS:
S161
Motor Accidents Authority of New South Wales, Australia. CONTACT:
amoseley@mail.usyd.edu.au
ETHICS COMMITTEE: University of Sydney Human Research
Ethics Committee and South Western Sydney Area Health Service
Research Ethics Committee
Research Report Platform Presentation
2645 Monday 4 June 15:20
PP Crystal Pavilion B & C
FACTORS FACILITATING PHYSIOTHERAPISTS TO UNDERTAKE
TAUGHT MASTER’S EDUCATION
Glover P1 , Bulley C2 ; 1 NHS Lanarkshire, Glasgow, Scotland,
United Kingdom; 2 Queen MArgaret University College, Edinburgh,
Scotland, United Kingdom
PURPOSE: To explore the personal perspectives of physiotherapists
regarding the factors that facilitated them to commence their taught
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
continuing professional development (CPD) to enable evidence-
based practice. Taught MLS provides guidance in this development.
Greater understanding of the factors assisting clinicians to undertake
MLS will enable more effective facilitation in clinical and educational
environments. PARTICIPANTS: A purposive sample of 9 volunteers
(8 female, 1 male, mean age: 36 ±7.29) was recruited. Participants
were: engaged in part-time taught MLS; registered with the
United Kingdom’s professional regulatory body; working within
the National Health Service, and possessed a minimum of four
years clinical experience. METHODS: A qualitative, interpretative,
phenomenological study was undertaken with the assumption that
reality is individual and all viewpoints are valid. Following ethical
approval, individual, semi-structured interviews (mean time: 67
minutes) were conducted using an interview schedule. Questions
were derived from a literature review, two developmental interviews,
and two pilot interviews. ANALYSIS: Interviews were transcribed
verbatim and a summary was member-checked to ensure that
initial interpretations were appropriate. Data analysis was conducted
using the framework of interpretative phenomenological analysis.
This focuses on analysis and interpretation of the participants’
words in context to gain deeper understanding of their experiences.
Quotations that communicated similar meanings and ideas were
grouped to form themes. Where conceptual links were identified,
key themes emerged. Peer verification of this analysis was
conducted to increase rigour and involved reflexive discussions
with an experienced qualitative researcher. RESULTS: Four key
themes emerged that described the facilitating factors in different
environments: social, educational, clinical, and working. Within the
Social Environment, participants commented that a settled home
life and future domestic plans influenced their MLS commencement.
There were several facilitators associated with the Educational
Environment; some individuals expressed positive emotions towards
learning, while others were seeking the challenge of MLS. Also, the
content of the Master’s programmes being clinically relevant and
accredited, and the flexibility of the modular structure were motivating
factors for some participants. Regarding the Clinical Environment;
some individuals indicated a desire to develop their skills within
their professional role, or for career progression. Finally, Working
Environment facilitation came from the provision of professional
support, the expectation for CPD, and interactions with colleagues
with experience of MLS. CONCLUSIONS: The experiences of this
group of post-qualifying students suggest that the factors facilitating
them to undertake MLS were varied and individualised. Their
facilitators could be practical, personal or professional in nature.
Further research into the facilitators to undertake various types of
post-qualifying education is required to generate a body of evidence
to help develop effective mechanisms for supporting clinicians in
S162
their formal CPD. IMPLICATIONS: Educational institutions may need
to consider promoting the professional and personal benefits of
undertaking their programmes to encourage clinician enrolment.
Whereas employers offering practical professional support may
also aid facilitation. KEYWORDS: Facilitation, Master’s Education.
FUNDING ACKNOWLEDGEMENTS: Unfunded. CONTACT: pe-
ter.glover@lanarkshire.scot.nhs.uk
ETHICS COMMITTEE: Queen Margaret University COllege Re-
search Ethics Committee; Lanarkshire Research Ethics Committee
Research Report Platform Presentation
1493 Monday 4 June 15:20
VCEC Ballroom A
A THEORY-BASED QUALITATIVE STUDY TO EXPLORE
POSSIBLE DETERMINANTS OF GUIDELINE ADHERENCE
AMONG DUTCH PHYSIOTHERAPISTS
Harting J1 , Rutten S2 , Rutten G3 , Kremers S1 ; 1 Department of
Health Education and Promotion, Maastricht University, Maastricht,
the Netherlands; 2 Praxis für Physiotherapie und Manuelle Therapie,
Aachen, Germany; 3 Centre for Quality of Care Research (WOK),
UMC St Radboud Nijmegen, Nijmegen, the Netherlands Practice
for Physiotherapy and Manual Therapy, Uden, the Netherlands
PURPOSE: The studies primary goal was to explore possible
determinants of physiotherapists’ adherence to the guidelines for
low back pain in the Netherlands. This should yield the information
necessary for a subsequent quantitative determinant study. A
secondary goal was to investigate the applicability and value of
Rogers’ Diffusion of Innovations theory in implementation research.
RELEVANCE: Various studies indicate that the implementation of
clinical guidelines is far from optimal. Interventions to enhance
guideline adherence have been found to be of limited effectiveness.
This has been attributed to the absence of a coherent theoretical
framework. In addition, determinant studies of guideline adherence
are lacking. This study presents a first but important step to
close these gaps. PARTICIPANTS: Three physiotherapy educational
cooperatives, of 12, 10, and 8 physiotherapists, respectively, were
found to be willing to participate. The total sample consisted of
both men and women and covered a wide range in age and years
of working experience. METHODS: Focus group interviews were
arranged to discuss the guidelines. The interview routing was based
on Rogers’ theory. According to this theory, physiotherapists perceive
guidelines as an innovation. The theory predicts that the diffusion
process of guidelines evolves through five succeeding stages:
knowledge, persuasion, decision, implementation, and confirmation.
The first two are called dissemination, the latter three adoption. For
each of the stages, different determinants are assumed to be of
influence. ANALYSIS: The interviews were recorded on audio tape,
transcribed verbatim, and qualitatively analysed within the computer
program NVivo 2.0. The structured analysis technique reflected the
most salient aspects of Rogers’ five diffusion stages. RESULTS:
The common stance towards the guidelines was rather negative. All
physiotherapists knew about the guidelines, but most of them did
not pay much attention to them, nor did they take a warm interest
in them (knowledge). They expressed serious doubts concerning
the guidelines’ fidelity, advantages, compatibility and complexity
(persuasion). Their motivation to gather further information was low.
Most participants had not even partially tried out the guidelines,
nor had they noticed many such trials by others (decision). They
used the guidelines neither regulary nor entirely, for instance
because of perceived social influences and operational problems
(implementation). Finally, they showed only little commitment to the
guidelines (confirmation). CONCLUSIONS: Among the participating
physiotherapists, the diffusion of the guidelines for low back pain
remained mainly restricted to the level of dissemination. For only
some of them, the level of adoption had been reached. Rogers’
theory appeared to be applicable as well as valuable in exploring
the determinants of guideline adherence. The main limitations of
WCPT 2007, Research Reports
the study were the small and predominantly non-adhering sample
and an emphasis on individual determinants. IMPLICATIONS: The
determinants associated with physiotherapists’ guideline adherence
in this study may be used in further research to determine whether
they indeed explain and predict guideline implementation. In future
implementation studies, Rogers’ Diffusion of Innovation theory could
very well serve as the foundation for a more coherent theoretical
framework. For that purpose, we suggest to consider the addition
of theories of behavioral and organisational change. KEYWORDS:
clinical guidelines, Diffusion of innovations theory, focus group
interviews. FUNDING ACKNOWLEDGEMENTS: This project was
unfunded. CONTACT: srutten@t-online.de
Research Report Platform Presentation
3026 Monday 4 June 15:20
VCEC Meeting Rooms 8&15
THE EFFECT OF EXERCISE TRAINING ON METABOLIC
FUNCTION AND LIPODYSTROPHY IN HAART-TREATED
ADULTS WITH HIV INFECTION IN RWANDA
Mutimura E1 , Stewart A2 , Crowther J3 ; 1 Kigali Health Institute,
Department of Physiotherapy, P. O. BOX 3286 Kigali, RWANDA, Tel:
+250 08769615 Fax: +250 57 17 87 e-mail: eumuran@yahoo.co.uk;
2 University of the Witwatersrand, School of Therapeutic Sciences,
Johannesburg, Republic of South Africa; 3 University of the
Witwatersrand, Department of Chemical Pathology, National Health
Laboratory Service, Johannesburg, Republic of South Africa
PURPOSE: To assess the effect of exercise training on serum
metabolic variables and lipodystrophy in a population of HIV-infected
African subjects taking HAART. RELEVANCE: As an increased num-
ber of HIV-infected adults access HAART in developing countries, the
task is how to manage HAART-associated metabolic abnormalities.
In Rwanda, lipodystrophy is present in approximately one-third of
subjects receiving WHO-recommended HAART. PARTICIPANTS:
A random sample of 100 HIV-positive adults with moderate to
severe lipodystrophy was selected. METHODS: The presence of
lipodystrophy was determined by a waist-to-hip ratio (WHR)  1.0
(men) and 0.90 (women). Participants were randomly assigned
to a 24-week intervention of moderate aerobic exercise (90-
min/day, 3-days/week) (HIV+LIPO+EXS, n=50, 30 women, 37.7±6.2
years) or non-intervention control group (HIV+LIPOnoEXS, n=50,
30 women, 37.7±6.3 years). The exercise program comprised
of 15 minutes brisk walk warm up and stretching, 60 minutes
of jogging, running and abdominal exercises and 15 minutes of
cool down and stretching exercises. Skin folds, WHR and fasting
total cholesterol, LDL-, HDL- and triglyceride, glucose and insulin
levels were measured at baseline and following the 24-week
exercise program or control period. ANALYSIS: Changes over
the 24 week period were compared between the exercise and
non-exercise group using the Mann-Whitney U test, expressing it
as a percentage of the baseline value. The Wilcoxon matched
pairs test was used to compare mean values for variables at
baseline and after the 24 week period. The relationship between
level of attendance at the exercise sessions and anthropometric
and metabolic variables were analysed using Pearson correla-
tions. RESULTS: BMI significantly decreased following exercise
training in HIV+LIPO+EXS subjects from 24.0±2.9 to 23.4±2.7,
p = 0.0001) compared to no change in HIV+LIPOnoEXS subjects
(24.4±2.2 to 24.5±2.7, p=NS). WHR decreased in HIV+LIPO+EXS
subjects (0.99±0.05 to 0.89±0.03, p = 0.0001) compared to no
change in HIV+LIPOnoEXS subjects (0.98±0.05 to 0.99±0.03,
p=NS). The percentage change in tricep (−8.73±11.73% vs.
−1.44±5.10%; p = 0.0001), bicep (−4.57±10.48% vs. −0.57±2.94%;
p = 0.01), subscapular (−9.22±14.20% vs. −2.34±6.81%; p = 0.003)
and suprailiac (−9.03±13.97% vs. −1.73±5.37%; p = 0.005) skin
folds were significantly greater in the HIV+LIPO+EXS than
the HIV+LIPOnoEXS group. Serum glucose levels changed by
−2.93±13.63% in the HIV+LIPO+EXS group and by +10.34±27.52
Platform Presentations, Monday 4 June
(p = 0.02) in the HIV+LIPOnoEXS cohort. Fasting triglyceride levels
were 1.34±0.40mmol/l at baseline in the intervention group and
1.12±0.28mmol/l (p = 0.004) after the 24 week exercise programme.
No significant change in triglyceride levels was observed in the non-
exercise group. The level of attendance at the exercise sessions was
significantly associated with WHR at the end (r=−0.52, p = 0.0001)
but not at the beginning (r=−0.24, p = 0.10) of the intervention.
CONCLUSIONS: Exercise decreases serum triglyceride levels and
WHR and blocks increases in serum glucose levels in HIV-infected
Africans with HAART-associated lipodystrophy. IMPLICATIONS:
Exercise can be an important treatment strategy for HIV-positive in-
dividuals suffering from HAART-associated lipodystrophy, particularly
in countries with minimal resources to manage HAART-associated
metabolic complications. These results highlight the role of physical
therapists in the multidisciplinary care of an HAART-treated, HIV-
positive population. KEYWORDS: Exercise training, HIV Lipodys-
trophy, metabolic function. FUNDING ACKNOWLEDGEMENTS: We
thank the Commission Nationale de Lutte Contre le SIDA and Multi-
Sectorial AIDS Program (MAP), RWANDA for sponsoring this study.
ETHICS COMMITTEE: National Ethics Committee (Rwanda),
and the University of the Witwatersrand (Johannesburg) Human
Research Ethics Committee for human subjects
Research Report Platform Presentation
2370 Monday 4 June 15:40
PP Crystal Pavilion A
THE EFFECT OF REPEATED PASSIVE ANKLE MOTION ON
INCREASED CALF MUSCLE STIFFNESS AFTER ACQUIRED
BRAIN INJURY
Singer B1 , Cawley D1,2 , Dunne J3 , Singer K1 ; 1 Centre for
Musculoskeletal Studies, The University of Western Australia,
Nedlands 6009, Australia; 2 Neurosurgical Rehabilitation, Royal
Perth Hospital, Perth 6000, Australia; 3 Department of Neurology,
Royal Perth Hospital, Perth 6000, Australia
PURPOSE: Increased calf muscle stiffness is a common impairment
following acquired brain injury which can severely compromise
functional mobility. The effect of passive cyclic stretching on
hypertonic muscle has not been extensively studied. RELEVANCE:
The aim of the study was to compare the effect of cyclic ankle
stretching on peak plantarflexor resistive torque (PPRT) in individuals
with hemiplegia and control subjects. A secondary aim was to
compare the effect of different stretch velocities. PARTICIPANTS: A
sample of convenience of subjects with hemiplegia following stroke
or traumatic brain injury (n=17, mean age = 45, range 22-76, time
since injury mean = 11.4, range 6–36 months, nine females) and
age and gender matched control subjects (n=11) were included
in the trial. METHODS: Cyclic stretches were applied for three
minutes at two stretch velocities (25º/sec-1 versus 5º/sec-1) using a
purpose-built dynamometer under Labview control (Labview, National
Instruments). The stretch excursion was 20º plantarflexion to 80% of
each subject’s maximal dorsiflexion range. Surface electromyography
from the medial soleus and tibialis anterior muscles was sampled
to ensure stretches were passive. ANALYSIS: Torque-angle curves
were derived from the data. PPRT was represented by the torque
(N.m) at 80% of maximal passive range of ankle dorsiflexion.
Baseline PPRT data were compared using paired and unpaired t-
tests with data at one, two and three minutes, and also between
stretch velocities for each time point, for hemiplegic and control
subjects and between limbs in the former group, respectively.
Acceptable test re-test reliability was demonstrated from control
data. RESULTS: PPRT during initial slow stretches (5º/sec-1) in the
hemiplegic limb was significantly greater than the less affected limb
(p = 0.001), and control limbs (p= 0.001). Control subjects showed
a small decrease in PPRT which stabilised during the first minute
of cyclic stretching. No effect of stretch velocity was identified. A
similar response pattern was noted in the less affected limb of
hemiplegic subjects. Post hoc analysis revealed two distinct trends
S163
in the hemiplegic limbs. In Group A (n=9) a small reduction in PPRT
was evident between baseline and one minute with a non-significant
decrease at three minutes. In group B (n=8) PPRT progressively
decreased over the three minutes of cyclic stretching (p < 0.001).
Marked velocity dependent stiffness was evident in Group B subjects
when comparing PPRT at slow stretches (5º/sec-1) with faster stretch
velocities (25º/sec-1). CONCLUSIONS: Velocity dependent passive
stiffness was demonstrated in the affected limb of some hemiplegic
subjects. The potential for cyclic stretching to have a short-term
influence on passive stiffness in a subset of individuals with acquired
brain injury is supported by these data. IMPLICATIONS: Further
investigation is required to identify the clinical characteristics of
those who might benefit from this intervention. It is anticipated that
reduced PPRT would increase the available range of dorsiflexion
during functional mobility tasks with the potential to impact on the
risk of falls due to tripping. KEYWORDS: Calf muscle hypertonia;
Cyclic stretching; Hemiplegia. FUNDING ACKNOWLEDGEMENTS:
None. CONTACT: bjs@cms.uwa.edu.au
ETHICS COMMITTEE: Ethics c’tee at Royal Perth Hospital, Western
Australia
Research Report Platform Presentation
1538 Monday 4 June 15:40
VCEC Ballroom A
EXPERT CONSENSUS EVIDENCE WAS COMBINED WITH
RESEARCH EVIDENCE TO DEVELOP CLINICALLY USEFUL
GUIDELINES FOR PEOPLE WITH PERSISTENT LOW BACK PAIN
Jackson A1 , Barlos P2 , Ferguson S3 , Harding V4 , Hettinga D1 ,
Klaber Moffett J5 , Martin D6 , May S6 , Mercer C7 , Monteath J8 ,
Roberts L9 , Taylor N10 , Woby S11 ; 1 The Chartered Society of
Physiotherapy, London, UK; 2 Keele University, Newcastle-under-
Lyme, UK; 3 Royal United Hospital, Bath, UK; 4 St. Thomas’ Hospital,
London, UK; 5 University of Hull, Hull, UK; 6 Sheffield Hallam
University, Sheffield, UK; 7 Worthing & Southlands Hospitals NHS
Trust, Worthing, UK; 8 Barnet & Chase Farm Hospitals Trust, London,
UK; 9 University of Southampton, Southampton, UK; 10 BackCare,
London, UK; 11 North Manchester General Hospital, Manchester, UK
PURPOSE: To generate expert consensus evidence, where the
research evidence was incomplete, in order to develop clinical
guidelines that were as complete as possible. These guidelines
sought to address 24 clinical questions about the effectiveness (in
reducing pain, improving function and improving psychological status)
of different types of exercise for people with persistent low back
pain (LBP). The systematic review of the literature found research
evidence to answer just seven of these questions. RELEVANCE:
Persistent LBP is expensive because of its prevalence is high;
treatment must be as effective as possible. Clinical guidelines are
recommendations for practice that are based on the best available
evidence. PARTICIPANTS: An expert group (n=23) including a
representative of the patient perspective, and back pain specialists
working in a range of settings (clinical practice, research and
management) throughout the UK. METHODS: Using a nominal
group technique the experts completed a questionnaire (using a
three-point Likert scale) giving their opinion to the 17 questions
unanswered by the systematic review. On a first round of this
questionnaire, consensus (defined as 75% agreement) was achieved
for five questions and these were removed from the questionnaire.
The remaining 12 questions were discussed over a two-week period
using electronic conferencing. After this a second round of the
consensus questionnaire was carried out. All communication was
by electronic methods and took place over a six-week time period.
ANALYSIS: After each round, the questionnaire responses were
recorded on an Excel spreadsheet and the percentage agreement
for each question calculated. RESULTS: On the second round
of the questionnaire, consensus was achieved for a further nine
questions. CONCLUSIONS: This process lead to 14 consensus
evidence statements (for example, mobilising and hydrotherapy
S164
exercises reduce pain) on which recommendations for practice were
formulated. The consensus questions are the recommendations for
future research. When the guidelines are updated, if the research
evidence is more complete, there will be less reliance on consensus
evidence. IMPLICATIONS: The expert consensus evidence enabled
the guideline developers to produce more clinically useful recommen-
dations for practice than would have been possible using the research
evidence alone. It also raised awareness of gaps in the literature
and generated discussion about these. KEYWORDS: consensus
evidence; evidence based recommendations; effective practice.
FUNDING ACKNOWLEDGEMENTS: This work was commissioned
by the Chartered Society of Physiotherapy, London, UK. CONTACT:
jacksona@csp.org.uk
Research Report Platform Presentation
1123 Monday 4 June 16:15
PP Crystal Pavilion B & C
CLINICAL FACTORS IMPACTING PARTICIPATION IN
COMMUNITY MOBILITY FOLLOWING STROKE
Robinson C, Shumway Cook A, Matsuda P, Ciol M, Beaverson J,
Soine S, Flemming A; Department of Rehabilitation Medicine,
University of Washington
PURPOSE: Limited participation in community mobility is a common
occurrence following stroke, however the skills and clinical factors
affecting participation are largely unknown. This study measured
participation in community mobility among adults with and without
stroke, and examined the relationship between clinical measures
of sensation, strength, range of motion, balance, and gait to
participation in community mobility in order to identify clinical factors
impacting participation. RELEVANCE: In the United States, stroke
is the leading cause of disability, and limited mobility is a major
factor contributing to disablement among adult survivors of stroke.
Recovery of participation in mobility is an important goal in the
rehabilitation of survivors of stroke. PARTICIPANTS: The sample
was composed of 25 adults diagnosed with stroke (mean age
68±9; mean time since stroke 40 mos, able to walk without the
assistance of another) and 25 adults (mean age 68±11) without
stroke. METHODS: Level of participation in community mobility
was determined by self-reported number of trips and walking-
related activities performed over a 12-day period (72 hour recall
trip activity log completed once a week for four weeks). Clinical
factors tested included balance (Berg Balance Test (BBT)), usual
gait speed (10m gait), lower extremity strength (dynamometer), range
of motion (goniometry), sensation (light touch and proprioception),
and spasticity (modified Ashworth scale). ANALYSIS: Comparisons
between the two groups were performed using Mann-Whitney
and Chi-square tests for continuous and categorical variables,
respectively. In the stroke group, the relationship between clinical
measures and total number of trips and walking-related activities
were analyzed using negative binomial regression, while linear
regression was used for the ratio of activities per trip. RESULTS:
Compared to adults without stroke, participation in community
mobility in adults with stroke was characterized by significantly fewer
trips (p = 0.001), fewer walking-related activities (p < 0.001), and a
lower ratio of walking-related activities per trip (p = 0.005). In addition,
adults with stroke reported a lower level of satisfaction with their level
of participation in community mobility (p < 0.001) compared to those
without stroke. Adults with stroke were significantly (<0.05) more
impaired on all clinical measures compared to non-stroke. Among
adults with stroke, after adjusting for age and sex, the clinical factors
affecting participation (number of walking-related activities performed
per trip) included strength (dorsiflexors and plantarflexors), hamstring
muscle length, balance, and usual gait speed. CONCLUSIONS:
Results confirm that participation in community mobility is limited
following stroke, and this is a source of dissatisfaction among
adult survivors of stroke. While adults with stroke were significantly
more impaired on all clinical measures, not all clinical measures
WCPT 2007, Research Reports
were associated with level of participation. Balance, usual gait
speed, lower extremity strength (ankle dorsiflexor and plantarflexor
muscle groups) and hamstring flexibility were important determinants
of level of participation, while spasticity and sensation were not.
IMPLICATIONS: An improved understanding of the factors impacting
recovery of the ability to walk safely and independently in the
community will assist therapists in developing effective clinical
strategies for retraining community mobility. KEYWORDS: stroke,
participation, mobility. FUNDING ACKNOWLEDGEMENTS: This
study was supported with funding from the Walter Stolov Research
Fund, University of Washington, Seattle, Washington. CONTACT:
cyndirob@u.washington.edu
ETHICS COMMITTEE: Institutional Review Board, Human Subjects
Division, University of Washington, Seattle, Washington.
Research Report Platform Presentation
989 Monday 4 June 16:15
VCEC Ballroom B & C
INTRA-TESTER RELIABILITY OF TWO CLINICAL TESTS OF
TRANSVERSUS ABDOMINIS MUSCLE RECRUITMENT
Menezes L1 , Costa L1,2 , Cançado R1 , Oliveira W1,3 , Ferreira P3 ;
1 Pontifı́cia Universidade Católica de Minas Gerais, Belo Horizonte,
Brazil; 2 Back Pain Research Group, School of Physiotherapy, The
University of Sydney, Australia; 3 Universidade Federal de Minas
Gerais, Belo Horizonte, Brazil
PURPOSE: The objective of this pilot study was to check the
intra-tester reliability of the Pressure Biofeedback Unit (PBU) and
the palpation test in assessing TrA recruitment. RELEVANCE: It
is widely accepted that the gold standard methods for measuring
recruitment of the transversus adbominis muscle (TrA) are needle
electromyography (EMG) and real time ultrasound (US). However,
these tools have limitations, EMG is an invasive method where
pain and infection are possible adverse side effects, and both
EMG and US are costly, limiting the use of these tools in clinical
practice. In clinical practice TrA recruitment is normally assessed
by palpation or by using the Pressure Biofeedback Unit (PBU).
PARTICIPANTS: Twenty-nine physiotherapy students participated in
the study. Inclusion criteria: Absence of low back pain during the
last 12 months and aged between 18-30 years. Exclusion criteria:
Pregnancy, previous spinal or abdominal surgery and menstruation
at the time of the tests. METHODS: A test-retest reliability study
was performed, with a seven-day interval between tests. The PBU
test was done with the volunteer in a prone position with the bags
positioned under the abdominal wall with the PBU being inflated to
70mmHg. The volunteer was asked to draw in their abdominal wall
for 10 seconds without pelvic movements while breathing normally.
This procedure was repeated 3 times and we collected the maximum
pressure value attained over a 2 second period of time. The palpation
test was performed with the volunteer positioned in a supine position
and the rater placed her fingers medially 2 centimeters from the
iliac crests. The rater asked the patient to draw in the abdominal
wall again for 10 seconds and classified the contraction into four
different categories. ANALYSIS: To evaluate the reliability of the PBU
assessments, we performed an Intraclass Correlation Coefficient
(ICC 2,1). To evaluate the reliability of the palpation test we used
the Kappa coefficient. RESULTS: Both tests achieved a moderate
reliability according to the benchmarks of Fleiss (1986). A Kappa of
0.52 (95% CI) (0.29 to 0.75)was obtained for the palpation test while
an ICC (2,1) of 0.58 (95% CI) (0.28 to 0.78) was obtained for the PBU
test. CONCLUSIONS: This is the first study to assess the reliability
of the palpation test. Our results demonstrate that both PBU and
palpation tests have sufficient reliability for assessing TrA recruitment
in clinical practice however it would be useful to consider whether
modifications to the test protocol may enhance reliability. For research
purposes, where precision is important, the EMG and US tests are
clearly better options to assess TrA recruitment. IMPLICATIONS:
These clinical tests are reliable, safe and low cost options for using in
Platform Presentations, Monday 4 June
clinical practice. KEYWORDS: Clinical tests, transversus abdominis,
reliability. FUNDING ACKNOWLEDGEMENTS: Leonardo Costa is
a PhD student supported by CAPES – Brazil. CONTACT: Luciola
Menezes – lmenezes@usyd.edu.au
ETHICS COMMITTEE: This study has ethics approval from Pontifı́cia
Universidade Católica de Minas Gerais Ethics Committee.
Research Report Platform Presentation
1096 Monday 4 June 16:15
VCEC Exhibit Hall A
THE EFFECT OF PENETRATING TRUNK TRAUMA ON THE
RECOVERY OF ADULT SURVIVORS:A PILOT STUDY
Van Aswegen H1 , Eales C1 , Richards G2 , Goosen J3 , Mudzi W1 ;
1 Physiotherapy department, School of Therapeutic Sciences,
University of the Witwatersrand, Johannesburg, South Africa;
2 Pulmonology department, Johannesburg General Hospital,
Johannesburg, South Africa; 3 Trauma Intensive Care Unit,
Johannesburg General Hospital, Johannesburg, South Africa
PURPOSE: Gunshot and stab wounds to the trunk are common
injuries seen in South African hospitals. These injuries necessitate
exploratory surgical intervention to manage injuries to internal
organs. Patients are managed in intensive care and often undergo
prolonged mechanical ventilation. Immobilization results in some
degree of muscle dysfunction. No database exists in South Africa
to reflect the recovery rate of these patients after hospital discharge.
RELEVANCE: Prolonged recovery and slow return to work rate after
critical illness may impact negatively on South African economy.
It is not known whether a rehabilitation programme is indicated
to enhance recovery of these patients. PARTICIPANTS: Twelve
consecutive adults with penetrating trunk trauma and prolonged
mechanical ventilation were recruited from the trauma intensive
care units of three hospitals in Johannesburg between February
2004 and June 2005. METHODS: Aims: a)Establish the feasibility
of carrying out longitudinal research for this population, b) identify
limitations posed for the main study, c) determine differences in
lung function, muscle strength, exercise capacity and quality of life
between survivors and an age and sex-matched control population.
A prospective observational pilot study was conducted. Patients were
evaluated at one, three and six months following hospital discharge.
Demographic data, lung function tests, muscle strength, exercise
capacity tests and quality of life tests were recorded. ANALYSIS:
Data collected were expressed as means and standard deviations.
A correlation coefficient was calculated for distance walked on the
6-minute walk test versus that of the peak oxygen uptake test.
Two tailed t-tests were used to compare subject data with the
control group data. A p < 0.05 was significant. RESULTS: Distance
walked (6MWT)was significantly reduced comparing subjects to
the control group over 6-months (p = 0.0025-0.0355). At 1-month
there was significant difference in triceps and quadriceps strength
between the subjects and control group (p = 0.0089 quadriceps;
p = 0.0246 triceps). No difference in muscle strength detected
between groups at 6-months. At 1-month there was significant
difference between actual (mean = 2.23L) and predicted (mean =
1.56L) residual lung volumes for study subjects (p = 0.0034). This
remained significant at 6-months (p = 0.0157). Below average peak
VO2 results were found in study subjects. Physical function, general
health and physical summary scores (SF-36) were significantly
different between groups at 1-month (p < 0.0001), 3-months (p
0.0001-0.0003) and 6-months (p 0.0001-0.013). CONCLUSIONS:
Longitudinal research is possible as the drop out rate was relatively
low. Survivors of penetrating trunk trauma and prolonged mechanical
ventilation have limitations in muscle strength up to 3-months
after discharge. They also present with limitations in exercise
capacity, lung function and physical quality of life at 6-months after
discharge compared to a control group. IMPLICATIONS: A trend
of physical limitations was detected in this group up to 6-months
after discharge. These findings support the continuation of the
S165
main study in order to identify the future role of physiotherapy in
their rehabilitation. KEYWORDS: critical illness; physical limitations.
FUNDING ACKNOWLEDGEMENTS: National Research Foundation
of South Africa Thuthuka Researchers in Training Programme;
Medical Faculty Research Endowment Fund of the University of the
Witwatersrand. CONTACT: vanaswegenh@therapy.wits.ac.za
ETHICS COMMITTEE: Committee for Research on Human Subjects
(Medical) of the University of the Witwatersrand, Johannesburg.
Research Report Platform Presentation
1535 Monday 4 June 16:15
VCEC Meeting Rooms 11-12
TOURNAMENT-RELATED ANXIETY IN PROFESSIONAL FEMALE
TENNIS PLAYERS: AN APPLICATION OF THE TRANSACTIONAL
MODEL OF STRESS AND COPING
Ortega C1 , Bartholomew J2 , Owen S1 ; 1 University of Texas Health
Science Center at San Antonio; 2 University of Texas at Austin
PURPOSE: Structural Equation Modeling (SEM) was used to
investigate this elite, under-studied population. A conceptual model
was constructed that describes the extent to which individual
differences in athlete’s social support, coping skills and tennis
ability, singly and in combination are related to the manifestation
of cognitive state anxiety. RELEVANCE: Physical therapists must
have an understanding of the cognitive processes that impact
stress in order to impact wellness and assist patients to manage
stress. This investigation provides insight into an understudied
population in a high performance, stressful situatin. PARTICIPANTS:
During the US OPEN, 94 professional female tennis players (18-
47 years) responded to a Competition Questionnaire. METHODS:
Factor analysis was used to test the validity structure of the scales
within this measurement instrument. The scales used addressed
dispositional coping strategies, cognitive appraisal, current coping
strategies, competitive state anxiety and perceived sense of social
support. ANALYSIS: Factor loadings for items were obtained to
identify the relevant indicators of the latent variables to be used
within the measurement models. Items loading <0.3 were discarded.
Goodness of fit for the constructed measurement models was tested.
A CFI value greater than 0.90 was considered indicative of acceptable
fit with a value greater than 0.95 indicative of close fit (Bentler &
Bonnett,1980). A RMSEA below 0.08 was considered a “reasonable
fit” with <0.05 a “close fit” (Browne & Cudeck, 1993). The Chi-square
statistic was also reported as a goodness of fit index. From the
measurement models, a larger model was constructed, goodness
of fit assessed and standardized path scores were reviewed for level
of significance (p < 0.05). Effect size was also determined with <0.2
considered small (Cohen, 1988). RESULTS: Retained paths included
those between primary appraisal and avoidance coping, (path score
= 0.98, p < 0.05), primary appraisal and state anxiety (path score
= 0.99, p < 0.05), avoidance coping to state anxiety (path score =
0.59, p= 0.04) and social support to approach coping (path score
=0.53, p < 0.05). The final model has an acceptable goodness of
fit with c2(65) = 82.4 (p = 0.07), CFI=.93 and an acceptable fit of
RMSEA=0.05 (CI low = 0.00 and CI high = 0.08). CONCLUSIONS:
Results demonstrate that elite athletes within this population differ
from the general population with regard to their experience and
management of stress. Findings suggest that use of avoidance
strategies increases competitive state anxiety and that as an
athlete perceives greater social support they will be more likely
to use approach coping strategies. Outcomes of this investigation
enhance measurement of the stress process and suggest that it is
inappropriate to use standard coping and appraisal measurements
without validation for this group. IMPLICATIONS: This model can
guide interventions and future investigations. Specifically, health
care providers, such as physical therapists who understand the
components of the TA model are in an ideal position to help patients
and athletes manage stress. The social support provided and the
ability to impact appraisal can help to diminish state anxiety and
S166
enhance wellness and performance. KEYWORDS: stress, coping,
appraisal, performance. FUNDING ACKNOWLEDGEMENTS: This
investigation was undertaken without funding provided by any entity.
CONTACT: ortegac2@uthscsa.edu
ETHICS COMMITTEE: Both University of Texas at Austin IRB and
Univ. of Tx. Health Science Center at San Antonio
Research Report Platform Presentation
1036 Monday 4 June 16:15
VCEC Meeting Room 16
COMPARISON OF TWO DIFFERENT TRUNK MUSCLE TRAINING
PROGRAMS IN MIDDLE-AGED HEALTHY MEN
Surakka J1 , Aunola S2 , Ailanto P3 , Alanen E2 , Kylliainen A2 ,
Karppi S4 ; 1 Arcada polytechnic; 2 National Public Health Institute;
3 Finnish Back Association; 4 Social Insurance Institution of Finland
PURPOSE: Decreased strength and power of the lower trunk
muscles is a potential risk factor for low-back disorders, therefore
it is important to find feasible methods for improving the trunk
muscle strength and power. The heterogeneity of the contents of
low-back training interventions make it difficult to evaluate which
training duration, frequency and training type are the most effective.
This study aimed to compare the efficacy of two different trunk
muscle training programs in healthy middle-aged men. RELEVANCE:
To find a feasible training type, duration and frequency in trunk
muscle training in preventing low-back disorders. PARTICIPANTS:
Fifty-one healthy male exercisers and 18 non-exercising controls
(43±9 years) paricipated in the study.The exercisers trained in
two groups with different training methods and durations; a 54-
week training group (W54, n=23, 44±5 years) and the 22-week
training group (W22, n=28, 45±6 years). METHODS: The 54-week
training group participated in controlled, individually planned basic
strength and power training using resistance machines and weights.
The 22-week group (W22, n=28, 45±6 years) participated in a
power and velocity training program carried out as supervised group
gymnastics, without external loads. The study was a controlled
intervention study Muscle torque and velocity in flexion and extension
were measured by using an isoinertial dynamometer before and
after the intervention. A questionnaire was used at the baseline to
obtain information about low-back, hip, shoulder and neck symptoms
and the type of present physical activity. Perceived health and
fitness were inquired before and after the intervention by means
of a questionnaire. ANALYSIS: The chi-square test was applied
to examine the distribution of musculoskeletal symptoms, physical
activity and self-rated health and fitness. The difference t-tests for
equality of means were applied. The one-way analysis of variance
was used for testing equality of means between the groups. Tukey-
Kramer method was applied in paired comparisons. RESULTS: Men
in the W54 group(25%) improved their maximal isometric flexion
torque to a significantly larger extent than men in the W22 group (7%)
(p < 0.05), whereas the W22 group(16-20%) achieved significantly
(p < 0.001) greater changes than W54 group (5-9%) did in the
trunk muscle flexion and extension velocities. No significant changes
were observed in controls. Perceived health improved significanly in
the W54 group during the exercise intervention (p < 0.03)compared
with the other groups. CONCLUSIONS: Training with resistance
machines and weights was superior in improving maximal trunk
flexion strength, while group gymnastics with power and velocity
training without external loads was superior in improving the flexion
and extension velocities. 54 weeks of exercising seemed also to
have a positive impact on subjective health. The results indicate
that the training-induced gains are specific to the exercise method
used, and varying training modes are needed for multifaceted
improvement of the trunk muscles. IMPLICATIONS: Both training
modes are needed; strength gain is essential for stabilizing and
strengthening the trunk muscles, and power and velocity training are
necessary for enhancing muscle coordination and ability to react to
sudden loadings. KEYWORDS: resistance training,strength,power,
WCPT 2007, Research Reports
trunk muscle,velocity,. FUNDING ACKNOWLEDGEMENTS: This
study was supported by a grant from the Social Insurance Institution
of Finland. CONTACT: jukka.surakka@arcada.fi
ETHICS COMMITTEE: Study was approved by the Ethical Commit-
tee of the Research and Development Centre of the Social Insurance
Institution of Finland
Research Report Platform Presentation
862 Monday 4 June 16:15
VCEC Meeting Room 17
CLINICAL REASONING IN THE BOBATH CONCEPT-A
THEORETICAL MODEL OUTLINING THE PARAMETERS OF
QUALITY OF MOVEMENT
Meadows L; Leeds Metroplitan University, Leeds, United Kingdom
PURPOSE: Explicit knowledge of the implicit skills of the Bobath
therapist are sparse and so this study sets out to identify
parameters of quality of movement used as a basis for clinical
reasoning. RELEVANCE: It is vital that the clinical application of
the Bobath Concept is systematically researched to achieve best
practice. PARTICIPANTS: 13 members of the British Bobath Tutors
Association(BBTA)took part in this study. They play a key role in
the teaching of the Bobath Concept predominantly in the UK, and
worldwide. METHODS: Focus group methodology was chosen in
order to generate qualitative data by capitalising on the interaction
that occurs within a group discussion. Three homogeneous groups
were used. Each session was moderated by the researcher and the
taped discussions transcribed. These were verified by a nominated
group member. The funnel approach was used for questions, which
were gathered from available evidence. ANALYSIS: Content analysis
was carried out using the model proposed by Kreuger(1998). This
involved unitising the data to code discussion on specific topics
including aspects such as frequency, extensiveness and intensity
of comments. The data was verified by two independent assessors.
RESULTS: Three main themes were identified: 1)An understanding
of the term quality of movement 2)Parameters of quality of movement
3)Clinical reasoning The parameters of quality of movement were
incorporated into a theoretical model. The five main themes
being: 1) Postural alignment; 2) Patterns/sequences of movement;
3) Speed/effort; 4) Functional range of movement; 5) Goal orientated
movement. The Bobath Concept was described as working towards
efficient movement, rather than normal movement, in order to explore
and access the potential of the individual. An understanding of how
the parameters of quality of movement interconnect was identified
as being the basis for the clinical reasoning process using the
Bobath Concept. The Bobath Concept is described as always linking
qualitative performance to function. Exploring the inherent plasticity
of the central nervous system, based on an understanding of the
individual’s impairment, is aknowledged as crucial. CONCLUSIONS:
The theoretical model developed in this study is a unique insight
into the implicit knowledge of the experienced Bobath therapist and
clarifies some of the underlying principles related to the clinical
reasoning process. This study identifies that a key principle of
the Bobath Concept is the link between movement performance
and function. The importance of implicit learning of motor skills by
the neurolgically impaired patient through the development of the
individual’s body schema is seen as vital in developing improved
functional performance. This study has produced a foundation of
descriptive information that could be used as a basis for further
research. In part it could be used to develop questions and
gather opinions from a larger population of therapists. The use of,
for example, single subject experimental designs would enable a
comparison between percieved and actual practice. IMPLICATIONS:
Clinically, the Bobath Concept is used by many therapists throughout
the world. In order to move forwards and progress with a sound
scientific basis, appropriate research questions need to be asked.
This can only be achieved by having a clear understanding of
the principles underpinning the concept and the clinical reasoning
Platform Presentations, Monday 4 June
process. KEYWORDS: Bobath Concept; Quality of Movement;
Clinical Reasoning. FUNDING ACKNOWLEDGEMENTS: The British
Bobath Tutors Association funded 50% of my Masters programme.
CONTACT: linzimeadows@blueyonder.co.uk
ETHICS COMMITTEE: Leeds Metropolitan University, United
Kingdom.
Research Report Platform Presentation
1544 Monday 4 June 16:15
VCEC Meeting Room 18
LANDING MECHANICS BETWEEN NON-INJURED YOUNG
WOMEN AND WOMEN WITH ACL RECONSTRUCTION DURING
A 40-CM DROP JUMP
Ortiz A1 , Libby C2 , Bartlett W2 , Etnyre B3 , Kwon Y4 , Olson S2 ;
1 School of Physical Therapy, University of Puerto Rico; 2 School
of Physical Therapy, Texas Woman’s University; 3 Department of
Kinesiology, Rice University; 4 Department of Kinesiology, Texas
Woman’s University
PURPOSE: The purpose of this study was to compare landing
mechanics during a 40-cm drop jump between women with
anterior cruciate ligament reconstruction and non-injured women.
RELEVANCE: Women with anterior cruciate ligament reconstruction
present with neuromuscular deficits that could predispose them to fur-
ther injuries during sports participation compared to women without
knee injury even after successful reconstruction and rehabilitation.
PARTICIPANTS: Fourteen physically active young women with ACL
reconstruction (mean age ± SD: 25.4±3.1, mean height: 167.5±5.6
cm, mean weight: 63.2±6.7 kg) and fifteen healthy non-injured young
women (mean ± SD age: 24.6±2.6; height: 164.6 cm; weight:
58.4 kg) participated in this study. METHODS: Each participant
had 12 retro-reflective markers attached over bony prominences on
the dominant lower extremity. Additionally, surface electromyography
(EMG) was recorded from the gluteus maximus, quadriceps, and
hamstrings. Each participant performed a warm-up protocol followed
by five drop jump task trials. The drop jump consisted of standing on a
40-cm platform and performing a maximal vertical jump after landing
onto a force plate. Peak joint angles, peak ground reaction forces,
peak knee joint moments, dynamically normalized rectified surface
electromyography and quadriceps/hamstrings co-contraction ratio
were analyzed. ANALYSIS: All kinematic, kinetic and electromyo-
graphic data were screened for normality assumptions and outliers
using the Kolmogorov-Smirnov Test and histograms. Multivariate
analyses of variance, with follow-up univariate analyses of variance
(ANOVA), were used for comparisons of kinematics, kinetics and
EMG data between groups. RESULTS: No statistically significant
differences between groups were found for peak hip and knee joint
angles. However, significant differences between groups were found
for the kinetic and EMG variables. Follow-up ANOVA on each kinetic
variable showed significantly lower peak anterior-posterior shear
forces, greater peak knee extension moments and greater peak
knee valgus joint moments in the group with ACL reconstruction.
Follow-up ANOVA on each EMG variable showed significantly greater
quadriceps/hamstrings co-contraction ratios, and normalized rectified
gluteus maximus and rectus femoris EMG in the group with ACL
reconstruction. CONCLUSIONS: This investigation demonstrated
that landing mechanics represented by peak hip and knee joint
angles in all three planes of motion were similar between healthy,
non-injured women and women more than one year after ACL
reconstruction. Electromyographic measures suggested neuromus-
cular compensation strategies in women with ACL reconstruction that
could explain the similarities in landing peak joint angles. However,
differences for the kinetic measures suggested differences in landing
strategies that could predispose women with ACL reconstruction to
further injury. IMPLICATIONS: This investigation found that young
women with ACL reconstruction exhibited different neuromuscular
and kinetic landing strategies than non-injured females during a
drop jump. The need for further research and rehabilitation of young
S167
women with ACL reconstruction to assess physical performance
is warranted. KEYWORDS: ACL, landing, drop jump. FUNDING
ACKNOWLEDGEMENTS: This work was supported in part by
an institutional grant from Texas Woman’s University (Research
Enhancement Program). CONTACT: alexisortiz@cprs.rcm.upr.edu
ETHICS COMMITTEE: Texas Woman’s University Institutional
Review Board
Research Report Platform Presentation
1183 Monday 4 June 16:15
VCEC Meeting Rooms 19-20
DEVELOPMENT OF AN OBJECTIVE EVALUATION TOOL OF
SHOULDER FUNCTION USING 3D KINEMATIC SENSORS
Pichonnaz C1,2 , Farron A1 , Bourgeois A1 , Coley B3 , Aminian K3 ,
Jolles B1 ; 1 Hôpital Orthopédique de la Suisse Romande, Lausanne,
Suisse; 2 HECVSanté-filière physiothérapeutes, Lausanne, Suisse;
3 Ecole Polytechnique Fédérale de Lausanne, Suisse
PURPOSE: The objectives of this research were to test the
applicability of a portable device using 3D kinematic sensors
(Physilog® ) for functional evaluation of the patient’s shoulder,
and to develop objective evaluation tools of function based on
this device RELEVANCE: Several functional shoulder scores are
commonly used but none of them is unanimously recognized as an
objective reference. Our purpose was to develop a score specifically
based on objective criteria. Movement recording by a body fixed
sensors (combination of accelerometers and gyroscopes) provides
objective and accurate parameters which are meaningful for shoulder
function evaluation. The recent development of portable devices has
made this process more accessible to researchers and clinicians.
PARTICIPANTS: 25 patients with unilateral shoulder pathology (18
had rotator cuff tear/7 had total shoulder arthroplasty, 9 women, 12
men, 59 years old +/−10) and 30 healthy participants (10 women, 30
men, 36 years old +/−7) have been included. All participants signed
a written informed consent and their surgery was performed in our
department by the same senior surgeon. METHODS: One sensor
was fixed on the dorsal side of distal humerus and another one on the
sternum. Each sensor was connected to a portable data logger. Nine
movements corresponding to daily activities were carried out. Signals
were digitized and analysed to measure acceleration, angular speed
and angles in three dimensions. Based on the results we defined
three scores to analyse differences between healthy and pathological
patient’s shoulder: the 3D shoulder range of angular velocity score
(RAV), the arm power score (P) and the humerus moment score
(M). The SST (Simple Shoulder test) and the Disabilities of the
Arm, Shoulder and Hand Score (DASH) questionnaires were also
completed. Healthy participants underwent the procedure twice at
one year interval. The patients had a follow up at 3 and 6 months.
ANALYSIS: Means and SD were calculated. Non-parametric tests
were applied to assess differences between healthy participants
and patients, as well as improvement at 3 and 6 months after
surgery. (a  0.05). RESULTS: The healthy subjects’ RAV, P and
M scores were significantly different from the patients’ scores at
baseline (before surgery) (p = 0.0009), at 3 months (p = 0.005) and
at 6 months (p = 0.0196). The patients’ scores were significantly
different between baseline vs. 3 and 6 months (p < 0.015). However,
the clinical scores showed no differences between baseline and
3 months, the differences becoming significant only at 6 months.
The tests on healthy participants showed a variability of the mean
of 0.4% +/−7.2 (RAV), −0.9% +/−8.9 (P) and 1.3 +/−9.3 (M).The
measurement method based on body fixed sensors had good
applicability. CONCLUSIONS: Three scores were developed with
very encouraging results for the objective evaluation of the shoulder
function. They allow the analysis of shoulder evolution after a surgical
procedure with more precision and sensitivity to change than regular
clinical scores. IMPLICATIONS: The newly developed scores could
be a good a contribution to outcome evaluation in physical therapy,
rehabilitation and surgery. The good applicability of the system
S168
opens perspectives for precise measurement of shoulder function
during daily activities. KEYWORDS: body fixed sensors, shoulder,
assessment. FUNDING ACKNOWLEDGEMENTS: Swiss National
Foundation (PNR 53) Grant nº 405340-104752/1. CONTACT:
cpichonn@hecvsante.ch
ETHICS COMMITTEE: Université de Lausanne, Faculté de Biologie
et de Médecine, Commission d’éthique de la recherche clinique
Research Report Platform Presentation
1384 Monday 4 June 16:35
PP Crystal Pavilion B & C
DO CANADIAN PHYSIOTHERAPISTS IDENTIFY, ASSESS AND
TREAT URINARY INCONTINENCE AFTER STROKE?
Dumoulin C1 , Korner-Bitensky N2 , Tannenbaum C3 ; 1 School of
Rehabilitation, Faculty of Medicine, University of Montreal; 2 School
of Physical and Occupational Therapy, Faculty of Medicine, McGill
University; 3 Faculty of Medicine, University of Montreal
PURPOSE: This study identify: the extent to which rehabilitation
professionals identify UI post-stroke as a problem in those affected;
the use of best practice assessments and interventions to manage
UI post-stroke and; the relationship between clinician, client, and
environmental variables and variations in UI problem identification,
assessment, and intervention practices. RELEVANCE: UI is a
common and distressing problem post-stroke. Although recent
evidence suggests effective UI rehabilitation interventions, it is
unknown whether physiotherapists’ actual practices reflect best
practices. PARTICIPANTS: A total of 656 physiotherapists, (76 men,
560 women) with a mean age of 40.46 + 9.79 years, working
across the continuum of stroke care in Canada, participated in this
study. METHODS: Participants were interviewed using a telephone-
administered questionnaire. Each responded to a series of open-
ended questions related to a generated clinical scenario of a typical
client with UI post-stroke corresponding to the clinician’s practice
setting – acute care (n=202), in-patient rehabilitation (n=223),
community care (n=231). ANALYSIS: Descriptive statistics were
used to indicate the prevalence of ‘UI problem identification’, ‘best
practice UI assessment’ and ‘best practice UI intervention’ by setting,
as defined by existing practice guidelines. Univariate analyses were
used to examine the association between 29 potential explanatory
variables related to the clinician, client, and environment, and being
a ‘UI problem identifier’, ‘best practice UI assessment user’ and ‘best
practice intervention user’. Logistic regression models, with stepwise
backward elimination of variables, determined the combination of
variables that predicted being a ‘UI problem identifier’ and ‘best
practice UI assessment user’. RESULTS: In all, 40.5% of the
physiotherapists identified UI post-stroke as a problem. Less than
15% indicated using best-practice UI assessments, and only 3%
used best-practice UI interventions. Univaritely ‘having answered
an acute vignette’ and ‘being in a inpatient work setting’ were the
2 only variable significantly associated with In all, 40.5% of the
physiotherapists identified UI post-stroke as a problem. Less than
15% indicated using best-practice UI assessments, and only 3%
used best-practice UI interventions. Univaritely ‘having answered
an acute vignette’ and ‘being in a inpatient work setting’ were the
2 only variable significantly associated with being a UI problem
identifier, c2: 14.697, p < 0.001 and c2: 9.155, p = 0.01 respectively.
Those spending a greater amount of time treating daily (OR: 1.187;
95% CI:1.051 to 1.341; p = 0.006), having time allocated for learning
(OR:1.441; 95% CI:1.016 to 2.043; p = 0.040) and having a social
worker in the workplace (OR:2.010; 95% CI:1.298 to 3.113; p = 0.002)
increased the likelihood of being a UI problem identifier. For the
outcome best practice UI assessessment user ‘treating longer hours
daily’, ‘seeing more stroke patients daily’ and ‘having answered a re-
habilitation vignette’ were the 3 only variables significantly associated
with being a best practice UI assessor, t:3.734, p < 0.001, X2:19.528,
p < 0.001 and X2:15.930, p = 0.001 respectively. CONCLUSIONS:
Canadian physiotherapists do not routinely identify UI post-stroke as
WCPT 2007, Research Reports
a problem, and best-practice assessments and interventions are un-
derutilized. IMPLICATIONS: Knowledge transfer strategies aimed at
undergraduate students and practicing clinicians are recommended
to increase the use of UI related best practices post-stroke and
close the gab between actual and best practice. KEYWORDS:
stroke, urinary incontinence, evidence-based practice, rehabilitation.
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
Provincial de recherche en adaptation réadaptation (REPAR), and the
Centre de recherche interdisciplinaire en réadaptation du Montréal
Métropolitain. CONTACT: chantal.dumoulin@umontreal.ca
ETHICS COMMITTEE: Institutional Review Board, Faculty of
Medicine, McGill University, in Montreal, Quebec, Canada
Research Report Platform Presentation
928 Monday 4 June 16:35
VCEC Ballroom A
CONTENT VALIDITY OF THE FIRST VERSION OF
INTERVENTION CATEGORIES FOR PHYSICAL THERAPISTS
BASED ON THE ICF: MUSCULOSKELETAL DOMAIN
Allet L1 , Cieza A2 , Bürge E3 , Finger M4 , Stucki G2 ,
Huber E5 ; 1 University hospital of Geneva, Switzerland;
2 Ludwig-Maximilians-University Munich, Germany; 3 Haute Ecole
de Sante, Geneva, Switzerland; 4 Rehaklinik Bellikon, Switzerland;
5 University hospital of Zürich, Switzerland
PURPOSE: The International Classification of Functioning, Disability
and Health (ICF) holds great promise for providing the rehabilitation
disciplines, including physical therapy, with a universal language with
which to discuss human functioning. A first version of intervention
goals for physical therapists treating patients with musculoskeletal
(MS) conditions in acute, rehabilitation and community health-care
situations based on the ICF has been developed based on a
methodologically sound process including Delphi-exercises and a
consensus conference. However, its content validity has not yet
been studied. The aim of this study was therefore to investigate
the content validity of the ICF intervention categories for physical
therapists treating patients with MS conditions. RELEVANCE: The
ICF, containing a list of 1454 categories which constitute the units
of the classification, is hierarchically organized and very exhaustive.
It thus becomes highly complex for daily use. In order to initiate its
use in clinical practice it has to be transformed into a user-friendly
tool. PARTICIPANTS: The study was performed with convenience
samples of 300 physical therapy clinical records of patients with MS
conditions, treated in 3 health-care situations: acute, rehabilitation
and community. Clinical records written in German, French or
Italian were included in the study if the patients to whom they
corresponded were at least 18 years old and had been treated
at any time from January 2003 to November 2005. METHODS:
The study was conducted as a retrospective cross-sectional multi-
center study in the three different language regions of Switzerland.
The heads of the physical therapy departments of 62 health-care
institutions were asked to send a pre-defined number of clinical
records to the study leader. The study leader extracted all treatment
goals and all interventions contained in the records and linked
them to ICF categories. The inter-rater agreement of this linking
process was established. ANALYSIS: Descriptive statistics were
used to describe the study population and to analyse how often
a goal, intervention or technique had been named in the clinical
records. A cutoff point of a frequency of 5% was chosen in
order to include the category in the checklists. RESULTS: Kappa
coefficients and nonparametric bootstrapped confidence intervals
showed that linker agreement exceeds chance (Kappa value 0.71-
0.9). Most of the ICF categories contained in the first version of
ICF intervention categories for physical therapists working in these
health-care situations have been confirmed and three checklists
Platform Presentations, Monday 4 June
with 38 second-level intervention categories for the acute, 46 for
the rehabilitation and 38 for the community health-care situation
are proposed. CONCLUSIONS: This study represents the first
step towards the validation of intervention categories for physical
therapists treating patients with MS conditions. These three checklists
have now to be applied in clinical practice and their usefulness
assessed. The data provide a promising approach for future research.
IMPLICATIONS: These lists form a user-friendly tool and may
also have wider implications by contributing to the definition of
the scope of the physical therapy profession and by providing the
transparency increasingly demanded of health-care providers in the
current political climate. KEYWORDS: International Classification
of Functioning, Disability and Health, Intervention, physical therapy,
musculoskeletal. FUNDING ACKNOWLEDGEMENTS: We gratefully
acknowledge the Swiss Physiotherapy Association for its financial
support and the cooperation of all participants in this study.
CONTACT: lara.allet@hcuge.ch
ETHICS COMMITTEE: The study was approved by the local ethics
committees: University hospital of GENEVA and ZURICH
Research Report Platform Presentation
1403 Monday 4 June 16:35
VCEC Ballroom B & C
TRAINING OF REPEATED VOLUNTARY CONTRACTIONS
LEADS TO PERSISTENT CHANGES IN POSTURAL CONTROL
IN PEOPLE WITH RECURRENT LOW BACK PAIN
Tsao H, Hodges P; Division of Physiotherapy, The University of
Queensland, Brisbane, Australia
PURPOSE: Deficits in control of the trunk muscles have been
demonstrated in people with recurrent low back pain (LBP). These
changes continue to be present despite the resolution of symptoms
and are thought to be associated with recurrence and chronicity. One
approach that has been shown to reduce symptoms and prevent
recurrence involves rehabilitation of trunk muscle control. Although
we have recently shown that this rehabilitation strategy induces
immediate changes in coordination of the trunk muscles, no study
has investigated whether improvement can be maintained. Using
the model of changes in control of the deep abdominal muscle,
transversus abdominis (TrA), in people with LBP, this study aimed
to investigate whether four weeks of training of repeated voluntary
TrA contractions could induce persistent improvements in control of
the trunk muscles. RELEVANCE: Understanding of motor control
changes with motor training will help to explain the efficacy of
this type of intervention for improvements in pain, function and
recurrence rates. PARTICIPANTS: Nine volunteers with recurrent
LBP lasting longer than 3 months were recruited for this study.
METHODS: Subjects trained isolated voluntary TrA contractions
twice per day for four weeks. Coordination of the abdominal muscles
was assessed during single rapid arm movements and self-paced
walking. Recordings of electromyographic activity (EMG) were made
from trunk and deltoid muscles. Measures were made before and
after initial training, before and after training at week two, at week
four, and at six months. Feedback of contraction during training was
provided at the initial session, and during the session at two weeks
with real-time ultrasound imaging. TrA EMG was maintained at 5% of
the maximum root-mean-square EMG amplitude. ANALYSIS: Onsets
of trunk muscle EMG was identified during arm movement and the
coefficient of EMG variation (CV) was calculated during walking.
RESULTS: Onset of TrA EMG was earlier during arm flexion and
extension immediately after a single session of training, and was
further improved with four weeks of training. The CV of the TrA EMG
during walking was reduced (indicating more sustained activity) over
four weeks of training. Changes in timing and CV after one month
were retained at the six month follow-up despite cessation of training.
Changes in other trunk muscles were not significant. Consistent
with previous studies, significant improvements in self-reported pain
and function were also observed (p<0.05). CONCLUSIONS: The
S169
results suggest that a four week training program of isolated voluntary
contractions of TrA is associated with consistent changes in motor
control of this muscle during functional tasks. IMPLICATIONS: The
findings suggest that changes in motor control may help to explain
the improvements in self-reported symptoms that have been reported
from previous clinical trials. Future randomised and controlled
clinical trials are required to confirm the changes in coordination
of the trunk muscles and their association with pain and functional
outcomes. KEYWORDS: motor training, low back pain, feedforward
postural adjustments. FUNDING ACKNOWLEDGEMENTS: Funding
was provided by the National Health and Medical Research Council
of Australia. CONTACT: h.tsao@uq.edu.au
ETHICS COMMITTEE: Medical Research Ethics Committee of the
University of Queensland, Brisbane, Australia
Research Report Platform Presentation
1593 Monday 4 June 16:35
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
PURPOSE: Early Mobilization has been a key word for aggressive
post operative rehabilitation. ABG being an important parameter used
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
chest physiotherapy on ABG. The purpose of the study is to measure
the effects of mobilization on ABG values as an outcome measure
RELEVANCE: Cardiopulmonary dysfunction is seen in patients post
cardiac surgery. Immobility is said to have a lot of disadvantages.
Chest Physiotherapy and mobilization are the most common treat-
ment techniques used by physiotherapist to prevent and treat post op-
erative pulmonary complications. PARTICIPANTS: 30 Subjects who
underwent CABG and were haemodynamically stable between 35-65
years of age group. The subjects were selected by convenient sam-
pling technique. METHODS: The study design is prospective inter-
ventional cross over design. On the 1st post-op day after extubation
a pre-intervention ABG was taken. The patient was given chest phys-
iotherapy (CPT) followed by mobilization to a chair. The patient was
made to sit for ten minutes and then mobilized back to bed. Post inter-
vention ABG was taken. This was considered as intervention I. After
four hours a pre-intervention ABG was taken again. The patient was
given CPT only. A post intervention ABG was taken. This was con-
sidered as intervention II. PH, PO2 and PCo2 measurements taken
from ABG samples were the main outcome measures. ANALYSIS:
The statistical software namely SPSS 11.0 and Systat 8.0 were used
for data analysis and Microsoft word and excel to generate graphs,
tables, etc. Student paired t test has been used to find significance
of mean difference of ABG parameters for CPT and mobilization.
The Cohen effect size has been computed to find the effect of CPT
and mobilization on ABG parameters. RESULTS: On analyzing the
results of intervention I, there was no change in the PH following
mobilization, while there was 13.05% increase in the PO2 (significant
at 1%) and 5.60% decrease in the PCo2 (significant at 1%). Cohen
effect size showed a mild effect of mobilization on PO2 and a moder-
ate effect on PCo2. On analyzing the changes following intervention
II, it was noted that the ABG values showed no change in the PH,
while there was a 7.24% increase in the PO2 (Significant at 1%) and
a 3.09% decrease in the PCo2 (Significant at 5%). Cohen effect size
showed a mild effect of CPT on PO2 and PCo2. CONCLUSIONS:
Our study showed a significant improvement in the ABG when mobi-
lization was used as an add on to chest physiotherapy in post opera-
tive CABG patients. A similar kind of study can be done on patients,
post valvular heart surgeries and on post operative patients with lung
pathologies. IMPLICATIONS: Early mobilization may be considered
as a treatment of choice in the rehabilitation of haemodynamically
stable patients post CABG. This in turn could reduce the need for
S170
supplement oxygen therapy and thus reducing the duration of stay
in Critical care due to respiratory complications and improving cost
effectiveness. KEYWORDS: Chest Physiotherapy, mobilization, coro-
nary artery bypass surgery. FUNDING ACKNOWLEDGEMENTS:
Unfunded. CONTACT: veenakiran_nambiar@yahoo.co.in
ETHICS COMMITTEE: Ethical Committee of MSRMC, Bangalore
India and Narayana Hrudhayalaya of Cardiac Sciences.
Research Report Platform Presentation
2746 Monday 4 June 16:35
VCEC Meeting Rooms 11-12
DOES EXERCISE AFFECT THE PERFORMANCE OF SELECTED
NEUROLOGICAL SCREENING TEST ITEMS FOR SPORTS
RELATED CONCUSSION?
Schneiders A1 , Sullivan S1 , McCrory P2 ; 1 School of Physiotherapy,
University of Otago; 2 Centre for Health, Exercise & Sports
Medicine, University of Melbourne
PURPOSE: To determine the effect of moderate intensity exercise
on three selected measures of motor performance used in sports-
concussion screening. RELEVANCE: Sport-related concussion
(SRC) is a common injury associated with contact and collision
sports and represents a major worldwide public health concern.
Players who are suspected of having sustained a concussion require
medical screening to determine the presence and extent of injury
and to guide return to play decisions. Commonly reported physical
signs of concussion include gait unsteadiness, poor balance and
coordination. Recently an international consensus document, termed
the “Sport Concussion Assessment Tool” (SCAT), was developed
that included a sideline/pre-hospital screen for SRC. While many
aspects of the SCAT are well researched, reliability and validity
of the motor performance components designated the “Neurologic
Screening Protocol”, have not been assessed. Exercise and sport
participation have been shown to effect some measures of motor
performance and for the SCAT to be reliable at detecting a SRC
the effect of exercise on neurological screening items needs to be
established. PARTICIPANTS: Thirty subjects (18-25 years) with no
known neurological, musculoskeletal or cardiovascular conditions.
Participants were screened using the Physical Activity Readiness
Questionnaire (PAR-Q) screening test. METHODS: Finger-to-Nose
(FTN), Tandem Gait (TG) and Single Leg Stance (SLS) tests were
administered four times (T1-4) at 15-minute intervals. Measures were
taken twice before and twice after 15-minutes of exercise at 75-85%
of age predicted maximum heart rate. The type of exercise interven-
tion simulated workloads associated with playing rugby-union, a sport
with a high incidence of concussion in New Zealand. A repeated mea-
sures within subjects design was used. ANALYSIS: Comparisons of
performances across trials were made using mixed models (SAS
9.1.2) with direct product covariance structures to account for the
within-trial (replicates) and between-trial covariances and a random
subject effect. Kenward-Rogers approximation for the denominator
degrees of freedom was used in all cases. Trial, gender, and ordering
effects were treated as fixed and were compared using least-square
means. Mixed model analyses and Intra Correlation Coefficients
(ICC) were calculated. RESULTS: When mean ICC values were used
the reliability was “almost perfect” for FTN (ICC = 0.935) and TG
(ICC = 0.983). TG also had an “almost perfect” score for the single
measures (ICC = 0.827). When the mean values were used SLS
scores were less reliable, but still acceptable with an “almost perfect”
score at T-1 (ICC = 0.85) and a “moderate” score at T-2 (ICC = 0.562).
CONCLUSIONS: The FTN, TG and, to a lesser extent, the SLS are
reliable measures of motor performance in healthy individuals with
the FTN and TG tests demonstrating a facilitatory effect immediately
following moderate intensity exercise. There was no evidence that
measures taken immediately after exercise were different from those
taken after resting for 15 minutes. IMPLICATIONS: This project is
directed at improving the health and safety of athletes by adding pre-
cision in the identification of possible concussions and thus reducing
WCPT 2007, Research Reports
the risk of further, and perhaps more serious injury.The neurological
screening items studied are stable motor performance measures
and can be administered immediately after moderate intensity
exercise. KEYWORDS: Motor performance, Balance, Coordination,
Concussion. FUNDING ACKNOWLEDGEMENTS: The authors wish
to thank The New Zealand Centre for Physiotherapy Research for
support with this project. CONTACT: tony.schneiders@otago.ac.nz
ETHICS COMMITTEE: University of Otago Human Ethics Committee
Research Report Platform Presentation
1323 Monday 4 June 16:35
VCEC Meeting Room 16
ARE THE APPARENT EFFECTS OF STRETCH ON TISSUE
EXTENSIBILITY SOLELY EXPLAINED BY CHANGES IN
STRETCH TOLERANCE? A RANDOMISED CONTROLLED TRIAL
Flopp H1 , Deall S1 , Harvey L2 , Gwinn T3 ; 1 School of Physiotherapy,
University of Sydney, Sydney, Australia; 2 Rehabilitation Studies
Unit, Northern Clinical School, Faculty of Medicine, University of
Sydney, Sydney, Australia; 3 School of Exercise and Sports Science,
Faculty of Health Science, University of Sydney, Sydney, Australian
PURPOSE: It is widely believed that regular stretch induces lasting
changes in tissue extensibility reflected by increases in passive
joint range of motion. However, the results of recent trials provide
conflicting results. Some indicate that regular stretch does increase
joint range of motion and others indicate that it does not. One possible
explanation for these conflicting results, that we sought to explore, is
that investigators fail to distinguish between changes in tissue ex-
tensibility (joint angle corresponding with a standardised torque) and
changes in subjects’ tolerance to an uncomfortable stretch sensation
(joint angle corresponding with maximal torque tolerated). The pur-
pose of this study was to determine whether the apparent increases
in joint range of motion observed with stretch programs can be solely
explained by changes in subjects’ tolerance to an uncomfortable
stretch sensation RELEVANCE: Stretch is commonly administered
by physiotherapists to induce lasting changes in muscle extensibility.
PARTICIPANTS: Twenty healthy able-bodied individuals. METHODS:
A within-subjects design was used whereby one leg of each subject
was randomly allocated to the experimental condition and the other
leg was allocated to the control condition. The hamstring muscles of
each subject’s experimental leg was stretched daily for 20 minutes
over four weeks. Hamstring muscle extensibility (hip flexion with
a standardised torque) and stretch tolerance (hip flexion with the
highest torque subjects would tolerate) were assessed on both legs at
the beginning and end of the study by blinded assessors. ANALYSIS:
Mean changes from initial to final measures were calculated for
both experimental and control legs and 95% confidence intervals
for between-leg differences in change scores were calculated.
RESULTS: The intervention did not increase the extensibility of the
hamstring muscles (mean change in hip flexion with a standardised
torque was −1 degree, 95% CI −4 to 3 degrees) but did increase
subjects’ tolerance to an uncomfortable stretch sensation (mean
change in hip flexion with the highest torque subjects could tolerate
was 8 degrees, 95% CI 5 to 12 degrees). CONCLUSIONS: Regular
stretch changes subjects’ tolerance to an uncomfortable stretch
sensation. This leads to an apparent, but not real, increase in muscle
extensibility. IMPLICATIONS: These results highlight the importance
of distinguishing between real and apparent increases in muscle
extensibility when assessing the effectiveness of stretch, and indicate
that whilst a four-week stretch program increases subjects’ tolerance
to an uncomfortable stretch sensation it does not increase hamstring
muscle extensibility. The results also help explain the inconsistent
results of recent clinical trials. KEYWORDS: stretch; contracture;
extensibility; range of motion. FUNDING ACKNOWLEDGEMENTS:
nil. CONTACT: l.harvey@usyd.edu.au
ETHICS COMMITTEE: University of Sydney, Sydney, Australia
Platform Presentations, Monday 4 June
Research Report Platform Presentation
2447 Monday 4 June 16:35
VCEC Meeting Room 17
FACTORS AFFECTING STIFF-LEGGED GAIT IN HEREDITARY
AND SPONTANEOUS SPASTIC PARAPARESIS
Marsden J1 , Ramdharry G1 , Wood N2 , Thompson A2 ; 1 Sobell
Department of Motor Neuroscience and Movement Disorders.
Institute of Neurology London UK; 2 Department of Molecular
Neuroscience Institute of Neurology London UK; 3 Department
of Headache, Brain Injury and Rehabilitation Institute of Neurology
London UK
PURPOSE: A slow, stiff legged gait is commonly seen in people
with spontaneous and hereditary spastic paraparesis (SP). The
cause of reduced walking speed and knee flexion velocity during
swing phase is unclear and may be related to weakness; hypertonia
or inappropriately timed antagonist activity. This study aims to
investigate the factors affecting stiff-legged gait. RELEVANCE:
People with spastic paraparesis present with multiple impairments
that may affect walking, understanding the factors that contribute
to walking dysfunction will allow for the development of specifically
targeted therapies. PARTICIPANTS: 20 people with hereditary
(n=15) or spontaneous spastic paraparesis were compared to 5
healthy controls matched for age, gender and mass. METHODS:
A 10m walkway with two embedded force plates (Kistler type
9286A,Switzerland) was used in conjunction with 3D motion analysis
(CODAmotion, UK) in the recording and determination of joint
kinematics and kinetics. Control subjects walked at the same
cadence and stride length as the people with SP. Isometric muscle
strength of the lower limb hip, knee and ankle muscles was recorded
using a dynamometer (Biodex System3 USA). To estimate non-neural
and neural stiffness in the ankle plantarflexors and quadriceps low
amplitude (5º) slow (5º/s) and fast (60º/s) stretches were applied
with the subject at rest. ANALYSIS: Differences between groups
in muscle strength and knee flexion velocity were compared using
a two-tailed unpaired t-test. Differences in muscle hypertonia were
assessed using a repeated measures general linear model (2
conditions: slow Vs fast stretch). In people with SP the relationship
between the parameters of gait and measures of impairment was
investigated using multiple linear regression. RESULTS: People with
SP showed a significant reduction in isometric muscle strength that
was greater distally than proximally (41% mean reduction in the ankle
plantarflexors and dorsiflexors Vs 25.5% mean reduction in the knee
flexors and extensors Vs 24.5% mean reduction in the hip flexors
and extensors). Stiffness was significantly higher in people with SP
following both slow and fast stretches (Group effect Plantarflexors
F(1,23) = 8.2 P < 0.05; Quadriceps F(1,23) = 7.09 P < 0.05). Stretch
reflex activation was only seen with fast stretches. In people with
SP maximal walking speed was slower (SP 1.2 m/s +/− 0.5 standard
deviation Controls 1.9 m/s+/−0.2 t=3.7 P < 0.005) and maximal knee
flexion velocity was reduced (SP 216 o/s +/− 126 SD Controls 311 o/s
+/−66 t=2.2 P < 0.05). Isometric hip flexor and plantarflexor strength
accounted for 71% of the variance in walking speed in people with
SP [F(2,19) = 21.2 P < 0.001]. Passive stiffness seen following a slow
quadriceps stretch and plantarflexor isometric strength accounted for
56% of the variance in the maximal knee flexion velocity during swing
phase [F(2,19) = 10.6 p < 0.001]. CONCLUSIONS: In agreement with
findings in stroke both plantarflexor and hip flexor strength are im-
portant for maximal walking speed. In SP slower knee flexion during
swing phase is associated with weakness in the plantarflexors, which
normally help to initiate swing phase, and increased passive stiffness
in the quadriceps. IMPLICATIONS: The influence of muscle strength
and passive stiffness on walking speed and kinematics suggest
that these properties may be appropriate targets for physiotherapy
intervention. KEYWORDS: Hereditary spastic paraparesis; walking,
hypertonia. FUNDING ACKNOWLEDGEMENTS: Medical Research
Council. CONTACT: j.marsden@ion.ucl.ac.uk
ETHICS COMMITTEE: Joint National Hospital for Neurology and
Neurosurgery and Institute of Neurology Ethics committee
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Research Report Platform Presentation
1653 Monday 4 June 16:35
VCEC Meeting Room 18
EXPLORATION OF VOLUNTARY ACTIVATION OF QUADRICEPS
FEMORIS IN PATIENTS WITH ACUTE ANTERIOR CRUCIATE
LIGAMENT RUPTURE
Trees A1 , Howe T2 , Dixon J1 ; 1 Teesside Centre for Rehabilitation
Science, University of Teesside, Middlesbrough, United Kingdom;
2 HealthQWest, Glasgow Caledonia University, Glasgow, United
Kingdom
PURPOSE: Following injury to the anterior cruciate ligament (ACL),
it is accepted that a weakness of quadriceps femoris is due not
only to disuse atrophy but to a decrease in voluntary activation,
caused by arthrogenic muscle inhibition. The purpose of this study
was to investigate the degree of maximal voluntary activation (MVA)
in patients with acute ACL ruptures and the relationship with strength
and function. RELEVANCE: Unimpaired MVA is essential if the
patient wishes to return to previous levels of activity. Rehabilitation
can be hindered by impaired MVA, which may reduce the ability to
strengthen the muscle. PARTICIPANTS: Twenty consecutive patients
(14 male and 6 female) with acute isolated unilateral ACL rupture
were recruited from an acute knee clinic at a mean of 86 days (range
16-172) after injury and all consented to participation in the study.
ACL rupture was confirmed by clinical examination (arthrometry,
Lachman testing and anterior drawer tests) and MRI (15 participants).
Mean age of the group was 30.5 years (SD 9.15). METHODS:
This was a cross-sectional observational study. Assessment of the
participants included subjective functional questionnaires (Lysholm,
Tegner and IKDC Subjective Score), measurement of knee laxity and
demographics. Quadriceps peak torque and MVA were assessed
during maximal voluntary isometric contractions (MVIC) using the
twitch interpolation technique. Participants were seated in an upright
position, with the knee flexed to 90º. Stimulation was delivered using
a Digitimer DS100A, using 1Hz current of pulse width 200ms during
a rest period and during a MVIC. This was repeated three times
with a rest period of 120 seconds between repetitions. ANALYSIS:
Paired t-tests were used to compare side-to-side differences in MVA
and peak torque. Bivariate correlations examined the relationships
between MVA, peak torque, functional scores and time since injury.
Significance levels were set at 0.05. RESULTS: The mean MVA was
84.1% (SD 8.9) for the injured limb, and 88.4% (SD 7.7) for the
un-injured limb. Mean difference was 4.2% (95% CI -.35 to 8.84),
p > 0.05. The peak torque of the injured limb (164.6Nm, SD 72.5)
was significantly lower than that of the un-injured limb (231.9 Nm,
SD 80.6), with a mean (95% CI) difference 67.4 Nm (47.6 to 87.2
Nm), p < 0.001. For the injured limb MVA demonstrated a significant
relationship with IKDC score (p < 0.05, r=.48) and peak torque
(p < 0.05, r=.43). In addition, positive relationships were demonstrated
between peak quadriceps torque per unit body mass and Tegner
activity level (injured limb p < 0.01, r=.54; uninjured limb p < 0.05,
r=.43). CONCLUSIONS: The results of this study suggest that in
the acute stage of ACL rupture a reduction in MVA of the quadriceps
may not be solely responsible for quadriceps weakness. Although
decreased activation was present to a similar degree in both limbs,
there was a comparative significant weakness of the injured limb.
Further studies should consider the efficacy of differing rehabilitation
regimes on improving MVA of the quadriceps post-ACL rupture.
IMPLICATIONS: Decreases in the quadriceps strength and activation
could increase susceptibility to joint injury, if not addressed with
appropriate rehabilitation. KEYWORDS: ACL; Activation; Strength.
FUNDING ACKNOWLEDGEMENTS: No funding was received for
this study. CONTACT: amanda.trees@hotmail.co.uk
ETHICS COMMITTEE: South Tees Local Research Ethics Commit-
tee, Middlesbrough, UK
S172
Research Report Platform Presentation
1269 Monday 4 June 16:35
VCEC Meeting Rooms 19-20
THE CHANGES OF MUSCLE STRENGTH ON SHOULDER JOINT
AFTER STRENGTHENING OF SCAPULAR MUSCLES
Ijiri T, Miyashita K, Urabe Y, Takemoto Y, Obayashi H, Koshida S;
Department of Sport Rehabilitation, Graduate School of Health
Sciences, Hiroshima University, Hiroshima, Japan
PURPOSE: Muscular weakness on shoulder complex could be
influenced by not only glenohumeral joint but also scapulothoracic
joint. The representative case of muscle weakness on scapulotho-
racic joint is winging scapula. The patients with winging scapula
are usually instructed to perform exercise to strengthen scapular
muscles. However, the effect of exercises for scapular muscles is
still unclear. Therefore, the purpose of this study was to examine the
changes of muscle strength on shoulder joint after scapular abduction
and adduction exercise. RELEVANCE: This study could demonstrate
kinetic relationship between scapulothoracic joint and shoulder joint.
PARTICIPANTS: Thirty healthy male subjects participated in this
study (average 22.5 years). Informed consent was obtained by all
the subjects prior to the experiment. METHODS: Each 10 subject
was assigned to abductor group(AB group), adductor group(AD
group), or control group(CO group). At first, muscle strength of
right shoulder flexion (FL), abduction(AB), external rotation(ER),
and internal rotation(IR) was measured in all the groups. The
measurement positions of shoulder FL and AB were adopted
from Manual Muscle Testing (Daniels and worthingham 2002). The
positions of shoulder ER and IR were set with elbow flexion angle
of 90 degree (1st position). The AB group and the AD group
were instructed to perform the scapular abduction exercise and
the scapular adduction exercise, respectively. Scapular abduction
exercise was modified “elbow push up plus”. Scapular adduction
exercise was to perform scapular adduction with arms droop. Both
exercise groups were required to complete exercises with three sets
of 20 repetitions a day for seven days. The CO group did not perform
any exercise. Seven days later, subjects in all the groups were
measured the muscle strength in the same way as the first time again.
Muscle strength obtained on the last day was normalized to the initial
strength of the measurement and compared. ANALYSIS: Paired
t-test was used to compare the muscle strength between before
and after the exercises each three group. The level of statistical
significance was set at 0.05 in this study. RESULTS: The muscle
strength of shoulder FL(107±6), AB(112±11), and IR(114±10) was
significantly increased in AB group, whereas the strength of shoulder
ER(106±7) was significantly increased in AD group. On the other
hand, nothing changed significantly in CO group. CONCLUSIONS:
Based on our results, it is suggested that scapular abduction
exercise increases muscle strength of shoulder FL, AB, and IR.
Since shoulder FL, AB, and IR include the scapular posterior tilt,
upward rotation, and protraction movement, the increase of scapular
abduction strength could have lead to the increase of shoulder FL,
AB, and IR. The reason that scapular adduction exercise increased
muscle strength of shoulder ER will be the same mechanism. The
muscle strength of shoulder complex would depend on the function
of scapulothoracic joint that was strengthened. IMPLICATIONS: This
reveals biomechanical construction of shoulder complex and may
be helpful information to physical therapy. KEYWORDS: Scapula,
Strength, Shoulder. FUNDING ACKNOWLEDGEMENTS: This study
was unfunded.
ETHICS COMMITTEE: Ethical Review Board in Hiroshima University
WCPT 2007, Research Reports
Research Report Platform Presentation
2660 Monday 4 June 16:55
PP Crystal Pavilion A
EFFECTIVENESS OF DATABASE SEARCHING FOR EVIDENCE-
BASED PHYSIOTHERAPY: COMPARING SEARCHING
METHODS TO IDENTIFY OPTIMAL SEARCH STRATEGIES
Fell D1 , Burnham J2 , Caswell C1 , Nuchereno A1 , Smolinski A1 ,
Wood C1 ; 1 University of South Alabama, Department of Physical
Therapy, Mobile, AL USA; 2 University of South Alabama, Baugh
Biomedical Library, Mobile, AL, USA
PURPOSE: This study compared effectiveness of Internet search
methods among physical therapy (PT) related personnel, to
identify characteristics of the most effective search methodology
and techniques as a basis for effective training programs for
PT students and clinicians to support evidence-based practice.
RELEVANCE: Previous studies have investigated the effectiveness
of search methodology in other healthcare fields, but none in PT.
PARTICIPANTS: This cross-sectional study utilized eight participants
with various levels of search experience: two biomedical librarians,
two PT students, two PT faculty, and two PT clinicians. METHODS:
Subjects were given two specific clinical questions devised by an
experienced faculty member. Subjects then used search engines or
databases of choice to find relevant articles and of those select
the three articles most relevant to the clinical questions. Written
and electronic logs of search activities and downloaded results
were collected. A computerized spreadsheet was used to manage
results including citation ratings, and for each search: number
of retrieved articles, number of relevant articles, time length for
search. All articles retrieved were compiled in one spreadsheet
from which the expert faculty member, blinded to searcher identify
for each citation, rated each article for relevancy using an ordinal
scale. The rankings, along search logs were used to analyze the
results and determine which search strategies/methods were most
efficient. ANALYSIS: Descriptive statistics and retrieval rates for
relevant articles are compared among searchers. RESULTS: After
elimination of duplicates, a total of 30 articles remained. Eight
articles were rated “highly relevant” (1+), with each participant
group contributing some relevant (1 and 1+) articles. Longer mean
search times were associated with searches for highly relevant
articles (31 minutes mean time for 1+, vs. 17.6 minutes mean
time for “not relevant”). Productive strategies are identified and
will be discussed. CONCLUSIONS: Certain search strategies and
techniques were associated with improved search results. Database
choice did not affect the quality of retrieved articles, nor did
the participant group. However, 8/8 highly relevant articles were
later found to be accessible through Medline, and 5/8 through
CINAHL. IMPLICATIONS: By using these databases, and using
the suggested search strategies, including sufficient time, health
professionals can increase return of high quality, relevant literature.
KEYWORDS: literature, literature search, evidence-based prac-
tice. FUNDING ACKNOWLEDGEMENTS: Unfunded. CONTACT:
dfell@jaguar1.usouthal.edu
ETHICS COMMITTEE: University of South Alabama Institutional
Review Board
Research Report Platform Presentation
2103 Monday 4 June 16:55
PP Crystal Pavilion B & C
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
Platform Presentations, Monday 4 June
stroke depression, but people with stroke suggest that it may
exist independently. The aim of this study was to evaluate fatigue
and depression following a stroke. In addition the relationship
between both conditions was investigated. RELEVANCE: Population
demographics are changing in Ireland. An increasing number of
people over the age of 65 is anticipated to lead to an increase in the
prevalence of cardiovascular disease and stroke. People with stroke
participate in physiotherapy rehabilitation and frequently report that
fatigue is a limiting factor in complete participation, both in hospital
and post discharge. Thus fatigue may prevent optimum recovery from
stroke. PARTICIPANTS: 60 people with a WHO diagnosis of stroke
in the previous three years, and who were living in their own homes
in the community, participated in the study. These were aged and
gender matched with 60 people in the community who have not had
a stroke. METHODS: All 120 participants completed a questionnaire
that included: • The Multidimensional Fatigue Inventory, • The
Geriatric Depression Scale, • The Barthel ADL index, and • The
Reintegration to Normal Living Index, which measures the extent to
which person has adapted to limitations imposed by a condition.
ANALYSIS: The quantitative data was analysed in using non-
parametric significance tests and chi-squared analysis. RESULTS:
The Multi-dimensional Fatigue Inventory returns fatigue scores in 5
domains; general fatigue, physical fatigue, reduced activity levels,
reduced motivation and mental fatigue. Significant differences were
noted across all five domains between people with stroke and
those without, Mann-Whitney p < 0.0000 for all and point estimates
for the difference of 7.0, 9.0, 7.0, 5.0 and 6.0 respectively. The
Geriatric Depression Scale ranges from 0-30. A difference between
people with stroke and age/gender-matched controls exists, and
is statistically significant (Mann-Whitney p < 0.0000). A relationship
exists between the mental fatigue subscale of the MFI and depression
in people with stroke. Chi-squared analysis returns c2 =7.6, p < 0.01.
Mental fatigue scores in people with stroke are higher in those with
depression than those without. Mann-Whitney analysis computes the
point estimate for the difference as 4, the 95% confidence interval is
(1.999-6), p < 0.002. CONCLUSIONS: Fatigue and depression are
both largely reported in people with stroke in Ireland. The levels
of fatigue and depression are much higher in people who have
had a stroke, indicating they are attributable to the stroke. Fatigue
and depression may co-exist in people with stroke, but increasing
evidence suggests that fatigue is independent of depression. This
fatigue remains under-investigated and untreated in people who have
had a stroke in Ireland. IMPLICATIONS: Fatigue and depression are
common after a stroke. They are widely reported and appear to exist
independently of function. The results of this study will be used to
inform the creation of a randomised controlled trial to investigate
possible physiotherapeutic interventions to alleviate fatigue after
a stroke. KEYWORDS: Stroke, Fatigue, Depression. FUNDING
ACKNOWLEDGEMENTS: None. CONTACT: oconnene@tcd.ie
ETHICS COMMITTEE: The Joint Research Ethics Committee of
the Adelaide and Meath Hospital Tallaght and St. James’s Hospital,
Dublin, Ireland.
Research Report Platform Presentation
1140 Monday 4 June 16:55
VCEC Ballroom A
CONTENT VALIDITY OF THE FIRST VERSION OF
INTERVENTION CATEGORIES FOR PHYSICAL THERAPISTS
BASED ON THE ICF: INTERNAL-MEDICINE AREA
Bürge E1 , Cieza A2 , Allet L3 , Finger M4 , Stucki G2 ,
Huber E5 ; 1 Haute Ecole de Santé Geneva Switzerland;
2 Ludwig-Maximilians-University, Munich, Germany; 3 University
Hospital Geneva Switzerland; 4 Rehaklinik Bellikon Switzerland;
5 University Hospital Zurich Switzerland
PURPOSE: Physical therapists have been among the first to recog-
nize the potential of the International Classification of Functioning,
Disability and Health (ICF) to improve clinical practice and health
S173
services provision. However, the ICF is not yet being widely used by
physical therapists in clinical practice. In Switzerland, an exhaustive
process involving a Delphi exercise and a consensus conference
enabled development of a first version of so-called ICF intervention
categories for physical therapists treating patients with problems
in internal medicine. The next step in the development process
and the aim of this study is to address the content validity of
these ICF intervention categories. RELEVANCE: The health-political
demand for transparency regarding services of health-care providers
is increasing. In this context, a tool like lists of ICF intervention
categories is of interest, because they offer the opportunity to define
a profile of patient’s problems that can potentially be treated by
physical therapists using a language understood by all different
health professionals. PARTICIPANTS: The study was performed
with convenience samples of 300 clinical records. The records
were included if patients were at least 18 years old, had received
physical-therapy treatment for an internal medicine condition in
acute, rehabilitation or community health-care situations at any time
from January 2003 to November 2005. METHODS: The study was
conducted as a retrospective cross-sectional multicenter study in
Switzerland. In each center, a person responsible for the study sent
a predefined number of records to the study leader. The study leader
extracted all treatment goals and all interventions documented in
the patient records and linked them to the ICF categories based
on established linking rules. To assure the accuracy of the linking
process, 10% of the clinical records were randomly selected and
linked by a second health professional. ANALYSIS: Descriptive
statistics were used to describe the study population and to describe
how often a goal, intervention or technique had been named in the
clinical records. A cut-off point of a frequency of 5% was chosen to
identify the ICF categories that were to be included in the lists. The
reliability of the linkage process was evaluated by calculating kappa
coefficients and nonparametric bootstrapped confidence intervals.
RESULTS: Estimated kappa values range from 0.79 to 0.84.
None of the 95% confidence intervals encloses zero, showing that
linker agreement exceeds chance. The validation process enabled
identification of 36 second-level ICF intervention categories for the
acute, 41 for the rehabilitation and 38 for the community health-care
situations. CONCLUSIONS: Most of the ICF intervention categories
contained in the first version have been confirmed. These lists of ICF
intervention categories are available for intervention documentation
in a standardised common language. IMPLICATIONS: The defined
ICF intervention categories offer the possibility to make physical-
therapy interventions intelligible for the different partners in the
health-care system. In clinical work, the use of these lists, implying
critical evaluation of the interventions, could have a positive
impact on treatment. KEYWORDS: International Classification of
Functioning, Disability and Health, Intervention, Physical therapy,
Internal medicine. FUNDING ACKNOWLEDGEMENTS: We grate-
fully acknowledge the Swiss Physiotherapy Association for its
financial support and the cooperation of all participants in this study.
CONTACT: elisabeth.burge@hesge.ch
ETHICS COMMITTEE: The study was approved by the local ethics
committees of Geneva and Zurich
Research Report Platform Presentation
2347 Monday 4 June 16:55
VCEC Ballroom B & C
TRUNK MUSCLE CONTROL IN BACK PAIN: HOW CAN THE
VARIABILITY BE EXPLAINED?
Hodges P1 , Cholewicki J2 , Coppieters M1 , Macdonald D1 ; 1 Division
of Physiotherapy, The University of Queensland, Brisbane, Qld,
Australia; 2 Department of Orthopaedics & Rehabilitation, Yale
University School of Medicine, New Haven, CT, USA
PURPOSE: Low back pain (LBP) is associated with changes in
trunk muscle control. However, these changes have been debated as
authors cite both increased and decreased activity. Such variability
S174
is difficult to reconcile and often interpreted to suggest that the
trunk muscle adaptation to pain is heterogeneous. Yet, the variability
could be explained by the system’s redundancy, that is, multiple
strategies can achieve the same goal. We argue that the nervous
system commonly aims to increase spinal stability to protect it from
pain and (re)injury but the strategy may vary between individuals
and between tasks. We addressed this issue by investigation of
individual and task variation in the response of trunk muscles
to experimental pain. RELEVANCE: Physiotherapists train trunk
muscle control for the management of LBP based on evidence of
deficits in this system. However, without clear understanding of the
underlying mechanism the rationale for these interventions is unclear.
PARTICIPANTS: Seventeen healthy volunteers with no history of
LBP, or major respiratory or neurological disorders participated.
METHODS: Electromyographic activity (EMG) of trunk flexor (rectus
abdominis (RA), obliquus internus (OI) and externus abdominis
(OE)) and extensor (thoracic (TES) and lumbar erector spinae
(LES) and latissimus dorsi (LD)) muscles was recorded bilaterally
while participants slowly moved the trunk between −20º (extension)
and +20º (flexion) prior to and after injection of hypertonic saline
into the right longissimus, and after pain resolution. Pain was
reported on an 11-point numerical rating scale. Two trials were
performed in each direction. ANALYSIS: EMG data were rectified,
low pass filtered at 1 Hz and the root mean square (RMS) of
the 12 EMG signals was calculated at each trunk angle. The
minimum RMS EMG was calculated and the value for each muscle
at this angle was recorded. EMG was defined to be increased
or decreased if it changed by>15% from baseline. Minimum RMS
EMG was compared between trials before, during and after pain
with a repeated-measures ANOVA. RESULTS: Participants reported
pain of 6.1(2.7) after saline injection. With movement between
flexion and extension the minimum RMS EMG increased by 13-30%
during pain (P < 0.05). After the pain resolved minimum RMS EMG
returned to control values. There was considerable variation between
individuals with variable combinations of increased and decreased
activity. Left OI, RA and right OE and OI EMG increased in>50%
of participants. Right LD, RA, OE and TES, and left OI and TES
EMG decreased in>25%. CONCLUSIONS: These data indicate that
although experimental LBP was associated with variable changes
in trunk muscle activity, there was a net increase in activity when all
muscles were considered. This finding is consistent with the proposal
that the nervous system responds to pain by increasing muscle
activity to protect the spine from the real or perceived threat of pain
or (re)injury. IMPLICATIONS: Rather than training people with LBP
to increase the stability of the spine the goal of training may be
better directed to optimization of spinal stability. This may involve
reduced activity of some of the trunk muscles. This underscores
the necessity for detailed assessment to direct management.
KEYWORDS: Low back pain, spinal stability, electromyography.
FUNDING ACKNOWLEDGEMENTS: Paul Hodges is supported by
the National Health and Medical Research Council of Australia.
Jacek Cholewicki is supported by NIH grant R01 AR051497. Michel
Coppieters is supported by the University of Queensland. CONTACT:
p.hodges@uq.edu.au
ETHICS COMMITTEE: Medical Research Ethics Committee of The
University of Queensland
Research Report Platform Presentation
1663 Monday 4 June 16:55
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
WCPT 2007, Research Reports
of their families, on blood pressure, exercise capacity and body
mass index (BMI). RELEVANCE: Hypertension is a difficult condition
to manage because of the need for patients to change their
health behaviour.This study is a follow-up to a more complex
study done at a hypertension clinic in a tertiary care hospital
in Johannesburg,South Africa, in which encouraging results were
shown in improvements in cardiovascular risk factor modification
in patients with hypertension. PARTICIPANTS: Thirty two patients
participated in this study (80% power using a drop in blood
pressure of 5(±4) mmHg at a significance level of 95%). New
patients to the clinic were invited to participate in the study and
signed informed consent prior to any data collection. No specific
exclusion criteria were imposed as health behaviour is independent
of age,severity of disease,signs and symptoms. METHODS: Baseline
data included demographic information and the measurements of
weight,height,(BMI) resting blood pressure and resting heart rate.
Patients underwent a six minute walk test. Patients were randomly
allocated to an experimental group or a control group once baseline
data had been collected. All patients were given a structured
progressive home walking programme and an exercise diary. The
patients in the experimental group and a member of their families
had a once a month educational telephone call from a research
assistant not involved in the data collection.The calls covered basic
dietary changes needed,progression of the walking programme and
the need to take all medication as prescribed at the same time
each day. The control group had no intervention.At six months all
patients were weighed,their resting blood pressure measured and
their exercise capacity measured. All measurements were taken by
the author whio was blinded as to group allocation and baseline
data. ANALYSIS: The similarity of the baseline data was established
using the independent t test for continuous data and Fisher’s
exact test for categorial data. Changes in blood pressure,exercise
capacity and BMI were established by the Wilcoxon Rank Sum
and Kruskal- Wallis test as data were not normally distributed.
An intention to treat analysis was followed. RESULTS: Fourteen
patients in the experimental group and fifteen patients in the control
group completed the programme. There was a clinically significant
difference in the change in systolic blood pressure(p = 0.01) and
diastolic blood pressure(p = 0.02) between the experimental and
control groups. There was a clinically significant difference (p < 0.001)
in the change in exercise capacity between groups.There was no
change in BMI in either group. (p = 0.58). CONCLUSIONS: The better
control of blood pressure and improvement in exercise capacity in
the experimental group indicates that when patients unerstand what
they have to do and are supported, better blood pressure control and
improved exercise capacity can be achieved. Reductions in BMI are
too difficult to achieve in an intervention like this. IMPLICATIONS:
This is a simple and potentially effective way to educate and support
patients as they attempt to change their health behaviour. Future
work would include multi-centered studies and cost analyses of this
programme. KEYWORDS: family-support,hypertension,education.
FUNDING ACKNOWLEDGEMENTS: Funding was obtained from
the Faculty Research Fund at the University of the Witwatersrand.
CONTACT: stewartav@therapy.wits.ac.za
ETHICS COMMITTEE: Obtained from the Committee for Research
on Human Subjects at the University of the Witwatersrand Johannes-
burg. Protocol Number:M030839
Platform Presentations, Monday 4 June
Research Report Platform Presentation
2938 Monday 4 June 16:55
VCEC Meeting Rooms 11-12
TRAINING RISK FACTORS ASSOCIATED WITH ADOLESCENT
DANCE AND ACROBATIC GYMNASTICS INJURY
Purnell M1 , Shirley D1 , Adams R1 , Nicholson L1 , Crookshanks D2 ;
1 School of Physiotherapy, University of Sydney, Sydney, Australia;
2 School of Theatre, Film and Dance, University of New South
Wales, Sydney, Australia
PURPOSE: The purpose of this study was to determine risk factors
for injury associated with dance and acrobatics training during
adolescence. RELEVANCE: Dance and acrobatic gymnastics are
artistic sports which require superior flexibility, control and intensive
training during adolescence. The incidence of traumatic and overuse
injury is high however little is known about the risk factors in
order to successfully treat these injuries and prevent reoccurrence.
PARTICIPANTS: 148 male and female participants (75 ballet and/or
theatrical dance students and 73 acrobatic gymnasts) volunteered for
the study. Dance students aged 16 to 19.5 years, were recruited from
Sydney based dance schools and universities. Acrobatic gymnasts
aged 8 to 26 years were recruited from New South Wales acrobatic
gymnastics clubs. METHODS: A widely used Australian dance injury
survey was modified for the purpose of this study which requested
information regarding chronic injury, most recent dance or acrobatics
related injury as well as treatment, dieting behaviour, training history
and awareness of injury prevention strategies. ANALYSIS: Data was
analysed with SPSS 12 for Windows. Risk factors were examined by
Pearson’s correlation, ANOVA, t-tests and ROC curves. RESULTS:
The results indicate that 47% of dance students and 37% of acrobats
had sustained an injury within the past 6 months. The majority of
dance students (51%) and acrobats who were also aged 16 years
and over (62%) reported being affected by chronic injury at the
time of the survey. Age of onset for acrobatics-related injury and
chronic injury averaged 13.7 and 14.7 years respectively, comparable
with adolescent dance injuries at 14.1 and 14.9 years. The knee
and ankle were the most common sites of injury. The majority of
participants (82%) who required treatment for their most recent dance
or acrobatics-related injury consulted a Physiotherapist. Significant
risk factors for injury were training over 8.5 hours per week at age
14 years (p < 0.001) for dancers and age 13 years for acrobats
(p < 0.001). No increase in injury risk was identified in those who
trained in additional sports. CONCLUSIONS: A training threshold
may exist for 13 and 14 year old dance students and acrobatic
gymnasts, which if exceeded, increases the risk of injury. These
injuries most commonly affect the knee and ankle. Further research
is warranted to determine optimal training loads in order to minimise
injury risk as well as explore specific risk factors for knee and ankle
injuries. IMPLICATIONS: Limiting training hours of 13 and 14 year
old acrobatic gymnasts and dancers to 8.5 per week may prevent
injury. As participation in sporting activity did not increase injury risk,
cross-training may enable these athletes to improve fitness without
subjecting their bodies to high intensity dance and acrobatics training
during this critical period. Both health professionals and coaches
have a role in developing such a training program. KEYWORDS:
adolescent injury. FUNDING ACKNOWLEDGEMENTS: This work
was unfunded. CONTACT: dancephysio@hotmail.com
ETHICS COMMITTEE: University of Sydney Human Research Ethics
Committee
S175
Research Report Platform Presentation
1399 Monday 4 June 16:55
VCEC Meeting Room 16
THERAPEUTIC EXERCISE IN MUSCULOSKELETAL
PHYSIOTHERAPY: A SUMMARY OF SYSTEMATIC REVIEWS
Taylor N, Dodd K, Shields N, Bruder A; School of Physiotherapy,
La Trobe University, Melbourne, Australia
PURPOSE: To evaluate the evidence from systematic reviews that
therapeutic exercise in musculoskeletal physiotherapy practice can
lead to health benefits. RELEVANCE: The treatment of problems
of movement is one of the major dimensions of musculoskeletal
physiotherapy practice. Prescription of exercise is one of the most
common treatment options applied by physiotherapists. Conclusions
based on systematic reviews of randomised controlled trials are
considered to provide the highest level of evidence about the
effectiveness of an intervention. PARTICIPANTS: The ‘participants’ in
this study were 21 systematic reviews in the area of musculoskeletal
practice. Reviews were selected by searching electronic databases
for systematic reviews that evaluated the effects of therapeutic
exercise. As well as being required to be a systematic review
that evaluated therapeutic exercise in a musculoskeletal diagnostic
group, reviews also had to include at least one randomised
controlled trial, be considered to be good or reasonable quality
as assessed on a quality assessment scale, and be written in
English. METHODS: The quality assessment was completed by
two independent reviewers using a quality checklist designed for
systematic reviews and data were extracted from each included paper
using a standardised form. ANALYSIS: The quality assessment was
completed by two independent reviewers using a quality checklist
designed for systematic reviews and data were extracted from each
included paper using a standardised form. RESULTS: The review
included seven reviews on low back and neck pain, 10 reviews on
peripheral musculoskeletal practice (including fracture rehabilitation
and musculoskeletal disorders of the upper and lower limbs), and
four reviews on arthritis. In total 226 randomised and controlled
trials were evaluated and the reviews were rated between 73 and
84 out of 100 on the quality assessment scale (M 78.5, SD 4.9).
In musculoskeletal practice, therapeutic exercise reduced pain and
improved activity levels in people with chronic low back pain, and
osteoarthritis of the knee; reduced sick leave in people with sub-
acute and chronic low back pain; and improved activity and led
to a faster return to work after lumbar disc surgery. There was
also moderate or limited evidence to support the effectiveness of
therapeutic exercise in such diverse clinical groups as ankylosing
spondylitis, cervicogenic headache, whiplash associated disorders,
acute mechanical neck disorders, fractures of the proximal femur
and humerus, shoulder pain, lateral epicondylitis, patellofemoral pain
syndrome, and acute lateral ankle sprain. There were indications
that exercise programs were more effective when they were relatively
intense and individualised, but in many areas of practice one form
of exercise was no more beneficial than another. Very few adverse
effects of exercise were reported. CONCLUSIONS: This summary
of systematic reviews provides evidence that prescription of exercise
can lead to health benefits for many of the clients presenting to
physiotherapy with musculoskeletal complaints. Future research is
required to determine the types and details of exercise programs
that lead to optimum benefits. IMPLICATIONS: Prescription of
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.
CONTACT: N.Taylor@latrobe.edu.au
S176
Research Report Platform Presentation
2621 Monday 4 June 16:55
VCEC Meeting Room 17
A DESCRIPTIVE STUDY OF IMPAIRMENT, ACTIVITY LIMITATION
AND HEALTH STATUS IN PATIENTS WITH CHRONIC
INFLAMMATORY DEMYELINATING POLYNEUROPATHY, CIDP
Eriksson Westblad M1,2 , Forsberg A2 , Press R3 ; 1 Department
of Physical Therapy, Karolinska University Hospital Huddinge,
Sweden; 2 Division of Physiotherapy, Department of Neurobiology,
Care Sciences and Society, Karolinska Institute, Stockholm,
Sweden; 3 Department of Clinical Neuroscience, Karolinska
University Hospital Huddinge, Sweden
PURPOSE: Chronic inflammatory demyelinating polyneuropathy
(CIDP) is a disorder affecting the peripheral nerves. Despite of
immunomodulatory treatment the symptoms can proceed and lead
to considerable disability. The purpose of this study was to describe
the extent of impairments, activity limitations and health status in
patients with CIDP. RELEVANCE: There is a lack of descriptive data
on the functional consequences of CIDP. Therefore, the rehabilitation
and medical care of patients with CIDP may be enhanced and
optimized if based on a stronger scientific body of knowledge.
PARTICIPANTS: All 22 patients above 18 years of age registered
at the Neurology Department of the Karolinska University Hospital
in Huddinge diagnosed with CIDP by a neurological physician were
sent a letter with information of the study and were at the same time
asked to participate. Twenty one patients gave informed consent.
Their mean age was 54 years (range18-82). METHODS: Vibration
perception threshold (VPT) was measured with a Biothesiometer.
Fatigue was quantified with the Fatigue Severity Scale. Functional
Balance was tested using the Berg Balance Scale. The Nine-hole
Peg Test was used to evaluate finger dexterity. For the quantification
of basic functional mobility the Timed “Up and Go” test was used.
The Swedish version of the SF-36 questionnaire was used to
indicate health status. ANALYSIS: The data were analyzed with non-
parametric descriptive statistical methods, including median score
and inter quartile range (IQR). RESULTS: Fifty seven percent of the
group had a higher thumb VPT in relation to published normative
data. Similarly, 67% showed a higher ankle VPT. The Fatigue Severity
Scale showed that 38% scored over 5, previously used as a cut-off
value for classifying the patient as severely fatigued. The majority
of the patients had reduced functional balance as indicated by
the Berg Balance Scale with a median score 49 (IQR13). Sixty
two percent had a subnormal result in the Nine-hole Peg Test
compared to what has been reported in the literature. The SF-36
questionnaire showed that the study group scored lower than the
Swedish norm on the sub-scales describing physical health. For
the sub-scales measuring psycho-social health no clear difference
were observed compared to the normative values. CONCLUSIONS:
The majority of the patients with CIDP had impairments and activity
limitations, and the physical health was also affected. There is a need
of research to investigate if rehabilitation and physical therapy for
patients with CIDP, might effect impairments and activity limitations.
IMPLICATIONS: Physical therapy might be necessary for improving
and maximizing a limited level of functioning. These results show that
the CIDP group has impairments, activity limitations and a reduced
health status. KEYWORDS: CIDP. Fatigue. Balance. FUNDING
ACKNOWLEDGEMENTS: The study was funded by grants from
the Swedish Association of Persons with Neurological Disabilities.
CONTACT: mimmi.eriksson-vestblad@karolinska.se
ETHICS COMMITTEE: The Regional Ethic Committee of Karolinska
Institute in Stockholm.
WCPT 2007, Research Reports
Research Report Platform Presentation
1822 Monday 4 June 16:55
VCEC Meeting Room 18
DYNAMIC POSTURAL CONTROL FOLLOWING AN ANTERIOR
CRUCIATE LIGAMENT RECONSTRUCTION
Clifford A1 , Holder-Powell H2 ; 1 University of Limerick, Ireland;
2 London South Bank University, UK
PURPOSE: Postural control is fundamental to the performance of
normal activities of daily living as well as many sporting activities
[1]. This study analysed dynamic postural control in subjects
following an anterior cruciate ligament (ACL) reconstruction during
a dynamic balance task, namely, a single-leg squat. This manoeuvre
is frequently assessed clinically as it requires dynamic control
of the body over the weight-bearing limb and is a movement
frequently assumed during many sporting activities RELEVANCE:
The assessment and optimisation of postural control are important
in the prediction and prevention of a lower-limb injury [2,3] and re-
injury. It is proposed that the objective measurement of dynamic
postural control in subjects following their ACL-reconstruction will
assist in the design and implementation of more specific and
successful rehabilitation programmes PARTICIPANTS: Following
ethical approval, subjects with no previous history of lower-limb
injury other than a unilateral ACL-injury who underwent an ACL-
reconstruction and four months of post-operative rehabilitation were
informed regarding the study. Fourteen subjects (9 males), with
a mean age ± SD of 31.2±8.0, volunteered to participate in
the study. METHODS: Three-dimensional movement, using the
Cartesian Optoelectronic Dynamic Anthropometer (CODA) motion
analysis system, (Charnwood Dynamics, UK) was recorded during
a single-leg squat of 5 seconds duration. The sampling frequency
was 100 Hz measured by two sensor units from 24 light emitting
diodes placed on specific anatomical landmarks. Data was recorded
from both the injured and uninjured limbs. ANALYSIS: The data
pertaining to segment rotation about the i) sagittal plane; ii) coronal
plane and iii) vertical axis were exported and analysed in a Mathcad
2001i mathematical programme. The degree of movement and
wobble (defined as the deviation in movement from the mean
path), occurring at the pelvis, hip, knee, and ankle was established.
Comparisons between the injured and uninjured side were made
using the Student’s paired t-test. RESULTS: Significantly less
ankle (p = 0.001), knee (p < 0.001) and hip (p = 0.01) flexion were
found during an injured leg single-leg squat compared to the
uninjured leg squat. The analysis of wobble identified a significant
increase in wobble during knee flexion-extension (p = 0.04), foot
supination-pronation (p = 0.045) and foot alignment (p = 0.02) on the
injured side. CONCLUSIONS: At four months following an ACL-
reconstruction, deficits in dynamic postural control exist, as identified
by an increase in wobble. Additionally, a reduced degree of ankle,
knee and hip flexion persists in most subjects; which appears
to be in contrast with normal subjects when wobble decreases
with reduced knee flexion. It is recommended that future studies
examine the effects of specific postural control training protocols
on the outcome measures used in this study. IMPLICATIONS:
Alterations in postural control following an ACL-reconstruction have
been identified in this study, which may predispose individuals to
further injury or re-injury. Thus, it is proposed that future rehabilitation
programmes assess and address postural control in order to optimise
functional outcome and reduce the risk of injury following an
ACL-reconstruction. References: [1] Adlerton AK, Moritz U, Moe-
Nilssen R. Forceplate and accelerometer measures for evaluating
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
Platform Presentations, Monday 4 June
injuries in high school basketball players. Clinical Journal of Sport
Medicine 10, 239-244. 2000. KEYWORDS: Postural control, anterior
cruciate ligament and wobble. FUNDING ACKNOWLEDGEMENTS:
This work was part of a PhD project that was done on a studentship
from King’s College London. Some funding was received from the
Association of Orthopaedic Chartered Physiotherapists to purchase
equipment for this project. CONTACT: amanda.clifford@ul.ie
ETHICS COMMITTEE: Guy’s Research Ethics Committee, King’s
College London Research Ethics Committee, St Marys Local
Research Ethics Committee
Research Report Platform Presentation
1590 Monday 4 June 16:55
VCEC Meeting Rooms 19-20
ACTIVE SHOULDER EXTERNAL ROTATION RANGE OF MOTION-
DOES THE METHOD OF MEASUREMENT INFLUENCE RANGE?
Chen J1,2 , GinnK2 ,Herbert R2 ; 1 Prince
of Wales Hospital, Sydney,
Australia; 2 The University of Sydney, Sydney, Australia
PURPOSE: To compare results of different, commonly-used methods
of measuring active shoulder external rotation range of motion
RELEVANCE: Shoulder stiffness is a common but poorly understood
disorder of the glenohumeral joint. It is the major cause of shoulder
disability and pain, and is a consistent symptom of primary frozen
shoulder, with restriction especially in passive external rotation and
abduction. External rotation is a common component of the physical
assessment of the shoulder, being measured both actively and
passively. It is customary to measure this with the arm in neutral, or
at 90º of abduction, with the patient in sitting or in supine-lying. This
study investigated the variations in range of shoulder external rotation
as measured in these positions. PARTICIPANTS: 60 subjects, aged
30 to 86 years (mean 66.3), presenting for physiotherapy treatment
at a large teaching hospital for shoulder pain and stiffness of more
than one month’s duration, were invited to participate. Twenty healthy
adult, aged 22 to 50 years (mean 31.9), with no previous history
of shoulder complaints, were also invited to participate. METHODS:
Active external rotation was measured using photography, in sitting
and in supine-lying, in random order. In both positions, the shoulder
was abducted to 90 degrees in the coronal plane, elbow flexed to 90
degrees and forearm pronated. The olecranon and the ulnar styloid
process were marked. External rotation range was determined as
the angle between the line passing through the olecranon and the
ulnar styloid and the horizontal frame of the plinth. ANALYSIS: We
calculated 95% confidence interval (CI) for mean differernce in range
of motion in sitting and in supine-lying using t-distribution. Pearson’s
correlation coefficient (r) was used to describe the strength of the
relationship between the measurements obtained in sitting and in
supine-lying. RESULTS: In the patient population, the mean range
of active shoulder external rotation in sitting (73º) was larger than
in supine-lying (38º) (mean difference: 35º; 95% CI: 29-41º). Similar
results were observed in the healthy subjects, with a mean active
external rotation range of 105º in sitting and 75º in supine-lying (mean
difference: 30º, 95% CI: 25-35º). The correlation between sitting and
lying measurements was only moderate in both groups (r = 0.45, r2
= 0.20 in the patients and r = 0.52, r2 = 0.27 in the healthy subjects).
CONCLUSIONS: Range of active shoulder external rotation is
greater in sitting than in supine-lying. The correlation between these
two measures is weak. These results were similar in both patients and
in healthy adults. IMPLICATIONS: Measurements of active shoulder
external rotation performed in sitting and lying probably reflect
different muscle actions and different scapulo-humeral relationship.
Considerable care must be exercised when interpreting clinical
measures of active shoulder external rotation range of motion so
as not to over-estimate shoulder joint stiffness as this could have
significant clinical implications for intervention. KEYWORDS: shoul-
der, stiffness, measurement. FUNDING ACKNOWLEDGEMENTS:
S177
Physiotherapy Research Foundation Tagged Grant 2005. CONTACT:
Judy.Chen@sesiahs.health.nsw.gov.au
ETHICS COMMITTEE: South East Sydney Area Health Service
Human Research Ethics committee-Eastern Section; The University
of Sydney Human Research Ethics Committee
Research Report Platform Presentation
2676 Monday 4 June 17:15
PP Crystal Pavilion B & C
DOES PERFORMANCE VARY DURING THE SIX MINUTE WALK
TEST IN PERSONS FOLLOWING HEMILIPLEGIC STROKE?
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
PURPOSE: This study investigated how persons with varying
degrees of impairment following stroke performed the 6 min walking
test (6MWT). We hypothesized that the distance completed, the
temporal-spatial parameters of gait and heart rate (HR) would change
over the duration of the test. RELEVANCE: The 6MWT is commonly
used to assess walking endurance and aerobic fitness in persons
following stroke. PARTICIPANTS: Eighty-four persons (age 63±13 yr;
40±52 months since stroke) participated. METHODS: The distance
completed and the maximum HR within each minute of the 6MWT
were recorded. Also, for 24 participants, the temporal-spatial gait
parameters were measured in the first and last minute of the test.
ANALYSIS: The overall total distance was normalised to predicted
distance based on age, height and weight and overall maximal HR
was normalised to age-predicted maximal HR. Participants were
categorized ‘severely impaired’ if the normalised distance completed
in the 6MWT was <50% predicted distance and ‘less impaired’ if
distance was 50% predicted distance. Two-way repeated measures
ANOVA assessed change in gait and HR over time, accounting
for difference in severity of impairment. Pearson correlations
assessed the relationship between gait and HR. RESULTS: Less
impaired (n=39) and severely impaired participants (n=45) achieved
80.0±18.8% and 28.1±12.6%, respectively, of predicted distance.
The distance covered in each minute did not vary significantly across
time for both groups. The distances achieved in the 1st and 6th
min for the less impaired group were 68.1±15.2 m and 66.9±8.2
m respectively, and 28.7±15.0 m and 26.9±15.2 m for the severely
impaired group. In the five severely impaired and 19 less impaired
participants in whom temporal-spatial variables were assessed, these
did not change from the 1st to 6th minute. Resting HR was not
significantly different between groups, but exercise HR increased
significantly during the 6MWT with the degree of tachycardia differing
between groups. Less impaired participants achieved 70±12%
predicted HR while severely impaired participants achieved 64±14%
predicted HR. Post-hoc analysis of the change in HR during
6MWT revealed that HR in the less severe participants significantly
increased over each consecutive minute of walking; severely impaired
participants’ HR did not significantly increase after the second minute.
Maximum HR was small but significantly correlated with the 6MWT
distance (r = 0.41, P < 0.01. The correlation of these two variables
slightly decreased when distance and HR were expressed relative
to predicted values (r = 0.31, p < 0.01) CONCLUSIONS: Walking
performance did not deteriorate over the duration of the 6MWT in
people after stroke. However, use of the 6MWT solely as a proxy for
aerobic fitness is not supported. As is the case in other older cohorts,
the contribution of non-cardiovascular attributes to 6MWD, such as
strength, balance, body composition, and neuropsychological status,
needs to be investigated further in cohorts of stroke survivors, to
understand how to interpret this test clinically. IMPLICATIONS: The
6 MWT is a valid measure of walking capacity across a range
of walking abilities in persons following stroke. Temporal-spatial
measures can be derived from a sample of the test as a reflection
of the individual’s walking performance. KEYWORDS: gait, CVA,
S178
measurement. FUNDING ACKNOWLEDGEMENTS: The project was
financially supported by the National Health and Medical Research
Council of Australia (Project 302013 and 253639). CONTACT:
s.kilbreath@fhs.usyd.edu.au
ETHICS COMMITTEE: University of Sydney Human Ethics Commit-
tee, Sydney Australia.
Research Report Platform Presentation
2692 Monday 4 June 17:15
VCEC Exhibit Hall A
PHYSICAL THERAPY’S ROLE IN THE PREVENTION, DETEC-
TION AND MANAGEMENT OF ASTHMA: GLOBAL TRENDS AND
NEW DIRECTIONS BASED ON CONTEMPORARY EVIDENCE
Dornelas de Andrade A1 , Kelms C2 , Dean E3 ; 1 Department of
Physiotherapy and Department of Physiology, Federal University
of Pernambuco Recife, Brazil; 2 School of Physiotherapy, Dalhousie
University, Halifax, Nova Scotia, Canada; 3 School of Rehabilitation
Sciences, University of British Columbia, Vancouver, Canada
PURPOSE: We conducted structured and systematic reviews related
to adult asthma to report on 1. the prevalence across countries
and changes over time, 2. the status of physical therapy’s role
in prevention, detection and management, and 3. evidence-based
directions for practice and research. RELEVANCE: Reports of
the World Health Organization(WHO) support that the prevalence
of asthma is increasing worldwide. Whether this represents an
increase, or increased detection is unclear. For physical therapy
to be responsive to global healthcare needs, a state-of-the-
art update is timely regarding the prevalence of asthma, its
etiology and diagnostic features, and evidence-based prevention
and management strategies.symptoms is not entirely clear, nor
its effectiveness in reducing medical intervention, medication,
and hospitalization. PARTICIPANTS: study citations (1996-2005)
were screened according to inclusion and exclusion criteria. Key
words/strings were defined. Citation sources included Cochrane
Library, Medline, PubMed and CINAHL METHODS: A structured
review was conducted of WHO epidemiological reports and estab-
lished databases to extract asthma prevelance data. A systematic
review was conducted to provide state-of-the-art evidence regarding
the effectiveness of physical therapy interventions. Standardized
guidlines for systematic reviews (Edger 2003) and quality rating
scale were adopted (Sakett et al 2000). Implications for practice
and research were derived. ANALYSIS: 39 extracted studies related
to asthma prevention/education; and 52 studies to intervention,
31 of which were ecclectic programs. Research directions were
based on the congruence of epidemiological and pathophysiology
literature, the International Classification of Function, and the WCPT
definition of physical therapy (Strategic Directions and Priorities,
2003). RESULTS: Physical therapists are pre-eminently suited to
address the needs of people with asthma. There is a dearth of
controlled trials on adult asthma regarding prevalence and physical
therapy intervention (prevention/management) which precluded valid
systematic review. Studies were limited by lack of standardized
definitions and reporting, and flaws in research methodology.
Although commonly practiced, breathing control and breathing
pattern re-education have little conclusive support. Relaxation has
modest support, but may improve lung function. Exercise training
improves fitness but not lung function. The role of physical therapists
in aerosol use was not evident in the literature. Self-monitoring
was encouraged (e.g., peak flow rate). If mentioned, the effect
of education was confounded by other interventions. Although
physical therapy has traditionally had a role in asthma prevention
and management, the role of the nurse in symptom-reduction
education is more often cited. CONCLUSIONS: With respect to
prevalence, disparities may reflect different diagnostic standards,
and access to medical care. Inconsistent findings from outcome
studies may reflect lack of control for disease stage and acuity. There
is support for education, relaxation, and exercise. Well-controlled
WCPT 2007, Research Reports
studies are needed on physical therapy’s effectiveness in prevention
and management IMPLICATIONS: Our findings will be published
as a state-of-the-art report on practice standards to provide a
baseline on cross cultural disparities on asthma prevalence and
an explanation for these, disparities in practice standards, and on
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
KEYWORDS: asthma, best practice, education, epidemiology, prac-
tice, prevalence, prevention. FUNDING ACKNOWLEDGEMENTS:
Professor Dornelas de Andrade supported by Coodenacao de
Aperfeicoamnto de Pessoal de Nivel Superior (CAPES), Brazil.
CONTACT: armeledornelas@yahoo.com
Research Report Platform Presentation
3015 Monday 4 June 17:15
VCEC Meeting Rooms 11-12
EFFECT OF TWO ANKLE BRACES AND TWO ANKLE
BANDAGES ON ANKLE POSITION AND ANKLE MOBILITY: A
COMPARATIVE STUDY
Vaes P1 , Vandenbussche G2 , Duquet W2 , Van Gheluwe B2 ;
1 Physiotherapy dept., Faculty of Physical Education and Physical
Therapy, Vrije Universiteit Brussel, Brussels, Belgium; 2 Human
Biometry and Biomechanics department, Faculty of Physical
Education and Physical Therapy, Vrije Universiteit Brussel,
Brussels, Belgium
PURPOSE: To measure and document effects of different methods
of external ankle support on joint stability. RELEVANCE: The
high incidence of trauma to the foot-ankle complex in sports and
recreational activities has contributed to a proliferation of external
ankle-stabilizing supports such as strapping, taping and bracing.
Preventive measures are thought to decrease ankle sprain incidence
by providing mechanical support. There is a need for a reliable
procedure to collect data on changes in mobility with the use of
the external support. PARTICIPANTS: A group of 22 volunteers
with healthy ankles (12 men) with a mean age of 21.6 years
(range 18-27±2.2), were included in the brace study and a group
op 15 volunteers with healthy ankles (10 men) with a mean age
of 22.3 years (range 16-30±2.8) were included in the bandage
study. METHODS: Two commercially available ankle braces (ASO
ankle stabilizer and Aircast A60) and two bandage procedures
(multilayer strapping and self applied taping) were tested; using
a surface EMG and an inversion stress apparatus. To compare
braces and bandages, the restriction of rest position and inversion
mobility in relation to the no-support condition was measured.
ANALYSIS: A repeated measures ANOVA was used to compare
the no-brace versus braces and the no-bandage versus bandages
setting. Paired samples t-tests with Bonferroni correction was used
as a posteriori test. Finally an ANCOVA was applied to compare
the tested braces results with the strapping and taping. The level of
statistical significance was set at P < 0.05. A statistical power of >0.90
was obtained. RESULTS: A significant decrease of inversion mobility
(p < 0.05) was found during stress in healthy ankles supported by
therapeutic strapping, self applied taping, A60 and ASO bracing
(51.3º in the no-bandage condition versus 36.8º with therapeutic
strapping and 42.9º with taping; 46.2º in the no-brace condition
versus 41.2º with A60 and 41.3º with ASO). Comparing bandages
with braces in the stress situation, the only significant differences
found were between both braces and strapping. The A60 brace
reached significant inversion mobility decrease during the 15kg
inversion stress test although this brace caused a significantly
smaller change in inversion position of the ankle in the rest
position. CONCLUSIONS: Multi layer ankle strapping applied by
an experienced physiotherapist reduced ankle inversion significantly
more than the two ankle braces. Rest position was significantly
overcorrected in eversion position after applying the strapping
Platform Presentations, Monday 4 June
procedure. IMPLICATIONS: Physiotherapists can advice patients
about efficacy and reliability of external ankle support based on
measurements of influence on rest position and limitation of inversion
mobility. KEYWORDS: ankle, inversion mobility, external support,
ankle brace, ankle bandage. FUNDING ACKNOWLEDGEMENTS:
The research committee of the Physical Education and Physical
Therapy Faculty of the Vrije Universiteit Brussel funded this research
project-FWOAL384. CONTACT: pvaes@vub.ac.be
ETHICS COMMITTEE: The Ethics Committee of the Academic
Hospital of the Vrije Universiteit Brussel-Brussels-BELGIUM
Research Report Platform Presentation
1460 Monday 4 June 17:15
VCEC Meeting Room 16
MUSCULAR DEMANDS DURING ELLIPTICAL TRAINING
COMPARED TO OVERGROUND WALKING
Burnfield J1−3 , Buster T1 , Provorse A1,2 , Takahashi S1,2 ;
1 Movement Sciences Center, Madonna Rehabilitation Hospital,
Lincoln, NE, USA; 2 University of Nebraska – Lincoln, Lincoln,
NE, U.S.A.; 3 Department of Biokinesiology and Physical Therapy,
University of Southern California, Los Angeles, CA, USA
PURPOSE: Retaining or regaining walking function is a primary
goal of many persons with chronic medical conditions. The elliptical
crosstrainer, widely available in fitness and rehabilitation settings,
has been advertised as a device which promotes movements similar
to walking. Buster et al (2006) identified general similarities in leg
movements during elliptical training (EL) and overground walking
(OG), with the notable exception that subjects were postured in
greater flexion at the hip, knee and ankle during EL. The extent
to which more flexed postures influence lower extremity muscle
activation patterns, however, was not reported. The current study
compares lower extremity muscle demands during EL to OG walking.
It was hypothesized that leg extensor muscle activity would be
greater during EL owing to the need to stabilize the flexed hip, knee
and ankle, and that dorsiflexor activity would be lower during EL
due to the external support provided by the footplate throughout
swing. RELEVANCE: Greater understanding of muscular demands
associated with EL is essential to guide clinicians’ therapeutic
recommendations with this device. PARTICIPANTS: Seven adults,
free from impairments that might hinder gait (mean age = 26 years).
METHODS: Subjects participated in three familiarization sessions
on the Elliptical Cross-Trainer (Life Fitness™ 95Xi). During session
four, foot-floor contact patterns (compression closing footswitches)
and dominant leg muscle activation patterns (EMG) were recorded
simultaneously as subjects ambulated OG at a self-selected speed
and elliptical trained at a speed approximating (±5%) that obtained
during OG walking. ANALYSIS: Footswitch (OG) and footplate
(EL) data defined gait cycle phasing. EMG activation patterns
(expressed as a percentage of maximal activity recorded during OG
walking, %Max OG) were identified for gluteus maximus(GMAX),
gluteus medius(GM), vastus lateralis(VL), medial hamstrings(MH),
medial gastrocnemius(MG), and tibialis anterior(TA). Paired T-
tests determined if EMG (mean, duration) varied significantly
between conditions for each muscle (Bonferroni adjusted alpha
level, p < 0.0083). RESULTS: Mean EMG activity was decreased
during EL training compared to OG walking in MH (15 vs. 58%Max
OG; p = 0.001), MG (21 vs. 53%Max OG; p < 0.001), and TA (11
vs. 48%Max OG; p < 0.001). EMG duration was longer during EL
compared to OG in GMAX (43 vs. 14%Max OG; p < 0.001), GM (36
vs. 18%Max OG; p = 0.006), and VL (83 vs. 28%Max OG; p < 0.001).
In contrast, TA EMG duration was shorter during EL compared to
OG (11 vs. 44%Max OG; p < 0.001). CONCLUSIONS: Consistent
with the original hypothesis, EMG duration was greater in select
lower extremity stabilizers (GMax, GM, VL) during EL training. One
exception was that the mean MG EMG was reduced during EL. The
finding of reduced TA EMG (mean and duration) also was consistent
with the original hypothesis. Collectively, these data suggest that EL
S179
training at similar speeds to OG walking presents greater muscular
challenges to single joint hip and knee stabilizers, yet reduces
demand on key stance and swing ankle muscles. Further work
is required to determine the impact of altered movement patterns
on muscular demands in select patient populations (e.g., stroke).
IMPLICATIONS: This study’s results provide essential guidance
related to recommending EL training as a therapeutic intervention
across the continuum of care. KEYWORDS: Gait, therapeutic in-
terventions, electrophysiology. FUNDING ACKNOWLEDGEMENTS:
Daniels Fund, Denver, CO. CONTACT: jburnfield@madonna.org
ETHICS COMMITTEE: Institutional Review Board, Madonna Reha-
bilitation Hospital, Lincoln, NE, USA
Research Report Platform Presentation
2697 Monday 4 June 17:15
VCEC Meeting Room 17
ISCHAEMIA AS A MODEL OF FOCAL NERVE INJURY
Boland R1−3 , Han S1,4 , Kiernan M1,3,4 ; 1 Spinal Cord Research
Centre, Prince of Wales Medical Research Institute, Randwick,
Australia; 2 School of Physiotherapy, Faculty of Health Sciences,
University of Sydney, Lidcombe, Australia; 3 Institute of Neurological
Sciences, Prince of Wales Hospital, Randwick, Australia
PURPOSE: Focal peripheral neuropathies are characterised by
paraesthesias and numbness but mechanisms underlying these
symptoms are complex and not well understood. The aim of this study
was to investigate mechanisms underlying neurological symptoms
in response to experimental ischaemia of the median nerve.
RELEVANCE: Understanding the relationship between neuropathic
symptoms such as paraesthesia and pain, and axonal function
may improve the current management of focal neuropathies and
suggest new therapeutic interventions. PARTICIPANTS: Five healthy
participants aged between 21 and 43 years volunteered to participate
and ethics approval from the South Eastern Sydney Area Health
Service was granted before the study commenced. METHODS:
Ischaemia as a model of focal nerve injury was induced by inflating
a sphygmomanometer cuff above the elbow to an occlusive pressure
of 200 mmHg for 10 minutes in the right arm of participants.
Median nerve sensory excitability was assessed before, during, and
after the ischaemic period using electrical techniques that monitor
the threshold current required to excite the nerve. A computer
controlled external current source stimulated median sensory axons
while continuously adjusting stimulus intensity to maintain the
target proportional response of maximum threshold. Concurrent
recordings of paraesthesia rated on a 0-10 scale of intensity were
taken throughout the experimental period. ANALYSIS: Data were
analysed using Memplots for Windows©. All data were pooled and
means (for each minute) for the following parameters were plotted
against time for the experimental period of 47 minutes: Normalised
thresholds for each stimulus intensity; changes in supernormality
and superexcitability; and intensity of paraesthesiaas. RESULTS:
Threshold currents for stimulus durations of 0.2 and 1 ms fell
by 19% and 22% respectively during ischaemia, peaking at 8
minutes, which coincided with significant changes in refractoriness
and supernormality. The intensity of paraesthesias peaked at
7/10 after 7 minutes of ischaemia before declining in the final
3 minutes of occlusion. Changes after release of the cuff were
rapid, with axonal hyperpolarisation, and associated reductions in
refractoriness and supernormality. Intense paraesthesias of 9/10
intensity peaked 4 minutes after cuff release and ceased by the
10th minute when electrical parameters approached but had not
reached pre-ischaemia levels. CONCLUSIONS: Nerve ischaemia
induced significant paraesthesias but perhaps counter-intuitively,
more intense levels accompanied release of ischaemia. This can
be explained by mechanisms underlying post-ischaemic axonal
hyperpolarisation. IMPLICATIONS: This study has implications for
physiotherapists treating patients with focal neuropathies such
as carpal tunnel or cubital tunnel syndromes. The rationale for
S180
using interventions such as manual therapy must account for
the neurophysiological mechanisms that induce symptoms such
as paraesthesias. KEYWORDS: ischaemia, nerve, paraesthesia.
FUNDING ACKNOWLEDGEMENTS: NSW Ministry for Health
and Medical Research and Spinal Cord Injury Grants Program.
CONTACT: R.Boland@fhs.usyd.edu.au
ETHICS COMMITTEE: South Eastern Sydney Area Health Service
Human Ethics Committee
Research Report Platform Presentation
2454 Monday 4 June 17:15
VCEC Meeting Room 18
RELIABILITY AND VALIDITY FOR TEST BATTERIES FOR
MAXIMAL SINGLE-LEG HOP PERFORMANCE AND MUSCLE
POWER IN PATIENTS WITH ACL INJURY
Neeter C1 , Gustavsson A, Thomeé R, Grävare Silbernagel K,
Augustsson J, Karlsson J; 1 Dept of Orthopaedics, Lundberg
Laboratory, Göteborg University
PURPOSE: The purpose was to develop test batteries with high
ability to discriminate performance between the injured and the
uninjured side in patients with anterior cruciate ligament (ACL) injury.
RELEVANCE: The literature clerly points out that there is a need for
reliable, valid and sensitive instruments to evaluate muscle functionto
in order to determine when it is safe to return to strenuous physical
activities. PARTICIPANTS: For the single-leg hop test battery 15
healthy subjects performed five hop tests at three separate occasions
in a test-retest design on each leg (n = 30). Thereafter 30 patients
with ACL injury were tested 6 months after injury and 35 patients
were tested 12 months after ACL reconstruction. For the muscle
power strength test battery 13 healthy subjects were tested in a
test-retest design on each leg (n = 26). Twenty-three patients with
an ACL injury were tested 6 months after injury and 44 patients
were tested 6 months after ACL reconstruction. METHODS: Five
hop tests were analysed and the three tests with the highest ability
to discriminate hop performance between the injured and uninjured
side were chosen for the test battery: the counter movement jump,
the hop for distance and the side hop test. Three tests were chosen
for the strength test battery to reflect quadriceps and hamstrings
muscle power in a knee extension and a knee flexion test (open
chain) and lower extremity muscle power in a leg press test (closed
chain). ANALYSIS: Conventional methods were used for descriptive
statistics and correlations. Non parametric methods were used for
group comparisons. Significance was considered at p < 0.05. Test-
retest analysis was determined by intraclass correlation coefficient
(ICC). A methodological error in percent was calculated. Lower
limb symmetry index (LSI) was calculated to determine whether a
side-to-side leg difference was classified as normal or abnormal.
In this study LSI greater than or equal to 90% was classified as
normal. RESULTS: No significant differences were found between
test occasions in any of the three strength tests or the three hop tests.
The ICC ranged from 0.87 to 0.98 and the methodological error from
3 to 10%, for the strength and hop tests. The sensitivity for the hop
test battery was 87% in the patients with ACL injury and 91% in the
patients after ACL reconstruction. The three strength tests combined
into one test battery gave a sensitivity of 60% for the patients 6
months after ACL injury and 94% for the patients 6 months after ACL
reconstruction. CONCLUSIONS: The principal finding of this study
was that a test batteries had high ability in terms of discriminating
hop as well as strength performance between the injured and the
uninjured side, both in patients with ACL injury and in patients after
ACL reconstruction. It is concluded that the test batteries showed
high test-retest reliability and a higher sensitivity than any of the
tests individually. IMPLICATIONS: The test battery may contribute
to the decision-making process of deciding whether patients can
return safely to strenuous physical activities after ACL injury or
reconstruction. KEYWORDS: power, hop, test battery. FUNDING
ACKNOWLEDGEMENTS: This study was supported by a grant from
WCPT 2007, Research Reports
the Swedish Centre for Research in Sports and The Local Research
and Development Council for Gothenburg and Southern Bohuslän,
Sweden. CONTACT: camille.neeter@orthop.gu.se
ETHICS COMMITTEE: Approval for the study was obtained from the
Human Ethics Committee at Göteborg University, Sweden.
Research Report Platform Presentation
2771 Monday 4 June 17:15
VCEC Meeting Rooms 19-20
IN VIVO KINEMATICS OF HEALTHY SHOULDERS DURING
LOADED AND UNLOADED SCAPTION MEASURED BY A
SINGLE-PLANE SHAPE-MATCHING TECHNIQUE
Gamada K1 , Nishinaka N2 , Kon Y2 , Banks S2 , Tsutsui H3 ; 1
Department of Physical Therapy, Hiroshima International University,
Higashi-Hiroshima Japan; 2 Department of Mechanical and
Aerospace Engineering, University of Florida, Gainesville, USA;
3 Department of Orthopaedics and Rehabilitation, Showa University
Fujigaoka Rehabilitation Hospital, Yokohama, Japan
PURPOSE: Scapulohumeral rhythm and glenohumeral kinematics
are 2 major components of shoulder biomechanics and the effects
of loading during scaption (scapular plane abduction) on shoulder
kinematics have not been determined. The goals of this study
were to determine if scapular upper rotation is different and if
the superior translation of the humeral head is different between
loaded and unloaded shoulder scaption. We hypothesized that
there would be no differences in glenohumeral translation and
scapulohumeral rhythm for the 2 conditions in healthy shoulders.
RELEVANCE: Selection of a load in therapeutic exercise may be
a key to modifying kinematics. This study will provide knowledge
in the effect of 3kg-loading on healthy shoulder kinematics during
scaption. PARTICIPANTS: Ten healthy shoulders of 10 participants
(8 males) were enrolled in this IRB-approved, prospective study.
METHODS: A shape-matching technique (Banks, 1996) using single-
plane fluoroscopy and CT-based patient-specific shoulder models
were used for kinematic analysis. Participants performed 3 cycles
of unilateral scaption with and without a 3kg hand-held load under
fluoroscopic surveillance at 15 Hz, during which the fluoroscopy
was set at approximately 90º from the scapula plane. They also
underwent CT scan at 0.5mm slice pitch, from which geometric bone
models of the humerus and scapula were created. ANALYSIS: A
custom program (KneeTrack) produced by a co-author (SB) was
used for the shape-matching procedure to obtain 6 degrees-of-
freedom shoulder kinematics, whose estimated errors were 1.5mm
in sagittal translations and 1.5 degrees in 3 rotations in knee
kinematics (Fregly, 2005). Cardan/Euler angle convention (Tupling
and Pierrynowski, 1987) was used for quantitative analyses. Two-
way repeated measure ANOVA was used for kinematics comparisons
and p < 0.05 were used for the level of significance. RESULTS:
Approximately 60º of glenohumeral abduction was observed for both
loaded and unloaded conditions. The starting location (contact point)
of the humeral head, defined as the location of the nearest point of
the humeral head projected onto a hypothetical glenoid plane, was
at 2mm inferior to the midpoint of the glenoid fossa and the ending
location was at the midpoint for both conditions. The superior-inferior
contact points at any of the abduction angles showed no statistical
differences between loaded and unloaded conditions. Scapular upper
rotation during 60º of glenohumeral abduction was 32º and 22º for
unloaded and loaded conditions, respectively. Statistical differences
were detected at 30º, 40º and 50º of glenohumeral abduction.
The largest difference in the glenohumeral rhythm (1.4 and 5.0 for
unloaded and loaded conditions, respectively), defined as a ratio
of glenohumeral abduction to scapular upper rotation at given 10º
increments of glenohumeral abduction, was detected at the range of
30º to 40º of the glenohumeral abduction. (Note that the larger the
ratio is, the smaller the scapular contribution is.) CONCLUSIONS:
A load of 3kg was not enough to change glenohumeral kinematics,
but was large enough to enhance stabilizing effect of the scapula
Platform Presentations, Monday 4 June
during scaption. IMPLICATIONS: A load of 3kg for scaption in healthy
shoulder may be a suitable load when the therapeutic intension is
to enhance scapular stability without changing glenohumeral kine-
matics. KEYWORDS: shoulder kinematics, glenohumeral translation,
scapulohumeral rhythm. FUNDING ACKNOWLEDGEMENTS: No
funding for this study was received by any of the authors. CONTACT:
kazgamada@ortho-pt.com
ETHICS COMMITTEE: Approved by the Ethics Committee of
Department of Orthopaedics and Rehabilitation, Showa University
Fujigaoka Rehabilitation Hospital
Research Report Platform Presentation
2736 Monday 4 June 17:35
PP Crystal Pavilion B & C
PREDICTING PHYSIOTHERAPY NEEDS FOLLOWING STROKE:
AN ANALYSIS OF CLINICAL AND DEMOGRAPHIC FACTORS
DePaul V1,2 , DeHuek A3 , Rieck M3 , Pollock B2,4 , Yip D4 ,
Pagliuso S4 , Moreland J1,2 ; 1 St. Joseph’s Healthcare, Hamilton,
Canada; 2 McMaster University, Hamilton, Canada; 3 Joseph Brant
Memorial Hospital, Burlington, Canada; 4 Hamilton Health Sciences,
Hamilton, Canada
PURPOSE: To determine the clinical and demographic factors of
individuals with stroke who feel they need follow-up physiotherapy
after discharge from hospital, but do not receive it. To examine
whether there is a bias in the provision of follow-up physiotherapy.
To improve prescription of physiotherapy follow-up. RELEVANCE:
On discharge from hospital, physiotherapists decide whether to refer
patients for ongoing therapy. We performed a comprehensive needs
assessment following discharge that showed some individuals felt
they needed physiotherapy but were not receiving it. To improve
how we meet patient needs, it is important to explore this finding.
PARTICIPANTS: 213 patients with stroke were recruited from 4
acute care hospitals. METHODS: This is a multi-centred prospective
longitudinal cohort study examining the comprehensive self-reported
needs of individuals with stroke at discharge, six months and
one year. Each individual participated in an extensive open-ended
interview as well as a comprehensive checklist survey of needs.
For this analysis, we examined data at discharge. Respondents
were divided into three groups: those that expressed a need for
PT and were not receiving it (24%), those that were receiving
PT (40%), and those that did not express a need for PT and
were not receiving it (36%). ANALYSIS: The three subgroups
were compared using chi-square and analysis of variance statistics.
RESULTS: There were clinically important differences between
groups in: receipt of TPA (p < 0.05), home care services before stroke,
employment before stroke, education, first language, discharge living
situation (lives with family) and inability to drive (p < 0.05). The
acute FIM score for patients reporting a need for physiotherapy
was 70.0, 80.3 in the group receiving physiotherapy and 93.5 in
those not needing physiotherapy (p < 0.10). Discharge FIM scores
were similar for all groups. On open-ended questions, patients
reporting a need for physiotherapy reported more needs related to
motor control, energy, driving (p < 0.05) and affordable transportation.
This group reported a higher need to resume their roles (p < 0.05)
and independence (p < 0.05). A greater need was also reported
for day hospital (p < 0.05). On surveys (close-ended questions),
individuals reporting a need for physiotherapy had just as much
difficulty or more difficulty with picking up things from the floor,
using their wheelchair, getting up and down from the floor, standing
for long periods, walking outdoors, walking in crowded places and
doing stairs. CONCLUSIONS: In many ways, patients expressing
a need for physiotherapy but do not receive therapy are similar
to those who receive physiotherapy. Some variables suggest that
decisions to refer to physiotherapy may be based on social and
transportation factors rather than physical need. Further research
on how decisions are made about referral to physiotherapy is
needed. IMPLICATIONS: Although therapists prepare patients for
S181
going home, consideration needs to be given to higher-level mobility
skills that enable role performance. It should not be assumed
that those who live with their families or who have received
TPA are not in need of further physiotherapy. Physiotherapists
should ensure that they do a comprehensive assessment of goals,
that the patient has adequate transportation, and advocate for
adequate community services. KEYWORDS: stroke, needs, service
delivery. FUNDING ACKNOWLEDGEMENTS: Hamilton Community
Foundation. CONTACT: depauv@mcmaster.ca
ETHICS COMMITTEE: Research Ethics Boards of St. Joseph’s
Healthcare Hamilton, Hamilton Health Sciences and Joseph Brant
Memorial Hospital
Research Report Platform Presentation
2491 Monday 4 June 17:35
VCEC Ballroom A
IDENTIFICATION OF INTERVENTION CATEGORIES FOR
PHYSIOTHERAPY ON THE ICF
Huber E1,2 , Stoll J3 , Finger M3,4 , Stucki G5,6 , Cieza A5 ;
1 Department of Rheumatology and Institute of Physical
Medicine, University Hospital Zurich, Switzerland; 2 Association
of Physiotherapy, Sursee, Switzerland; 3 Physiotherapy Science
Studies, Department of Rheumatology and Institute of Physical
Medicine, University Hospital Zurich, Switzerland and Faculty of
Health Sciences, Maastricht University, the Netherlands; 4 Rehaclinic
Bellikon, Bellikon, Switzerland; 5 ICF Research Branch of the
WHO FIC Collaborating Centre (DIMDI), IHRS, Ludwig-Maximilian
University, Munich, Germany; 6 Department of Physical Medicine
and Rehabilitation, Ludwig-Maximilians-University, Munich, Germany
PURPOSE: To identify, in consensus process, a first version
of intervention categories that describe the most relevant and
common patient problems treated by physical therapists based on
International Classification of Functioning, Disability and Health (ICF).
RELEVANCE: The ICF is a worldwide agreed-upon system for
classification of all aspects of human health. It provides health
professionals, patients and peers with a common language. The
assessment of patient’s functioning and identification of resources
is the basis of physiotherapists’ intervention plan, treatment, and
evaluation. If the results of assessment are translated into the
ICF, a functioning-oriented physiotherapy diagnosis can be created
based on worldwide agreed-upon classification system. The use of
ICF-based physiotherapy diagnosis can contribute to facilitate the
multidisciplinary work, to ensure quality of treatments and help to
standardize clinical quality programs. PARTICIPANTS: 59 senior
physiotherapists participated in a consensus conference in Switzer-
land. METHODS: The three diagnostic areas musculoskeletal,
internal medicine and neurological and three health-care situations:
acute, rehabilitation, and community health care were considered to
create nine different groups of physiotherapists. A formal decision-
making and consensus process integrating results of a Delphi
exercise was conducted in each of the groups to decide the most
relevant and common patient problems treated by physiotherapists
in each of the diagnostic areas and health-situations, respectively.
ANALYSIS: We reported absolute and relative frequencies of
ICF intervention categories of components body functions, body
structures, activities and participation and environmental factors.
Only those intervention categories which were voted for by more
than 50% of the senior physiotherapists are presented. RESULTS:
The nine lists containing first versions of intervention categories for
physiotherapists represent a total of 349 different ICF categories.
Twenty-five ICF categories were defined on chapter level, 162 on
first level, 142 on second level and 20 on third level. The greatest
accordance was discovered in the component Body Function chapter
7, Neuro-musculoskeletal and Movement Related Function and in
the component Activity and Participation, chapter 4, Mobility. The
resulting nine lists are very heterogeneous with respect to length
and ICF categories contained. The smallest list contained 57 and the
S182
largest 191 ICF categories. CONCLUSIONS: This study represents
a step toward identifying a list of intervention categories relevant
for physical therapy according to the ICF. The nine lists containing
the first versions of intervention categories for physiotherapists
are still very comprehensive. This reflects the complex profile of
patients treated by physiotherapists and the high demands which
confront physiotherapists in their daily work. Further investigations
are needed to validate the results of this study. IMPLICATIONS:
In the future, lists with intervention categories based on the ICF
could be established as checklists in clinical practice. They could
build the basis for a functioning oriented PT diagnosis. 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.
The intervention lists are intended to improve the professional status
of physical therapists. KEYWORDS: ICF, International Classification
of Functioning, Intervention categories, Physiotherapy. FUNDING
ACKNOWLEDGEMENTS: We gratefully acknowledge the Swiss
Physiotherapy Association for its financial support and the cooper-
ation of all participants in this study.
ETHICS COMMITTEE: The study was approved by the ethic
committee of Zurich, Switzerland
Research Report Platform Presentation
2794 Monday 4 June 17:35
VCEC Ballroom B & C
CO-CONTRACTION IS REDUCED RATHER THAN INCREASED
IN PREPARATION FOR UNEXPECTED TRUNK UNLOADING
McCook D, Hodges P; Physiotherapy Division, University of
Queensland, Brisbane, Australia
PURPOSE: Lumbopelvic stability relies on, amongst other factors,
co-contraction of the lumbo-pelvic muscles. Changes in load
and predictability are expected to affect the associated control
strategies of both the deep and superficial lumbo-pelvic muscles. We
hypothesized that co-contraction of the trunk muscles would increase
with increasing load and in preparation for an unpredictable unloading
perturbation. RELEVANCE: Despite evidence that the deeper trunk
muscles contribute to spinal control, few studies have considered
their role in incremental loading and unloading tasks, or whether their
activation may preclude or compliment increased co-contraction of
the more superficial lumbo-pelvic muscles. PARTICIPANTS: Eleven
healthy males with no low back pain history volunteered. METHODS:
Participants were positioned in a loading frame and performed 5 s
isometric extension and flexion efforts to randomly presented loads
of 50, 100, 150 and 200N. Tasks were repeated with participants
knowing the load would be released at an unpredictable time during
the isometric hold. Maximum voluntary contraction (MVC) efforts
were performed in both directions. Electromyographic activity (EMG)
was recorded from 8 trunk muscles using surface electrodes and fine-
wire electrodes. ANALYSIS: RMS EMG amplitudes were calculated
and normalized to MVC. Data were compared between force levels
and tasks with a repeated measures ANOVA. RESULTS: When
participants isometrically extended, EMG activity of the paraspinal
muscles increased with increases in load (P < 0.006). During the
flexion tasks, EMG activity of the abdominal muscles increased
from the 100N load (P < 0.0001), obliquus externus increased from
50N (P = 0.03). Activity of the antagonist muscles did not increase
during any of the predictable submaximal loading tasks, in either
direction (P > 0.15). Only transversus abdominis (TrA) EMG increased
in both directions; in flexion from 100N, and in extension from
150N (P < 0.028). When predictability was reduced, EMG of the
lumbo-pelvic agonist muscles in both the flexion and extension tasks
was less than in the predictable trials at 200N (P < 0.037), and
also at smaller loads for some muscles (P < 0.048). However, there
was minimal change in the respective antagonist muscles. Even
when the antagonist activity was pooled to account for individual
WCPT 2007, Research Reports
variations in strategy, there was little change at any of the loading
intervals (P > 0.05). Unlike the other abdominal muscles, the activity
of TrA was unchanged by reduced predictability. CONCLUSIONS:
Agonist/antagonist co-contraction did not increase during any of the
predictable or unpredictable loading tasks, instead agonist activity
reduced during the unpredictable tasks. TrA was the only muscle
that demonstrated increased activity with loading in both directions
and was unaffected by the reduced predictability. IMPLICATIONS:
Co-contraction was found to decrease when participants anticipated
the load release at an unexpected time. This is counterintuitive
as the nervous system is expected to prepare for a perturbation
by increasing co-contraction. While the purpose of this adaptation
is unclear, it appears that increased co-contraction is not always
perceived as the ideal strategy to protect the spine. This study also
provides further support for TrA contributing to lumbar stabilization in
a manner that is different to other trunk muscles. Increased activation
of TrA in flexion and extension may be advantageous by enhancing
stability without compromising the flexion or extension torque.
KEYWORDS: co-contraction, lumbar spine, stability. FUNDING
ACKNOWLEDGEMENTS: PH was supported by the National
Health and Medical Research Council of Australia. CONTACT:
d.mccook@shrs.uq.edu.au
ETHICS COMMITTEE: Ethical approval for this study was provided
by the Medical Research ethics Committee of the University of
Queensland.
Research Report Platform Presentation
3230 Monday 4 June 17:35
VCEC Exhibit Hall A
CLINICAL EFFECTIVENESS OF A CARDIAC REHABILITATION
AND PRIMARY PREVENTION PROGRAM DESIGNED FOR
WOMEN
Price J, Landry M, Delos-Reyes F, Rolfe D, Childerhose D,
Sternberg L; Women’s Cardiovascular Health Initiative, Women’s
College Hospital, Toronto, Ontario, Canada
PURPOSE: Background: Cardiac Rehabilitation (CR) has been
shown to be an important intervention in the care of cardiovascular
patients, however studies have reported lower enrollment and
participation rates for women compared to men. In addition to this
under-representation in traditional CR programs, there is a large
dropout rate among women. The purpose of this paper is to present
outcomes from this gender-specific program. RELEVANCE: The
Women’s Cardiovascular Health Initiative is unique in Canada and
offers comprehensive CR and primary prevention (PP) programs for
women. Components of the program include exercise training, group
education sessions on risk factor and lifestyle modification strategies,
and individual counseling and support. All of these components
encourage individual lifestyle changes, while also considering the
context of each woman’s life by utilizing a women-centered model
to guide its content and delivery. This may improve outcomes
for women who may otherwise not access or drop out of such
programs. PARTICIPANTS: Of 768 clients assessed for entry,
697 women enrolled between 11/01/1996 to 12/31/2003, with 298
joining the CR stream and 308 in PP. Baseline characteristics were
described and compared between CR and PP clients. METHODS:
This study is a retrospective cohort study design. Data was
collected through WCHI database files, individual client charts,
and the self-administered survey questionnaire. ANALYSIS: Among
590 completers, clinical outcomes (exercise capacity, body mass
index (BMI), waist circumference, body fat percentage) and health
outcomes (SF-36 physical and mental summary scores) were
compared before and after the program using a t-test. RESULTS:
Of the 632 women enrolled between November 1, 1996 and
May 31, 2004, 315 patients entered CR (mean age = 64.4±11.4
yrs) and 317 entered PP (mean age = 57.6±10.1 yrs). Baseline
characteristics will be described in both CR and PP patients. Among
542 patients completing the program, clinical outcomes (exercise
Platform Presentations, Monday 4 June
capacity, body mass index (BMI), waist circumference (WC), body
fat percentage (BF)) and health outcomes (SF-36 physical and
mental summary scores) were assessed before and after partaking
in the program. The compliance rate to completion for both
groups was 85%. Statistically significant improvements (p < 0.0005) in
exercise capacity (mean change = 2.36 METS ±1.77 (CR) (n=218),
1.86±1.58 METS (PP) (n=213)), BMI (mean change −0.53±1.35
(CR), −0.82±3.16 (PP)), WC (mean change −2.7±4.61 cm (CR),
−1.88±4.05cm (PP)), BF (−0.56±2.32% (CR), −1.11±1.75% (PP))
and SF-36 physical scores (4.3±7.94 (CR), 2.93±7.55 (PP)), mental
scores (3.02±9.31 (CR), 3.64±8.67 (PP)) were observed at time
of discharge. CONCLUSIONS: The valuable effects of participation
in a women-centered program, demonstrated by improvements in
exercise capacity, quality of life, and greater patient compliance,
provides evidence of the need for consideration of gender-specific
variables when designing and implementing CR and PP programs
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,
women’s health, outcomes. FUNDING ACKNOWLEDGEMENTS:
None. CONTACT: mireille.landry@wchospital.ca
ETHICS COMMITTEE: Ethics approval from the Toronto Academic
Health Sciences Council Ethics Review Board, for Research Ethics
Involving Human Subjects was awarded
Research Report Platform Presentation
2023 Monday 4 June 17:35
VCEC Meeting Room 16
CHANGES IN BALANCE AND STRENGTH PARAMETERS
FOLLOWING TRAINING WITH SPINEFORCE® OR HUBER®
DEVICE IN HEALTHY SUBJECTS
Portero P1,2 , Couillandre A3 , Duque Ribeiro M1 , Thoumie P1 ;
1 Service de Rééducation Neuro-Orthopédique, INSERM UMR 731,
Hôpital Rothschild, 33 boulevard de Picpus, 75571 Paris Cedex 12,
France; 2 Département STAPS, Université Paris 12, 94000 Créteil,
France; 3 UFR STAPS, Université Paris 10, 92000 Nanterre, France
PURPOSE: The aim of this study was to analyse the effects of
training performed on a SpineForce® (Huber® ) device design by
LPG Systems (France). RELEVANCE: This device designed to
improve balance and muscular function has not yet been assessed
during a training programme that could be proposed to patients
with altered motor function by physical therapists. PARTICIPANTS:
Twelve healthy adults took part in the training programme. This study
was approved by the Ethics Review Committee of Pitié-Salpêtrière
Hospital in Paris and informed consent was obtained from each
subject prior to participation. METHODS: The training programme
lasted two months, three times a week on a rehabilitation device
involving the whole body. Instrumental assessment of postural control
(Satel® force platform) and muscular function (Cybex Norm® ) was
performed before and after training. Postural control was measured
in different experimental conditions by a parameter of position (mean
anteroposterior position of center of foot pressure (CP)) and by two
parameters of stability (length and surface of the displacement of
CP). The assessment of the muscular function was performed during
knee and spine extension and included maximal voluntary isometric
contraction (MVIC), as well as a measure of muscle fatigability.
The Bouchard questionnaire allowed us to split the population into
sedentary and active groups. ANALYSIS: A Wilcoxon test was used
to examine the training effect for each group and pooled subjects.
A Mann-Whitney test was used to compared groups.Regression
analyses were performed using Spearman coefficient correlation.
RESULTS: For static postural control, a more forward CP position
for the maximal backward inclination condition (p < 0.01), a diminution
of the length of CP displacement in eyes closed on foam condition
and in the maximal forward inclination condition were observed. In
this latter condition a diminished surface of the CP displacement
S183
was also notable (p < 0.01). For the muscular function, an improved
MVIC for knee extension was only observed in the sedentary group
(p < 0.05), a functional improvement of muscle fatigability for all the
subjects. CONCLUSIONS: These results suggested that postural
control and muscular function were sensitive to training on such a
rehabilitation device. IMPLICATIONS: It seems likely that training on
this device would better suit a population with an initial low physical
activity level and could be applied to elderly or disabled people,
especially those with sensory disabilities. Moreover, for healthy active
or trained subjects, greater effects could be obtained by increasing
exercises’ intensity and specificity. KEYWORDS: motor function,
rehabilitation device, training. FUNDING ACKNOWLEDGEMENTS:
This study has been funded by LPG Systems, France. CONTACT:
p.portero@rth.aphp.fr
ETHICS COMMITTEE: This study was approved by the Ethics
Committee of Pitié-Salpêtrière Hospital in Paris, France.
Research Report Platform Presentation
2967 Monday 4 June 17:35
VCEC Meeting Room 17
CAN GROSS MOTOR FUNCTION CLASSIFICATION SYSTEM
PREDICT FUNCTIONAL LIMITATIONS AMONG OLDER ADULTS
WITH CEREBRAL PALSY?
Furui T1 , Furui M, Shiraishi K2 , Tuchiya Y3 , Collins D4 ; 1 Osaka
Kawasaki Rehabilitation University, Kaizuka, Japan; 2 Office IL, the
Center of Independent Living, Kohriyama, Japan; 3 Aich University,
Toyohashi, Japan; 4 University of Pittsburgh, Human Engineering
Research Laboratories, Pittsburgh PA, USA
PURPOSE: To investigate the progression of functional limitations
among older adults with cerebral palsy (CP) living in community
settings as assessed by performance on the Gross Motor Function
Classification System (GMFCS) [1]. RELEVANCE: CP is the most
disabling, childhood onset condition for adults [2]. The Japanese
population of people with CP was estimated to be 99,800 in a
2001 survey [3]. Straus et al. found that preserved mobility was
a predictor of mortality rate of individuals living with CP aged 60
years or older in a longitudinal epidemiologic study [4]. Our study
focused on investigating secondary problems which often lead to
declines in quality of life and independence among adults with CP [5].
PARTICIPANTS: Inclusion criteria: individuals with CP over the age
of 36 living in community. Sixty-four participants (mean age 50.5 SD
7.53, male 56.1%) were recruited through support organizations for
people with disabilities in Japan. METHODS: Using peer interviews,
people with CP gathered information and life histories from consented
participants; one variable included in the data collected was age
at time of cervical spinal surgery. The GMFCS was also used to
quantify the progression of functional limitations longitudinally. The
GMFCS is an ordinal rating scale, ranging from 1 (most functional)
to 5 (least functional) [1]. Recently, Jahnsen et al found self-reported
level of the GMFCS by adults with CP was reliable. [6]. We regarded
the GMFCS level at 12 years of age as the variable by which
participants were categorized at baseline as follows: G1: Highest
Functioning group – GMFCS Level 1, 31% (n=20), G2: Marginal
Ambulatory group – GMFCS Level 2-3, 36% (n=21) G3: Wheelchair
group – GMFCS Level 4-5, 36% (n=25). ANALYSIS: Event 1 (E1):
age at time of cervical spinal surgery for secondary problems,
Event 2 (E2): age when people declined one level of the GMFCS
from baseline. Times of events were compared between groups by
Logrank test after the evaluation of cumulative incidence by Kaplan-
Meier survival curve. Hazard ratio and its 95% confidential interval
were calculated by Cox’s proportional hazards model. RESULTS:
(E1) 17 participants (26%)had histories of cervical spinal surgery;
G1 participants received this surgery at a younger age than other
participants (p < 0.05), and hazard ratio of surgery at G1 was 3.583
(95% CI; 1.195-10.743). (E2) 41 participants (64%) declined one level
of the GMFCS from baseline; G2 participants declined at a younger
age than those in other groups (p < 0.05), and hazard ratio was 4.636
S184
(95% CI; 2.322-9.255). CONCLUSIONS: These finding suggest that
the level of the GMFCS at age of 12 can be critical in predicting
cervical spinal surgery and declines in functional performance due to
aging. Surprisingly the people who had the highest baseline GMFCS
scores received cervical spinal surgery more often and at a younger
age than participants in other groups. The vulnerability of marginal
walkers in our results is consistent with the result of Strauss et
al. [4] and Jahnsen et al. [5]. IMPLICATIONS: We should consider
physical therapy approaches for individuals with CP from a life-long
perspective to rather than an infantile approach, which places too
much stress on achievement of walking. References: 1. Palisano R,
Rosenbaum P, Walter S, Russell D, Wood E, Galuppi B. Development
and reliability of a system to classify gross motor function in children
with cerebral palsy. Developmental Medicine and Child Neurology
1997; 39: 214-223. 2. Krigger KW. Cerebral palsy: an overview.
American Family Physician 2006 January; 48(1): 91-100. 3. Ministry
of Health, Labor and Welfare. 2001 Survey on the Actual Status
of People with Physical Disabilities. Accessed on line September 9
2006 at: http://www.dbtk.mhlw.go.jp/toukei/kouhyo/indexkk_9_1.html.
4. Strauss D, Ojidane K, Shavelle R, Rosenbloom L. Decline in
function and life expectancy of older person with cerebral palsy.
NeuroRehabilitation 2004;19:69-78. 5. Ko HY, Park-ko I. Spinal
cord injury secondary to cervical disc herniation in ambulatory
patients with cerebral palsy. Spinal Cord. 1998 Apr; 36(4): 288-
92. 6. Jahnsen R, Aamodt G, Rosenbaum P. Gross Motor Function
Classification System used in adults with cerebral palsy: agreement
of self reported versus professional rating. Developmental Medicine
and Child Neurology. 2006 Sep; 48(9): 743-8. KEYWORDS: Adults
with Cerebral Palsy,Secondary Ploblems, Gross Motor Function
Classification System. FUNDING ACKNOWLEDGEMENTS: This
study partially supported by Office IL, Center of Independent Living,
and a fellowship grant through University of Pittsburgh. CONTACT:
furuitoh@yahoo.co.jp
ETHICS COMMITTEE: Board of Directors, Office IL, the Center of
Independent Living.
Research Report Platform Presentation
2628 Monday 4 June 17:35
VCEC Meeting Room 18
SUMMATED EXTENSION MOMENTS OF LOWER
EXTREMITY FOLLOWING ANTERIOR CRUCIATE LIGAMENT
RECONSTRUCTION
Radwan A1,2 , Khalil M1 , Elazzazi A2 , Elhafez S1 ; 1 Faculty of
physical therapy, Cairo University, Egypt; 2 Utica College, Utica,
New York, USA
PURPOSE: To adequately absorb shock during the loading response
subphase of the gait cycle, a rapid increase in lower extremity
joints extension moments occur. This increase was found to be
significantly lower in persons who had anterior cruciate ligament
(ACL) reconstruction using the patellar tendon autograft. This
study investigated extensor moments of subjects’ who had ACL
reconstruction using the hamstrings muscle tendon as an autograft.
RELEVANCE: Inability of the lower extremity extensor muscles
to generate sufficient moments may lead to excessive anterior
translational shear force on the upper end of the tibia. Adequate
moments are necessary to offset the flexion tendency during the
loading response and protect the new graft from being exposed
to excessive premature stresses especially during high demanding
activities. PARTICIPANTS: Kinetic gait parameters were collected
from both operated and non-operated lower extremities of 7 male
subjects who had ACL reconstruction 6 month ago with mean
(standard deviation) age 28.3 (6.7), height 1.77 m (.09), and
weight 83.4 kg (9.7). Subjects were included in the study if they
underwent the same operative technique and followed a standardized
rehabilitation protocol. Subjects were excluded if they had other
lower extremity surgeries or if the operated extremity scored less
than 85% on the single leg hop test or subjective key of the
WCPT 2007, Research Reports
Cincinnati rating scale of knee examination compared to the non-
operated extremities. In a pilot study, there was no difference between
summated extension moments of current samples’ non-operated
extremities and matched healthy subject). METHODS: A within-
subject design was selected to compare extension moments of the
operated and non-operated sides. Bilateral lower extremity kinetic
data were collected during walking on an instrumented walkway.
Data from two successive trials of foot-force plate contact were
analyzed. The mean summated extension moment of hip, knee
and ankle of each lower extremity was calculated and compared
on both sides. Additionally, knee extension moments on both sides
were compared. ANALYSIS: Data were analyzed using paired t-
test with a = 0.05. RESULTS: There was no significant difference
(p = 0.8) between the summated extension moment of the operated
and non-operated lower extremities with means (standard deviation)
of 0.7 (0.25) and 0.73 (0.27), respectively. Similarly, there was no
significant difference (p = 0.56) between the knee extension moment
of the operated and non operated limbs 0.28 (0.12) and 0.37 (0.08)
respectively. CONCLUSIONS: The similarity of the summated lower
extremity and knee moments between both limbs may indicate that at
the end of the rehabilitation period, subjects undergoing this operative
technique were able to adequately absorb the shock imposed on
their lower extremities during the loading response subphase of the
stance phase. Future trials should include more demanding tasks
such as jogging and running to investigate the difference between
the moments of operated and non operated sides. IMPLICATIONS:
Kinetic parameters may help establish evidence about outcomes
of rehabilitation programs. The results of this study indicate that,
earlier return to functional activity may be safer for patients who had
anterior cruciate ligament reconstruction using hamstring autograft
compared to patients with patellar tendon autograft. KEYWORDS:
Knee, moments, rehabilitation. FUNDING ACKNOWLEDGEMENTS:
None. CONTACT: aradwan@utica.edu
ETHICS COMMITTEE: The Faculty and University Councils of Post
Graduate Studies and Scientific Researches, Cairo University, have
approved the research work plan.
Research Report Platform Presentation
2364 Monday 4 June 17:55
VCEC Meeting Room 17
HAND FUNCTION AND RELIABILITY OF OUTCOME MEASURES
IN PERSONS WITH CHARCOT-MARIE-TOOTH’S DISEASE
Svensson E, Hager-Ross C; Department of Community Medicine
and Rehabilitation Section for Physiotherapy, Umeå university,
Umeå, Sweden
PURPOSE: To describe hand function in persons with Charcot-
Marie-Tooth’s disease (CMT) and to evaluate the reliability of
selected outcome measures addressing dexterity, grip strength and
sensation. As a comparison, we tested the function of the lower
extremity with Short Physical Performance Battery (SPPB), and
evaluated test-retest reliability. RELEVANCE: Charcot-Marie-Tooth is
a peripheral neuropathy causing progressive sensory loss, muscle
atrophy and weakness. The lower extremities are first affected and
most studied. The hand function is successively reduced but is not
so well described. Although CMT is the most common inherited
neuropathy, research on physiotherapy management is limited. It is
important to establish the conditions and needs of these patients,
and to have reliable outcome measures to monitor the illness and
evaluate rehabilitation. PARTICIPANTS: Twenty out of 24 persons
with CMT registered at the neurological clinics in three counties
of northern Sweden (~630,000 inhabitants, comparative to world
reported incidence); 9 men, 11 women aged 24-73 years. All
subjects were right handed. METHODS: We examined hand function
and evaluated test-retest reliability (1 week interval), using Box
and Block Test; BBT, Nine-Hole Peg test; NHP, grip and pinch
strength; Grippit® , tactile sensation with Shape Texture Identification
test; STI, and for the lower extremity Short Physical Performance
Poster Displays, Monday 4 June
Battery; SPPB. ANALYSIS: Descriptive statistics were used for
evaluation of functional ability. To assess test-retest reliability we used
intraclass correlation coefficients (ICC), limits of agreement (LOA)
according to Bland Altman, coefficient of repeatability (CR) and the
average within-subject coefficient of variation (CV). For STI, linear
weighted kappa was used. RESULTS: All but one person had hand
symptoms including reduced sensation. Patients scored on average
approximately 2/3 compared to age- and sex-matched controls in
the BBT, and needed 60-95% more time to finish the NHP test while
the grip strength was reduced by 50%. As for reliability, the BBT
and NHP showed very high ICC values (0.95 and 0.99 respectively;
interpreted according to Munro). Grip strength showed very high
reproducibility between tests (ICC 0.99), acceptable LOAs, no bias
and low CVs. Pinch strength showed very high ICC values, but a large
range of LOA and a high CR (8.5N). The STI showed limitations
in terms of how well it can describe patients either performing
very well or very poorly. CONCLUSIONS: Impaired hand function
is common in CMT and the tested instruments can all be used
for evaluation. Certain factors, however, like limited time aspects
for the NHP test and the number of trials used, should be taken
into consideration. Pinch strength evaluation should be interpreted
with caution. The STI test is not optimal to evaluate changes
in sensation because of the limited scale. IMPLICATIONS: The
reliability and clinical implementation of above outcome measures
is communicated, which is important in order to develop evi-
dence based physiotherapy management of people diagnosed with
CMT. KEYWORDS: Charcot-Marie-Tooth’s disease, reliability, hand
function. FUNDING ACKNOWLEDGEMENTS: Swedish Association
of Persons with Neurological Disabilities (NHR), Swedish Asso-
ciation of Registered Physiotherapists’ minnesfond, Stiftelsen JC
Kempes Stipendiefond and Västerbotten County Council, Sweden.
CONTACT: charlotte.hager-ross@physiother.umu.se
ETHICS COMMITTEE: Regional Ethical Review Board, Umeå,
Sweden.
Poster Displays, Monday 4 June
Research Report Poster Display
01-01 Monday 4 June 09:00
VCEC Exhibit Hall B & C
A RANDOMIZED CONTROLLED TRIAL FOR THE
EFFECTIVINESS OF MANIPULATIVE THERAPY AND
ACUPUNCTURE ON PAIN CAUSED BY MECHANICAL
THORACIC SPINE DYSFUNCTION
Lehtola V1 , Korhonen I2 ; 1 Kuopio University, Faculty of Medicine,
Health Sciences (FINLAND); 2 Kotkan OMT-Fysio (FINLAND)
PURPOSE: A randomized, assessor blinded, placebo-controlled trial
was conducted in order to make a comparison between the short-
term effectiveness of manipulative therapy and acupuncture on
the pain caused by mechanical thoracic spine dysfunction and on
pressure pain threshold. RELEVANCE: Neck and shoulder areas
are traditionally assessed and treated as being dysfunctions of the
cervical spine. The share of the thoracic spine has hardly been
studied epidemiologically. It has, however, been noted clinically that
local pain dysfuncions in the thoracic area do exist. PARTICIPANTS:
The research sample consisted of 114 female patients aged between
20 and 60. The primary complaint of the subjects was pain in the
thoracic spine area. The continuance of the symptom had to be
less than three months before the first assessment. The recruitment
to the trial happened in the arranged local GP and occupational
health centres, whose staff were advised to refer potential subjects
to a private physiotherapy clinic for evaluation. 114 subjects of the
total of 133 patients sample with the mechanical thoracic spine
dysfunction were randomized to the final study on grounds of a
questionnaire and a clinical examination. Five persons dropped out
the trial. The total of 109 subjects were randomly divided into
the manipulation group (n=37), the acupuncture group (n=35), and
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the placebo group (interference-electrotherapy with suction cups
without electricity) (n=37). METHODS: Subjects were treated four
times with a one-week follow-up assessment. The measurements of
VAS and pressure pain threshold were taken three times (baseline,
before the second treatment and one week after the last treatment).
The whole intervention took 4-5 weeks. The assessor was blinded
with the treatment method. ANALYSIS: The data were analysed
statistically with SPSS for Windows, Release 11.0.0 (SPSS Inc.,
1989-2002). The distributions of VAS measurements were non-
normal tested with the Shapiro-Wilk test. Nonparametric tests were
used. The intragroup mean changes of VAS in time were analysed
with the Friedman test. The Mann-Whitney test was used in pairwise
comparisons of the groups on VAS and pressure pain threshold
measurements. Bonferroni correction was used. RESULTS: The VAS
measurement performed a week after the last treatment pointed
out that comparing manipulative therapy with placebo the p-value
was 0.02, which is a statistically significant result (95% confidence
interval). The intra-group results of the VAS measurements between
the first and the last measurement showed clinically significant pain
reduction in all three groups. Pressure pain threshold values had
increased in both the manipulation group and in acupuncture group,
whereas in the placebo group they had decreased. The differences
were not statistically remarkable. CONCLUSIONS: Manipulative
therapy is more efficient than placebo in treating the pain caused
by mechanical thoracic spine dysfunction when measured one
week after the last treatment. The difference between the effect
of acupuncture and placebo is not significant. Within the future
studies manipulative therapy should be combined to other treatments,
especially exercise therapy, to achieve similarity with the real
treatment procedure. The need for further studies is obvious
because of neck-shoulder problems generality. IMPLICATIONS: The
education of using manipulative therapy is essential for clinical
practices. KEYWORDS: manipulative therapy, acupuncture, thoracic
spine, mechanical dysfunction. FUNDING ACKNOWLEDGEMENTS:
None. CONTACT: vesa.lehtola@omt.org
Research Report Poster Display
01-05 Monday 4 June 09:00
VCEC Exhibit Hall B & C
REFLEXOLOGY: A TREATMENT FOR PHANTOM LIMB PAIN?
Brown C1 , Lido C2 ; 1 Prosthetic Services Centre, Wolverhampton
City NHS Trust, Wolverhampton, England; 2 Thames Valley
University, London
PURPOSE: The main objective was to test if reflexology could be
used as a non-invasive form of phantom limb pain relief. The second
objective was to test the possibility that patients might be able
to achieve any positive results with self-treatment. RELEVANCE:
Management of phantom limb pain has always been a part of the
physiotherapists role and whilst there have been single case studies
by physiotherapists into using reflexology to treat this phenomenon,
the author could not find any larger research studies. It was felt
that more research is needed in this area in order to build the
evidence base required for this method of phantom limb pain
relief. PARTICIPANTS: There were 7 men and 3 women with
unilateral lower limb amputations, varying from below knee to hind
quarter levels, and a history of phantom limb pain. Aetiologies were
osteomyelitis, trauma, diabetic gangrene, ulceration, thigh tumour
and necrotizing fasciitis. The mean age was 62.5 years. METHODS:
Same-subject, experimental pilot study; recording pain in weekly pain
diaries during a 30-week period. Phase 1 six weekly diaries for base
line of pain. Phase 2 six weekly diaries and six weekly reflexology
treatments. Phase 3 six weekly diaries only, resting phase. Phase 4
six weekly diaries and six weekly teaching sessions. Phase 5 six
weekly diaries and self treatment. ANALYSIS: A numerical rating
pain scale; 0 = no pain, 1 = mild pain, 2 = moderate pain, 3 = severe
pain, an ordinal duration rating scale; 0 = not applicable, 1 = once a
week, 2 = a few days a week, 3 = once a day, 4 = more than this, and
S186
a numerical lifestyle scale; 0 = not applicable, 1 = does not interfere,
2 = slight interference, 3 = moderate interference, 4 = interferes
a lot, 5 = completely interferes were used in the diaries. These
scales were sanctioned by a clinical specialist in pain management.
The statistician entered the data into the Statistical Package for the
Social Sciences (SPSS), it was analysed using both parametric and
non-parametric tests, there was no difference between the results
of these and therefore, parametric tests were reported (ANOVA &
LSD). Effect sizes analysis was also carried out in order to account
for the small sample. RESULTS: Repeated measures ANOVA for
average reported pain revealed a highly significant ‘overall’ difference,
whereby the treatment phase does makes a difference to pain;
F(4,28) = 4.38, p = .007. This indicates that the probability of finding
this pattern due to chance is less than 1%. The same test was used
for the analysis of duration and affect on lifestyle; F(4,36) = 4.98,
p = .003 and F(4,36) = 3.57, p = .01 CONCLUSIONS: The project
indicated that reflexology treatment, teaching and self-treatment
were effective in eradicating or reducing the intensity and duration
of phantom limb pain in this group of patients. IMPLICATIONS:
Physical therapists could play a pivotal role in the treatment of this
phenomenon by using reflexology and could empower the patients
to self-treat. KEYWORDS: Intensity, duration, lifestyle. FUNDING
ACKNOWLEDGEMENTS: Wolverhampton City NHS Primary Care
Trust, c/o Research & Development Department, The Beeches,
Penn Hospital, Wolverhampton, West Midlands, England. CONTACT:
tina.brown@wolvespct.nhs.uk
ETHICS COMMITTEE: Wolverhampton District Local Research
Ethics Committee; REC reference number: 04/Q2701/31; Approved:
11th February 2005; Completed December 2005
Research Report Poster Display
02-13 Monday 4 June 09:00
VCEC Exhibit Hall B & C
CHARACTERIZATION OF ACUTE EXACERBATION AFTER
PULMONARY REHABILITATION IN INDIVIDUALS WITH
CHRONIC OBSTRUCTIVE PULMONARY DISEASE
Carr J1,2 , Goldstein R1,2 , Brooks D1,2 ; 1 West Park Healthcare
Centre, Toronto, Canada; 2 University of Toronto, Toronto, Canada
PURPOSE: This study was designed to characterize acute exacerba-
tions (AEs) after pulmonary rehabilitation (PR) and to examine their
effects on functional exercise capacity and health-related quality of
life (HRQL). RELEVANCE: Despite improvements in health status
achieved through (PR), the benefits diminish with time. Patients have
identified experiencing an AE as a main contributing factor to reduced
adherence. Exacerbations are related to a general deterioration in
health. As disease severity increases, the frequency of AEs and
hospital admissions also increase. Little research has been done
on the effects of AEs on functional exercise capacity or HRQL
after PR. PARTICIPANTS: Sixty patients who completed PR were
recruited. Of these, seven dropped out leaving 53 who completed
the study. METHODS: This descriptive study used prospective data
collection. Baseline measures were done at completion of PR and
patients were followed for 26 weeks. If patients experienced an AE,
measures were repeated two weeks after the onset of symptoms.
Primary outcome measures were the 6-minute walk test (6MW) and
the Chronic Respiratory Disease Questionnaire (CRQ). ANALYSIS:
Between-group comparisons using t-tests were done to compare
those who experienced AEs to those who did not, and repeated
measures comparisons using paired samples t-tests were done for
pre-, post- AE analyses. RESULTS: At baseline, the mean age was
69 (+/− 9 years), 49% were female, 23% were on oxygen with
activity, 66% had moderate COPD, 34% had severe COPD and
the mean number of co-morbidities was 5.9 (+/− 2.5). Of the 53
patients, 34 (64%) experienced a moderate or severe AE within
26 weeks. The difference in baseline 6MW distance between those
who did (416 +/− 95m) and those who did not (350 +/− 95m)
experience an AE was 66m (p = 0.018). Twenty-seven experienced a
WCPT 2007, Research Reports
moderate AE while 7 experienced a severe AE. Acute exacerbations
resulted in a significant reduction in 6MW (mean change 59 +/−
80m, p < 0.001). While there was no effect of AE on dyspnea
(p = 0.1), there was a significant reduction in the fatigue domain of
the CRQ (mean change = 0.99 +/−1.29, p < 0.001), the emotion
domain (mean change = 0.58 +/− 0.95, p = 0.003) and mastery
domain (mean change = 0.53 +/− 1.36, p = 0.04). CONCLUSIONS:
Patients with lower functional exercise capacity are more likely to
experience exacerbations. The incidence of AE after PR is higher
than previously reported. This study shows a significant loss in
functional exercise capacity and in some areas of HRQL two weeks
after AE. IMPLICATIONS: Future treatment of AE should include
targeting functional exercise capacity and HRQL. Further research
on early intervention with PR is indicated. KEYWORDS: Acute
exacerbation of COPD, 6-minute walk test, health-related quality of
life. FUNDING ACKNOWLEDGEMENTS: S. J. Carr was awarded
Fellowships from the Ontario Respiratory Care Society, Ontario Lung
Association and from the Canadian Respiratory Health Professionals
of the Canadian Lung Association. Dr. D. Brooks holds a New
Investigator Award from the Canadian Institute for Health Research
(CIHR). Financial support was received from the Ontario Thoracic
Society.
ETHICS COMMITTEE: Research Ethics Committee at West Park
Healthcare Centre and the Ethics Review Committee at the University
of Toronto.
Research Report Poster Display
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-
LAR RESPONSES AND AUTONOMIC NERVOUS ACTIVITIES
Matsumoto T, Matsunaga A, Saitoh M, Yonezawa R, Kutsuna T,
Nanri Y, Ishii A, Yamamoto K, Sato T, Sawairi T, Masuda T; Graduate
school of medical sciences, Kitasato university, Kanagawa, Japan
PURPOSE: The patients who have severe left ventricular dysfunction
(LVD) were generally prescribed lower intensity exercise in the
beginning of a phase I cardiac rehabilitation, because excessive
increases of heart rate (HR) and blood pressure (BP) were observed
during the exercise and induced serious arrhythmias originated from
the imbalance of autonomic nervous activities. On the other hand, the
prolonged expiration breathing (PE) that is controlled 1 to 2 of the
inspiration and expiration time is known to activate parasympathetic
nervous activity resulting in decreases of HR and BP after PE.
However, there are few reports that examined the influence of
PE on autonomic nervous activities during exercise. The purpose
of the present study was to clarify the influence of the exercise
characterized by breathing mode of PE on cardiovascular responses
and autonomic nervous activities. RELEVANCE: The present study
helps to prescribe the patients with severe LVD safer and more
effective exercise in a cardiac rehabilitation. PARTICIPANTS: Thirty-
four healthy young men (22+-1 years old) and 30 elderly men (68+-
4 years old) were classified into two groups: the Japanese style
calisthenics was carried out with a controlled respiration time of
2-second inspiration and 4-second expiration in PE group or with
normal breathing in control group. METHODS: The Japanese style
calisthenics was performed after 15-minute rest and followed by
another 15-minute rest as the exercise protocol, which spent 5
minutes 30 seconds in PE group and 3 minutes 10 seconds in control
group. HR and BP were measured by a Holter electrocardiogram
(ECG) and the cuff method using autonomic manometer, respectively.
Respiration rate (RR), tidal volume (TV) and peak oxygen uptake
(peak VO2) were measured by using the expired gas analysis. The
power of low- and high-frequency components (LF: 0.04-0.15Hz,
HF: 0.15-0.40Hz) was analyzed by heart rate variability that was
obtained from a Holter ECG. HF and the ratio of LF to HF
(LF/HF) were used as indexes of parasympathetic nervous activity
Poster Displays, Monday 4 June
and the dominancy in sympathetic nervous activity, respectively.
The change from plasma concentration of norepinephrine (NE) at
rest to NE after exercise (DNE) was analyzed as an index of
sympathetic nervous activity. ANALYSIS: The changes in these
parameters were analyzed by two-way ANOVA. RESULTS: HR,
RR, peak VO2 and LF/HF during exercise were significantly lower
in PE group than those in control group regardless of age
(P < 0.05,respectively). TV and HF during exercise were significantly
higher in PE group than those in control group regardless of age
(P < 0.05,respectively). DNE did not change significantly in PE group,
although it elevated significantly in control group regardless of age
(P < 0.05). In PE group, the increase of HR during exercise was
significantly lower in elderly men than in young ones (P < 0.05). In
both groups, BP during exercise was significantly higher in elderly
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
by breathing mode of PE for elderly persons or severe LVD patients.
KEYWORDS: breathing mode, autonomic nervous activity, exercise
training. FUNDING ACKNOWLEDGEMENTS: None. CONTACT:
matsutaku0225@hotmail.com
ETHICS COMMITTEE: The study protocol was approved by the
Ethics Committee of Kitasato University.
Research Report Poster Display
02-21 Monday 4 June 09:00
VCEC Exhibit Hall B & C
UPPER LIMB MOVEMENTS, PAIN AND STERNAL SEPARATION
IN PATIENTS WITH STERNAL INSTABILITY FOLLOWING
CARDIAC SURGERY
El-Ansary D1,2 , Adams R2 , Waddington G1 ; 1 The University
of Canberra, ACT, Australia; 2 The University of Sydney, Sydney,
Australia
PURPOSE: The purpose of this study was to examine the effects of
a variety of upper limb exercises on the patient with sternal instability
after first evaluating the reliability of ultrasound measurement
of sternal separation. RELEVANCE: Physical therapists routinely
prescribe upper limb exercises for patients who have undergone a
median sternotomy during cardiac surgery. It is not currently known
whether upper limb exercises should be unilateral or bilateral, and
conducted with or without additional loading, in order to minimise pain
and further sternal separation. PARTICIPANTS: Eight subjects who
had chronic sternal instability after cardiac surgery. METHODS: The
region of greatest instability along the sternum for each participant
was identified as a reference point for all measurements. The amount
of sternal separation at this point was measured from the projected
ultrasound image. In order to evaluate the effects of unilateral versus
bilateral upper limb exercises, a series of upper limb movements were
examined with each participant in a supported seated position. These
simulated the routine active range of shoulder motion exercises
used by physical therapists, and sternal separation measures were
taken at rest (0 degrees), midrange (90 degrees) and at the end
of the range (180 degrees or earlier as determined by the subject’s
capability), both with and without a 1kg weight placed in the hand/s.
Pain was recorded using a visual analogue scale. Each movement
condition was repeated three times, in a random order, and the
mean sternal separation under the particular condition combination
obtained. ANALYSIS: Analysis of Variance with repeated measures
was used to examine the effects of the three factors: load, arm/s and
position on the ultrasound-determined size of the sternal separation.
Receiver Operating Characteristic (ROC) analysis was conducted
on pain report and individual patient sternal separation. Data were
analysed with a p value <0.05 throughout, using SPSS version
12.0.1 for Windows. RESULTS: Test-retest reliability for sternal
separation measurement with upper limb exercises ranged between
0.77 and 0.93. Amount of sternal separation was not related to
S187
type of upper limb activity, but both unilateral and unilateral loaded
positions were found to be significantly associated with sternal pain
(p = 0.009). CONCLUSIONS: In this group of patients with chronic
sternal instability, bilateral upper limb movements were significantly
less associated with sternal pain than unilateral movements.
IMPLICATIONS: Consideration should be given during rehabilitation
planning to the choice of unilateral, bilateral, weighted or unweighted
exercise for those patients with sternal separation who report pain
on upper limb movement. The results here provide preliminary data
to suggest that bilateral unloaded movements were associated with
lower frequency of pain. KEYWORDS: Sternal Instability, Cardiac
Surgery, Exercise. FUNDING ACKNOWLEDGEMENTS: University
of Sydney, Australia. CONTACT: dela2819@fhs.usyd.edu.au
ETHICS COMMITTEE: The University of Sydney, Australia.
Research Report Poster Display
03-17 Monday 4 June 09:00
VCEC Exhibit Hall B & C
FACTORS CONTRIBUTING TO COMPETENCY OF PHYSIO-
THERAPY CLINICAL INSTRUCTORS: A QUALITATIVE STUDY
Fox P, Yeung E, Chung E, Helm D
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
the competencies required for physiotherapy clinical instructors to
perform well and the factors that facilitate and hinder performance.
PARTICIPANTS: All physiotherapists from 3 teaching hospitals in
Toronto, Canada were invited to participate in the study. Sixteen
physiotherapists who had supervised at least 2 students in the
past 2 years volunteered to participate in the study. The majority
of participants were female (81%) and 50% of the participants
had less than 5 years of clinical experience. Fifty-six percent of
participants had supervised 3 or more students in the past year.
METHODS: A qualitative approach using focus group methodology
was used. Three focus groups were conducted by an experienced
moderator using 9 open-ended questions with probes. In addition,
participants were asked to identify and rate the 5 most important
competencies (out of a list of 15 competencies) of a clinical instructor.
Key points were written on a flip chart for the purpose of verification
by participants. The focus groups were audio taped. The audio tapes
were transcribed verbatim. ANALYSIS: NVivo was used to organize
and code the data. Open and axial coding was used to analyze data
and generate themes. RESULTS: In general, similar themes were
generated in the 3 focus groups. Participants agreed that taking on
the role of a clinical instructor was a positive learning experience
but could be challenging as well. Specific challenges related to
students were identified as: personality differences, difficulty with
providing feedback on inappropriate professional behaviours, conflict
resolution, and students performing at a lower competency level
than what they perceive. Participants also described the presence
of competing priorities in their role as clinical instructor. Participants
identified the following intrinsic qualities of a successful clinical
instructor: professionalism, flexibility, respectfulness, approachability,
sensitivity and possessing a passion for their area of practice.
Strategies to facilitate a student’s clinical experience were: utilizing
good organizational skills, setting expectations of student and
clinical instructor early on, clear and on-going communication
between student and clinical instructor, role modeling for student,
establishing a good relationship with student and collegial support.
Participants rated the most important competencies of a clinical
instructor as 1) establishes a good learning environment, 2) adjusts
teaching to student needs, and 3) asks questions that promote
learning. Supporting quotes illustrate the themes. CONCLUSIONS:
Participants identified several intrinsic qualities of a competent
physiotherapy clinical instructor as well as strategies to facilitate the
student experience. Although clinical teaching provides a positive
learning experience for physiotherapy clinical instructors, several
S188
challenges were identified. IMPLICATIONS: Findings from this study
may be used to plan initiatives to support professional development of
clinical instructors. The results may also be used to identify or develop
a tool for students to evaluate the clinical instructor. Future studies
need to examine student perspectives on competencies of clinical
instructors. KEYWORDS: clinical instructors, competency, focus
groups. FUNDING ACKNOWLEDGEMENTS: This work was funded
by the Allied Health Research Fund at the University Health Network
in Toronto, Ontario, Canada. CONTACT: euson.yeung@uhn.on.ca
ETHICS COMMITTEE: University Health Network Research Ethics
Board; St. Michael’s Hospital Research Ethics Board
Research Report Poster Display
04-01 Monday 4 June 09:00
VCEC Exhibit Hall B & C
REPORTED LEVELS OF SUPERVISION DURING FULL-TIME
CLINICAL EDUCATION EXPERIENCES: PERSPECTIVES OF
CLINICAL INSTRUCTORS AND STUDENTS
Karges J; The University of South Dakota, Department of Physical
Therapy
PURPOSE: The primary purpose of this study was to determine the
level of supervision for two classes of physical therapy students as
they progressed from novice to entry-level while on their full-time
clinical education experiences (CES). The secondary purpose was
to analyze the supervision data in relation to the American Physical
Therapy Association (APTA) HOD 06-00-18-30 and other practice
issues to develop educational opportunities for clinical instructors
to facilitate appropriate supervision across all CES. RELEVANCE:
Direct supervision is the standard set by the APTA, yet that level of
supervision has not been typically reported by students while on full-
time CES. PARTICIPANTS: Thirty-six students from a potential of
116 CES from the classes of 2003 and 2004 participated (31.03%).
Thirty-three of 116 clinical instructors (CIs) participated (28.45%).
METHODS: Data collection for this IRB approved study occurred
from November 2002-July 2004. A daily log sheet was developed
for the CIs and students to independently track the total number
of patients seen each day and the level of supervision provided by
the CI. Definitions were given for the following supervision choices:
Direct Supervision (HOD 06-00-18-30), Minimal Supervision, No
Supervision/Independence, and Observation Only (student observed
only). Participants were also asked questions relating to challenges
with supervision, beneficial strategies for supervision issues, and
reasons for observation only. ANALYSIS: Levels of supervision
were summarized with percentages; SPSS 11.5 was used to
analyze the differences in supervision between the two groups.
RESULTS: There was no significant difference (t=.123; p = 0.904)
between the supervision levels as reported by the CIs versus
the students. However, the supervision levels did change from
the first to the last clinicals. Supervision reported by the CIs for
Clinical Education I was Direct 39.88%, Minimal 27.51%, None
7.14%, Observation Only 25.56%, and for Clinical Education IV
was Direct 6.94%, Minimal 17.14%, None 41.19%, Observation
Only 32.93%. Supervision recorded by the students for Clinical
Education I was Direct 44.79%, Minimal 27.24%, None 4.48%,
Observation Only 23.48%, and for Clinical Education IV was Direct
8.53%, Minimal 20.21%, None 38.29%, Observation Only 32.96%.
The most common challenge for supervision reported by the CIs
and students was the Medicare B regulation. The most common
times the students observed were for Medicare B patients, at
the start of the rotations, new or unique cases/techniques, and
when watching other therapists. Open communication between the
students and CIs was the most commonly reported strategy for
dealing with supervision issues. CONCLUSIONS: The level of
supervision provided to these students decreased as they progressed
through their clinical education experiences and did not necessarily
follow the guidelines from HOD 06-00-18-30. The Medicare B
restrictions also seemed to be a challenge in the outpatient settings.
WCPT 2007, Research Reports
IMPLICATIONS: Educational opportunities need to be provided to
the clinical educators to promote direct supervision and implement
strategies for providing this supervision throughout all levels of
clinical education experiences. KEYWORDS: Clinical Education,
Supervision. FUNDING ACKNOWLEDGEMENTS: N.A.
ETHICS COMMITTEE: Received approvoal from the Institutional
Review Board at The University of South Dakota prior to the
conduction of this study.
Research Report Poster Display
07-05 Monday 4 June 09:00
VCEC Exhibit Hall B & C
REFLECTIVE PHYSIOTHERAPISTS FROM PROBLEM-BASED
LEARNING ENVIRONMENTS
Lähteenmäki M1,2 ; 1 Pirkanmaa Polytechnic, Tampere, Finland;
2 Tampere University, Tampere, Finland
PURPOSE: Problem-based learning (PBL) is getting more and
more popular as a pedagogical approach for professional education.
RELEVANCE: There is still considerable debate around the learning
outcomes and effectiveness of PBL. The first aim of this research
is to examine the elements that are intrinsic for creating problem-
based learning environments. The second aim is to compare PBL
physiotherapy education with subject-based physiotherapy education
from students’ perspective. PARTICIPANTS: The target group
consisted firstly of first year physiotherapy students (PBL) from one
educational institution. Secondly there were physiotherapy students
from the second, third and fourth academic year from three different
educational institutions from two different countries. Two of the last
student groups studied in subject-based (16 + 16 students) and
three in problem-based education (6 + 13 + 5 students). In addition
there were also teachers (4), physiotherapists (4) and last year
students (5) from one institution that used problem based learning.
METHODS: This was an ethnomethodological study. For the first aim
of the study I interviewed teachers, physiotherapists and last year
students. In addition I gathered written descriptions and organised
three group discussions with the first year physiotherapy students.
For the second aim of the study I gathered written descriptions
from five different students groups about their experiences during
all their practical placements. ANALYSIS: For the data analysis
I used qualitative content analysis for finding different categories
from the students’ descriptions. After that I calculated the amount
of descriptions for different categories per each student group.
RESULTS: Problem-based learning environment was conceived
of dialogical co-operation between teachers, physiotherapists and
students. Four types of dialogue was identifies: understanding
dialogue in developing and updating curricula, expert dialogue in
creating problems, teachers inner dialogue in developing education
and guiding dialogue in making decisions about the students best.
PBL environment was perceived as an environment that supported
student’s reflective learning as an experimental learning process. I
categorized the descriptions that subject-based and problem-based
students wrote about in terms of three categories: performance-
centred therapy, therapy that takes the patient into account and
reflective therapy. Subject-based students described their therapy
mostly as performance-centred as well as therapy that takes the
patient into account. Problem-based students described their therapy
mostly as therapy that takes the patient into account as well
as reflective therapy. CONCLUSIONS: These results support the
conclusion that problem-based learning environment as realized in
this case helps the students to become reflective in their therapy
practices. This means for instance that they are goal oriented, search
and use new knowledge actively for therapy and they are critical
in problem solving. IMPLICATIONS: This research suggests that
problem-based learning is a successful pedagogical approach in
physiotherapy for developing patient-oriented reflective practitioners.
It is why PBL is worth implementing and developing. KEYWORDS:
Physiotherapy education, Problem-based learning, Subject-based
Poster Displays, Monday 4 June
learning. FUNDING ACKNOWLEDGEMENTS: I want to thank The
Finnish Academy and especially it’s Life as Learning-project and
Pirkanmaa Polytechnic that have made this research possible.
CONTACT: marja-leena.lahteenmaki@piramk.fi
ETHICS COMMITTEE: Ethical boards in different health care
organisations in Finland.
Research Report Poster Display
08-13 Monday 4 June 09:00
VCEC Exhibit Hall B & C
EFFECTS OF LOW-LEVEL LASER (ASGAINP) THERAPY ON
THE HEALING OF THIRD-DEGREE BURNS IN RATS
Calazans V1 , Meyer R1 , Munin E2 , Lima J1 ; 1 LABMORF/UNISUAM;
2 UNIVAP
PURPOSE: Low-level laser therapy (LLLT) is a form of phototherapy
that involves the application of low power monochromatic and
coherent light to injuries and lesions. It has been used successfully
to induce wound healing in nonhealing defects. RELEVANCE: Other
wounds treated with lasers include burns, amputation injuries, skin
grafts, infected wounds, and trapping injuries. PARTICIPANTS: We
used 30 rats Wistar, females (weigh 200 g). The animals were divided
in three groups of ten animals: Sulfa Group, treated with conventional
therapy (SULFA), bath with PVPI and dressing with sulfadiazine;
Laser Group (LASER), treated with laser therapy; and Sulfa +
Laser Group (SULFA+LASER), treated with conventional therapy
more laser therapy. METHODS: The animals were anesthetized
with Ketamine i.m. After that, we made a third-degree burn with a
circumferential metal blade (iron), measuring 3 cm of diameter for 5
seconds. The temperature was controlled for a digital thermometer
in 100º C. Immediately after the burn, we removed a biopsy, with
a pusch of 3mm of diameter. Eight sessions of laser therapy with
Laser Diode (AsGaInP), with wavelength of 658 nm and power of
30 mW, in five fixed points with fluency of 3 J/cm2 for area. After
15 days, the animals were sacrificed and we removed the last
biopsy. ANALYSIS: Histopathologic evaluation using hematoxylin and
eosin and Picro-Sirius staining showed a fibrionopurulent exudate
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
in SULFA+LASER group. CONCLUSIONS: Our data indicate that
Low-level laser therapy associated with sulfadiazine (conventional
treatment) constitute a promising therapy for the third-degree burns.
IMPLICATIONS: This study is to important for physical therapy
practice because the Low-level laser therapy is a clean, fast and
efficient form of treatment of burns. KEYWORDS: third-degree
burns; low-level laser; Rats. FUNDING ACKNOWLEDGEMENTS:
PIBIC/UNISUAM. CONTACT: januario@unisuam.edu.br
ETHICS COMMITTEE: UNISUAM ethics committee approved this
study.
Research Report Poster Display
08-17 Monday 4 June 09:00
VCEC Exhibit Hall B & C
THE EFFECTS OF LASER IRRADIATION ON PROLIFERATION
IN OSTEOSARCOMA CELL LINES (MG63 AND U2OS)
Renno A1 , Mcdonnell A2 , Laakso L3 , Parizotto N4 ; 1 Federal
University of São Carlos, Sao Carlos, Brazil; 2 Griffith University,
Brisbane, Australia; 3 Griffith University, Gold Coast, Australia;
4 Federal University of São Carlos, Sao Carlos, Brazil
PURPOSE: In order to progress our understanding of the physiolog-
ical processes and clinical parameters involved in the field of laser
therapy, and to determine the responses of malignant bone cells to
laser irradiation, we investigated the dose-response effects of 670nm,
780 nm and 830 nm laser on cell proliferation of two osteosarcoma
(MG63 and U2OS) cell lines in vitro. RELEVANCE: Low level laser
S189
therapy (LLLT) has been used as a treatment in many clinical
conditions and with effects on reducing post-injury inflammation
and accelerating soft and hard tissue healing. LLLT stimulates
mitochondrial respiration, increases the synthesis of DNA, RNA and
regulatory proteins, and promotes cell proliferation in normal and
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
irradiation, the wells of 96-well plates were seeded with 1x104 cells
in fresh growth medium then incubated for 24hr at 37ºC in 5%CO2.
A single dose of irradiation was performed (670nm, 780 nm and
830 nm, 30 mW) at the intensities of 0.5, 1, 5 and 10 J/cm2.
Cell proliferation was assessed 24hr after treatment by colorimetric
spectrophotometry ANALYSIS: Data were described as means and
standard deviation (SD) of the percentage. A 2-way ANOVA test
was used to assess the significance of differences between the
percentage of increase or decrease of irradiated groups compared
with negative (untreated) controls, and the Duncan’s test to identify
the differences. A p value of 0.05 was set for determining statistical
significance. RESULTS: It was observed that MG63 osteosarcoma
cell proliferation increased significantly after 670nm (at 5 J/cm2) and
780nm laser irradiation (at 1, 5 and 10 J/cm2, p 0.05), but did not
alter after 830nm laser irradiation. In contrast, U2OS cell proliferation
was found significantly increased after irradiation with all laser
wavelengths studied and at all doses (p 0.05). CONCLUSIONS:
The results of the present study suggest that laser irradiation has
stimulatory effects on osteosarcoma cell proliferation. However, these
data highlight that different osteosarcoma cell lines have different
responses to different types of laser using specific irradiation pa-
rameters. Further investigations are required to investigate possible
response mechanisms that may explain the outcomes obtained when
examining laser irradiation of cultured cells. IMPLICATIONS: Such
future studies will undoubtedly contribute to a better understanding
of the safety and efficacy of LLLT in clinical oncology. KEYWORDS:
cell proliferation, low level laser therapy, osteosarcoma. FUNDING
ACKNOWLEDGEMENTS: Capes-Coordenação de Aperfeiçoamento
de pessoal de Nivel Superior. CONTACT: acmr_ft@yahoo.com.br
Research Report Poster Display
08-21 Monday 4 June 09:00
VCEC Exhibit Hall B & C
LOW LEVEL LASER THERAPY (670 NM) ON THE VIABILITY OF
RANDOM SKIN FLAP IN RATS
Parizotto N1,2 , Bossini P2 , Rennó A1 , Fangel R1 , Habenschus R1 ;
1 Department of Physiotherapy, Federal University of São Carlos,
São Carlos (SP), Brazil; 2 Bioengeneering Master Program,
University of São Paulo, São Carlos (SP), Brazil
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
lot of studies have investigated treatments able to increase the
viability of the flap and the low level laser therapy (LLLT) has been
chosen as an efficient treatment to reduce post-injury inflammatory
processes and to stimulate the formation of new blood vessels.
However, the use of a wide range of fluences by different authors
and the lack of standardized experimental conditions make it difficult
to compare published results. RELEVANCE: The aim of this study
was to investigate the dose-response effects of 670 nm laser on the
viability of random skin flap in rats. PARTICIPANTS: One hundred
Wistar male rats were used in this study. The animals were divided
into 5 groups: group 1 (control group); group 2 (treated with 3
J/cm2); group 3 (treated with 6 J/cm2); group 4 (treated with 12
J/cm2) and group 5 (treated with 24 J/cm2). METHODS: The skin
flap was made on the back of all animals studied (dimensions: 10
x 4 cm) and before the sutures were done, a plastic sheet was
S190
interposed between the flap and the donor site. Laser irradiation
was performed immediately after the surgery and on days 1, 2,
3 and 4 post-surgery. The irradiation was made punctually, on 24
points on the skin surface and around it. The percentage of the
necrosis area of the flap was calculated by the paper template
method at the day 7 postoperative. ANALYSIS: The ANOVA test
was used to compare changes among the groups and the Tukey
test to identify the differences. A p level of  0.05 was considered
as being statically significant. RESULTS: The animals of all treated
groups showed a statistically significant difference when compared
to the control group (necrosis area: 49, 92%). The necrosis area of
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
of reaching better results at higher dosages. IMPLICATIONS: We
think that this results can help the physical therapists in their
clinical practice. KEYWORDS: low level laser therapy, fluences, sur-
gical flaps, necrosis. FUNDING ACKNOWLEDGEMENTS: CAPES,
CNPq. CONTACT: parizoto@power.ufscar.br
ETHICS COMMITTEE: The Animal Ethics Committee of Federal
University of São Carlos approval this project.
Research Report Poster Display
10-01 Monday 4 June 09:00
VCEC Exhibit Hall B & C
EFFECT OF REAL-TIME ULTRASOUND IMAGING FEEDBACK
ON LEARNING TRANSVERSUS ABDOMINIS CONTRACTION
Murai M1 , Ohashi Y1 ; 1 Ibaraki Prefectural University of Health
Sciences; 2 Ibaraki Prefectural University of Health Sciences
PURPOSE: The purpose of this study was to investigate the
effect of ultrasound feedback on learning how to draw the
abdominal wall in. RELEVANCE: This study clarifies the difficulty of
training a person to voluntarily control the transversus abdominis.
PARTICIPANTS: Subjects were 9 healthy young women with no
history of musculoskeletal disorders. Mean age was 22.1±0.9
years, mean body weight was 53.6±5.3 kg, and mean height was
161.1±2.9 cm. METHODS: 1) The design consisted of a) a pretest
immediately followed by b) 10 minutes of practice with ultrasound
feedback, then c) a posttest 15 minutes after the practice ended.
The task in each of these three phases was voluntary activity of
tightly drawing the abdomen inward. 2) During the 10 minutes of
feedback the subject, viewing an ultrasound image of the abdominal
muscles 1 cm medial to the ASIS, practiced widening the layer
corresponding to the transversus abdominis. 3) Relative degree of
widening was determined for all three layers of abdominal muscles
in the region. As an index of contractile activity for each muscle
layer. the difference between the width observed during voluntary
effort and the width observed during rest was divided by the width
observed at rest. ANALYSIS: Relative changes in thickness of all
three abdominal muscles over the three phases were subjected
to two-way factorial analyses of variance. Scheffé’s test was used
for multiple comparisons. RESULTS: The internal oblique and
transversus abdominis exhibited significantly greater relative changes
in thickness than the external oblique whenever the subject voluntarily
tried to draw the abdominal wall in. The external oblique displayed no
notable change from the resting state. Relative change in thickness
did not significantly vary across the pretest, practice, and posttest
phases for any muscle. The transversus abdominis did, however,
show a tendency to be selectively activated during the practice
phase, but the results were variable and statistical significance was
not reached (p = 0.06). CONCLUSIONS: These results suggest that
the transversus abdominis cannot easily be selectively activated
without the internal oblique being activated as well. Even though
the transversus abdominis might be amenable to selective activation
when ultrasound imaging is presented for feedback, carryover of this
selectivity beyond the feedback appears to be nil. These results are
WCPT 2007, Research Reports
based on a single practice session, so other conditions might merit
further investigation. IMPLICATIONS: Ultrasound imaging does not
provide the kind of feedback that can be immediately and intuitively
used by a patient to selectively control muscle activity. KEYWORDS:
transversus abdominis muscle, learning, ultrasonography. FUNDING
ACKNOWLEDGEMENTS: This work was supported by grant-in-aid
for scientific research no. 17791630 by the Ministry of Education,
Culture, Sports, Science and Technology in Japan. CONTACT:
murai@ipu.ac.jp
ETHICS COMMITTEE: This work was approved by the ethics
committee of Ibaraki Prefectural University of Health Sciences
Research Report Poster Display
10-05 Monday 4 June 09:00
VCEC Exhibit Hall B & C
COMPARATIVE ELECTROMYOGRAPHIC ANALYSIS OF
LUMBAR ERECTORS RECRUITMENT AT STAND POSITION
AND THERAPEUTIC RIDING POSITIONS
Santos R3 , Cyrillo F1,2 , Sakakura M3 , Perdigão A3 , Torriani C2 ,
Monteiro C2 ; 1 UNICID; 2 FMU; 3 Hı́pica de Santo Amaro
PURPOSE: This study aimed to analyze the muscular recruitment of
lumbar erector muscle in healthy subjects, comparing itself muscle
recruitment necessary for stand position maintenance, and its relation
with the horseback riding positions. RELEVANCE: Studying and
understanding the physiological aspects of human body allows the
applicability of knowledge of rehabilitation, in order to elaborate
more effectiveness and individualized programs of treatment to
each patient. Inside physical limitations, many times stand position
isn’t possible of being adopted and kept, making difficult trunk
muscle activation in these patients. Thus, position’s changes during
therapeutic riding session aim activate or inhibit muscle recruitment
in diverse ways. PARTICIPANTS: Nine female healthy subjects,
aged 20 to 25 years METHODS: The subjects were positioned
standing and seated frontal and dorsal on the back of the horse.
Electromyography surface MIOTEC® and a software Myography with
4 channels, bipolar circle surface silver electrodes were positioned
at erector lumbar muscle motor point, according to the technique
suggested by Cram et al 1998. Horse was maintained static and
with slow steps walking, 20 meters straight. Orthostatic position
was analized during 30 seconds.Data were analyzed considering
average recruitment in each task (stand on the floor, sitting frontal and
dorsal over horseback). ANALYSIS: Statistic analysis using Wilcoxon
Test including a significance level of 0.05 (5%). RESULTS: The
results was, comparing the values of muscle recruitment average
at stand position, 18.78mV, already seated on the stopped horse,
being the subject seated frontal, the average was 20.83mV, and at
dorsal position 21.61mV (p = 0.206). In the maximum peak of muscle
recruitment, values gotten in the stand position, frontal and dorsal on
horseback, had been, respectively, 28.56mV, 39.83mV and 43.06mV
(p = 0.108). Already with the horse walking, the position frontal had a
average of 30.00mV, and dorsal 56.89mV (p = 0.001). For the muscle
recruitment peak the values gotten in the positions frontal and
dorsal had been, respectively, 57.11mV and 103.11mV (p = 0.002).
CONCLUSIONS: Inside rehabilitation process, to inhibit or to
facilitate postural standards is one of the bases for the therapeutically
success. Seen the varied physical disabilities, we inquire that average
similarity does not exist that is considered statistically significant in
the muscular recruitment when compared the stand positions and
horseback riding, as much how much dorsal frontal, for the peak
and average. Thus, we consider that these positions do not have
statistical differences, what shows similar muscle activation of the
trunk when seated on the back of the horse comparative to the
position in foot in the ground. These data indicate that biomechanic
relation between the positions exists, what in the clinical applicability
offers to therapists conditions to elaborate complementary treatment
programs for trunk motor control.We concluded that exists difference
between the positions dorsal and frontal, considered statistically
Poster Displays, Monday 4 June
significant. Of this form, we can say that in the dorsal position
we always have the average greater. IMPLICATIONS: Physical
Therapy Practice KEYWORDS: Hippotherapy, Postural Control,
Rehabilitation. FUNDING ACKNOWLEDGEMENTS: Hı́pica de Santo
Amaro. CONTACT: ftfabiocyrillo@uol.com.br
ETHICS COMMITTEE: São Paulo
Research Report Poster Display
10-09 Monday 4 June 09:00
VCEC Exhibit Hall B & C
MORPHOLOGICAL EVIDENCE OF APOPTOSIS IN THE RAT
KIDNEYS FOLLOWING STRENUOUS EXERCISE
Iwatsuki H1 , Shoumura K2 , Suzuki T1 ; 1 Aomori University of Health
and Welfare; 2 Hirosaki University
PURPOSE: The presence of weakly bound Fe3+ and Fe2+ is
very important in the pathogenesis of ischemia/ reperfusion injury
of various organs, because they can catalyze the generation of
highly reactive hydroxyl radicals (OH•) through Haber-weiss reaction.
The purpose of this study was to demonstrate through visuals the
distribution of Fe2+ and Fe3+ in the rats’ kidney by acute exercise
using perfusion-Perls and -Turnbull methods. RELEVANCE: This
study is based on the prescriptions of physical fitness for the athletes.
PARTICIPANTS: This study was carried out in accordance with
the Guidelines for Animal Experimentation, Aomori University of
Health and Welfare. Twelve male adult Wistar rats (8-12 weeks of
age) were divided into three groups as control, exercise only once
and 5 days of exercise groups. METHODS: The exercise-trained
groups ran on a motor-driven treadmill (0% grade) for 45 min at
a speed of 25 m/min a day. The animals were anesthetized with
intraperitoneal pentobarbital sodium (40 mg/kg) and transcardially
perfused with the flushing solution, fixative and nonheme iron staining
solution. After the perfusion, the rat kidney paraffin sections were
carried out by DAB/CoCl2 intensification to visualize nonheme iron.
ANALYSIS: One-way analysis of variance followed by Bonferroni
post-hoc comparisons were used to analyze the differences between
each groups. RESULTS: 1) Some tubular cells positively stained for
Fe2+ and Fe3+ exhibited nuclear condensation in 5 days of exercise
group. 2) Fe2+ positive reaction product was distributed in the cortex
and in the outer stripe of the outer medulla in rats during the 5 days
of exercise. However, Fe2+ positive reaction product did not appear
in those regions of rats that exercise only once. 3) High intensity-
exercise causes an acute decrease in renal blood flow and on
immediate increase in regional blood flow after exercise. Therefore,
extensive nuclear injury caused by generation of weakly bound Fe2+
and hydroxyl radicals within nuclei through reduction of intranuclear
Fe3+ by superoxide (O2•−), and extrusion of injured nuclei into
the tubular lumen. CONCLUSIONS: Some tubular cells positively
stained for Fe3+ and Fe2+ exhibited nuclear condensation in the rat
kidneys after strenuous exercise, suggesting that they are undergoing
apoptotic cell death. IMPLICATIONS: We suggest that this study
is based on the prescriptions of physical fitness for the athletes.
KEYWORDS: Strenuous exercise, Rat kidneys, Histology. FUNDING
ACKNOWLEDGEMENTS: This work was supported by a Grant(06A-
4) from the Research Center for Health Sciences at Aomori University
of Health and Welfare, Japan. CONTACT: h_iwatsuki@auhw.ac.jp
ETHICS COMMITTEE: Animal Research Committee, Aomori
University of Health and Welfare
S191
Research Report Poster Display
11-13 Monday 4 June 09:00
VCEC Exhibit Hall B & C
EXERCISE IN PREVENTION AND TREATMENT OF ANXIETY
AND DEPRESSION AMONG CHILDREN AND YOUNG PEOPLE
Larun L1 , Nordheim L1 , Ekeland E2 , Hagen K3 , Heian F4 ;
1 Norwegian Knowledge Centre for the Health Srvices; 2 Norwegian
Physiotherapist Association; 3 Diakonhjemmet Hospital, Oslo;
4 Molde Hospital, Norway
PURPOSE: To assess the existing evidence on the effects of exercise
interventions to reduce or prevent anxiety or depression in children
and young people up to 20 years of age. RELEVANCE: Depression
and anxiety are common psychological disorders for children and
adolescence. Psychological (e.g. psychotherapy), psychosocial (e.g.
cognitive behavioral therapy) and biological (e.g. SSRIs or tricyclic
drugs) are among treatments offered. The large varieties of thera-
peutic interventions give rise to questions of clinical effectiveness
and side effects. Physical exercise is inexpensive with few if any side
effects. PARTICIPANTS: Children and young people up to the age of
20, with or without anxiety and depression. METHODS: A systematic
review based on randomized controlled trials with outcome measures
for depression and anxiety. We searched the Cochrane Controlled
Trials Register (latest issue available), MEDLINE, EMBASE, CINAHL,
PsycInfo, ERIC and Sportdiscus up to August 2005. Two authors
independently selected trials for inclusion, assessed methodological
quality and extracted data. ANALYSIS: The trials were combined
using meta-analysis methods. A narrative synthesis was performed
when the reported data did not allow statistical pooling. RESULTS:
16 studies with a total of 1191 participants between 11 and 19
years of age were included. Eleven trials compared vigorous exercise
versus no intervention in a general population of children. Six
studies reporting anxiety scores showed a non-significant trend in
favour of the exercise group (SMD −0.48, 95% CI −0.97 to 0.01).
Five studies reporting depression scores showed a statistically
significant difference in favour of the exercise group (SMD −0.66,
95% CI −1.25 to −0.08). However, all trials were generally of low
methodological quality and they were highly heterogeneous with
regard to the population, intervention and measurement instruments
used. Five trials comparing vigorous exercise to low intensity exercise
show no statistically significant difference in depression and anxiety
scores in the general population of children. Three trials reported
anxiety scores (SMD −0.14, 95% CI −0.41 to 0.13). Two trials
reported depression scores (SMD −0.15, 95% CI −0.44 to 0.14). Four
trials comparing exercise with psychosocial interventions showed no
statistically significant difference in depression and anxiety scores in
the general population of children. Two trials reported anxiety scores
(SMD −0.13, 95% CI −0.43 to 0.17). Two trials reported depression
scores (SMD 0.10, 95% CI −0.21 to 0.41). CONCLUSIONS: Exercise
is promoted as an active strategy to prevent and treat depression
and anxiety. Research data are sparse and mostly done on college
students. Exercise may decrease anxiety and depression in healthy
children when compared to no intervention. The research base
for children in treatment is scarce. IMPLICATIONS: Exercise is a
much less expensive intervention than those currently applied by
many practitioners. For children and young people in treatment
the evidence is scarce. Since exercise has no known negative
effects, and has many positive effects on somatic health, it might
be an important instrument in improving children and young peoples
emotional health. KEYWORDS: Children, youth, exercise, anxiety,
depression, systematic review. FUNDING ACKNOWLEDGEMENTS:
None. CONTACT: lillebeth.larun@nokc.no
S192
Research Report Poster Display
11-17 Monday 4 June 09:00
VCEC Exhibit Hall B & C
A PHYSIOTHERAPY HEALTH EDUCATION PROGRAM IS
EFFECTIVE IN IMPROVING KNOWLEDGE ON BACK CARE IN
PRIMARY SCHOOL LEARNERS IN SOUTH AFRICA
Mostert K, Barrie A, Biniek A, van Heerden A, De Beer N, Sirilli S,
Powell Y; University of Pretoria, Pretoria, South Africa
PURPOSE: The aim of this study was to develop and implement
a four-week physiotherapy health education program on back care
in a school with limited resources, in a previously disadvantaged
rural area in South Africa. Would such a program be effective in
increasing learners’ knowledge on back care? Would it influence
their views on physical activity positively? RELEVANCE: The World
Health Organisation launched a Global School Health Initiative to
promote the health of the youth. Unfavorable health behavior, such
as bad postural habits, seems to be established by the age of
12 years. In a South African province the lifetime prevalence of
low back pain in school children aged 13 to 18 years is 56.2%.
Although a few health education studies showed short-term success
in improved knowledge on principles of back care, documented
evidence in a developing country was not found. PARTICIPANTS:
The population were the grade six primary school pupils from
two schools in a rural district(Moretele,Hammanskraal) North-West
Province. Both schools do not offer formal, structured physical
education. The intervention group comprised 30 participants and
the control group 28. (This sample had 90% power to detect a
difference in mean score of 15%s, assuming a SD of 16.5%).
Although in the same district the schools were not in close proximity
to each other in order to prevent interaction between the groups. All
participants and their parents / guardians gave consent to participate
in the study by signing a comprehensive information form after a
verbal explanation. Permission was received from the Department of
Education. METHODS: The immediate effects of the health education
program were studied by means of a questionnaire in a pre-test/post-
test, non-equivalent control group design. The program, based on
evidence, was implemented twice weekly, each session lasting 60
minutes, over a four week period. Participants were taught the basic
anatomy and pathology of the spine and the basic principles of back
care during daily activities. ANALYSIS: The baseline comparability
of the intervention and control groups was determined using Fisher’s
exact test. A two-group t-test was applied to compare the post-
test scores. The findings were confirmed with ANOVA with the
pre-intervention score as covariate. The chi-square test was used
to statistically compare attitude towards physical activity scores.
RESULTS: At baseline the groups were comparable in terms of de-
mographics and base-line knowledge. After invervention, knowledge
regarding ergonomics was significantly higher in the intervention
group than the control (p < 0.0001). Post-test the intervention group
also had a more positive view of physical activity after the program
(p < 0.01). CONCLUSIONS: These results illustrate that primary
school children, in a rural area in the North-West Province, SA,
understood the principles of back care and had a positive change
in views regarding physical activity, after participating in a health
promotion programme, such as the one used in this study. However,
the long-term effects, for example after one and six months, require
further research. IMPLICATIONS: In line with the WHO Global
Health Initiative, physiotherapist could effectively implement health
education programs on back care in primary schools. KEYWORDS:
Ergonomics, health promotion. FUNDING ACKNOWLEDGEMENTS:
Unfunded. CONTACT: karien.mostert@up.ac.za
ETHICS COMMITTEE: Faculty of Health Sciences Ethics Committee,
University of Pretoria, Pretoria, South Africa
WCPT 2007, Research Reports
Research Report Poster Display
11-21 Monday 4 June 09:00
VCEC Exhibit Hall B & C
10,000 STEPS PER DAY TO IMPROVE HEALTH: INVESTIGATING
FAST AND SLOW WALKING SPEEDS
Purcell C, Bulley C, MacPherson C, Macmillan L, Crawford L,
Joyce D; Queen Margaret University College, Edinburgh, Scotland
PURPOSE: This study investigated whether individuals walking
10,000 steps per day at fast and slow walking speeds are likely
to achieve the minimum recommended daily energy expenditure
from physical activity. RELEVANCE: The promotion of participation
in physical activity (PA) and exercise is increasingly important in
physiotherapy practice. One strategy is to encourage walking; the
British Heart Foundation (2005: http://www.bhf.org.uk) suggest a
minimum of 10,000 steps per day to reduce risk factors for disease.
The American College of Sports Medicine (ACSM) recommend that
at least 140 kilocalories per day are expended through PA (Balady et
al., 2000: ACSM’s Guidelines for Exercise Testing and Prescription).
However, there is a lack of research to investigate whether individuals
walking 10,000 steps per day expend more than 140 kilocalories,
and whether walking speed influences the likelihood of meeting
ACSM guidelines. PARTICIPANTS: A convenience sample of 30
undergraduate students was recruited (12 men: mean age 25.5
years; mean height 190.5 cm; mean weight 75.0 kg; 18 women:
mean age 22.3 years; mean height 166.5 cm; mean weight
58.3 kg). Individuals with relevant medical history were excluded.
Ethical approval was granted by Queen Margaret University College
research ethics committee. METHODS: An experimental same-
subject design was used in a laboratory-based study comparing
physical activity energy expenditure (PAEE: kilocalories) while
walking at 3.2 kilometres per hour (kph: slow speed) and 6.4kph
(fast speed). Each participant walked for 1,000 steps on a level
treadmill, measured using the tally-count method, while wearing
a Tritrac-R3D accelerometer to monitor PAEE (kilocalories). Data
were collected on two separate days and the order of walking
speeds was randomised. ANALYSIS: Data were processed by
multiplying PAEE achieved during 1,000 steps on a treadmill by 10
to estimate the likely PAEE from the recommended 10,000 steps.
The percentage of individuals who would theoretically achieve the
recommended level of PAEE was calculated. The estimated PAEE
for each walking speed was compared using the Wilcoxon signed-
ranks test as not all the data were normally distributed (Shapiro-
Wilks: 3.2 kph trial: p = 0.03; 6.4 kph trial: p = 0.00). RESULTS:
Out of 30 participants, 29 (96.7%) participants achieved the daily
PAEE recommended by the ACSM during the slow walking speed
(3.2 kph). The theoretical PAEE (kilocalories) from walking 10,000
steps was significantly greater at the faster walking speed (Z=-4.782,
p = 0.000). CONCLUSIONS: On extrapolation from 1,000 steps on a
treadmill, energy expenditure while walking 10,000 steps at a slow
walking speed is likely to meet ACSM recommendations, although
significantly more energy is expended at a faster walking speed. This
exploratory study used a controlled setting that removed the impacts
of conditions such as gradient and wind resistance; it is likely that the
estimate of PAEE during 1000 steps on a treadmill underestimates
the energy expended in a real life setting. Further field-based work
is recommended, including the impact of accumulating short or
long periods of stepping. IMPLICATIONS: These results suggest
that physiotherapists can recommend the accumulation of 10,000
steps per day while walking at slow or fast speeds. KEYWORDS:
Physical activity; exercise; recommendation; energy expenditure.
FUNDING ACKNOWLEDGEMENTS: Queen Margaret University
College. CONTACT: cpurcell@qmuc.ac.uk
ETHICS COMMITTEE: Queen Margaret University College research
ethics committee
Poster Displays, Monday 4 June
Research Report Poster Display
13-01 Monday 4 June 09:00
VCEC Exhibit Hall B & C
TRUNK MUSCLE ACTIVITY PATTERN DURING NORMAL
WALKING
Egasaki E1 , Takeda H2 ; 1 Department of Physical Therapy, Nakano
General Hospital, Nakano-ku, Tokyo, Japan; 2 Department of
Physical Therapy, Faculty of Health Sciences, Mejiro University,
Iwatsuki-ku, Saitama-shi, Japan
PURPOSE: There are many reports about lower-limb muscles
pattern by using surface electromyogram (SEMG), however, there
is few that shows the characteristic pattern of trunk muscle as a
basic index. The purpose of this study is to analyze trunk muscle
activity pattern in normal walk. RELEVANCE: We will be able
to evaluate patient’s condition with effective way and to exercise
the therapy, after understanding trunk muscle activity pattern in
normal walk. PARTICIPANTS: Subjects were 13 volunteers (man
12, woman 1). Their age was from 18 to 27 years (mean, 20.0
years), body mass index (BMI) was from 18.0 to 29.7 (mean, 21.9).
They had no injuries or disease in trunk and lower-limbs. Subjects
were explained about this research, they agreed with participation
in the study. METHODS: The muscles were left Rectus abdominis
(RA), bilateral Obliquue internus abdominis (OIA), bilateral Obliquue
externus abdominis (OEA) and bilateral Lumbar paraspinals (LP).
Foot-switch was attached with left foot (toe, first metatarsal head,
fifth metatarsal head, and heel). Muscle activity and foot pressure
data were collected using TeleMyo2400T V2® (Noraxon), in advance
all signals were sampled at 1500Hz by MyoVideo™ (Noraxon),
and MyoReserch (Noraxon) was analyzed. Each muscles maximal
voluntary contraction (MVC) was measured by Daniels et al muscle
manual test (MMT). Each EMG, standing posture and walking,
were represented by percent maximal voluntary contraction (%MVC).
Subjects maintained standing and walked comfortably for 10 meters
on a wooden floor then analyzed third step as a walking cycle. A
walking cycle was from the contact of left heel to the next contact
of same heel. A walking cycle was divided into heel contact, loading
response, foot flat, heel rise, toe-off and swing phase. ANALYSIS:
The collected data of potential muscle action was rectified, and
normalized using MVC for one second. Analysis was applied with
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
the other side, OIA was significantly (p < 0.01) high in walking cycle
compared with it in standing. LP was significantly (p < 0.01) increased
from at the time of heel contact and also between heel rise and
toe-off. CONCLUSIONS: RA and OEA have no particular activity
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
between heel rise and toe-off. Consequently OIA and LP are needed
for the acquisition of the normal walking cycle even if possible to
stand. Further studies are necessary with the trunk muscle activity
pattern during walking, using bilateral foot-switch. And then the trunk
muscle activity should be developed concerning with lower-limb.
IMPLICATIONS: Evaluation and therapeutic exercise with OIA and
LP are needed as well as lower-limb muscles before gait exercise.
KEYWORDS: trunk muscle, walking, electromyogram. FUNDING
ACKNOWLEDGEMENTS: We would like to express to the volunteer
students of the Faculty of Health Sciences in Mejiro University
and physical therapists of San-ai hospital, our deepest gratitude for
supporting. CONTACT: choose_peace_of_mind@ybb.ne.jp
S193
Research Report Poster Display
13-05 Monday 4 June 09:00
VCEC Exhibit Hall B & C
WHAT DOES THE PHYSICAL THERAPIST SEE IN
OBSERVATIONAL GAIT EVALUATION?
Takizawa M, Iwai K, Ito H; Ibaraki Prefectural University of Health
Sciences, Ami. Ibaraki, Japan
PURPOSE: The purpose of this research was to examine the
relationship between the results of observational gait evaluation
by physical therapists and actual walking data. RELEVANCE:
Exploring the content of observations by a physical therapist may
be useful in confirming the content validity of subjective evaluation.
PARTICIPANTS: The subjects of this study were 9 physical therapists
(with 2-18 years of experience) and 21 people over 65 years
old age who were ambulant and independent in activities of daily
living without the need for a brace or a cane. METHODS: Gait of
the elderly people over a 10 m walkway was recorded by video
cameras from two directions and footprints were recorded by ink on
paper. Variability of stride length in walking 10 m was calculated
by coefficient of variation (CV). Viewing the video recordings, the
physical therapists used a five-level scale to subjectively grade
propulsive force, lack of steadiness, and risk of falling. ANALYSIS:
Multivariate comparison analysis was used to compare gait speed
or CV of step length with the subjective grades assigned by the
physical therapists. RESULTS: Grades for propulsive force and for
lack of steadiness differed with gait speed and stride length CV.
Grades for risk of falling differed with stride length CV, but not with
gait speed. CONCLUSIONS: When judging risk of falling by visual
observation of an elderly person who is independent in activities of
daily living, a physical therapist does not appear to use gait speed
as an important factor in that judgment. IMPLICATIONS: Part of the
content of clinical observation by the physical therapist was able to
be confirmed. KEYWORDS: observational gait evaluation, speed,
variability. FUNDING ACKNOWLEDGEMENTS: This research was
partially supported by the Ministry of Education, Culture, Sports,
Science and Technology Grant-in-Aid for Exploratory Research.
CONTACT: takizawa@ipu.ac.jp
ETHICS COMMITTEE: This work approved by the ethics committee
of Ibaraki Prefectural University of Medical Sciences in Japan
Research Report Poster Display
13-09 Monday 4 June 09:00
VCEC Exhibit Hall B & C
ACCURACY OF TWO-DIMENSIONAL GAIT ANALYSIS USING A
DIGITAL VIDEO CAMERA
Suzuki Y, Sato H, Simoda H; kitasato university, Japan
PURPOSE: A digital video camera is a useful tool for recording
human motion in clinical situations. The purpose of this study
was to determine the accuracy of two-dimensional gait analysis
using a digital video camera. To collect kinematic data with high
accuracy, we tried to correct the depth of the image of a digital video
camera. RELEVANCE: In order to determine treatment goals or to
evaluate the effect of a therapeutic intervention, a physiotherapist
visually observes the patient’s gait. However, such observational gait
analysis has poor reliability because it is a subjective method. If the
kinematic data are collected with a digital video camera that is often
used in clinical practice, the gait analysis may be more accurate.
PARTICIPANTS: Kinematic data were obtained for ten normal adult
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,
S194
and the heads of the first and fifth metatarsal bones. The kinematic
data were collected over five walking trials. ANALYSIS: To modify
the depth of the two-dimensional image, we used the same lower
limb length for the limb on the far side and that on the near side
of the camera. The positions of the kinematic data collected from
a digital video camera and an Optotrak system were compared. To
quantitatively indicate the degree of accuracy of the marker position,
a multiple correlation coefficient was calculated. RESULTS: The
average of the multiple correlation coefficient between the kinetimatic
data derived from the digital video marker position with correction and
Optotrak data was 0.94 with a standard deviation of 0.05. Whereas
the average of the multiple correlation coefficient between the non-
corrected kinematic data derived from digital video and Optotrak
was 0.69 with a standard deviation of 0.1 for the kinematic data for
the toe of the interior side lower limb. CONCLUSIONS: Improved
accuracy was achieved in detecting marker position by modifying
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
analysis. FUNDING ACKNOWLEDGEMENTS: NA. CONTACT:
mm06031y@st.kitasato-u.ac.jp
Research Report Poster Display
14-13 Monday 4 June 09:00
VCEC Exhibit Hall B & C
WHICH SPINAL LEVEL MOST COMMONLY CORRESPONDS TO
THE ILIAC CRESTS? A STUDY USING ULTRASONOGRAPHY
Downing A1 , Zawadzki A2 , Hayter R3 , Hayward T4 , Barker T5 ,
Rogers-Nash I6 ; 1 University of the West of England, Bristol,
UK; 2 University of the West of England, Bristol, UK; 3 University
of the West of England, Bristol, UK; 4 University of the West of
England, Bristol, UK; 5 University of the West of England, Bristol,
UK; 6 University of the West of England, Bristol, UK
PURPOSE: The purpose of this study was to identify which spinal
level most commonly corresponds with the highest point of the iliac
crests. RELEVANCE: The received understanding within manual
therapy practice and its teaching commonly declares that the highest
point on the iliac crests corresponds with a particular posterior spinal
level in the prone lying position. This is used as a landmark to
guide identification of the spinal level. Commonly cited relationships
(such as the 4th or 5th lumbar spinous process) are not supported
by evidence other than some work undertaken by anaesthetists
with subjects in the lumbar flexed position, which may lead to a
different iliac crest/spinal segment relationship. PARTICIPANTS: A
mixed gender, ethically approved sample of convenience (N=34)
consisted of healthy, volunteering undergraduate students from the
Faculty of Health & Social Care at the University of the West of
England. Subjects were excluded if they had a history of spinal
injury or pathology. METHODS: Following assessment by palpation
of the iliac crests with the subjects in prone lying, a piece of fine
metal wire was placed across the spine between the highest points
of the crests. The corresponding spinal level was then identified
by ultrasonography, using the clearly seen image of the wire as a
guide to the relate the iliac crest level with the relevant point on
the posterior spine. ANALYSIS: Descriptive analysis identified the
range of corresponding spinal levels and the frequency distribution
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.
WCPT 2007, Research Reports
They indicate that on palpation, the spinal level corresponding
to the iliac crests can vary between individuals by three spinal
segments. They also indicate that in the majority of cases (76%),
the level is likely to equate to either the 4th spinous process or
the 4th/5th spinous process interspace. Further work might explore
the gender variation in more detail, any effect of age variation
or any possible diurnal variation in corresponding spinal levels.
IMPLICATIONS: The implications suggest the use of caution in
clinical practice when identifying spinal levels by reference to the
iliac crests and this study provides an important description of the
variation which might be expected. These implications are particularly
relevant in the teaching of novices. KEYWORDS: anatomy, palpation,
teaching. FUNDING ACKNOWLEDGEMENTS: University of the
West of England. CONTACT: Angela.Downing@uwe.ac.uk
ETHICS COMMITTEE: Faculty Ethical Committee, Faculty of
Health & Social Care, University of the West of England, Bristol, UK
Research Report Poster Display
14-21 Monday 4 June 09:00
VCEC Exhibit Hall B & C
DYNAMIC ANALYSIS OF SCAPULO-HUMERAL RHYTHM BY
3-DIMENSIONAL MOTION ANALYZER
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
PURPOSE: Few data about comparison of dominant and non-
dominant arms has been available in shoulder kinematics. The
purpose of this study is to evaluate scapulo-humeral rhythm
during abduction and adduction for bilateral upper extremities.
RELEVANCE: These studies are useful in evaluation and treatment
of the disturbance in function of the shoulder. PARTICIPANTS:
Twenty healthy subjects, 19-50 years old, were participated. Informed
consent were obtained for all participants. METHODS: The reflecting
markers were put on the skin surface of bilateral coracoids processes
of scapula, posterior horns of the acromion inner borders of spine of
scapula, epicondylus lateralis of the humerus, epicondylus medialis
of the humerus, 5th lumbar vertebra, 2nd and 7th thoracic vertebra.
The 3-dimensional motion analyzer was used to measure scapulo-
humeral rhythm. Movements of the Humerus and Scapula (Spina
scapulae) were evaluated in every 10 degree of upper extremity with
upward and downward motions. These proportional values were com-
pared between dominant and non-dominant sides. ANALYSIS: The
paired t-test was used to examine the difference between dominant
and non-dominant sides of the scapulo-humeral rhythm. RESULTS:
There was no significant difference between dominant and non-
dominant sides of the scapulo-humeral rhythm when it was observed
every 10 degrees (P < 0.05). CONCLUSIONS: There was a certain
tendency of the fluctuation in the proportional value of the scapulo-
humeral rhythm with individualistic variability. IMPLICATIONS: These
findings will due to provide the one of etiological considerations about
the shoulder disturbance. KEYWORDS: Scapulo-humeral rhythm,
Domination of upper extremity, 3-dimensional motion analyzer.
FUNDING ACKNOWLEDGEMENTS: The president Fujiwara of
Koriyama Tohto Academy acknowledgements the fund of our work.
CONTACT: k-yoshi@k-tohto.ac.jp
ETHICS COMMITTEE: There are meny fine system for ethics in the
Japanese University
Poster Displays, Monday 4 June
Research Report Poster Display
16-01 Monday 4 June 09:00
VCEC Exhibit Hall B & C
IT TAKES TIME TO RESTORE THE BELIEF IN ONE’S ABILITY –
EXPERIENCES OF PERSONS TREATED WITH ANTERIOR
CRUCIATE LIGAMENT RECONSTRUCTION
Olofsson L1 , Söderman K2 ; 1 The Research and Development
Unit, Jämtland County Council, Östersund, Sweden; 2 Department
of Community Medicine and Rehabilitation, Physiotherapy, Umeå
University, Umeå, Sweden
PURPOSE: The treatment of anterior cruciate ligament (ACL) injuries
is conservative or surgical depending on the degree of knee instability
and the individuals demand for activity level. There is a lack
of studies focusing on experiences from the patients perspective
covering the period from injury to recovery. The aim of this study
was to describe and enhance the understanding of how individuals
treated with ACL reconstruction experience their injury, rehabilitation
and recovery. RELEVANCE: It takes long time to recover after
an ACL injury and it is therefore important for physiotherapists to
understand how these persons experience the rehabilitation process.
PARTICIPANTS: Four men and three women, 19-57 years, were
interviewed at one occasion between 10 and 31 months after the ACL
reconstruction. They were selected to reach a maximum variation
sample according to gender, age, activity level, time between injury
and ACL reconstruction and time between surgery and the interview.
METHODS: A qualitative approach was used in order to capture the
informants own perceptions and experiences. Data were collected
with semi-structured interviews. The interviews were audiotaped and
transcribed verbatim. An emergent design was applied, meaning that
the design emerged during the study period, allowing the researchers
to adapt the design as understanding deepened. ANALYSIS: The
analyses were carried out using the grounded theory method of
constant comparison. To increase trustworthiness and to confirm
the findings further triangulation of researchers and member check
was used. RESULTS: The analysis resulted in the core category
“From loss towards restored belief in one’s ability” that represents
the process starting when the informants were injured. For some
of the informants this process was still ongoing at the time for the
interview. The process contained different stages that interacted
with each other. The informants used different procedures in order
to manage incidents that occurred and strived towards restored
belief in their own ability during the temporally extended process.
CONCLUSIONS: The recovery was a long process and it took a
lot of effort for the informants to restore the belief in their own
ability. We conclude that the psychological aspects are important to
consider during the rehabilitation. IMPLICATIONS: Physical exercise
does not seem to be enough to enhance full recovery after
ACL reconstruction. The findings suggest that the belief in one’s
ability needs to be focused on during the rehabilitation process.
KEYWORDS: Physiotherapist, Qualitative approach, Rehabilitation
process. FUNDING ACKNOWLEDGEMENTS: We wish to thank
the County Council of Jämtland, Östersund, Sweden for financial
support. CONTACT: lena.a.olofsson@jll.se
ETHICS COMMITTEE: The study was approved by the Ethical
Committee of Medicine, Umeå University, Umeå, Sweden
Research Report Poster Display
16-05 Monday 4 June 09:00
VCEC Exhibit Hall B & C
TOTAL KNEE ARTHROPLASTY AND AGE AS A PREDICTOR OF
EARLY REHABILITATION OUTCOMES POST SURGERY
Monaghan B1 , Baxter D2 , Barrett L1 ; 1 Physiotherapy Department,
Our Lady’s Hospital, Navan, Co Meath; 2 Department of
Physiotherapy, University of Otago, Dunedin, New Zealand
PURPOSE: The purpose of this study was to investigate the
relationship between age and early rehabilitation outcome post
S195
total knee arthroplasty for osteoarthritis. RELEVANCE: Although
extensive evidence supports the improvement in pain and dysfunction
for the majority of patients following total knee arthroplasty, the rate
of improvement over the immediate postoperative period particularly
in the older age group is less well documented in the literature.
PARTICIPANTS: This was a different subject experimental design
using a convenience sample of nine patients under 70 years and
nine patients over 70 years undergoing primary elective total knee
arthroplasty at Our Lady’s Hospital, Navan, Co Meath in Ireland.
METHODS: The WOMAC (The Western Ontario and Mc Master
Universities Index questionnaire)was completed preoperatively and
at 3 and 6 weeks postoperatively by both groups. Length of
stay, discharge destination, time in rehabilitation, and rate of post-
operative complications were also compared across both groups.
Evaluation with the WOMAC questionaire was made preoperatively
in person by a physiotherapy assistant blinded to the study
question. The questionaire was repeated by telephone at 3 and
6 weeks post-operatively. The patients were also blinded as to
the specific information being examined i.e. effect of age on
outcome. ANALYSIS: The (WOMAC) questionnaire was completed
preoperatively and at 3 and 6 weeks postoperatively by both groups.
Length of stay, discharge destination, time in rehabilitation, and rate of
post-operative complications were also compared using appropriate
statistical analysis. RESULTS: There was no significant difference
in the WOMAC scores of either groups preoperatively or at three
weeks with regard to pain stiffness or function. There was no
significant difference in length of stay, discharge destination, rate of
complications or number of physiotherapy sessions required prior
to discharge. At 6 weeks the younger group reported significantly
greater stiffness than the younger group. Patients in both groups
showed significant improvement in pain, function, and stiffness at
3 weeks and 6 weeks when compared with their preoperative
scores. CONCLUSIONS: The age of patients post knee arthroplasty
replacement does not determine preoperative status or outcome at
3 weeks. There is limited evidence to suggest that the perception
of stiffness post surgery is higher among the younger population.
IMPLICATIONS: The results of this study contribute to an increasing
body of evidence which supports the theory that age does not affect
recovery of function and pain alleviation in patients following total
knee arthroplasty. Clinically this is relevent with an increasing move
towards integrated care pathways for Orthopaedic patients. This
study also increases the evidence to support the findings that there is
no difference in length of stay, discharge destination, or rehabilitation
needs in older or younger groups following total knee arthroplasty.
Finally this study contributes to the body of evidence which reports
improvement in pain alleviation, reduced stiffness and restoration
of function as early as three weeks post-operatively in all patients
following knee arthroplasty. KEYWORDS: Key words: Osteoarthritis,
Total knee arthroplasty, Age, Early outcome measurements, Length
of stay. FUNDING ACKNOWLEDGEMENTS: There was no specific
funding provided for this research which was completed as part of
an MSc in Physiotherapy at the University of Ulster at Jordanstown,
Belfast in 2005. CONTACT: brenda.monaghan@maile.hse.ie
ETHICS COMMITTEE: Health Service Executive (Dublin North East);
Republic of Ireland.
Research Report Poster Display
16-09 Monday 4 June 09:00
VCEC Exhibit Hall B & C
MUSCULAR RECOVERY AROUND THE HIP AND KNEE JOINT
AFTER TOTAL HIP ARTHROPLASTY
Tsukagoshi R1 , Ichihashi N2 , Ohata K2 , Eguchi S1 , Okumura H3 ;
1 Department of Rehabilitation, Rakuyo Hospital, Kyoto, Japan;
2 School of Health Sciences, Faculty of Medicine, Kyoto University,
Kyoto, Japan; 3 Department of Orthopedic Surgery, Rakuyo Hospital,
Kyoto, Japan
PURPOSE: This study examined differences between hip and knee
muscular recovery in the early postoperative phase after total hip
S196
arthroplasty (THA). RELEVANCE: Most of the studies investigating
recovery of muscle strength after THA for hip osteoarthritis have
focused on hip abductor muscle, and it is reported that abductor
strength increases to more than the preoperative level within
several months after surgery. However, there are very few reports
that evaluated the time course of changes in muscle strength
around the hip and knee joint throughout the preoperative and
postoperative period after THA. PARTICIPANTS: Fifty-four women
with hip osteoarthritis who underwent unilateral cementless THA
participated in this study (mean age 60.0±7.8 years). METHODS:
Hand-held dynamometer was used to measure maximal isometric
force of hip abductors, extensors, flexors, knee extensors, and
flexors on the involved and uninvolved limbs preoperatively and
again 2, 4, and 6 weeks postoperatively. The values of the
maximal muscle torques were divided by the individual subject’s
body weight for normalization (Nm/kg). Furthermore, preoperative
ratios were calculated and expressed as a percentage (postoperative
value/preoperative value x100). ANALYSIS: ANOVAs and Scheffe’s
F post hoc tests were used for statistical analyses. P < 0.05 was
considered significant. RESULTS: Hip abductor, extensor, and flexor
strength values of the involved limb 2 weeks postoperatively were
significantly lower than the preoperative values, respectively, but
these 3 values 4 and 6 weeks postoperatively did not differ from
the preoperative values. Knee extensor strength of the involved limb
2, 4, and 6 weeks postoperatively was significantly lower than the
preoperative value. Knee flexor strength value of the involved limb 2
weeks postoperatively was significantly lower than the preoperative
value, but the value after 6 weeks was greater than the preoperative
value. There were no significant differences in preoperative ratios
between hip abductors, extensors, flexors, and knee extensors 2
weeks postoperatively in the involved limb (ranged from 54 to 63%),
but the ratio of knee flexors (87%) was significantly higher than
those of the other 4 muscle groups. Six weeks postoperatively,
there were no significant differences in preoperative ratios between
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
extensor strength was delayed in comparison with hip musculature
and knee flexors after THA. IMPLICATIONS: Exercise programs
for patients with THA should address knee extensor strength in
addition to strengthening of hip musculature. KEYWORDS: hip
osteoarthritis, total hip arthroplasty, isometric strength. FUNDING
ACKNOWLEDGEMENTS: This study was unfunded and indepen-
dently performed. CONTACT: mskp50625@nike.eonet.ne.jp
Research Report Poster Display
17-13 Monday 4 June 09:00
VCEC Exhibit Hall B & C
ISOKINETC AND FUNCTIONAL STATUS IN KNEE
OSTEOARTHRITIS
Emrani A, Bagheri H, Hadian M, Talebian S, Jabalameli M,
Olyaie G; Tehran Uniersity of Medical Sciences, Tehran, Iran
PURPOSE: The aim of the study was to investigate and compare
the concentric torque of knee muscles (quadriceps and hamstring)
and functional status in two matched groups. RELEVANCE: Knee
osteoarhtirits is one of the most common musculoskeletal diseases
in middle-aged population.To better management, it is imperatvie to
know the different kinetic,kinematic and functional changes following
the disease.This study was designed to provide useful information
in knowing some common aspects of disease. PARTICIPANTS: The
subjects were invited to participate in the study from the public at
large, using posters and interviews. They were 20 patients with knee
OA and 20 matched healthy subjects (controls). The following criteria
were used to match the two groups: weight, height, age, and the
activity level of the subjects. The patients (20 males and females)
had clinical symptoms and signs consistent with knee OA, and met
WCPT 2007, Research Reports
the grade II criteria suggested by Altman. They had grade I or II
tibiofemoral OA as judged by Kellgren and Lawrence scale. The
controls consisted of 20 healthy males and females. None of them
had any clinical or radiological sign of patellofemoral or tifiofemoral
OA. METHODS: The study was a non-experimental case control
study. Concentric peak torques of quadriceps and hamstring were
measured in both groups at an angular velocity of 90 and 150
degree/second. In addition, selected functional tests (timed-walking
test), selected lower extremity range of motion (ROM) and thigh girth
were assessed in both groups. ANALYSIS: Paired t-test showed
no significant difference between the two lower extremity concentric
peak torques at different speeds. Thus, the dominant and most
painful side (right in all participants) was selected for all statistical
analyses. The collected data for concentric peak torques at different
speeds, timed-walking test, lower extremity ROM and thigh girth
were analyzed statistically using the independent t-test to ascertain
any significant differences between the patient and healthy groups.
RESULTS: The independent t-test revealed statistically significant dif-
ferences between the two groups with regard to isokinetic concentric
peak torque at different angular velocities and for timed-walking test.
However, no significant difference in lower extremity joints’ ROM and
thigh girth were seen. CONCLUSIONS: In conclusion, patients with
knee OA, even in low grades and with minimum symptoms and signs,
had muscle weakness and functional limitation in comparison with
the matched healthy subjects. IMPLICATIONS: Based on the results
of this study isokinetic and functional changes are anticipated even
in low grades of knee osteoarthrits. In order to better rehabilitation
and management, considering and knowing the different changes in
osteoarthritis are essential. KEYWORDS: Osteoarthritis; Isokinetic
test; Functional Status. FUNDING ACKNOWLEDGEMENTS: Tehran
University of Medical Sciences in Iran provided funding sources that
supported our work. CONTACT: anita.emrani@gmail.com
ETHICS COMMITTEE: Tehran University Medical Sciences in
Tehran – Iran
Research Report Poster Display
17-17 Monday 4 June 09:00
VCEC Exhibit Hall B & C
THE INTERNAL KNEE ABDUCTION MOMENT DURING
STEPPING IN SUBJECTS WITH KNEE OSTEOARTHRITIS IS
CORRELATED WITH PAIN AND DISABILITY
Kito N1,2 , Shinkoda K2 , Kanemura N2 , Kato H3 , Ishii S4 ; 1 Hiroshima
International University, Higasihiroshima, Japan; 2 Hiroshima
University, Hiroshima, Japan; 3 Kivi International University,
Takahashi, Japan; 4 Kanagawa University of human services,
Yokosuka, Japan
PURPOSE: The severity of symptoms in medial osteoarthritis of knee
(knee OA) can be difficult to assess. Given that knee OA often affects
the medial compartment, studies have characterized the dynamic
knee joint loads using the internal knee abduction moment. In theory,
reduction of medial load may have a beneficial disease-modifying
effect on medial knee OA. However, there is debate as to whether
pain and disability of knee OA correlates with the magnitude of knee
abduction moment. The purpose of this study was to determine if
a relationship exists between radiographic measures of knee OA
severity, clinical assessments of symptoms (pain and function) and
Internal knee and hip abduction moment (KAbM, HAbM) during
stepping movement. RELEVANCE: Knee OA is the most common
cause of chronic disability amongst seniors. The results support
the use of biomechanical analysis of stepping movement as a
clinical evaluation tool for patients with knee OA. PARTICIPANTS:
30 patients with early medial knee OA and 18 age-matched
asymptomatic control subjects. METHODS: Biomechanical data were
collected from two force plates (ANIMA) and motion analysis system
(Kissei Comtec), and the KAbM, HAbM were calculated. We defined
that %KAbM was the value which broke B by the value which added
KAbM and HAbM, and was shown by %. Pain and function measured
Poster Displays, Monday 4 June
using the pain and function subscales of the WOMAC index. Weight-
bearing antero-posterior radiographs were taken for all knee OA
subjects. All raradiographs were read by auther and the Kellgren and
Lawrence grade (K-L grade) was determined for each subject using a
standard atlas. ANALYSIS: Significant differences between knee OA
and control subjects were identified with t-tests. In knee OA subjects,
stepwise forward regression was used to identify which variables
contributed to the pain and function subscale of the WOMAC
index. RESULTS: In knee OA subjects, there was poor correlation
between radiographic K-L grade, pain or function, with no statistically
significant associations. The pain subscale of the WOMAC index was
significantly correlated with the function subscale of the WOMAC
index(r = 0.73, p < 0.001). KAbM was significantly correlated with the
pain subscale of the WOMAC index(r = 0.37, p < 0.05). KAbM, HAbM
did not differ statistically between the knee OA and control subjects.
A significant difference in %KAbM was found between the two groups
(p < 0.05)(mean ±SD: knee OA subjects 52.27% ±7.9%, control sub-
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
%KAbM during stepping movement provide non-invasive, objective
information in the assessment of knee OA. It may be useful in assess-
ment of physical therapy intervention for knee OA. IMPLICATIONS:
Our results suggest the need for future studies to examine the thera-
peutic effect of interventions targeting hip abduction moment for knee
OA subjects. KEYWORDS: Knee osteoarthritis, Internal knee abduc-
tion moment, pain, disability. FUNDING ACKNOWLEDGEMENTS:
The work was unfunded. CONTACT: n-kito@hs.hirokoku-u.ac.jp
ETHICS COMMITTEE: the ethics committee of hiroshima university
Research Report Poster Display
17-21 Monday 4 June 09:00
VCEC Exhibit Hall B & C
INTRA-ARTICULAR CORTICOSTEROID AND VISCOSUPPLE-
MENTATION INJECTIONS FOR OSTEOARTHRITIS OF THE
KNEE: A REVIEW OF THE LITERATURE
Lewis T; St Helens and Knowsley PCT, Prescott, Merseyside,
United Kingdom
PURPOSE: The purpose of this study was to evaluate the the efficacy
and safety of intra-articular corticosteroids and viscosupplemenation
in treatment of osteoarthritis (OA) of the knee. RELEVANCE:
Currently physiotherapists are working in extended scope and un-
dertaking intra-articular injection. Many more physiotherapists as first
line assessors are referring patients for such procedures. it is useful
for them to have an evidence upon which to base their treatment and
referral criteria. PARTICIPANTS: The literature was searched from
1966 to August 2006 using Medline and from 1980 to 2006 using Em-
base. The Cochrane Central Register of Controlled Trials (CENTRAL)
were also searched. METHODS: All published, peer-reviewed studies
assessing the effects of intra-articular steroid and viscosupplemen-
tation in OA knee were looked at. In particular randomised controlled
clinical trials single/double blind, placebo-based/comparative studies
reporting ay least one core OMERACT III outcome measure.
ANALYSIS: Methodological quality of trials was assessed and data
were extracted. RESULTS: In one study no statistically significant
differences were noted at 1-4 weeks post injection. The period where
intra-articular steroid was most efficacious was at two to three weeks.
Viscosupplementation was said to be most effective at the 5-13 week
post injection period. Side effects with viscosupplementation are local
inflammatory responses at a rate of 0-8%. One study showed that
intra-articular steroid could be administereed at 3-monthly intervals
for two years with no adverse effects when compared with placebo.
A subgroup of younger patients with lower grade osteoarthritis on
the Kellgren-Lawrence scale were said to most likely benefit from
viscosupplementation. This is contrary to the hypothesis of several
authors who felt that viscosupplementation was an end of the line
treatment when all else had failed CONCLUSIONS: Intra-articular
S197
injection of corticosteroid and viscosupplementation are recognised
and accepted treatment modalities for OA knee. Some physiothera-
pists working in extended roles are undertaking such injections. Corti-
costeroids appear to have a short-term effect,repeated injection every
three months is said to be safe for at least two years.the response
to viscosupplementation appears to be more durable justifying its
greater cost. There is growing evidence that the younger patient
(<65) with mild to moderate OA knee is more likely to respond to
viscosupplementation as a preventative measure rather than an older
patient with advanced disease. better patient selection would further
justify the higher cost of viscosupplementation. IMPLICATIONS: A
better appraisal of the mode and length of action of intra-articular
corticosteroid and viscosupplementation for OA knee is useful. This
will help the clinical reasoning process when the decision is made
as to which patints are most likely to benefit. KEYWORDS: OA
Knee; Intra-articular corticosteroid; Viscosupplementation. FUNDING
ACKNOWLEDGEMENTS: This work was unfunded.
Research Report Poster Display
19-05 Monday 4 June 09:00
VCEC Exhibit Hall B & C
INFLUENCE OF WEIGHT-BEARING PAIN ON MOTOR
COGNITION AND PERFORMANCE IN POSTOPERATIVE
PATIENTS WITH FEMORAL NECK FRACTURE: AN ANALYSIS
BY AUTO-ESTIMATICS
Tanoue Y1 , Nishio Y2 ; 1 The School of Rehabilitation, National
Hospital Organization Kure Medical Center, Kure, Japan; 2 Tokiwadai
Home
PURPOSE: A weight-bearing pain is thought to be very influential
in performance in postoperative patients with femoral neck fracture.
In this study, we investigate how the pain affects motor cognition
and performance in the patients by using the step over task of
Auto-estimatics(AE). RELEVANCE: We may understand disablement
deeper by importing the concept of motor cognition in an assessment.
PARTICIPANTS: Twelve postoperative patients with femoral neck
fracture (9 women, 3 men, mean age 78.6y ± SD 9.4). METHODS:
We applied the step over task of AE to the patients. The procedure
of the task was; (1) A tape showed in front of a patient’s tiptoe was
left away slowly, (2)The patient estimated the furthest distance that
she/he thought she/he could step over without any failure, (3) The
patient stepped over the tape actually. The estimated distance (ED),
the actual distance (AD) and the success rate (SR) of the task were
recorded for 4 weeks. ANALYSIS: The patients were divided into 2
groups: One was composed of 9 patients with pain (painful group;
PF), the other was composed of 3 patients without pain (painless
group; PL). We compared PF with PL, and the 1st week’s average
with the 4th week’s average for each date. The statistical analysis
was carried out using an SPSS package. A two-way layout ANOVA
was employed. RESULTS: In AD and ED, PL was significantly better
than PF (p < 0.05), and the 4th week’s average was significantly
better than the 1st week’s average(p < 0.01). In SR, on the other
hand, no significant differences were found in any comparison.
CONCLUSIONS: These results suggest followings in postoperative
patients with femoral neck fracture; (1)A weight-bearing pain declines
performance, but does not affect SR so much, (2)The patients do not
have extremely declined SR even in an early stage. IMPLICATIONS:
Declined SR means inappropriate motor cognition, that is, a patient
can not move as she/he expected to. According to our previous
study, patients with hemiplegia showed declined SR in an early
stage. In postoperative patients with femoral neck fracture, however,
there are not serious problems about SR. It implies that they can
manage to understand their motor changes accordingly and move
as they expected to, even though a weight bearing pain decrease
their motor performance. KEYWORDS: weight-bearing pain, Auto-
estimatics, motor cognition. FUNDING ACKNOWLEDGEMENTS:
unfunded. CONTACT: luppy@jt9.so-net.ne.jp
S198
Research Report Poster Display
19-09 Monday 4 June 09:00
VCEC Exhibit Hall B & C
INTRA-RATER RELIABILITY OF IN-VIVO MEASUREMENTS OF
LUMBAR SPINE FORCE-DISPLACEMENT PROPERTIES
Stanton T, Kawchuk G; University of Alberta
PURPOSE: The purpose of this study was to determine the intra-rater
reliability of postero-anterior measures of spinal force-displacement
properties in-vivo. RELEVANCE: The intra-rater reliability of manual
methods to characterize the postero-anterior loading response of
spinal tissues is modest at best. Should the use of technology
increase measurement reliability when assessing the spine’s re-
sponse to postero-anterior loading, the use of this technology in
clinical practice may be warranted. PARTICIPANTS: Twelve female
and eleven male asymptomatic subjects between the ages of 18-
30 years participated in this study which was approved by the
University of Alberta. Seven potential subjects were excluded based
on age, previous injury, and discomfort when prone. METHODS:
An indenter device was placed perpendicularly over the spinous
process of the 4th lumbar vertebrae in each prone subject. The
indentation device consisted of a moveable piston connected in-
series to a load cell and linear velocity displacement sensor (LVDT).
The piston was moved manually to apply indentation to the spine
to a maximum of 100N. The resulting load and displacement of
the indenter were quantified in real time. Ten indentations were
then performed at two minute intervals. Subjects were instructed
to remain at rest and breathing patterns were standardized. From
the resulting force-displacement data, two variables were calculated:
the mean maximal stiffness (MMS, peak force divided by peak
displacement) and global stiffness (GS, the slope of the force-
displacement data between 30 and 100 N). ANALYSIS: Given the
variability in subject responses to the initial indentation, outcome
variables were computed for indentations 2-10. From these data,
intraclass correlation coefficients (ICC) were computed to determine
reliability. Error values (using the difference between consecutive
trials) were calculated for each subject using coefficients of variation.
Finally, a paired t-test was used to determine if a significant difference
existed between the 2nd and 10th indentations. RESULTS: Both
MMS and GS had ICC values greater than 0.90 (ICC = 0.93 and
0.91, respectively). Mean error values were calculated to be 7.70%
(+/− 5.33%) for MMS and 6.24% (+/− 4.52%) for GS. Paired t-tests
demonstrated a significant difference between indentation trials 2 and
10 for GS values only (p = 0.003). CONCLUSIONS: Measurement of
spinal stiffness using indentation demonstrated excellent reliability
in a single rater. Given that the indentation is performed manually,
rate-dependant variables such as GS showed greater between-trial
variation than MMS which is less influenced the rate of indentation.
Further research is required in this area to compare the reliability
of stiffness quantification using multiple raters and at different
anatomic sites. IMPLICATIONS: Due to the subjective nature of
manual assessment, technologies able to quantify spinal stiffness
in a reliable manner are an important clinical tool in evaluating
the effect of therapies aimed at complex musculoskeletal systems
such as the spine. KEYWORDS: Stiffness, Indentation, Reliability.
FUNDING ACKNOWLEDGEMENTS: Province of Alberta Graduate
Scholarship. CONTACT: nliddle@ualberta.ca
ETHICS COMMITTEE: University of Alberta Health Research Ethics
Board
WCPT 2007, Research Reports
Research Report Poster Display
19-13 Monday 4 June 09:00
VCEC Exhibit Hall B & C
EFFECTS OF MYOFASCIAL RELEASE AND STRETCH
TECHNIQUES ON RANGE OF MOTION AND REACTION TIME
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 investigate the
effects of myofascial release (MFR), muscle stiffness and stretch
techniques in physical therapy on range of motion and reaction
time. RELEVANCE: MFR and stretch techniques are used in
physiotherapy technique. However the effects of these techniques are
uncertain. PARTICIPANTS: Thirty healthy college students (mean
age: 21.0 19–24 yr.) participated to this study. Informed written
consent had been obtained. The experiment was approved by Tokyo
Metropolitan University Ethics Committee. METHODS: Subjects were
randomized divided three groups; 1) Myofascial release 2) Stretch 3)
Control group. All groups were ten persons (five male) and there
were no significance in age. MFR group was enforced myofascial
release to quadriceps areas for eight minutes in supine position.
Stretch group was enforced static stretch of quadriceps for eight
minutes in prone position. Control group was just lying in supine
for eight minutes. Evaluation was measured three devices; active
and passive range of motion (ROM) of knee joint, muscle stiffness
of quadriceps, reaction time of knee extension. Muscle stiffness
was measured using a durometer (Type FP: Asker co.) at points of
10cm, 15cm, 20cm above lateral knee joint space. Reaction time was
measured using electormyogram (Polygraph RM-7000: Nihon kohden
co., Power Lab: AD Instruments co.). Pre-motor time, motor time
and reaction time were measured. ANALYSIS: Statistical analyses
of differences among three groups were performed using two-way
repeated analysis of variance (ANOVA). For ANOVA model with a
significant effect, paired t-test and one-way ANOVA were performed
post hoc to localize the effects. RESULTS: In active range and
passive range of knee were significantly increased by MFR and
stretch. There were no significant difference in muscle stiffness at
the points of 10cm and 15cm. At the point of 20cm, there were
trends to decrease in MFR and stretch. Pre-motor time (PMT)
and reaction time (RT) were significantly decreased in MFR. There
was no significant difference in motor time (MT). CONCLUSIONS:
MFR and static stretch improve the range of motion. Only MFR
improve the RT. Stretch exercise was the exercise only extend the
muscle length. So stretch techniques improved the ROM but didn’t
improve RT. MFR techniques applies to fascial restrictions and will
realign fascial planes, reset the soft tissue proprioceptive sensory
mechanism. So MFR improved both ROM and the skill of movements.
IMPLICATIONS: If the patient’s have the problem of their joint, it’s
difficult to stretch enough. But MFR is useful for patient’s who have
joint problem. This study proved that not only ROM but also skill of
movements were obtained in MFR. KEYWORDS: myofascial release,
stretch, reaction time. FUNDING ACKNOWLEDGEMENTS: None.
CONTACT: kuruma@metro-hs.ac.jp
ETHICS COMMITTEE: Tokyo Metropolitan University Ethics Com-
mittee
Research Report Poster Display
20-21 Monday 4 June 09:00
VCEC Exhibit Hall B & C
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
Poster Displays, Monday 4 June
external rotator muscle activation during dynamic activities in persons
with patellofemoral pain (PFP). RELEVANCE: Recently, it has been
recognized that the patellofemoral joint can be influenced by the
segmental interactions of the lower extremity. [Powers, 2003] Using
dynamic MRI methods under weightbearing conditions, Powers et al.
[2003] demonstrated that the primary contributor to lateral patellar
tilt and displacement in a group of individuals with patellar instability
was femoral motion (internal rotation) and not patellar motion. This
finding calls into question the long-held assumption that subluxation
is the result of the patella moving on the femur. Given the recent focus
on the control of hip motion as a possible treatment option for PFP,
the S.E.R.F. Strap™ (Don Joy Orthopaedics Inc.) was developed to
assist in this effort. This femoral strap consists of thin, elastic material
that is secured to the proximal tibia, wraps around the distal thigh,
and is anchored around the pelvis (Fig. 1). The line of action of the
S.E.R.F. Strap™ is designed to pull the thigh into external rotation.
It is thought that femoral strapping may augment muscular control at
the hip as well as improve lower extremity kinematics during dynamic
activities. PARTICIPANTS: Five subjects with a diagnosis of PFP
took participated (4 females, 1 male; mean age 32 yrs). METHODS:
Pain levels (VAS pain scale), 3D kinematics (8-camera Vicon motion
analysis system; 60 Hz), and EMG activity of the gluteus maximus
(surface electrodes, 1200 Hz) were obtained as subjects performed
a step-down maneuver, a drop-jump task, and ran at 3.5 m/sec.
Each subject performed all tests with and without femoral strapping.
ANALYSIS: Data from three trials were averaged for analysis.
Dependent variables included average pain scores during the step-
down task, peak hip internal rotation, and average gluteus maximus
EMG during the stance phase of each activity. Statistically significant
differences between femoral strapping and no strapping for the
dependent variables were determined using paired t-tests, with an
a level of 0.05. RESULTS: On average, subjects reported a 50%
reduction in pain following the application of the S.E.R.F. Strap™ (Fig.
1). Femoral strapping was found to significantly reduce hip internal
rotation during the step down maneuver (9.1º IR vs. 2.5º ER), running
(8.7º IR vs. 1.0º ER), and the drop jump task (3.8º IR vs. 3.9º ER).
When averaged across all conditions tested, gluteus maximus EMG
activity was found to increase 178% following the application of the
femoral strap (Fig. 3). CONCLUSIONS: Following the application of
a femoral strap, all subjects reported a reduction in symptoms. This
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
treatment of PFP. IMPLICATIONS: The results of this preliminary
study support the premise that patellofemoral joint dysfunction
may have a proximal origin (i.e. hip). KEYWORDS: Patellofemoral
pain, musculoskeletal biomechanics, femoral strapping. FUNDING
ACKNOWLEDGEMENTS: This work was not funded.
ETHICS COMMITTEE: University of Southern California
Research Report Poster Display
21-01 Monday 4 June 09:00
VCEC Exhibit Hall B & C
DILEMMAS OF IDENTITY IN PEOPLE WITH RHEUMATOID
ARTHRITIS. A GENDER PERSPECTIVE ON SOCIAL ROLES AND
THE CONSEQUENCES FOR PHYSIOTHERAPY INTERVENTIONS
Oredson C; Odense University Hospital, Denmark
PURPOSE: The purpose of this project was to see whether social
roles are of importance in the treatment of people with Rheumatoid
Arthritis. RELEVANCE: Patients with Rheumatoid Arthritis frequently
struggle with dilemmas of identity due to the problems to live
up to the demands and expectations that are attached to their
social roles, which can act as a barrier in relation to be able
to follow the recommendations of training. PARTICIPANTS: Two
middle-aged men and women who all were married and having
children, suffering from longstanding RA, and in ongoing medical
treatment with biological medicine, were intentionally selected from
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a leading university hospital in Denmark. Both their professional
lives – all had been forced to withdraw from their jobs due to their
illness – and their social roles as fathers, mothers, husbands and
wives were affected. METHODS: Four semi-structured interviews
were conducted on the basis of the researcher’s own experience
as a physiotherapist treating patients suffering from RA – combined
with a literature search in primarily international sociological and
psychological databases. The interviews were taped and afterwards
transcribed word by word. ANALYSIS: The qualitative data were
analysed from a phenomenological/hermeneutical point of view. The
transcriptions were divided into major themes, and questions related
to the themes were then asked. The results were finally discussed
in relation to theories regarding communities of practice (Wenger
2004) and gender research studies. RESULTS: The analysis and
interpretation clearly showed the difference between the dilemmas
of identity of the two sexes. The crucial dilemma of the men was
trying to live up to the socially accepted identity of work. For the
women the essential thing was trying to live up to their families’
demands and expectations as regards an unaltered role of traditional
housewife, at the same time as managing their jobs and the RA.
Where the men were supported by their families and therefore
managed to rest and do their exercises, the women didn’t manage
to take care of themselves because of the unaltered expectations
to fulfil their social roles – regardless of their RA. CONCLUSIONS:
The demands and expectations from the other family members are
of great importance, both to men and women suffering from RA
in the Danish Society. Whether men and women suffering from
RA, but living in other cultural settings,have the same experiences,
could be interresting to find out in future research. IMPLICATIONS:
Physiotherapists treating patients suffering from a chronic illness
such as RA should ease their attention towards the great importance
of the social roles – the expectations and demands – with regard
to patients’ ability to take care of themselves when it comes
to rest and exercise. It is recommended that physiotherapists
involve especially the families of their female patients in the
treatment. This important implication is well-authenticated by the
participation domain of the ICF. KEYWORDS: Rehabilitation, Gender
health, Arthritis. FUNDING ACKNOWLEDGEMENTS: The Danish
Physiotherapy Association. The Danish Arthritis Patient Organisation.
CONTACT: charlotte.oredson@ouh.fyns-amt.dk
Research Report Poster Display
21-05 Monday 4 June 09:00
VCEC Exhibit Hall B & C
AN EVALUATION OF THE EFFECTIVENESS OF PASSIVE
SHOULDER JOINT MOBILIZATION FOR THE TREATMENT OF
SHOULDER PAIN: TWO RANDOMIZED CLINICAL TRIALS
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
and longer-term effectiveness of passive mobilizations of shoulder
joints for the treatment of shoulder pain with and without movement
restriction. RELEVANCE: Shoulder disorders are the most common
of all peripheral joint complaints and the incidence of shoulder
pain is reported to increase with age. Exercise and passive
shoulder region joint mobilizations are commonly used for the
treatment of shoulder pain. While there is evidence to support the
efficacy of exercise therapy, scientific evidence to support shoulder
region joint mobilization therapy is lacking. PARTICIPANTS: One
hundred and eighty-eight subjects presenting with shoulder pain
of local mechanical origin will be recruited for two trials – 90
with restricted shoulder movements will participate in one trial and
98 without restriction will participate in a second trial. Statistical
power calculations for each of these trials, indicate that these
sample sizes have an 80% chance of detecting a change of 15
points on the Shoulder Pain and Disability Index (SPADI) based
on standard deviations of 24 and 25 respectively, assuming a 10%
S200
loss to follow-up. METHODS: • Two primary outcome measurements
will be used: 1) shoulder pain and functional impairment using
SPADI, and 2) subjects’ perceived change in symptoms using a six-
point Likert scale. • All subjects will receive advice and exercises
designed to restore neuromuscular control at the shoulder of proven
treatment efficacy. • The experimental group will also receive passive
joint mobilizations applied specifically to shoulder region joints.
• After obtaining baseline outcome measurements, subjects will
be randomly allocated to control or experimental groups using a
concealed procedure. • subjects will receive 4 to 8 treatments
during a one-month period at which time outcome measurements
will be re-assessed by a blinded researcher. • Treatment may then
continue for a maximum of 12 treatments over a maximum of
8 weeks. • Blinded assessment will be repeated 6 months after
recruitment. ANALYSIS: Two-tailed paired samples t tests will be
used to compare mean changes in all outcome measurements
between the experimental and control groups. RESULTS: In the
study involving patients with shoulder pain and restricted shoulder
movements 63 subjects have been recruited to date – average age
66 years. Thirty of these have received advice and exercises (control
group) and 33 advice, exercises and passive shoulder region joint
mobilizations (experimental group). Five subjects (7.9%) failed to
attend for short term follow-up and 33 of 34 potential subjects (97.1%)
have completed longer term follow-up. In the study involving patients
with shoulder pain without shoulder movement restriction 44 subjects
have been recruited to date – average age 60 years. Twenty-three
of these have been allocated to the control group and 21 to the
experimental group. One subject failed to attend for short term follow-
up and 27 of 29 potential subjects (93%) have completed longer
term follow-up. CONCLUSIONS: Completion of data collection for
both trials is expected 2008. IMPLICATIONS: This robust randomized
controlled clinical trial will provide evidence for the efficacy of passive
shoulder joint mobilizations in the management of shoulder pain with
and without accompanying stiffness. KEYWORDS: Passive joint mo-
bilization, shoulder pain, shoulder stiffness,painful arc,impingment,
frozen shoulder, capsulitis. FUNDING ACKNOWLEDGEMENTS:
Physiotherapy Research Foundation Tagged Grant 2005. CONTACT:
r-y@bigpond.net.au
ETHICS COMMITTEE: 1)The University of Sydney – Human
Research Ethics Committee. 2)Central Sydney Area Health Service –
Research Development Office
Research Report Poster Display
22-13 Monday 4 June 09:00
VCEC Exhibit Hall B & C
VALIDATING A CLINICAL TEST OF AUTONOMIC DYSFUNCTION
IN ADULTS WITH MULTIPLE SCLEROSIS
Hale L1 , Nukada H2 , du Plessis L3 ; 1 University of Otago, Dunedin,
New Zealand; 2 University of Otago, Dunedin, New Zealand;
3 Dunedin Public Hospital, Dunedin, New Zealand
PURPOSE: The purpose of this study was to validate a simple
clinical screening test for cardiovascular autonomic dysfunction in
adults with Multiple Sclerosis (MS) by investigating the relationship
between autonomic dysfunction and the heart rate response to a
simple cycle test. RELEVANCE: Autonomic dysfunction can occur
in people with multiple sclerosis (MS) causing blunted heart rate
and systolic blood pressure responses to routine laboratory-based
autonomic testing. The presence of autonomic dysfunction should be
taken into account when prescribing exercise programmes, however
the routine tests used to assess the autonomic nervous system are
not easily applied in the clinical physiotherapy setting; the autonomic
nervous system is usually only evaluated formally on specific medical
referral. PARTICIPANTS: A convenience sample of thirty-one adults
with MS and 31 non-disabled, sedentary age-matched adults were
recruited. METHODS: The autonomic function of all participants was
assessed using continuous heart rate and blood pressure responses
to rhythmic deep breathing, the Valsalva manoeuvre, sustained hand
WCPT 2007, Research Reports
grip, postural change and a cycle challenge test. The severity of
the disease was evaluated in the MS participants, and the type
of MS and duration since diagnosis recorded. Height and weight
of all participants was measured. ANALYSIS: All demographic and
measured data were analysed descriptively. Two-sample t tests
were used to compare differences between MS and control group
means for height, weight, and age. The Wilcoxon signed-ranks test
was used to compare differences between group means for all
the autonomic test results, as these were not normally distributed.
RESULTS: The thirty-one participants with MS (26 female, 5 male)
had a mean age of 46±8.00 years (32-60 years) and their mean
Expanded Disability Severity Scale was 3 (1-6). The mean duration
since diagnosis was 10.3 years (0.1–39 years). Thirty-one age-
matched healthy controls (26 female, 5 male) had a mean age
of 45±9.5 years (24-57). There were no significant differences in
age, height or weight (p < 0.05) between the two groups. There
were no significant differences between the MS and control group
on any of the autonomic tests results (p < 0.05). Of the sample of
thirty-one participants with MS four participants (13%) appeared to
have compromised cardiovascular components of their autonomic
nervous systems on formal testing; however, the results of their heart
rate responses to the cycle test were comparable with that of the
control group. CONCLUSIONS: Although autonomic dysfunction was
indicated in 13% of participants with MS there were no significance
difference between the MS and control groups on any of the
autonomic tests, including the cycle test. The cycle test protocol
used in this study was unable to detect the presence of abnormal
heart rate responses to exercise and probably requires modification
to present a greater challenge to participants’ cardiovascular
system. IMPLICATIONS: A simple clinical test to screen autonomic
dysfunction would enable physiotherapists to safely prescribe
exercise programmes to adults with MS. Monitoring the heart rate
responses to exercise is one method of achieving this but the
required exercise protocol still needs to be more rigorously defined.
KEYWORDS: autonomic dysfunction,Multiple Sclerosis, screening,
exercise. FUNDING ACKNOWLEDGEMENTS: New Zealand Society
of Physiotherapy Scholarship Trust Fund and the Healthcare Otago
Charitable Trust. CONTACT: leigh.hale@otago.ac.nz
ETHICS COMMITTEE: Otago Ethics Committee (a regional health
ethics committee in New Zealand), reference number 03/06/05
Research Report Poster Display
22-17 Monday 4 June 09:00
VCEC Exhibit Hall B & C
FACTORS ASSOCIATED WITH INDEPENDENCY IN ADL AND
SOCIAL/LIFESTYLE ACTIVITIES IN MS: ACCOUNTING MOTOR
AND COGNITIVE FUNCTION, SOCIO-DEMOGRAPHIC FACTORS,
COPING CAPACITY
Einarsson U1,2 , Gottberg K2 , von Koch L2 , Widén Holmqvist L1,2 ;
1 Division of Physiotherapy, Department of Neurobiology, Care
Sciences and Society, Karolinska Institutet, Stockholm, Sweden;
2 Division of Neurology, Department of Clinical Neuroscience,
Karolinska Institutet, Stockholm, Sweden
PURPOSE: The purpose of this study was to describe and analyze
independency in personal and instrumental activities of daily living
(ADL), and frequency of social/lifestyle activities in a population-
based sample of people with multiple sclerosis (MS) in Stockholm,
taking into account motor and cognitive function; socio-demographic
factors; and coping capacity. RELEVANCE: One of the important
health-care services for people with MS in Stockholm is physiother-
apy, for example evidenced-based exercise therapy. Physiotherapists
are supplying health care services with aims relevant to the lifestyle
of people with MS at every stage of disease severity. Consequently,
there is a great need for a more detailed understanding of factors that
might account for differences in functioning among people with MS.
For this purpose, there is a need to identify: a) target sub-groups
of people with MS, b) realistic goals; and c) the most promising
Poster Displays, Monday 4 June
intervention strategies for the purpose of improving independence
and participation in social activities. PARTICIPANTS: 166 people
with MS. METHODS: Data were collected using measurements and
structured interviews in the home environment of the people with
MS. Cognitive function was assessed by the Symbol Digit Modalities
Test; manual dexterity by the Nine-hole Peg Test; walking ability
by need for aid/ support when walking10-metres; coping capacity
by the Sense of Coherence scale; independency in ADL by the
Barthel Index and the Katz Extended ADL Index; and frequency of
social/lifestyle activities by the Frenchay Activities Index. ANALYSIS:
In uni-variate analyses, differences in proportions were examined by
a chi-square test, and the significance of differences between sub-
groups was assessed by the Wilcoxon-Mann-Whitney test or the
Kruskal-Wallis test. Probability values of <0.001 were considered
statistically significant. In the multi-variate analysis, associations
between potential predictors and outcome variables were assessed
using chi-square test and a forward, stepwise logistic-regression
analysis was needed to allow identification of the most important
predictive factors. RESULTS: Significantly more favourable results –
with regard to ADL and normal frequency of social/lifestyle activities –
were found in the sub-groups: people with MS with normal cognitive
function; normal manual dexterity; ability to walk without walking
aid and support; living in a private household; and working. Ability
to walk without aid and support, and current employment, were
associated with independency in ADL and normal frequency of
social/lifestyle activities. In addition, living together with a partner
was associated with independence in the Barthel Index; normal
manual dexterity speed with independence in the Katz Extended
ADL Index; and normal coping capacity with normal frequency of
social/lifestyle activities. CONCLUSIONS: The most important factor
associated with independency and normal frequency of daily and
social activities was the ability to walk. There is a great need for
effective rehabilitation interventions focusing on cognitive function,
manual dexterity, walking ability, ADL and social/lifestyle activities
for people with MS in Stockholm. IMPLICATIONS: Knowledge of
the relative importance of different contributing factors to indepen-
dency in ADL and frequency of social/lifestyle activities, together
with evidence-based treatments, is essential in setting priorities
and in clinical decision-making, when planning and organizing
physiotherapy and other rehabilitation resources for people with
MS in Stockholm. KEYWORDS: human activities, movement,
multiple sclerosis. FUNDING ACKNOWLEDGEMENTS: The study
was funded by grants from the Board of Research for Health
and Caring Sciences and the Health Care Sciences Postgraduate
School, Karolinska Institutet, the Swedish Association of Persons
with Neurological Disabilities, the Swedish Research Council and the
Vardal Foundation. CONTACT: ulrika.einarsson@karolinska.se
ETHICS COMMITTEE: Ethical approval for the study was obtained
from the Ethics Committee of Huddinge University Hospital, (Dnr:
164/97).
Research Report Poster Display
23-21 Monday 4 June 09:00
VCEC Exhibit Hall B & C
RELATIVE PRESERVATION OF ECCENTRIC STRENGTH IN THE
PARETIC AND NONPARETIC LEG MUSCLES OF INDIVIDUALS
WITH CHRONIC STROKE
Lomaglio M1,2 , Eng J1,2 , MacIntyre D1,2 ; 1 Rehabilitation Research
Laboratory, Vancouver, Canada; 2 GF Strong Rehab Centre,
Vancouver, Canada
PURPOSE: It has been well documented that most individuals
with stroke have reduced isometric and concentric muscle strength.
However, reports examining eccentric muscle strength are scarce
despite its important contribution to functional task performance.
The purpose of this study was to measure and compare eccentric
and concentric muscle strength in the paretic and nonparetic ankle,
knee, and hip flexors and extensors of individuals with chronic
S201
stroke. RELEVANCE: A more intricate understanding of how stroke
impacts muscle performance is needed in order to develop more
effective strengthening interventions for this population. This study
newly identified impairments in eccentric and concentric muscle
strength and provides evidence-based recommendations to assist
physiotherapists in designing exercise programs that are specific to
these impairments. PARTICIPANTS: Eighteen subjects with stroke
(6 women and 12 men) were each age and sex matched to one
of 18 healthy control subjects (6 women and 12 men). On average,
subjects with stroke were 64.9 years of age and control subjects
were 63.3 years of age. All subjects were recruited voluntarily from
the community. Subjects with stroke were at least one year post
infarct and able to walk ten metres with or without an assistive
device. METHODS: An isokinetic dynamometer set at 30 degrees per
second was used to measure peak maximum voluntary concentric
and eccentric joint torques of the paretic and nonparetic legs of
subjects with stroke and the nondominant leg of control subjects.
ANALYSIS: Relative eccentric and concentric torque (percentage of
control subject torque) across all six joint actions was compared using
separate multivariate analyses of variance (MANOVA) for the paretic
and nonparetic legs of individuals with stroke. Significant differences
were followed by post-hoc paired T-Tests and Wilcoxen Signed Ranks
tests for each measured joint action. RESULTS: Relative eccentric
torque was significantly higher than relative concentric torque for
the paretic (P = 0.032) and nonparetic legs (P = 0.012). Across
all joint actions, paretic leg eccentric and concentric torque was
74% and 58% of control torque respectively; five out of six joint
actions were significant (P = 0.001–0.014). Across all joint actions,
nonparetic leg eccentric and concentric torque was 101% and 87% of
control torque respectively; four out of six joint actions were significant
(P = 0.001–0.010). CONCLUSIONS: Individuals with chronic stroke
demonstrate a relative preservation of eccentric strength in both
the paretic and nonparetic leg muscles compared to concentric
strength. To increase the generalization of these findings, similar
studies should be performed for the upper extremity and also during
the acute stage of stroke recovery. IMPLICATIONS: Physiotherapists
should determine both the maximum concentric and eccentric torque
capabilities to avoid underloading the muscle during the lengthening
phase of resisted exercises. In addition, individuals with extreme
hemiparesis may be able to perform isolated eccentric movements
prior to concentric movements, thus allowing physiotherapists to
stimulate muscle activity and strength gains early in the rehabilitation
process. However, further research is required to determine the
effects of eccentric training in individuals with stroke. KEYWORDS:
Stroke; eccentric torque. FUNDING ACKNOWLEDGEMENTS: This
study was supported by an operating grant from the Canadian
Institutes of Health Research and the Michael Smith Foundation of
Health Research. CONTACT: Janice.Eng@vch.ca
ETHICS COMMITTEE: University of British Columbia Ethics Board
and the Vancouver Coastal Health Approval
Research Report Poster Display
24-01 Monday 4 June 09:00
VCEC Exhibit Hall B & C
CLINICAL ASSESSMENT METHOD OF LEFT UNILATERAL SPA-
TIAL NEGLECT USING A HEAD MOUNTED DISPLAY SYSYTEM
Tanaka T1 , Sugihara S2 , Nara H3 , Ishikawa A4 , Ino S5 , Ifukube T5 ,
Shirogane S6 , Oyama Y7 , Maeda Y8 ; 1 Department of Design,
Sapporo City University; 2 Sapporo Shuyukai Hospital; 3 AdIn
Research, Inc.; 4 Department of Physical Therapy, Sapporo
Medcial University; 5 Research Center for Advanced Science and
Technology, The University of Tokyo; 6 Institute of Rehabilitation
Science, Tokuyukai Medical Corporation; 7 Tokeidai Memorial
Hospital; 8 Hokkaido Univesity
PURPOSE: Unilateral spatial neglect (USN) is a common syndrome
in which a patient fails to report or respond to stimulation from the
side of space opposite a brain lesion, and where these symptoms
S202
are not due to primary sensory or motor deficits. The purpose of this
study was to analyze an evaluation process system of USN in various
visual fields using HMD in order to understand more accurately
any faults of USN operating in the object-centred co-ordinates.
RELEVANCE: Neglect is associated with a poor performance on
measures of impairment, as well as on measures of disability in
ADL. USN is one of the major disruptive factors impeding functional
recovery and rehabilitation success. PARTICIPANTS: Ten stroke
patients (mean age 66.7 years old) participated in this study after
gaining their informed consent and all subjects had Left USN as
diagnosed by a clinical test. Two medical doctors checked for the
degree of right hemisphere damage of all subjects by CT scan.
METHODS: Assessments of USN were performed by the BIT
(Behavioral Inattention Test) common clinical test (the line bisection
test and the stars cancellation test) and two special tests; the zoom-
in condition (ZI) condition and the zoom-out condition (ZO) condition.
The subjects were first evaluated by the common clinical test without
HMD and then two spatial tests with HMD. Moreover, we used a
video-recoding for all tests to analyze each subject’s movements.
ANALYSIS: An ANOVA or Student’s t test was used as a comparison
between the common clinical test and the two special tests with HMD.
Multivariate ANOVA tests were performed in each group and Shėffe
post hoc tests were performed if significant differences were found
at the 5% significance level. RESULTS: For the line bisection test
under the common condition, the mean percentage of the correct
answers at the left side in the test paper was 94.4%. In the ZI
condition, the left side was 61.8% and the right side was 92.4%.
In the ZO condition, the left side was 79.9% and the right side
was 91.7%. There were significant differences among the three
conditions. The results of the stars cancellation test also showed
the same tendency as the line bisection test. CONCLUSIONS: The
results showed that the assessment of USN using a technique of
HMD system may indicate the disability of USN in greater detail than
the common clinical tests. Moreover, it might be hypothesized that
the three dimensional measurement in the USN test may be a better
indicator for various damages and the occurrence of USN than only
the two dimensional test. It might be hypothesized that the USN test
using HMD may display greater accuracy and be able to assess the
occurrence and degree of USN in greater detail than the common
clinical test. IMPLICATIONS: The assessment of USN using an HMD
system may clarify the left neglect area which can not be easily
observed in the clinical evaluation for USN. KEYWORDS: Unilateral
spatial neglect, head mounted display system, virtual reality,
clinical assessment. FUNDING ACKNOWLEDGEMENTS: This work
was supported by the grant-in-aid for scientific research from
HOKKAIDO SMALL BUSINESS SUPPORT CENTER,JAPAN,2005-
2006. CONTACT: t.tanaka@scu.ac.jp
ETHICS COMMITTEE: sapporo city university
Research Report Poster Display
24-05 Monday 4 June 09:00
VCEC Exhibit Hall B & C
AN EXERCISE PROGRAM FOR PEOPLE WITH CHRONIC
STROKE IMPROVES AMBULATORY CAPACITY: ASSOCIATION
WITH INCREASE IN CARDIOPULMONARY FITNESS AND
MUSCLE STRENGTH
Pang M1−3 , Eng J2,3 ; 1 Hong Kong Polytechnic University, Hong
Kong; 2 University of British Columbia, Vancouver, Canada; 3 GF
Strong Rehabilitation Centre, Vancouver, Canada
PURPOSE: To determine the factors that are associated with im-
proved ambulatory capacity in individuals with chronic stroke follow-
ing a 19-week community-based exercise program. RELEVANCE:
Ambulatory capacity is the most striking area of difficulty in
individuals with chronic stroke. Exercise intervention has been
shown to be effective in improving ambulatory capacity in this
population. However, ambulatory capacity has multiple determinants
(e.g. balance, muscle strength, cardiopulmonary fitness). To what
WCPT 2007, Research Reports
extent does each factor contribute to improvement in ambulatory
capacity following exercise intervention requires further investigation.
PARTICIPANTS: A convenience sample of 63 older adults (50
years of age or older) with chronic stroke (stroke onset 1 year
or more) were recruited from the community. METHODS: This
is a secondary analysis of a randomized controlled clinical trial.
Thirty-two and 31 individuals were allocated to the experimental
group and control group, respectively. The experimental group
underwent a comprehensive exercise program aimed to improve
cardiopulmonary fitness, balance, muscle strength, and mobility.
The control group underwent a seated upper extremity program.
Both groups of individuals had 3 sessions a week in a community
hall for 19 weeks. Ambulatory capacity was measured by Six
Minute Walk Test (6MWT). Cardiopulmonary fitness was indicated
by peak maximal oxygen consumption (peak VO2 ). Isometric knee
extension muscle strength on both sides was measured by hand-held
dynamometry. Functional balance was measured by Berg balance
scale. All of the above outcomes were measured twice: before the
commencement of the program, and again after the termination
of the program. ANALYSIS: Analysis of variance (ANOVA) with
repeated measures was used to determine whether there was
a treatment effect on each of the outcome variables (significant
group by time interaction). Percent change of each outcome variable
was computed. Pearson’s r correlation coefficient was used to
determine the degree of association between the percent change
of 6MW distance and other outcomes. A significance level of
0.05 was set for all statistical tests. RESULTS: The experimental
group had significantly more improvement than the control group
in ambulatory capacity, paretic knee extension muscle strength,
and cardiopulmonary fitness (p < 0.05). Balance in both groups
improved and there was no significant between-group difference
(p > 0.05). The percent change of 6MW distance is significantly
correlated with the percent change of peak VO2 , and paretic knee
extension muscle strength (p < 0.05), but not balance (p > 0.05).
CONCLUSIONS: Increase in ambulatory capacity is related to
improvement in cardiopulmonary fitness and leg muscle strength.
The lack of relationship between improvement of ambulatory capacity
and that of balance may be due to the relatively high level
of balance pre-intervention (i.e. ceiling effect). IMPLICATIONS:
Treatment approaches to enhance cardiopulmonary fitness and leg
muscle strength are important for improving ambulatory capacity.
KEYWORDS: stroke, ambulation, balance, muscle strength, car-
diopulmonary fitness. FUNDING ACKNOWLEDGEMENTS: Natural
Sciences and Engineering Research Council of Canada (Marco
Pang); Heart and Stroke Foundation of Canada (Janice Eng);
Canadian Institutes for Health Research (Maureen Ashe, Janice
Eng); The Michael Smith Foundation for Health Research (Janice
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
committee
Research Report Poster Display
25-09 Monday 4 June 09:00
VCEC Exhibit Hall B & C
PERFORMANCE OF PEOPLE WITH A STROKE IN A DUAL –
TASK ACTIVITY
Silva de Andrade M1 , Teixeira P1 , Callil Voos M1 , Zanchetta
Castelli L1 , Ribeiro do Valle L2 ; 1 Department of Speech, Physical
Therapy and Occupational Therapy, Faculdade de Medicina,
Universidade de São Paulo; 2 Department of Biomedical Sciences,
Universidade de São Paulo
PURPOSE: This experiment aimed to investigate the existence of
negative interaction between a visual and a motor task and to
evaluate the difference between the performance of people with a
stroke and control subjects. RELEVANCE: The association of visual
Poster Displays, Monday 4 June
and motor tasks has a high functional importance in daily life activities
such as crossing a street. Therefore, it is necessary to verify the
impact of CNS lesions in activities that demand interaction of visual
and motor abilities. PARTICIPANTS: Eight volunteers with a stroke
(3 women, 5 men; 58.25±4.27 years) and twelve controls (6 women,
6 men; 55.33±2.05 years), MMSE23. METHODS: The test was
run in a room with reduced illumination, using a computer with the
applicative MEL2. It consisted on (1) a training session (2) a visual
task; (3) a motor task; (4) both tasks associated. The visual test
measured the accuracy of recognition of two visual targets of 150ms
(bus and/or truck) and were presented simultaneously: one appearing
at the fixation cross and one appearing in one of eight periphery
positions. The volunteers would have to classify if the targets were
equal or different (32 trials). The answer was typed on adapted
joystick, by the examiner. The number of committed errors and the
duration of the visual test were registered. The motor task consisted
on alternating steps from the ground to a 10cm platform, as fast as
possible, with the same duration of the visual test. The alternations
were videotaped and counted. ANALYSIS: The number of steps per
second in the absence and the presence of the visual task and the
number of errors in the visual task in the presence or absence of
motor task were analyzed by two ANOVAs (a ≡ 0.05). RESULTS:
The speedy of people with a stroke was lower when compared to the
controls [F1,18 ≡ 24.904; p  0.001]. For both groups, the number of
steps decreased when associated to the visual task [F1,18 ≡ 6.010;
p ≡ 0.036]. There was no difference in the number of errors in the
visual task between people with a stroke and controls [F1,18 ≡ 0.614;
p ≡ 0.443], the performance did not change when the visual was
associated to the motor task [F2,36 ≡ 0.435; p ≡ 0.651]. The visual
task had 50% of correct answers and was probably considered
difficult for both groups. CONCLUSIONS: The speedy of people with
a stroke was lower when compared to the controls. For both groups,
attention seems to be necessary for performing the motor task. On
the other hand, apparently, performing a motor task does not interfere
with attention in a visual task for both groups, probably because the
visual task was too difficult. Future experiments will intend to increase
the difference between the shapes of the stimuli in order to make the
visual task easier and verify the impact of the association of motor
task to it. IMPLICATIONS: It is important to include speed training to
improve the control of lower limbs in people with chronic stroke during
the physical therapy sessions. The individuals with better speed
should also practice dual – task activities (such as visual and motor
tasks associated). KEYWORDS: perceptual motor performance,
dual-task, stroke. FUNDING ACKNOWLEDGEMENTS: this work
was unfunded. CONTACT: marianeandrade@hotmail.com
ETHICS COMMITTEE: This study was approved by the Institute of
Biomedical Sciences Ethics Committee – Universidade de São Paulo
(Brazil).
Research Report Poster Display
25-13 Monday 4 June 09:00
VCEC Exhibit Hall B & C
THE EFFECTS OF EXERCISE AND REST BREAKS ON
MUSCULOSKELETAL DISCOMFORT DURING COMPUTER
TASKS: AN EVIDENCE BASED PERSPECTIVE
Barredo R1 , Mahon K2 ; 1 Tennessee State University, College or
Health Sciences; 2 Arkansas State University, Graduate Program
in Physical Therapy
PURPOSE: The purpose of this study is to appraise the strength of
research evidence on exercise and rest breaks on musculoskeletal
discomfort during computer tasks and to compare the research
evidence with current clinical guidelines. RELEVANCE: Physical
therapists frequently treat patients who have developed computer
related musculoskeletal disorders. Many exercise and work-rest
protocols have been suggested for computer operators. Physical
therapists need to educate patients, employers, and the public about
effective exercises and work-rest schedules to prevent development
S203
and recurrence of computer related musculoskeletal disorders.
DESCRIPTION: A literature search of Pubmed and OVID from
1990-2005 was conducted using the following inclusionary criteria:
exercise protocols could be completed within 10 minutes, rest
break parameters were defined, and exercise and rest breaks were
analyzed separate from other interventions. Additional articles were
obtained by reviewing references of eligible articles obtained from
Pubmed and OVID. Eligible articles were appraised by the primary
author. The second author reviewed the appraisals performed by the
first author. Discrepancies were discussed to achieve consensus.
Articles were appraised using the method developed by the American
Academy of Cerebral Palsy and Developmental Medicine. A grade of
evidence, as outlined by the Centre for Evidence Based Medicine,
was assigned to each intervention based on the aggregate strength
of all articles for their respective intervention. The grades were
compared to existing clinical guidelines. EVALUATION: Fifteen
articles met the inclusionary criteria. These include 3 articles
on exercise, 7 on rest breaks, and 5 articles examining both
interventions. Based on the research evidence, both exercise and
rest breaks were assigned a grade of C. Comparisons between
the results of this study and clinical guidelines suggested by the
Occupational Safety and Health Administration and the Official
Disability Guidelines Treatment in Worker’s Compensation revealed
similar recommendations. CONCLUSIONS: Evidence exists support-
ing exercise and rest breaks as effective interventions to decrease
discomfort in computer tasks. The current evidence suggests no
additional benefits of exercise over rest breaks alone in reducing
musculoskeletal discomfort during computer tasks. IMPLICATIONS:
Physical therapists need to evaluate the research evidence on
the efficacy of treatment interventions. Additional well-designed
randomized controlled trials are needed to strengthen the evidence
of exercise and rest breaks as effective interventions in preventing
the development and recurrence of computer related musculoskeletal
disorders. Research is needed to determine optimal work-rest
schedules and exercise protocols for computer operators. Further
studies are needed on subjects who have current computer related
musculoskeletal disorders and subjects who have a history of com-
puter related musculoskeletal disorders. KEYWORDS: Computers,
visual display terminal, musculoskeletal discomfort, exercise, rest
breaks. FUNDING ACKNOWLEDGEMENTS: Unfunded. CONTACT:
RBarredo@tnstate.edu
ETHICS COMMITTEE: Institutional Review Board, Arkansas State
University
Research Report Poster Display
25-17 Monday 4 June 09:00
VCEC Exhibit Hall B & C
TIME DIMENSIONS IN SERVICE WORK AND BODILY
CONSEQUENCES
Moe S; University of Tromsoe
PURPOSE: Large portions of work life are contigent on availability
and service. In the service professions, information communication
technology (ICT) is used as a tool for work. On the one hand, ICT
often results in better effiency; on the other hand, availability is in-
creased and results in time pressures for the worker. The purpose of
this presentation is to investigate the time elements that characterize
this type of work and the workser‘s movements. RELEVANCE: In
occupational work, knowledge is needed about time dimensions in
the various work tasks as well as how these are significant in the
coping with time pressures and the development of strain injuries.
PARTICIPANTS: Three female claims representatives, each with
lengthy experience in the field of work procedures and software were
included. METHODS: Over a period of three months,I performed
field work in an insurance company. The participants were observed
during the performance of routine work and were filmed periodically.
Through conversations during the course of the investigation,
information emerged concerning the participant‘s perception of work
S204
tasks, routines and priorities. ANALYSIS: The overall perspective
for analysis is body phenomenology, supplemented with terms from
Bourdieu‘s theory of practice and Hall‘s dimensions of time. This
point of departure is helpful in analyzing dimensions of time in work
tasks and in elucidating how time pressure occurs. Film recordings
provide the basis for microanalyses of work situations, along with
information obtained through conversations with the participants.
RESULTS: At the computer, one‘s attention is continually focused
on the work at hand. The participants sit in a stand-by position; time
must be filled. The claims representatives are required to be available
to clients, and communications from outside split up time. Client
contact entails a double role; it is important, while at the same time it
takes time away from claims casework. CONCLUSIONS: In relational
situations, time cannot be managed, whereas the overriding goal of
effiency requires the worker to make the best use of time. When
relational development and productivity are combined, the tasks‘
dimensions of time become incompatible, and compound pressure
is experienced. IMPLICATIONS: The fragmentation of work routines
along with time pressure is a strain over time and can result in
stress reactions. It is important to analyze the tasks‘ dimensions
of time and to organize work so that unfavourable dimensions
of time are not combined. This is a particular challenge when
working with ICT, as the time-space relationship is neutralized.
KEYWORDS: time, information communication technology, strain.
FUNDING ACKNOWLEDGEMENTS: The study was financed by
The Norwegian Fund for Post-Graduate Training in Physiotherapy.
CONTACT: sirim@fagmed.uit.no
ETHICS COMMITTEE: The Regional Committee for Medical
Research Etics, Health Care Region 5, Norway
Research Report Poster Display
26-21 Monday 4 June 09:00
VCEC Exhibit Hall B & C
ELDERLY PRESENT IMPAIRED PERFORMANCE WHEN
EXECUTING A DUAL-TASK ACTIVITY
Teixeira P1 , Callil Voos M1 , Zanchetta Castelli L1 , Silva de
Andrade M1 , Ribeiro do Valle L2 , Pimentel Piemonte M1 ;
1 Department of Speech, Physical Therapy and Occupational
Therapy, Faculdade de Medicina, Universidade de São Paulo;
2 Department of Biomedical Sciences – Universidade de São Paulo
PURPOSE: the aim of this study was to verify the interference
between a visual task and a motor task and the differences between
the performance of young and elderly people. RELEVANCE: the
association of visual and motor tasks is common in daily life activities,
such as crossing a street. The risk of accidents is higher in elderly
people, consequently it is necessary to identify their deficits in dual-
task activities. PARTICIPANTS: thirteen healthy elderly volunteers
(71.08±2.34 years of age) matched with thirteen young volunteers
(25.54±1.26 years of age). MMSE23. METHODS: the test was
run in a room with reduced ilumination, using a computer with
aplicative MEL2. It consisted on (1) a divided attetion visual task;
(2) a motor task of alternating steps as fast as possible; (3)
both tasks associated. The visual task measured tje accuracy
of recognition of two visual targets (bus and/or truck) of 150ms,
presented simultaneously: one appearing at the fixation cross and
one appearing in one of eight periphery positions. The volunteers
had to classify if the targets were equal or different. The answer was
typed on an adapted joystick, by the examiner. This test had one block
of 32 trials. The number of errors and the duration of the visual test
were registered. The motor task consisted on alternating steps from
the ground to a 10cm plataform, with the same duration of the visual
test. The experiment was videotaped and the number of alternations
was counted. All subjects were familiarized with the experiment task
before making it. ANALYSIS: The number of steps per second in
the absence and the presence of the visual task and the number
of errors in the visual task in the absence and the presence of the
motor task were analysed by two ANOVAs (a ≡ 0.05). RESULTS: The
WCPT 2007, Research Reports
motor performance of the elderly was slower when compared to the
young [F1,24 ≡ 69.072; p  0.001]. The motor performance decreased
when the motor task was associated to the visual task in both groups.
[F1,24 =37.074; p  0.001]. The elderly committed more errors in the
visual task than the young volunteers [F1,24 ≡ 5.057; p ≡ 0.034]. The
association of the motor task did not increase the number of errors
in the visual task [F1,24 ≡ 0.283; p ≡ 0.600]. CONCLUSIONS: The
ageing process seems to disturb the performance of dual-tasks. The
elderly were slower in the motor task and committed more errors
in the visual task when compared to the young volunteers. The
elderly people maintained performance of 50% in the visual task with
and without the motor concurrent task. In future works we intend to
increase the differences between the stimuli to make this task easier.
IMPLICATIONS: Besides practicing motor and visual tasks isolated,
the elderly should also practice these tasks associated. The capacity
of association of motor and visual abilities should be assessed in
order to detect deficits in daily life activities, such as crossing a
street. KEYWORDS: vision, perceptual motor performance, dual-
task, ageing. FUNDING ACKNOWLEDGEMENTS: this work was
unfunded. CONTACT: patpsteixeira@yahoo.com.br
ETHICS COMMITTEE: This study was approved by the Institute of
Biomedical Sciences Ethics Committee – Universidade de São Paulo
(Brazil)
Research Report Poster Display
27-01 Monday 4 June 09:00
VCEC Exhibit Hall B & C
CHARACTERISTICS OF FORWARD LUNGE EXERCISE IN
ELDERLY PERSONS
Koyanagi M1 , Takeoka K2 , Mukai K2 , Higuchi Y3 ,
Tanaka N1 ; 1 Faculty of Biomedical Engineering,Osaka
Electro-Communication University,Osaka,Japan; 2 Faculty of
Physical Therapy,Shijonawate-gakuen University,Osaka,Japan;
3 Faculty of Rehabilitation,Osaka prefectural University,Osaka,Japan
PURPOSE: Previous researches have revealed that maximum step
length of forward lunge (FL) motion in elderly persons was a
useful index for physical function and prevention of fall. There were,
however, few scientific reports focusing motion analysis of FL in
elderly persons, the changes of motion with aging was still unknown.
The purpose of this study was to clarify the characteristics of
forward lunge in elderly persons by motion analysis. RELEVANCE:
Knowledge of the characteristics of FL motion in elderly persons is
useful for developing the movement therapy that improves motor
function, prevents fall. PARTICIPANTS: Twelve elderly persons
(age 73.4 plusminus 4.9years) and ten young persons(age 20.7
plusminus 1.9years)as control group were participated in this
study.The subjects gave their informed consent to take part in the
experiment. METHODS: Twelve elderly persons (age 73.4 plusminus
4.9years) and ten young persons(age 20.7 plusminus 1.9years)as
control group were instructed to perform the FL with maximum
step length. Center of gravity (COG), joint motion and moment
of the lower extremity were analyzed using a motion analysis
system (VICON512) and force plate (AMTIOR6). ANALYSIS: The
comparison between two groups was performed by the Mann-
Whitney test. The level of statistical significance was set at p-value
less than 0.05. RESULTS: Maximum step length and changes of
COG (upwards-downwards, anterior-posterior) decreased in elderly
group compared with control group. Flexion angle and extension
moment of the hip joint decreased on the stepping leg in elderly
group. Flexion angle of the knee also decreased, but there was
no statistical difference in extension moment of the knee joint.
Extension angle and moments of the hip, extension moments of
the knee were decreased on the support leg in elderly group.
Dorsiflexion moments of the ankle joint also decreased on both legs
with backward phase. The decrease rate of motion and moment
on hip joint was largest on both legs in comparison to the control
group. CONCLUSIONS: Maximum step length and changes of COG
Poster Displays, Monday 4 June
with FL decreased in elderly group. These changes were mainly
reflected in reduction of motion and moment on the both hip joints.
IMPLICATIONS: These results suggest that motion and moment of
the both hip joints with FL were specifically decreased in elderly
persons. Movement therapy for stability and mobility of hip joint may
be useful for improvement of locomotive function, prevention of fall in
elderly persons. KEYWORDS: forward lunge, elderly persons, motion
analysis. FUNDING ACKNOWLEDGEMENTS: None. CONTACT:
koyanagi@isc.osakac.ac.jp
Research Report Poster Display
27-05 Monday 4 June 09:00
VCEC Exhibit Hall B & C
RISK FACTORS FOR CERTIFICATION OF LONG-TERM CARE
NEED AND HEALTH DECLINE AMONG ELDERS
Kage H1,2 , Okuda M2 , Nakamura I1,2 , Kunitsugu I2 , Sugiyama S2 ,
Hobara T2 ; 1 Yamaguchi Health and Welfare College; 2 Department
of Public Health, Yamaguchi University School of Medicine
PURPOSE: To investigate the predictive value of physical perfor-
mance measures for long-term care eligibility and functional decline
among Japanese elders living at home. RELEVANCE: Physical
therapists are frequently involved in assessment of and intervention
with elders at risk for functional decline. Early assessment and
intervention may postpone admission into long-term care services
as well as functional decline. PARTICIPANTS: 63 community-
dwelling subjects aged over 65 years were located through a
community-based fall risk reduction program, and volunteered to
participate in the study. METHODS: Grip strength, 10m gait speed
at maximum speed, one-leg standing time with eyes open and
functional reach were measured before and after a 2-month fall risk
reduction program. One year later, the subjects’ functional status
and need certification for long-term care were investigated. (Long-
term care service eligibility is certified on a uniform basis in all
parts of Japan.) ANALYSIS: Subjects were divided into groups: long-
term care eligible group and the long-term care ineligible group/
functional-declining group and functional-maintaining group. (1)One-
leg standing time at baseline was compared between the long-
term care eligible group and the long-term care ineligible group
using the Mann-Whitney U test. Other values at baseline were
compared between the two groups using Student’s t-test. The same
methods were used to compare the functional-declining group and
the functional-maintaining group. (2)Logistic regression analysis was
used to identify the risk factors for long-term care need or functional
decline. (3)Changes before and after the fall prevention program were
analyzed in the same way. RESULTS: (1) Comparison between the
long-term care eligible group and the long-term care ineligible group
at baseline showed significant differences in age (P = 0.001), 10m
gait time (P < 0.001), one-leg standing time (P = 0.001) and functional
reach (P = 0.006). In comparing the functional-declining group and
functional-maintaining group, there were significant differences in
10m gait time (P < 0.001), one-leg standing time (P = 0.017) and
functional reach (P = 0.015). (2) In logistic regression analysis, odds
ratio of occurrence of long- term care eligibility was significantly high
against 10m gait time when adjusted by sex and age(OR:1.64). Odds
ratio of functional decline was significantly high against 10m gait time
when adjusted by sex and age (OR:2.08), or adjusted by sex, age and
other performance measures (OR:2.13). (3) The impacts of changes
in performance before and after the intervention on long- term care
eligibility or health decline were not significant. CONCLUSIONS:
10m gait time is an effective predictor for long-term care need
certification and for functional decline. The study did not support the
use of changes in performance before and after a fall prevention
program as a predictor. IMPLICATIONS: Physical therapists should
remark gait speed as a predictor for functional decline of elders.
KEYWORDS: Elders, Predictor, Long-term care need. FUNDING
ACKNOWLEDGEMENTS: This study was unfunded.
ETHICS COMMITTEE: Kourei Fukushi department in Ube City
S205
Research Report Poster Display
28-03 Monday 4 June 15:30
VCEC Exhibit Hall B & C
THE EFFECTS OF AN INTERVENTION ON EXERCISE
ADHERENCE IN OLDER ADULTS DISCHARGED FROM
GERIATRIC DAY HOSPITALS: A PILOT STUDY
Ryan-Arbez N1 , Cooper J2 , Harvey D3 , Weinberg L1 ; 1 Department
of Physiotherapy, School of Medical Rehabilitation, University of
Manitoba; 2 Department of Occupational Therapy, School of Medical
Rehabilitation, University of Manitoba; 3 Faculty of Education
(Retired), University of Manitoba
PURPOSE: To evaluate the effectiveness of two interventions (home
visits and telephone calls) on self-efficacy of exercise, exercise
adherence, and mobility of community dwelling older adults following
discharge from Geriatric Day Hospitals (GDH). RELEVANCE: Older
adult mobility is challenged by the ageing process, chronic diseases
and sedentary lifestyle. Physiotherapist prescribe exercise programs
to older adults to improve mobility however adherence to exercise
rates (AER) after discontinuance of physiotherapy treatment is
unknown. PARTICIPANTS: Participants who were cognitively intact,
could read and speak English, had been prescribed an exercise
program for home and were discharged from GDH’s. METHODS:
A mixed method designed was used. Eighteen participants were
randomly assigned to a control, telephone intervention or home
visit intervention group. All participants were assessed for mobility
(Timed-Up and Go) [TUG], Berg Balance Scale [BBS] and confidence
to exercise (Self-efficacy for Exercise [SEE] one week after GDH
discharge. At 4 and 7 weeks after discharge, the interventions
participants received telephone calls or home visits whereby coun-
selling strategies to improve self-efficacy of exercise were performed.
At 10 weeks, all participants were reassessed (TUG, BBS, and
SEE) and AER were calculated; a qualitative interview was per-
formed to capture participants perceptions about barriers/facilitators
to exercise and outcome expectations for exercise. ANALYSIS:
ANOVA was used to compare group TUG pretest/posttest score
differences; Kruskal Wallis tests were used to compare group BBS
pretest/posttest score differences, group SEE pretest/posttest score
differences, and group AER. Spearman’s rank correlation coefficients
procedures tested the relationship between SEE pretest/posttest
score differences and AER, and the relationship between AER
and BBS pretest/posttest score differences. The Pearson product-
moment correlation coefficient was used to test the relationship
between AER and TUG pretest/posttest score differences. The
criterion for significance was p  0.05. Qualitative analysis used a
constant comparison of emerging themes. RESULTS: Although the
mean AER = 87.9±57.7%, only 59% of participant were exercising
at or above their prescribed rate. No significant difference was
found between groups for pretest/posttest score differences of
SEE, TUG, and BBS or for group AER scores. No significant
relationships were found between SEE and AER, AER and TUG
or AER and BBS. Participants reported that poor health, poor pain
control, poor self-discipline or motivation were barriers to exercise
adherence. The researcher identified participants’ lack of intention
to exercise and poor knowledge about exercise also contributed
to non-adherence. Furthermore, the researcher found that 45% of
intervention participants experienced exercise technique problems.
CONCLUSIONS: The quantitative results were inconclusive due to
the low power of the study; however qualitative evidence strongly
suggested that the older adults exercise behavior is compromised
after discontinuance of physiotherapy treatment. IMPLICATIONS:
Adherence to exercise and exercise and personal beliefs are mean-
ingful components of standard clinical physiotherapy assessment and
intervention. The barriers to exercise may be addresssed through
long-term provision of physiotherapy for older adults living in the
community. KEYWORDS: Older adults, exercise adherence, exercise
counselling. FUNDING ACKNOWLEDGEMENTS: Riverview Health
Centre, Winnipeg, Manitoba; and Department of Physical Therapy,
S206
School of Medical Rehabilitation, University of Manitoba. CONTACT:
ryanarbe@cc.umanitoba.ca
ETHICS COMMITTEE: Health Research Ethics Board, Bannatyne
Campus, University of Manitoba;
Research Report Poster Display
28-13 Monday 4 June 09:00
VCEC Exhibit Hall B & C
FALLS AMONG GREEK ELDERLY POPULATION ADMITTING
AT EMERGENCY DEPARTMENTS (EDS). A SIX-YEAR
EPIDEMIOLOGICAL STUDY
Strimpakos N, Gogou V, Apostolopoulos S, Spatharakis G,
Meliggas K, Kapreli E, Sakellari V, Gioftsos G; Department Of
Physiotherapy, Tei Lamias, Lamia, Greece
PURPOSE: To evaluate the incidence of falls and their consequences
in a Greek elderly representative sample leaving in Central Greek
region. RELEVANCE: Epidemiologic studies for the incidence of
falls in elderly are necessary to further elucidate risk factors for
falling and to direct preventive strategies. PARTICIPANTS: The
records of 204363 patients over 65, admitting the EDs of a local
hospital and two health centers in central Greece from January
2000 to December 2005 were reviewed retrospectively. METHODS:
Information about sociodemographic characteristics, health-related
behaviors, health status, falls and their consequences was collected
based on a structured data extraction form. ANALYSIS: Data was
analysed qualitatively as well as quantitatively by using percentages
and ratios RESULTS: 1.4% of patients presented at the EDs due to
a fall incidence, 23.3% being required hospitalization. The average
patient age was 75.2 (range= 65-102 years); male/female ratio 1:1.7.
Season was not a discriminative factor of falls. Falls’ aetiology
was known only in 14.6% cases due to underrecordable data,
making any estimation invalid. Based on incidence reports, 736
(25.8%) of those falls resulted in fracture. Hip fractures comprised
about 60% of total, while other most common areas were pelvis
(13%) and shoulder (10.7%). CONCLUSIONS: Falls in Greek elderly
community, in similar with other countries, are a great problem
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-
prevention programs should be directed towards Greek elderly people
and especially women. KEYWORDS: Falls, Elderly, epidemiology.
FUNDING ACKNOWLEDGEMENTS: This research as part of the
research project «Archimedes II» has been funded by grants from
the EC and the Ministry of National Education and Religious Affairs.
CONTACT: nikstrimp@teilam.gr
ETHICS COMMITTEE: Ethics Committe, Department of Physiother-
apy, TEI Lamias
Research Report Poster Display
28-17 Monday 4 June 09:00
VCEC Exhibit Hall B & C
FALLS AND FALL RISK IN OLDER ADULTS WITH HIP
OSTEOARTHRITIS
Arnold C, Faulkner R; University of Saskatchewan, Saskatoon,
Saskatchewan
PURPOSE: To determine fall risk, fall history, and circumstances
of falls in older adults with hip osteoarthritis (OA). RELEVANCE:
It is recognized that pain, loss of range of motion and reduced
strength,associated with hip osteoarthritis, may increase fall risk.
PARTICIPANTS: Men and women recruited for a larger intervention
study, over age 65 years, with hip pain present for 6 months or longer
and living independently in the community with no significant medical
or neurological conditions were eligible for this study. Of the 80 study
participants, 70% were female, mean age was 74 years (range 65 to
WCPT 2007, Research Reports
88) and 52% reported a diagnosis of hip OA by their family physician
or other health professional, the majority with confirmed radiology
diagnosis. METHODS: Participants were screened by a physiothera-
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).
ANALYSIS: Quantitative descriptive analyses were performed.
RESULTS: Forty-five percent of subjects reported one or more falls
in the past year defined as any body part coming into contact with the
ground or other lower surface. Ten percent reported two or more falls
in the past year. In total, 42 falls were described by 36 participants.
Approximately half of falls occurred in the home with the other half
occurring just outside the home or outdoors in the community. The
majority of falls were due to tripping on steps, curbs, obstacles (36%),
or slipping on ice, stairs, loose mats, wet floors (33%). Other reported
known causes included: getting up from a chair or bed,turning quickly,
leg giving away, reaching. Six of the 42 reported falls resulted in
a fracture (14%). Twenty-six percent of subjects reported injuries
other than fractures. Seventy percent reported near falls occurring
frequently (once a week or more, 30%) or occasionally (less than
once per week but more than once or twice in past year, 40%). Near
falls were defined as losing balance, slipping or tripping but able
to catch or stop fall before any body part touched the ground. The
mean score for the TUG test was 13 seconds (range 6.2 sec. to
37.5 sec.). Twenty-five percent of the sample scored 14 seconds or
greater, indicating a higher risk for future falls. Seventy percent scored
greater than 10 sec. Most healthy community living older adults would
score less than 10 sec. CONCLUSIONS: A sample of older adults
with hip OA reported falls and near falls in the past year. Injuries were
incurred with these falls including fractures. Tripping accounted for the
majority of falls which may be due to leg weakness, loss of motion or
proprioception. IMPLICATIONS: Identifying reasons for falling and fall
risk factors in this population are important in order to prevent serious
injury and develop effective physical therapy intervention strategies.
KEYWORDS: accidental falls, hip osteoarthritis, older adult, fall risk.
FUNDING ACKNOWLEDGEMENTS: Canadian Institutes of Health
Research; College of Medicine, University of Saskatchewan.
ETHICS COMMITTEE: University of Saskatchewan
Research Report Poster Display
29-21 Monday 4 June 09:00
VCEC Exhibit Hall B & C
FLUTTER® CAN REDUCE OBSTRUCTION IN CHILDREN WITH
PNEUMONIA
Lanza F1,2 , Gazzotti M1,2 , Luque A1,2 , de Paula C2 , Souto L2 ,
Santos L2 ; 1 Federal University os Sao Paulo/UNIFESP,Sao
Paulo-Brazil; 2 Sao Camilo University Sao Paulo-Brazil
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
of many methods of chest therapy which can improve secretion
mobilization, even for children because of its easy, and pleasure
caused on them. A technique to remove the secretion, after the
application of desobstruction technique, it is interesting, and forced
expiratory technique (FET) is one of them. Pneumonia is the
most important respiratory infection in childhood and this disease
results in the increase of mucus transport and the production of
pulmonary secretion; this situation can increase airway obstruction
and respiratory distress, it means that chest therapy may be useful.
The airway obstruction may be measured by mini-wright peak flow,
which measure peak expiratory flow (PEF). PARTICIPANTS: 18
children and teenagers between the ages of 6 and 15 years old,this
study was conducted inside a public hospital. METHODS: This was a
randomized case control study. There were 2 groups: the first group
was submitted to realize flutter for five minutes and FET (at the end of
flutter technique) until better pulmonary auscultation was noticed, at
least 3 times; the control group which only coughed until a enhanced
Poster Displays, Monday 4 June
pulmonary auscultation was noticed, also for at least 3 times. Res-
piratory rate (RR), PEF and pulmonary auscultation were performed
twice, before and after each protocol. ANALYSIS: Statistical analysis
was performed by ordinary ANOVA to compare between the groups,
and repeated analysis to compare in the group, statistica significance:
p < 0.05. RESULTS: There were not any differences between the
characteristics of patients (age, PEF, RR) at the beginning of the
study. There was an increase of PEF in the treated group after flutter
and FET utilization (186+25 lpmin before treat and 245+38 lpmin af-
ter, p < 0.05). There were not any changes in the control group before
and after treatment (167, 5+55 lpm, and 193, 7+44 lpm; p > 0.05).
There were not any changes in RR, but the pulmonary auscultation
was quality better only in treated group. CONCLUSIONS: Among
these patients diagnosed with pneumonia which were submitted to
flutter and FET, we observed a increase in PEF demonstrating that
chest physiotherapy may improve air flow in the lung when obstruction
by hyper secretion occurs. IMPLICATIONS: Tis is an easy technique
that the patient can used by yourself and can improve PEF and make
it in a hospital or in ambulatory sistem. KEYWORDS: chest physio-
therapy, Flutter® , pneumonia. FUNDING ACKNOWLEDGEMENTS:
None. CONTACT: Fernanda Lanza e-mail: fclanza@yahoo.com.br
ETHICS COMMITTEE: Ethics committee of General Hospital of
Pedreira, Sao Paulo-Brazil
Research Report Poster Display
30-01 Monday 4 June 09:00
VCEC Exhibit Hall B & C
VALIDITY OF THE HARRIS INFANT NEUROMOTOR TEST FOR
INFANTS FROM THE UNITED STATES OF AMERICA AND
INFANTS OF DIFFERENT RACES/ETHNICITIES
McCoy S1 , Smith-Blockley J1 , McConkey Bowman A1 , Sanders K1 ,
Megens A2 , Harris S3 ; 1 University of Puget Sound, Tacoma, WA,
USA; 2 Ottawa Children’s Treatment Centre, Ottawa, ON, Canada;
3 University of British Columbia, Vancouver, BC, Canada
PURPOSE: The first purpose was to collect data on the newly
developed Harris Infant Neuromotor Test (HINT) in the United States
of America (USA), and compare it to data previously collected
in Canada. Secondly, HINT scores from infants of ethnicities
(Hispanic/Latino or not), and races (African American, Asian, Pacific
Islander, and of more than one race) were compared to white infants.
We hypothesized that there would be no difference in HINT scores
between infants from USA or Canada, or across infants of different
color. RELEVANCE: The HINT is a screening tool developed to as-
sess infant neuromotor development. Although HINT data have been
collected in Canada, this is the first study examining data on USA in-
fants and infants of different color. If Canadian norms are appropriate
for infants from USA and infants of color, then we could support the
use of the test within the USA. PARTICIPANTS: Forty-three healthy
infants, age 0 to 12 months were recruited for testing from the USA
via convenience and snowball sampling. Infants were from the states
of Washington, Idaho, and Hawaii. Thirty-two infants in the USA
group were compared to 32 age, parental race/ethnicity, and parental
education matched infants from Canada. The Canadian data were
provided by the HINT author. Twenty-eight infants from USA (14 per
group) were age and gender matched for the comparison of white
infants with those of color. METHODS: HINT testing took place either
in the infants’ homes or in healthcare facilities. Data were collected by
DPT students from the University of Puget Sound, Tacoma, WA. Inter-
rater reliability [ICC(3,1) = 0.715–0.984] was established for all raters
during pilot testing through comparison to a physical therapist trained
and verified as reliable by the HINT author. ANALYSIS: HINT data
were verified to be normally distributed across groups. Differences
between HINT scores in the USA and Canadian groups and between
the groups of infants of color and white infants were analyzed via
independent samples t-tests and Chi-Square tests of independence,
using an a < 0.05. RESULTS: There were no significant differences
between the USA and Canadian groups for subject age, parental
S207
race/ethnicity, or parental level of education. The HINT total scores
between infants from USA and Canada showed no statistically
significant difference. There also were no significant differences
between age, genders and total HINT scores of the infants of color
and those who were white. CONCLUSIONS: The hypotheses of no
difference between USA and Canadian infants and USA infants of
various races and ethnicities were confirmed. A follow up study with a
larger subject pool would strengthen these results. Additionally, HINT
data for infants of color should be evaluated through comparison
of infants of individual racial or ethnic backgrounds to infants
who are white to determine the need for specific racial or ethnic
group norms. IMPLICATIONS: Based on the results, there is some
justification that norms developed from previously collected data on
infants from Canada could be appropriately applied in the USA.
Larger numbers of subjects should be evaluated to confirm this
result. KEYWORDS: infant screening, neuromotor development,
ethnic comparison. FUNDING ACKNOWLEDGEMENTS: University
of Puget Sound, Tacoma, WA, USA, Enrichment Committee Student
research Awards #SR0543. CONTACT: swestcott@ups.edu
ETHICS COMMITTEE: University of Puget Sound Internal Review
Board Committee, Tacoma, WA, USA
Research Report Poster Display
30-05 Monday 4 June 09:00
VCEC Exhibit Hall B & C
EFFECT OF MASSED PRACTICE TRAINING ON ANTICIPATORY
POSTURAL ADJUSTMENTS IN CHILDREN WITH CEREBRAL
PALSY
Chang H1 , Liu W1,2 , Lien H1 , Wong A1,2 , Jeng S3 , Hung W4 ;
1 Graduate Institute of Rehabilitation Science, Chang Gung
University, Kweishan, Taoyuan, Taiwan; 2 Department of Physical
Medicine and Rehabilitation, Chang Gung Memorial Hospital,
Taoyuan Branch, Kweishan, Taoyuan, Taiwan; 3 School and
Graduate Institute of Physical Therapy, College of Medicine,
National Taiwan University, Taiwan; 4 School of Sports Medicine,
China Medical University, Taiwan
PURPOSE: Children with cerebral palsy (CP) typically develop
inefficient, unsafe and laborious anticipatory postural adjustments
(APA). This study examined APA changes in CP children after
massed practice reaching a moving target while standing, and
explored the effect after massed practices with an external postural
support. RELEVANCE: This study is related to physical therapy
management for balance training in CP children. PARTICIPANTS:
Twelve children aged 3–12 years with spastic CP participated in this
study. They were divided into a massed practice only (MA group)
and a massed practice with external postural support group (EX+MA
group) according to their functional standing abilities. METHODS: A
pretest-posttest repeated measure study design was used. Children
in both groups practiced a functional forward reach task with moving
target for 60 trials on 3 consecutive days. Assessments took place on
four occasions: 3 days prior to practice (1st baseline test), one day
prior to practice (2nd baseline test), one day after practice (immediate
test), and 3 days after practice (short-term retention test). The APAs
were recorded by center of pressure (COP) and electromyography
(EMG) measurements as they reached forward for a stationary target
while standing. ANALYSIS: One-factor repeated measure analysis
of variance (ANOVA) and Friedman test were applied to identify
the changes to APA and speed in reaching the target. Two-factor
repeated measure ANOVA was used to compare changes between
the MA group and the EX+MA group. RESULTS: Despite the small
sample size, children demonstrated more consistent basic spatial
parameter, i.e., posterior shift during the APA period following massed
practice. Moreover, absolute time delay between COPy excursion and
reach movement, representing the relationship between focal move-
ment and postural movement was significantly reduced]. The EX+MA
group had a significantly increased frequency of posterior APA COPy
excursion, whereas the MA group did not. CONCLUSIONS: The
S208
results demonstrated that the APA development can be facilitated
by massed practice training in children with spastic CP. No adverse
effects during training were noted for either group. IMPLICATIONS:
This massed practice training was clinically feasible and effective
for children with spastic CP who had Gross Motor Functional
Classification System (GMFCS) levels I–III. KEYWORDS: massed
practice, anticipatory postural adjustment, cerebral palsy. FUNDING
ACKNOWLEDGEMENTS: The authors would like to thank the
National Science Council of the Republic of China, Taiwan, for
financially supporting this research under Contract No. NSC 93-2314-
B-182A-065. CONTACT: m9306001@stmail.cgu.edu.tw
ETHICS COMMITTEE: Institutional Review Board Chang Gung
Memorial Hospital, Taiwan
Research Report Poster Display
31-09 Monday 4 June 09:00
VCEC Exhibit Hall B & C
CHANGES IN QUALITY OF GROSS MOTOR PERFORMANCE
FROM 6-12 YEARS OF AGE
Watter P, Burns Y, Martin K, Cahill M, Doherty D, Brameld C;
The University of Queensland, Australia
PURPOSE: This study measured changes in quality of gross motor
performance in children aged 6-12 years using a clinical measure
of movement quality. Gender differences were also explored.
RELEVANCE: While physiotherapists evaluate a child’s ability to
perform a particular movement, it is equally important to consider
the quality of the movement performed. Quality of movement
performance relates to ease and efficiency of movement, affecting
the child’s ability to participate adequately in typical activities of daily
living. For example, if a child’s movement looks different then others
may exclude her/him from group activities, and if s/he fatigues due
to motor inefficiency, s/he cannot sustain participation. This study
described simple criteria which many physiotherapists use when
assessing children’s quality of movement, and evaluated the change
in these in typical children between 6 and 12 years of age. This
knowledge will provide a basis for comparison when assessing chil-
dren with motor impairment, and evaluating intervention outcomes.
PARTICIPANTS: A sample of convenience, 508 children (294 girls,
214 boys, was recruited from schools representing private and public
sectors, city/ suburban, and higher/ lower socioeconomic areas within
the greater Brisbane area, Queensland, Australia. Children were
included if they: were within 3 months of their 6th −12th birthday,
participated in standard curriculum in school, were well on the day
of testing, and provided informed signed consent. Children were
excluded if they had a known diagnosis likely to affect performance,
sensory loss, a history of severe sprain in the last 12 months or any
fractures. METHODS: Quality of performance during five gross motor
tasks was rated on a 1-3 scale for: jump a line (forward/ back and side
to side directions), astride jump, face stand maneuver, target foot ac-
curacy and standing long jump. Task order was randomized. Standard
instructions, practice and rest periods were given. Sixty-two children
distributed across all age groups were re-tested after one week for
reliability purposes. ANALYSIS: Cronbach’s Alpha Intraclass Correla-
tion (ICC) evaluated test-retest reliability of each task. Kruskal-Wallis
tests determined the effect of age and gender on test scores for each
task, with p set at 0.05. RESULTS: ICC ranged from r= 0.6- 0.8. Age
influenced the quality of motor performance in all tasks (chi squares
= 63-112, all p’s = 0.001), with the standing long jump just significant
(chi square =12.4, p = 0.05). Gender influenced the quality of motor
performance in the jump tasks only (chi squares = 9.5-54.7, p’s =
0.001- 0.002), with girls generally better than boys. CONCLUSIONS:
In typical children, the study demonstrated improvement in movement
quality on all tasks between 6-12 years, and the superiority of girls’
performance quality over boys for the jump tasks. Further studies
utilizing the criteria with client groups will demonstrate whether
they differentiate between client and typical groups, and if they
are useful for treatment prescription. IMPLICATIONS: The study
WCPT 2007, Research Reports
provides knowledge about motor performance in typical children,
informing our ability to more adequately assess children with impair-
ments, and to optimally direct intervention programs. KEYWORDS:
children; movement quality;development with age. FUNDING
ACKNOWLEDGEMENTS: The Financial Markets Foundation for
Children funded this project. CONTACT: p.watter@uq.edu.au
ETHICS COMMITTEE: Medical Research Ethics Committee, The
University of Queensland
Research Report Poster Display
31-13 Monday 4 June 09:00
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;
3 The Institute of Statistical Mathematics; 4 Faculty of Education,
Saitama University
PURPOSE: General movements (GMs) are part of the spontaneous
movement repertoire and are the most frequently occurring move-
ments in infants. They occur endogenously without any external
stimulation and are present from early fetal period until the end of
the first six months of life. This study investigated how their mother
or a nurse talking influenced the patterns of GMs in newborn preterm
infants. RELEVANCE: One of the important roles of physical therapist
is to promote a good relationship between a mother and an infant
in the Neonatal Intensive Care Unit (NICU). The parent hopes to
know how to build up a good relationship with their infant for his
good development in the future. This study gives a measure of
mother infant interaction by observing movement patterns of GMs.
PARTICIPANTS: Twelve low-risk newborn infants born preterm (23-
33 weeks postmenstrual age at birth) participated in this study.
METHODS: Before observing GMs, we recorded the voices of the
mother of each infant and a nurse on compact disks. Reflective
markers were attached to the infants’ wrists and ankles and the
infants were videotaped from above while in the supine position
when they were moving spontaneously without any stimulation at
35-41 weeks of postmenstrual age. We also filmed their movements
during the presentation of talking by their mothers or the nurse.
ANALYSIS: Using a two-dimensional image analysis system, we
digitized the movement pattern and analyzed the data statistically
to assess the pattern of GMs in addition to using Prechtl’s evaluation
method. We analyzed the first differences of the original time series
data using autocorrelations and estimated spectral density functions
adopting AR time series models. RESULTS: Eleven out of the 12
participants significantly reduced their movement speed and variance
of movements and sometimes stopped their movements on the
presentation of talking by their mothers or a nurse, as compared
to the non-stimulation period. We used the Wilcoxon signed-rank
test to ascertain these results. No obvious change in the GMs was
found between non-stimulation and the mother talking by observing
estimated spectral density. CONCLUSIONS: We found that infants
reduced their movements when they listen to their mothers or a
nurse talking. This suggests that it is useful for the facilitation of
mother infant interaction to talk to the infants when they are in a
stable state. We found no clear qualitative change in GMs between
non-stimulation and the mother talking. This result suggests that
some parts of the system that generate GMs in newborn infants
are not affected by social interactions at this time. IMPLICATIONS:
Physical therapists working in the pediatric area are able to
support parent to understand their infant more and facilitate mother
infant interaction by observing the movement patterns of general
movements. KEYWORDS: General Movements, Mother talking,
preterm infant. FUNDING ACKNOWLEDGEMENTS: unfunded.
ETHICS COMMITTEE: the ethics committee of Nagano Children’s
Hospital
Poster Displays, Monday 4 June
Research Report Poster Display
31-17 Monday 4 June 09:00
VCEC Exhibit Hall B & C
EFFICACY OF AN INTERDISCIPLINARY OUTPATIENT PAIN
MANAGEMENT PROGRAM
Scascighini L, Litschi M, Walti M, Sprott H; University Hospital Zurich,
Department of Rheumatology and Institute of Physical Medicine
PURPOSE: To investigate the effect of an interdisciplinary outpatient
pain program (IOPP) in a population with chronic pain syndromes.
RELEVANCE: Numerous inpatient and outpatient pain manage-
ment programs exist worldwide to treat chronic pain conditions.
Unfortunately, this therapeutic approach is usually introduced at
a very late stage and often as the last choice when other
interventions have failed. The long-term improvements are scarcely
reported in the literature. PARTICIPANTS: Patients with persisting
pain conditions showing psychosocial strain who completed an
IOPP. Between April 2001 and December 2005 176 patients (ICF-
b280) were included. The gender distribution was 32.1% male and
67.9% female, (age 43 years ±9.6, range 20 to 67). METHODS:
The IOPP is a multi-professional, bio-psychosocial oriented pain
program on an outpatient basis. The patients undertook an intensive
schedule, composed of different therapeutic units consisting of group
and individual therapy two mornings a week for a duration of
8 weeks. Current pain intensity, best, worst, and average of the
last week, were rated in an 11-point numeric rating scale (NRS).
Supplementary validated questionnaires were completed covering
principal outcomes, including the German version of Pain Disability
Index (Hermann et al.1995), cognitive and behavioral coping
strategies and psychological impairment (Verarbeitung chronischer
Schmerzen, Geisser et al. 1999), the Marburger questionnaire
about well-being (Basler 1999) and the questionnaire concerning
the processing of chronic pain (Fragebogen zur Erfassung der
Schmerzverarbeitung-FESV, Geisser et al. 2001). ANALYSIS: We
analyzed the participants in a single, prospective cohort design with
measurements at baseline, post-treatment, 3, 6, and 12 months.
Paired samples t-tests with a two-tailed significance level of p < 0.05
were calculated to compare the means across the follow- up times.
RESULTS: All mentioned variables, excepted pain intensity (NRS),
improved significantly immediately after the program. Whereas, after
the 1 year follow-up, most of the parameters returned to the baseline
values. Solely the subscale “Psychological impairment” remained
statistically significantly better compared to baseline (p < 0.05).
CONCLUSIONS: This study provides evidence for short-term effect
of an outpatient interdisciplinary program in chronic pain patients.
Moreover, our results suggest that periodical quality assessment
may have important consequences for further multidisciplinary
interventions. Indeed, this would allow to reflect and objectify the
quality of the therapeutic offer and therefore help in focusing and
optimizing the goals of the patients as well the contents of the
program IMPLICATIONS: The findings of this quality assessment
has led the IOPP team to introduce a refresher appointment with
the patient at 4 months post-intervention to attain, modify or set new
goals. Further strategies to achieve sustained long-term effects are
needed. KEYWORDS: chronic pain, interdisciplinary treatment, out-
patient, quality assessment. FUNDING ACKNOWLEDGEMENTS:
No funding. CONTACT: luca.scascighini@usz.ch
Research Report Poster Display
32-12 Monday 4 June 09:00
VCEC Exhibit Hall B & C
PARTNERSHIP PERSPECTIVES: CHANGING THE IMAGE OF
PHYSICAL THERAPY IN URBAN NEIGHBORHOODS THROUGH
COMMUNITY SERVICE LEARNING
Golub-Victor A, Lowe S, Fitzpatrick D, Freeman E; Northeastern
University, Boston, Massachusetts, United States
PURPOSE: The primary purpose of this study was to examine the
community’s perception of physical therapy. A secondary objective
S209
was to determine if community service learning was a venue for
impacting the community’s understanding of the scope of physical
therapy. RELEVANCE: To be an effective first contact practitioner,
the public must have a clear understanding of the scope of the
physical therapy profession. A review of the literature revealed
that the perception of physical therapy has been studied in Great
Britain, Hong Kong, and Australia but not in the United States.
PARTICIPANTS: Fifty three residents of an urban community and
8 community agency outreach workers and program directors who
were community service learning partners of an urban university
located in the northeast United States were included in this study.
Community residents who participated were predominately elders
(mean age 62.5, range 35-95 years) living within the same urban
area and volunteered to participate. METHODS: This mixed design
study featured data triangulation, including a review of the literature
regarding community perception of physical therapy, a community
resident survey, and community partner focus group and interview.
Community residents were queried about their understanding of
physical therapy. Community partners were asked three open-ended
questions in focus groups or interviews. ANALYSIS: Transcripts of
the focus groups and interviews were coded to reveal common
themes, trends, key words, and specificity of responses. Coding was
accomplished individually by each researcher and then collectively.
Descriptive statistics and chi square analysis were performed
on the survey data. RESULTS: Sixty four percent (64%) of
community residents reported they had seen a physical therapist;
36% participated in weekly community service learning physical
activity programs; and 89% knew that one needed to be licensed
to practice physical therapy. Only 45% of the residents knew that
physical therapists needed a college education. Community partners
reported an improved understanding and positive perception of the
physical therapy profession through community service learning. A
review of the literature revealed that the impact of service learning
on community perceptions of physical therapy has not been studied
in much detail. CONCLUSIONS: This pilot study may be one of
the first to investigate public perceptions of physical therapy in
the United States. Community partners and residents who have
been exposed to physical therapy may have a better understanding
of the profession than those who have not. Community partners
and residents who have been exposed to physical therapy through
community service learning have a positive understanding of the
benefits of exercise on their health and a more positive relationship
with the university. IMPLICATIONS: Community service learning
appears to be an educational pedagogy to help physical therapists
move towards their emerging role as first contact practitioners as
it may increase consumer awareness of physical therapy services.
Further studies addressing the public’s perception of physical therapy
are essential if we are to be recognized by consumers and other
health care professionals as direct entry into the health care system.
KEYWORDS: community service learning, community perceptions,
physical therapy. FUNDING ACKNOWLEDGEMENTS: This work
was unfunded.
ETHICS COMMITTEE: Institutional review board approval for this
project was obtained through Northeastern University’s Division of
Research Integrity.
Research Report Poster Display
32-21 Monday 4 June 09:00
VCEC Exhibit Hall B & C
PHYSIOTHERAPISTS’ JOB SATISFACTION IN ISHIKAWA
PREFECTURE, JAPAN
Araki H1 , Ogiwara S2 ; 1 Department of Medical Rehabilitation
Services, Kariya Toyota General Hospital, Kariya, Aichi, Japan;
2 The University of Kanazawa, Kanazawa, Ishikawa, Japan
PURPOSE: Healthcare professionals are prone to burnout. One
factor for this may be job dissatisfaction. The purpose of this study
was four-fold: 1) to provide evidence to show whether or not clinicians
S210
in Ishikawa Prefecture were satisfied with the level of professional
practice of physiotherapy; 2) to find out which factors caused
satisfaction or dissatisfaction; 3) to determine if the statements
presented in this study were considered relevant and appropriate
as a measure for job satisfaction in clinical practice; and 4) to
contrast the findings of this study with those of the Speakman et al’s.
RELEVANCE: This study would help contribute to our knowledge
of the positive and negative aspects in daily working conditions of
physiotherapists. PARTICIPANTS: A convenience sample of 352
physiotherapists in Ishikawa Prefecture participated in a mailed
survey. METHODS: A questionnaire using the Japanese version of
the Speakman’s scale sought the clinicians’ responses to 10-item
statements related to their job concerning paperwork, challenge,
physical demand, professional autonomy, fulfillment, and stress.
Specifically, the respondents were asked to rate their level of
agreement or disagreement for each of the statements on the seven-
point Likert-type scale. In order to examine the relevance of the 10-
item statements in regards to physiotherapists the respondents were
then asked to indicate how important they felt that the statement
related to their job satisfaction on a seven-point scale of importance.
ANALYSIS: Using the chi-square test, tests of independence
were carried out between gender and professional experience and
between gender and professional status. We also used the two-
tailed Mann-Whitney U test to analyse the difference between gender
and professional status. In addition, the Kruskal-Wallis test was
employed to compare among the groups the influence of their length
of professional experience, and this was accompanied with the use
of the Steel-Dwass test as required. RESULTS: The final sample
consisted of 183 (52.3%) questionnaires. The degree of agreement
with the scale was moderate (range: 3.0-5.6), though the respondents
considered themselves to be engaged in rewarding work. The
causes of their job dissatisfaction were excessive paperwork and
physical/mental stress. The degree of importance for the scale as a
measure of job satisfaction was also moderate (mean score: 4.9), as
opposed to that of their American colleagues who rated it high when
Speakman et al. conducted their study in 1996. CONCLUSIONS:
The respondents were able to find the positive aspects of their
job despite feeling stressed and discontented. They also may have
found the ‘hygienes’ factors such as salary and fringe benefits to
be of more importance for their daily job satisfaction. The results
should be interpreted in terms of culture and mores, differences in
healthcare systems and the time period in which the studies were
conducted. IMPLICATIONS: The findings provide us with possible
clues as to the solving of work-related problems, such as ones that
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,
and ethics approval was not required. CONTACT: EBreha@toyota-
kai.or.jp
Research Report Poster Display
33-01 Monday 4 June 09:00
VCEC Exhibit Hall B & C
RELIABILITY AND VALIDITY OF A PHYSIOTHERAPIST-DOCTOR
RELATIONSHIP SCALE
Sakamoto N, Ogiwara S; The University of Kanazawa
PURPOSE: A client’s expectation focuses on the expertise and
competence of each healthcare professional. One factor that
demonstrates whether the expertise offered by the professional
benefits a client is the viable working relationship among them.
The physiotherapist-doctor relationship (PDR) scale measures
the affective attitude component in this relationship. This study
focuses on the reliability and validity of this scale. RELEVANCE:
Psychometric measures must possess high reliability and validity.
In addition, precision instruments must be standardised and proven
viable to enable evidence-based study of PDR. Verification of the
WCPT 2007, Research Reports
PDR scale would therefore be conducive to future research on PDR
in Japan. PARTICIPANTS: A convenience sample of 144 out of 237
physiotherapy clinicians in Toyama Prefecture, Japan, participated.
METHODS: The PDR scale was used in the form of a mailed
survey. It contained 17 Likert-type statements to be responded
to within a five-point range, from ‘strongly agree’ to ‘strongly
disagree.’ ANALYSIS: The reliability of the scale was assessed
as homogeneity, and its validity as construct validity using the
Spearman’s rank correlation coefficient, followed by the calculation
of the Cronbach’s alpha reliability estimates. As for construct validity,
the responses to all of the statements were submitted to a factor
analysis; in this case, a principal component analysis with varimax
rotation. The number of factors was determined by using the factor
scree plot. We then carried out a second-order factor analysis using
the factors from the first-order factor analysis. This was followed by
the calculation of the alpha reliability coefficients in order to verify the
internal consistency of each of the factors. In addition, convergent
validity was addressed by using the stepwise multiple regression
analysis on the respondents’ background as the independent variable
and the PDR scale as the dependent variable. This was accompanied
by the use of the two-tailed Mann-Whitney U test. RESULTS: The
rate of return was 61.2%. The women-to-men ratio was equal with 72
men and 72 women. Fourteen out of the 17 statements were found
to have significant item-to-total correlations. The Cronbach’s alpha
estimate for the scale was 0.76. Some evidence for construct validity
was found in the four-factor solution, which explained 45.7% of the
total variance. Factors derived from Spearman’s rank correlation and
factor analysis were ‘understanding,’ ‘desire to learn,’ ‘collaboration,’
and ‘stand-in,’ with the rate of contribution (Cronbach’s alpha) being
being 24.39% (.70), 10.96% (.78), 5.54% (.72), and 4.83% (.69),
respectively. Strong evidence for construct validity was demonstrated
in the scale’s ability to differentiate between individuals whose age
ranged from 20 to 30 years old and those older than 40 years of age
with a mean score of 51.2 vs. 46.7. Convergent validity, as a form of
construct validity, was also supported for the scale. CONCLUSIONS:
The PDR scale has been proven to be a reliable instrument for a
group-level comparison in the current study population and can be
considered a reliable and valid measure of documenting trends of
importance in regards to PDR in Japan. IMPLICATIONS: The PDR
scale can be used for cross-sectional as well as longitudinal studies of
PDR. KEYWORDS: Physiotherapist-doctor relationship (PDR) scale,
Reliability, Validity. FUNDING ACKNOWLEDGEMENTS: This work
was unfunded, and ethics approval was not required. CONTACT:
nori0103t5@hotmail.com
Research Report Poster Display
35-21 Monday 4 June 09:00
VCEC Exhibit Hall B & C
HOW DOES THE USE OF VIDEO INFLUENCE THE
THERAPEUTIC SITUATION UNDER INVESTIGATION?
Hauksdottir N; University of Tromso, Norway
PURPOSE: In a recent study, I described, analysed and discussed
bodily and verbal communication in treatment. In this presentation
I want to focus on how video as a tool for assisting observa-
tion of physiotherapy practice affected the investigated practice.
RELEVANCE: Qualitative studies of physiotherapy practice as it
unfolds in the relation between the physiotherapist and the patient,
are vital in todays research. The vast body of research seems
to be within EBP and quantitative studies, which then are given
the power to define what is “good” and “updated” practice. That
leaves experienced based knowledge and physiotherapy practice
as it actually is out of focus. We still need to explore practice
itself. To do so, qualitative studies, and methods like observation
and video are useful. What considerations are then to be made?
How should the researcher handle questions like: One or more
cameras? The observer in or out of the room? What parts of the
situation should be in focus of the camera? The answers to these
Poster Displays, Monday 4 June
questions will have an impact on the situation you are observing
and on the data you get. And: How does the observation influence
on the situation and on the therapists decisions? PARTICIPANTS:
One physiotherapist working with outpatients in a big hospital,
considered as an “expert”, treating two different patients. METHODS:
Two sequences in neurological physiotherapy were observed and
videotaped. Afterwards the physiotherapist was interviewed while we
were watching the video together. ANALYSIS: The video footage
was thoroughly analysed and described in text. The interview was
used as a comment to what was observed in the situation and
on video. RESULTS: Many studies have concluded that observing
by video does not influence the observed situation. In my study
however, I found that the participants were very much aware of the
observer, and that they concentrated on not to show their awareness.
The interview stated that some of the physiotherapists decisions
regarding treatment actually were influenced, and that some aspects
of the treatment were paid more attention to. CONCLUSIONS:
Observation and the use of video will to some extent influence on the
situation that unfolds between the two parts, and on the treatment
given by the physiotherapist. By looking further into these decision
making processes and aspects,one will understand more about what
physiotherapists emphasise during practice, and what their profes-
sional beliefs are. IMPLICATIONS: In qualitative research studies,
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,
physiotherapy practice. FUNDING ACKNOWLEDGEMENTS: Fond
for etter og videreutdanning av fysioterapeuter, Norway. Tromso
University College, Norway. CONTACT: Nanna.Hauksdottir@hitos.no
ETHICS COMMITTEE: Norsk samfunnsvitenskapelig datatjeneste,
Norway
Research Report Poster Display
36-01 Monday 4 June 09:00
VCEC Exhibit Hall B & C
DISCRIMINATIVE VALIDITY OF THE DUTCH VERSION OF THE
ACTIVITIES SCALE FOR KIDS (ASK-NL)
van der Net J1 , Stukstette M1 , Takken T1 , Engelbert R1 , Young N2 ,
Helders P1 ; 1 University Children’s Hospital UMC at Utrecht, The
Netherlands; 2 Laurentian University, Sudbury,ON, Canada
PURPOSE: To determine discriminative validity of the Dutch version
of the ASK (ASK-NL) between different childhood chronic conditions.
RELEVANCE: The ASK is a generic self report measure to
describe and evaluate change in the level of daily life capabilities
and performance in children 5-15 years (Young 2000). The ASK
provides insight in children’s capabilities and level of performance
that are important for healthcare professionals for their clinical
reasoning process by formulating and evaluating treatment goals.
PARTICIPANTS: In order to investigate the discriminative validity
of the ASK-NL, 97 children above the age of 7 years and a good
understanding of the Dutch language were selected. The children
were classified in four distinct diagnostic groups: A] musculoskeletal
conditions (n=32, e.g. Osteogenesis Imperfecta, Achondroplasia,
Juvenile Idiopathic Arthritis and Dermatomyositis), B] neuromuscular
conditions (n=28, e.g. Spina Bifida, Cerebral Palsy, Sjögren Larsson),
C] miscellaneous conditions affecting physical functioning (n=23, e.g.
severe Haemophilia, renal insufficiency, congenital heart disease).
D] A group of healthy children (n=14). Informed consent of all
children was obtained. The local board of ethics approved this
study. METHODS: In all children the level of ambulation was
classified according the modified Bleck criteria (1981). All children
filled out the ASK-NL, both the capability and the performance
version, supervised by their physiotherapist (MS), at a school for
special education ‘Ariane de Ranitz’, Utrecht, The Netherlands
or by their physiotherapist on a regular outpatient clinic of the
Children’s Hospital Utrecht, The Netherlands (JN, RE), or when
S211
participating in an outcome studies from the Department of Pediatric
Physical Therapy & Exercise Physiology of this hospital. Healthy
children were recruited by family and friends of the researchers.
ANALYSIS: Skewness in the patient population was assessed
with the Pearson skewness statistic. Discriminative validity between
different subgroups was examined by analyses of variance (ANOVA).
ANOVA’s were corrected with Bonferoni test for multiple post hoc
comparisons. All analyses were performed with SPSS 11.5 (SPSS
Inc, Chigago, III). RESULTS: Median Bleck scores (A: 9.0; B: 4.5;
C: 9.0; D; 9.0.) differed significantly between the four groups. Mean
ASKp-NL (A; 76.3; B: 61.7; C: 94.0; D; 86.6) (p < 0.001) and mean
ASKc-NL (A: 82.4; B: 69.2; C: 95.2; D: 94.0) (p < 0.001) differed
significantly. Age was not correlated with both ASK-NL versions.
Boys scored not significantly better than girls. CONCLUSIONS:
Both versions of the ASK-NL can discriminate between children
with musculoskeletal conditions and children without musculoskeletal
conditions and between children with neurological conditions and
children without neurological conditions. IMPLICATIONS: The Dutch
language versions of the ASKc-NL and ASKp-NL are valid generic
functional outcome measures ready use in for clinical practice
and disability research. KEYWORDS: Functional Outcome; Physical
Activity; Childhood. FUNDING ACKNOWLEDGEMENTS: not appli-
cable. CONTACT: j.vandernet@umcutrecht.nl
Research Report Poster Display
36-05 Monday 4 June 09:00
VCEC Exhibit Hall B & C
APPLICATION OF RASCH ANALYSIS TO THE KOREAN
VERSION OF THE GROSS MOTOR FUNCTION MEASURE
Park S1 , Velozo C1 , Yi C2 , Kwon H3 , Kwon O2 , Ahn D4 , Jeon H2 ;
1 University of Florida, Gainesville, USA; 2 Yonsei University, Wonju,
Korea (South); 3 Daegu University, Daegu, Korea(South); 4 Inje
University, Kimhae, Korea(South)
PURPOSE: The purpose of this study was to investigate the item-
level psychometrics of a Korean translation of the Gross Motor
Function Measure (GMFM) using Rasch analysis. RELEVANCE: The
translated GMFM is the most widely used outcome measure in Korea.
Unfortunately, the translation is based on an earlier version of the
GMFM and there is little evidence that the translated instrument
shows good psychometric characteristics. PARTICIPANTS: The
participants were 206 Korean children with cerebral palsy diagnosed
by physician. Their mean age was 4.9 years (range: 8 months to
14.5 years). METHODS: The Korean GMGM user’s manual was
re-translated to reflect the most recent changes to the English
version. The final translation was based on unanimous agreement
of 29 Korean physical and occupational therapists on both the
manual text and item definitions. GMFM data for 206 children with
cerebral palsy were then collected by the 29 therapists across 11
outpatient rehabilitation facilities in Korea between August 2004
and April 2005. ANALYSIS: The Winsteps software program was
used to assess whether the Korean version of the GMFM fit the
Rasch measurement model. RESULTS: The re-translated version of
the GMFM demonstrated good internal construct validity showing a
person separation reliability of 0.99 (analogous to Cronbach’s alpha).
The GMFM has a person separation index was 12.7 which indicates
that the instrument separates the sample into 17.3 statistically
significant strata. Ninety-six percent (85/88) items fit the Rasch
model. The items, “Supine: Lift head 45 degrees,” “Supine: Flexes
right hip and knee through full range,” “Supine: Flexes left hip and
knee through full range” showed high infit statistics. In general,
the order of item difficulty of the remaining 85 items showed a
logical item difficulty hierarchy with the “lying and rolling” items being
the easiest and the “jumping and hopping” items being the most
difficult. CONCLUSIONS: The Korean version of the GMFM shows
outstanding item-level psychometric qualities. IMPLICATIONS: This
study suggests that the translated GMFM produces valid measures
of gross motor ability in children with cerebral palsy and furthermore
S212
appears to be sensitive in differentiating children with different
gross motor abilities. KEYWORDS: Cerebral palsy, Rehabilitation,
Treatment Outcome. FUNDING ACKNOWLEDGEMENTS: This
study was unfunded. CONTACT: soyeonparkpt@gmail.com
Research Report Poster Display
37-09 Monday 4 June 09:00
VCEC Exhibit Hall B & C
CHANGES IN FUNCTIONAL WALKING DISTANCE AND
HEALTH-RELATED QUALITY OF LIFE AFTER GASTRIC BYPASS
SURGERY
Tompkins J1 , Bosch P2 , Chenowith R2 , Swain J1 , Tiede J1 ; 1 Mayo
Hospital, Scottsdale, USA; 2 AT Still University, The Arizona School
of Health Sciences, Mesa, USA
PURPOSE: The primary purpose of this study was to measure
distances walked in a six minute walk test (6MWT) and scores on the
RAND 36-Item Survey (RAND-36) prior to undergoing gastric bypass
surgery (GBS), and at 3 and 6 months post-GBS. A secondary
purpose was to assess the relationship between perception of health-
related quality of life (QOL) and functional capacity before and after
GBS. RELEVANCE: Many individuals undergo weight-loss surgery
in an effort to manage morbid obesity. Prior to undergoing GBS
patients are given recommendations regarding post-surgery lifestyle
modifications, including the need to exercise regularly, yet specific
recommendations are generally not made. Currently, little research
is available on changes in functional capacity as a result of weight-
loss surgery, particularly during the first six months following GBS.
This information is needed in order to prescribe exercise programs
for individuals after GBS. PARTICIPANTS: Subjects included 26
individuals (24 females and 2 males) with a mean age of 44 ±6.3
years and a mean body mass index (BMI) of 45.5 ±6.9 who were
undergoing roux-en-y gastric bypass surgery. METHODS: Prior to
surgery (pre-GBS), then at 3 and 6 months post-GBS, subjects
completed the RAND-36 and performed a 6MWT. Rating of perceived
exertion (RPE) was measured during the 6MWT using the Borg
RPE scale. ANALYSIS: Separate, repeated measures analyses of
variance (ANOVA) were used to compare BMI, 6MWT distance,
RPE (final, minute 6 score), global RAND-36 score, as well as
physical functioning and general health perceptions subcomponents
of the RAND-36, at each time point. Planned comparisons were
conducted using simple effects contrasts. Pearson product moment
correlations were calculated to determine the association between
BMI and 6MWT, and RAND-36 and 6MWT. SPSS 14.0 was used
to conduct all analyses. RESULTS: Mean pre-GBS walk distance
was 55% ±14 of normative values established for healthy adults.
Subjects had a significant increase in 6MWT distances at 3 and 6
months post-GBS, representing 68% ±12 and 75% ±13 of normal
values for this age range. These changes were accompanied by a
significant decrease in final RPE at both 3 and 6 months post-GBS, in
comparison to pre-GBS. Improvements in QOL were demonstrated
as measured by significant changes in all RAND scores at both 3
months post-GBS and 6 months post-GBS. 6MWT distance was
inversely correlated with body mass index at all time points. There
was a significant positive correlation between the 6MWT and the
global RAND score at 3 months and at 6 months post-GBS only.
CONCLUSIONS: Individuals who undergo GBS experience marked
improvements in functional capacity within a short period of time,
and this is associated with enhanced QOL. In spite of these changes
post-GBS, subjects continue to have functional walk distances that
are 75% of age-matched peers within a normal weight range.
IMPLICATIONS: Patients would benefit from the development of
individualized exercise programs post-GBS, with close monitoring
to adjust and progress the exercise prescription. KEYWORDS:
Obesity, exercise, function, health-related quality of life. FUNDING
ACKNOWLEDGEMENTS: None. CONTACT: pbosch@atsu.edu
ETHICS COMMITTEE: Mayo Hospital IRB; ATSU-Mesa IRB
WCPT 2007, Research Reports
Research Report Poster Display
37-13 Monday 4 June 09:00
VCEC Exhibit Hall B & C
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
Otago, Dunedin, New Zealand; 2 Respiratory Research Unit, Dunedin
School of Medicine, Dunedin, New Zealand; 3 Tom McKendrick
Sleep Laboratory, Dunedin Hospital, Dunedin, New Zealand
PURPOSE: The study aimed to investigate prevention of sleep in
the supine position as a management option for subjects diagnosed
with positional obstructive sleep apnoea (OSA). RELEVANCE: OSA
is a common health problem in adults affecting 4% of males and 2%
of females world wide. OSA is often poorly diagnosed and patients
left untreated are at a higher risk of developing cardiovascular
disease. It is estimated that over 50% have positional OSA where
the apnoea-hypopnoea index (AHI) in supine lying is twice as high
as the AHI in the non-supine position. Despite clinical symptoms
such as disturbed sleep patterns and daytime hypersomnolence,
the overall AHI in subjects with positional OSA may not reach a
threshold that justifies management using continuous positive airway
pressure (CPAP) therapy and patients may thus be advised just to
avoid sleeping on the back. Few studies have been reported on the
role of sleep position for the management for adults with positional
OSA. PARTICIPANTS: Twenty one adult volunteers diagnosed with
positional OSA where the AHI in the non-supine position was
less than 10/h, were included in the study. METHODS: The study
was a cross-over design using two therapies: thoracic anti-supine
band (TASB) and CPAP, undertaken on an intention-to-treat basis.
Subjects were randomly allocated to have 4 weeks using each device
during sleep, with a 1-week washout period between therapies. An
overnight sleep study to measure AHI, sleep position and respiratory
parameters was completed at the end of each period. Subjects also
completed standardised questionnaires on sleep-related symptoms
and quality of life, and self-report diaries. ANALYSIS: Paired T-
tests were used to analyse respiratory data obtained from the
overnight sleep studies with the two therapies and data from the
questionnaires. RESULTS: All subjects completed the study. At
baseline the mean AHI was 21.86±12.22/h, range 6.00-51.20/h. and
mean AHI in supine lying was 58.18±27.58/h, 19.30-113.30/h. The
mean AHI with the TASB device, (11.98±14.13/h, 0.20-52.56/h), was
significantly higher than the mean AHI on CPAP (4.99±3.80, 0.80-
15.00/h), (p < 0.02). From individual data, 15/21 subjects (74%) on
TASB therapy and 19/21 subjects (90%) on CPAP therapy had an
overall AHI  10/h. The TASB device was successful in reducing the
sleep period in the supine position to 10% of total sleep time in
17/21 subjects (81%). Mean results for sleep-related symptoms and
quality of life parameters were not significantly different between
the two therapies. CONCLUSIONS: Management of positional OSA
by prevention of sleep in the supine position was successful in the
majority of subjects studied. However outcomes with CPAP therapy
were superior to TASB therapy as measured by improvements in
AHI. IMPLICATIONS: The clinical implications of the partial success
with TASB therapy are important. Results provide objective evidence
that supports trialling the anti-supine device to prevent sleep in the
supine position for subjects with positional OSA. Also, sleep position
may be considered as an alternative management for positional OSA
in subjects who are non-compliant with CPAP therapy, or who are
symptomatic but have a low overall AHI. KEYWORDS: sleep position;
obstructive sleep apnoea; continuous positive airway pressure.
FUNDING ACKNOWLEDGEMENTS: Otago Respiratory Research
Trust; University of Otago School of Physiotherapy. CONTACT:
margot.skinner@otago.ac.nz
ETHICS COMMITTEE: Lower South Regional Ethics Committee,
Dunedin, New Zealand
Poster Displays, Monday 4 June
Research Report Poster Display
37-17 Monday 4 June 09:00
VCEC Exhibit Hall B & C
THE PAIN EXPERIENCE IN PEOPLE WITH CHRONIC FATIGUE
SYNDROME(CFS) / MYALGIC ENCEPHALOMYELITIS(ME)
Marshall R, Paul L, Wood L; Glasgow Caledonian University,
Glasgow, Scotland
PURPOSE: CFS/ME is a neurological condition with unknown
aetiology and pathophysiology. It is widely accepted that fatigue
and pain are the two most common symptoms and, it has been
suggested that pain is more debilitating than fatigue. Yet, only a
few studies have been conducted into the chronic pain caused
by CFS/ME. Therefore, the aim of this study was to examine
the pain experience of people with CFS/ME. RELEVANCE: The
management of pain is one of the core principles of physiotherapy;
therefore, it is important that clinicians are knowledgeable about the
pain experienced by those with CFS/ME. PARTICIPANTS: There
were 42 people recruited to this study, including seven people
who were severely affected and were either housebound or bed
bound. The mean age of participants was 47.8(±9.8) years old.
The duration of illness ranged from 14 months to 26 years and
three months. Participants were recruited via local CFS/ME support
groups and CFS/ME charities. All recruits successfully passed a
diagnostic screening questionnaire that was based on the CDC
criteria (Fukuda, 1994)and the Canadian Guidelines (Carruthers et
al, 2003). METHODS: This study was of a prospective, descriptive,
cross-sectional design. All participants were required to complete a
structured subjective interview that included Visual Analogue Scales
(VAS) to measure pain intensity, mood and sleep disturbance. The
interview was one method amongst a battery of pain assessments to
examine the pain experience. ANALYSIS: The information collected
from the interviews was coded and entered into SPSS 14.0 for data
analysis and descriptive statistics were incorporated to explore pain
characteristics. RESULTS: The screening questionnaire revealed
that 47.6% of participants experienced all five pain based symptoms
from the CDC criteria (Fukuda, 1994). All participants felt pain on
rest, and on the day of the interview 77.1% reported muscle pain to
be the most painful symptom at that time. When experiencing pain
21.3% of participants experience further difficulties with concentration
and memory. The mean VAS measurement for current pain intensity
was 44.5mm (95% CI: 37.8 to 51.2), the mean VAS measurement
for pain intensity over the preceding 24 hours was 59.1mm (95% CI:
52.4 to 65.9). 38 participants reported both standing and walking
were the most painful activities. Heat was the factor that helped ease
pain for 26.8% of participants. Pain was reported to be worse in the
mornings by 45.3% of this sample. CONCLUSIONS: This research
provides objective data to support anecdotal and clinical reports of
the pain experience in those with CFS/ME. Future work could further
investigate emerging trends such as 24 hour pattern, pain triggers
and the use of heat to ease pain. IMPLICATIONS: Physiotherapists
need to be aware of important factors such as, how they interact
with the patient, the time of day, duration of assessments and form
of treatment offered with regards to managing chronic pain in people
with CFS/ME. KEYWORDS: Pain, CFS/ME, Assessment. FUNDING
ACKNOWLEDGEMENTS: The funding for this research was jointly
provided by Glasgow Caledonian University and ME Research UK.
CONTACT: Rebecca.Marshall@gcal.ac.uk
ETHICS COMMITTEE: The ethics committee at the School of Health
and Social Care at Glasgow Caledonian University approved this
research.
S213
Research Report Poster Display
38-21 Monday 4 June 09:00
VCEC Exhibit Hall B & C
MOTION ANALYSIS OF E3 FITNESS GRIPS™ USED WHEN
RUNNING
Lewis C, Hreljac A, Summers S, Williams B, Vojkufka J; Calfornia
State University, Sacramento Sacramento USA
PURPOSE: Running is associated with a high incidence of injury.
Techniques or devices that could improve running biomechanics and,
therefore, reduce running injuries are greatly needed. The e3 Fitness
grips™ are marketed as a device that helps prevent running injuries.
The e3 Fitness grips™ have not been scientifically studied. The
purpose of this study was to evaluate the efficacy of the e3 Fitness
grips™ as determined by changes in body alignment. RELEVANCE:
PT’s must keep abreast of technology that relates to patient care
and the evidence of it’s effectivness PARTICIPANTS: 21 recreational
and competitive runners with a mean age of 23 years old were
recruited. Subjects ran regularly at least 6 miles per week prior
to participation. None of the subjects had sustained injury within
the 6 months prior to the study. METHODS: 3D Motion System
analysis was used in order to collect and analyze static and dynamic
position of reflective markers located on shoulders, the sternum
and both anterior inferior iliac spine (ASIS). A series of pulsing
infrared strobe lights that operated at a sampling frequency of 60Hz
illuminated the position of the markers at discrete time intervals,
and an array of six cameras positioned in a U-shaped pattern in
front and along the sides of a Quinton Q55 series 90 treadmill.
Each Subject ran on a the treadmillwith the e3 Fitness grips TM
in their hands; with sham grips in their hands or without handgrips.
Motion analysis was used to determine change in shoulder level,
pelvis level and combination of the two. Following three minutes
of running, kinematic data was collected for 5 seconds. Analysis
of kinematic data was restricted to motions occurring in the frontal
and sagital plane. ANALYSIS: The means and standard deviations
for the three levels of the independent variable were calculated. A
repeated measures design was used and a single factor ANOVA
was completed for each level of the independent variable, clavicle
angle (F = 0.080, P = 0.923), waist angle (F = 0.715, P = 0.493, and
combined angle (F = 0.123, P = 0.885). A probability level of P < 0.05
was selected to determine statistical significance. RESULTS: No
significant difference was found in any joint angles measured when
compared across the three running conditions. Subjective response
to the three conditions was mixed. CONCLUSIONS: The e3 Fitness
grips™ did not significantly change the biomechanics of the runners
when comparing use of the e3 Fitness grips™ to carrying mock
grips and to carrying nothing. Subjective response to the 3 running
conditions indicated a small margin that preferred running with the e3
Fitness grips™ over running without anything in their hands. Further
studies might investigate the use of other and/or additional forms of
scientific analysis to measure variables of running while using the
e3 Fitness grips™. IMPLICATIONS: At this point in time physical
therapists do not have the evidence to recommend the e3Fitness
grips™ as a preventitive measure for running. Standard guidance
such as proper shoe fit, running surface and style include suggestions
that physical therapists can give their running patients. KEYWORDS:
running injuries prevention. FUNDING ACKNOWLEDGEMENTS:
unfunded. CONTACT: lewisc@csus.edu
ETHICS COMMITTEE: CSUS Institutional Review Board
S214
Research Report Poster Display
39-01 Monday 4 June 09:00
VCEC Exhibit Hall B & C
ENTHESIS PAIN PREVENTION IN JUNIOR HIGH SCHOOL
SOCCER PLAYERS – FACTORS ASSOCIATED WITH HEIGHT
GROWTH VELOCITY CURVE, TIGHTNESS, AND ALIGNMENT
Nakazawa R1 , Sakamoto M1 , Nakagawa K1 , Inomata N1 ,
Kusama Y2 ; 1 Gunma University Graduate School of Medicine;
2 Maebashi Kise Junior High School
PURPOSE: The enthesis pain, which occur frequently among young
athletes, may be caused by height growth velocity and excessive
tightness and alignment of the lower extremities. The purpose of this
study was to examine factors related to the occurrence of enthesis
pain by long-term longitudinal investigation and measurement in
junior high school soccer players, while intervening for its prevention.
RELEVANCE: This research report is helpful to early prevention of
injury among young athletes. PARTICIPANTS: The subjects were
107 male soccer players who played on the extramural soccer team of
three junior high schools in Gunma. Ages ranged from 12 to 15 years.
METHODS: The presence or absence of enthesis pain, the height
growth velocity, muscle tightness (iliopsoas, quadriceps, hamstrings,
hip adductors and gastrocnemius), and alignment (Q-angle, leg-
heel-angle, and heel-flour-angle) were longitudinally investigated,
and stretching was instructed periodically. The measurements were
performed a total 6 times once a month. This study was approved
by the Ethical Review Board of the Japanese Society of Physical
Fitness and Sports Medicine. ANALYSIS: The height growth velocity
curve was prepared using the cubic spline curve of SPSS. The
phases were determined according to Murata’s classification, and
the phase at the onset time of enthesis pain was investigated.
To investigate the association between the occurrence of enthesis
pain and each measurement item were compared (paired t-test)
between before and after appearance/disappearance of enthesis
pain in 3 groups of subjects who underwent all of the 1st, 3rd
(intermediate), and final measurements; Subjects developed enthesis
pain, subjects with disappeared of enthesis pain, and subjects
with repeated appearance and disappearance of enthesis pain
(Wilcoxon test). And, to investigate changes with time in muscle
tightness and the effect of intervention, muscle tightness on the
1st measurement was compared with that at each time point
(paired t-test). RESULTS: The time of enthesis pain occurrence
was consistent with phase II of the height growth velocity curve
in many cases. On comparison between before and after the
appearance/disappearance of enthesis pain, no association was
noted between the muscle tightness and occurrence of enthesis pain.
But, on comparison of changes with time in muscle tightness, the
tightness of the right quadriceps significantly increased. A significant
increase in the Q-angle was also noted when enthesis pain appeared.
Furthermore, the tightness of the bilateral iliopsoas, hamstrings, hip
adductors, and gastrocnemius had significantly improved on the final
measurement. CONCLUSIONS: Since height rapidly increases and
the growth of bones and muscles/tendons is imbalanced in phase
II, the onset time of enthesis pain most frequently corresponded to
phase II. In addition, the long-term longitudinal evaluation of muscle
tightness may help to predict the occurrence of enthesis pain. This
study showed the necessity of the long-term longitudinal evaluation of
muscle tightness, suggesting that there is a possibility of intervention
for prevention, as well as treatment in the field of physical therapy
for sports injuries in the growth period. IMPLICATIONS: For physical
therapy practice KEYWORDS: growth period, enthesis pain, injury
prevention. FUNDING ACKNOWLEDGEMENTS: The authors deeply
thank the presidents, teachers, and soccer club members of each
junior high school who cooperated in this study. We also thank
the physical therapists for their cooperation in the measurement.
CONTACT: riena@carrot.ocn.ne.jp
ETHICS COMMITTEE: This study was approved by the Ethical
Review Board of the Japanese Society of Physical Fitness and Sports
Medicine.
WCPT 2007, Research Reports
Research Report Poster Display
39-05 Monday 4 June 09:00
VCEC Exhibit Hall B & C
DOMESTIC VIOLENCE AGAINST WOMEN AS A GLOBAL
CONCERN: A SYSTEMATIC REVIEW OF INTERVENTIONS AND
PHYSIOTHERAPIST’S POTENTIAL ROLE
Smidova J1 , Hatlova B1 , Dean E2 ; 1 Faculty of Sport and Physical
Education, Charles University, Prague, Czech Republic; 2 School of
Rehabilitation Sciences, University of British Columbia, Vancouver,
Canada
PURPOSE: 1. To systematically review the international literature
related to interventions addressing the consequences of domestic
violence (DV) perpetrated against women. 2. To examine the
physiotherapist’s potential role in addressing consequences of DV.
RELEVANCE: DV crosses economic and professional groups as
well as cultures. DV is a complex problem associated with social,
psychological, and physical health consequences. Interventions
for survivors of DV need to reflect this complexity, in conjunc-
tion with comprehensive team work. Psychological and physical
consequences are related, and are reflected in the survivors’
overall health status. Physical discomfort can impact psychological
status and social integration. A role for physiotherapy may be
indicated. PARTICIPANTS: A total of 87 study citations were
screened according to stringent inclusion and exclusion criteria.
Citation sources included: the American Psychiatric Association,
Amnesty International, CINAHL, European Council, Google Scholar,
Medline, PsychINFO, PubMed, Social Abstracts, United Nations,
and World Health Organization. METHODS: A literature review of
studies describing interventions for women survivors of DV and their
outcomes was conducted based on established systematic review
procedures (Edgar, 2003). Definitions of DV used in the studies
were also reviewed. Review inclusion criteria were studies of: 1.
adult women survivors of DV (age range 18-60 y) regardless of
their heritage and marital status, and 2. women in heterosexual
relationships (with or without children), and further the studies
needed to include 3. the results of a controlled trial or clinical
study, and 4. an intervention and assessment of the outcomes.
ANALYSIS: Of 87 citations, 10 met the study inclusion criteria. The
interventions and their outcomes, and the definitions of DV reported
were recorded. RESULTS: 1.Studies meeting criteria were published
between 1991 and 2005. 2.Six studies evaluated interventions
including social support, personal counseling, and empowerment
coaching. 3.Three studies evaluated cognitive behavioral therapy.
4.One study evaluated hospital-based intervention including physical
and psychological health status monitoring, individual nurse assis-
tance, and social counseling. 5.Often, no standard definition was
reported, or inconsistent definitions were used. CONCLUSIONS:
The field of DV as an area of study is in its infancy, and is
relatively obscure in physiotherapy literature. The lack of use of
a consistent definition in the literature limits the evaluation and
usefullness of prevalence data, and interpretation of intervenion
studies. Methodological limitations of the studies to date limit
drawing conclusions. The relative effectiveness of interventions
related to psychological and physical needs of women survivors
of DV warrants systematic study based on stringent mixed mode
research approaches. IMPLICATIONS: 1.The complexity of the
phenomenon of DV and its social, psychological, and physical health
consequences, suggests that interventions for survivors of DV need
to reflect this complexity, and the involvement of an interdisciplinary
team. Physiotherapy that combines social and psycho-physical
approaches warrants being considered in addressing the needs of
survivors of DV. 2.Standardized means of evaluating DV needs to
be established (i.e. the use of an established standard definition
and standard prevalence measure) to provide a baseline for
research related to DV to examine its unique dimensions and
interpret the validity of intervention investigations. KEYWORDS:
Domestic violence; intimate partner violence; domestic violence
survivors; battered women; abused women; intervention; treatment.
Poster Displays, Monday 4 June
FUNDING ACKNOWLEDGEMENTS: The study was conducted with
the support of the School of Rehabilitation Sciences, University of
British Columbia, Canada. CONTACT: johancas@centrum.cz
Research Report Poster Display
01-03 Monday 4 June 10:30
VCEC Exhibit Hall B & C
EFFECTS OF EXERCISE AND ELECTROACUPUNCTURE ON
THE RECOVERY IN THE CEREBELLAR INJURED RATS BY
3-ACETYLPYRIDINE
Park S1 , Rho M2 , Park R3 ; 1 Department of Physical Therapy,
College of Rehabilitation, Daegu university, Daegu, Korea;
2 Department of Physical Therapy, College of Health Science,
Catholic University of Pusan, Busan, Korea; 3 Department of Physical
Therapy, College of Rehabilitation, Daegu university, Daegu, Korea
PURPOSE: The purpose of this study was to investigate the effects of
exercise(Ex) and electroacupuncture(EA) on the recovery in the cere-
bellar injured rats by 3-Acetylpyridine(3AP). 3AP induces cerebellar
injury which is chemoablation of the inferior olive. RELEVANCE:
It is related to physical Therapy practice. PARTICIPANTS: Twenty
five male Sprague-Dawley rats were divided 5 groups: normal
control, 3AP control and three experimental groups(Ex, EA, Ex with
EA groups). METHODS: 3AP was administered intraperitoneally in
volume of 2 ml/kg body weight. Each experimental group was treated
from 6days after being injured with the Ex(Rotarod, 20Rpm, 20min),
EA(Es-160, ITO, Japan, 2 Hz, 15min), Ex with EA everyday during
the 2 weeks. EA was applied to Zusanli point which is located at
the anterior tibial muscle between tibia and fibula. Maximal Height
Vertical Jump(MHVJ) was tested at pre-treatment on 1st day and
on 7th, 14th day after treatment on the cerebellar injured rats by
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
a one way ANOVA to compare the MHVJ and BDNF between
each groups. The significance level was 0.05. RESULTS: The
results of this experiment were as follows: MHVJ was increased
significantly in the Ex, EA and Ex with EA groups compared
with the 3AP control group(P < 0.05). The concentration of BDNF
of the serum was significantly decreased in the Ex, EA and Ex
with EA groups than 3AP control group(P < 0.05). CONCLUSIONS:
The results of this study showed that dynamic exercise and
electroacupuncture to Zusanli point have an effect on recovery in
cerebellar injured rats IMPLICATIONS: It may be suggested that the
application of exercise and electroacupuncture promote functional
recovery following cerebellar injury. KEYWORDS: 3-Acetylpyridine,
Cerebellar injury, Exercise, Electroacupuncture, BDNF. FUNDING
ACKNOWLEDGEMENTS: We don’t have any funds. CONTACT:
charm-soo@hanmail.net
Research Report Poster Display
01-07 Monday 4 June 10:30
VCEC Exhibit Hall B & C
SHORT-TERM EFFECT OF PHYSIOTHERAPY REHABILITATION
ON FUNCTIONAL PERFORMANCE OF LOWER LIMB
AMPUTEES: A RANDOMISED TRIAL
Rau B1 , Bonvin F1 , De Bie R2 ; 1 International Committee of the
Red Cross; 2 Maastrich University
PURPOSE: The objective of the trial was to evaluate the effective-
ness of a short and intensive physiotherapy programme versus usual
care, mainly consisting of walking. RELEVANCE: Little research has
been done so far in the field of young traumatic lower limb amputees.
Needs are important, as in conflict areas, around 15’000 persons
suffer yearly of new traumatic amputations. PARTICIPANTS: Fifty-
eight male unilateral lower limb amputees were randomized over
intensive care (N=29) and usual care (N=29). Groups included firstly
S215
and already fitted amputees (mean age=36). 25% of them were
trans-femoral amputees. METHODS: This randomised study was
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
built around 7 specific exercises, lasting approximately one hour
altogether. Trans-tibial amputees were tested the first day they were
fitted and then 2 days later; trans-femoral amputees were tested
when walking out of the parallel bars and 4 days later. ANALYSIS:
Effects were assessed on: 2-minute walk test, physiological cost
index (PCI), amount of weight bearing on both legs, 5 questions
of the Functional Measure for Amputees questionnaire and the
Timed Up and Go test. ANOVA and logistic regression statistic
tests were performed with SPSS software; level of significance
was set at p = 0.05 RESULTS: The experimental group showed
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
leg (p = 0.04). The other tests were not statistically different.
Qualitative results confirmed amputees and therapists’ satisfaction
about the intervention and the testing. CONCLUSIONS: Despite
limited means, research remains feasible in a developing country; this
study has demonstrated that physiotherapy is effective in improving
functional performance of lower limb amputees and therefore has
its place in every rehabilitation centre. IMPLICATIONS: Even limited
physiotherapy training is beneficial to lower limb amputees and
therefore should be implemented systematically whithin rehabilitation
centres. Minimum assessment and testing give a good appreciation
of the patient performance. KEYWORDS: Lower limb amputees;
Physiotherapy training; 2 minutes walk test; Developping countries.
FUNDING ACKNOWLEDGEMENTS: International Committee of the
Red Cross.
ETHICS COMMITTEE: following ICRC ethic rules
Research Report Poster Display
01-11 Monday 4 June 10:30
VCEC Exhibit Hall B & C
EFFECT OF INSPIRATORY MUSCLE TRAINING FOR PEOPLE
WITH CYSTIC FIBROSIS: A SYSTEMATIC REVIEW
Reid W1 , Geddes L2 , O’Brien K3 , Brooks D3 , Crowe J2 ; 1 School of
Rehabilitation Sciences, Division of Physical Therapy, University of
British Columbia, Vancouver, BC, Canada; 2 School of Rehabilitation
Science, McMaster University, Hamilton, ON, Canada; 3 Department
of Physical Therapy, University of Toronto, Toronto, ON, Canada
PURPOSE: To perform a systematic review to examine the effects of
inspiratory muscle training (IMT) for adults living with cystic fibrosis
(CF). RELEVANCE: IMT can reduce dyspnea and improve exercise
tolerance in people with chronic obstructive pulmonary disease,
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
CF was performed using electronic databases from their inception
to December 2005 according to Cochrane Collaboration protocol.
Reference lists were hand-searched. Personal contact was made with
authors to follow-up on missing information. Inclusion criteria included
randomized controlled trials among adults with stable CF, published
in English, comparing IMT to sham, no intervention, or other
interventions. To determine if the studies met the inclusion criteria,
two investigators reviewed abstracts independently. Data were
independently abstracted from included studies by two investigators
using standardized data abstraction forms. Methodological quality of
included studies was assessed. ANALYSIS: Meta-analyses using
random effects models wherever possible were performed using
RevMan computer software. RESULTS: Thirty-one studies were
retrieved, of which two met the inclusion criteria. Both studies
compared different intensities of IMT to sham or no intervention, and
used different starting intensities and progression. One study used
the Threshold trainer® . The other used an electronic manometer
S216
connected to a laptop computer with custom software. Two meta-
analyses were performed for forced expiratory volume in 1 second
(FEV1 ) (litres) and forced vital capacity (FVC) (litres) and showed
no change between the IMT group compared with the sham or no
intervention group. No other meta-analyses could be performed due
to differences in the outcomes measured. Results from individual
studies showed improved inspiratory muscle endurance (%Pimax)
(de Jong 2001), inspiratory muscle strength (maximum inspiratory
pressure) and sustained maximal inspiratory pressure (Enright 2004),
for the IMT group compared with the sham/no intervention groups.
One study found no difference in dyspnea (Borg scores) or exercise
capacity (maximal oxygen consumption, workload) (de Jong 2001).
One study measured anxiety and depression (Hospital Anxiety and
Depression Scale) and found improvements for the IMT group
compared with the no intervention group (Enright 2004). No change
in quality of life (Chronic Respiratory Disease Questionnaire) was
reported (Enright 2004). CONCLUSIONS: The literature on IMT for
people living with CF is sparse. Meta-analyses were limited due to
a small number of included studies and variability in the outcomes
measured. Improvements among individual studies were reported
for outcomes of inspiratory muscle endurance, inspiratory muscle
strength and anxiety and depression. IMPLICATIONS: Studies to
date provide limited evidence to support the benefits of IMT for
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
for selecting patients with CF who might benefit from IMT and, the
impact of IMT on measures of daily function and health related
quality of life. REFERENCES: Dejong et al. Resp Med 2001;95:31-
36; Enright et al. Chest 2004; 126:405-411. KEYWORDS: inspiratory
muscle training; respiratory muscles; obstructive lung disease.
FUNDING ACKNOWLEDGEMENTS: Funding for this research was
provided by the Ontario Lung Association and the Canadian Lung
Association. CONTACT: wdreid@interchange.ubc.ca
Research Report Poster Display
02-15 Monday 4 June 10:30
VCEC Exhibit Hall B & C
EFFECT OF A TRAINING SESSION ON CONTRACTILE FATIGUE
IN PATIENT WITH COPD
Saey D1 , Troosters T2 , Gosselink R3 , Gielissen S3 , Knoops A3 ,
Decramer M1 ; 1 Department of Pulmonology, University Hospital
Leuven, Leuven, Belgium; 2 Research Centre for Cardiovascular
and Respiratory Rehabilitation; 3 Faculty of Kinesiology and
Rehabilitation Sciences
PURPOSE: Contractile fatigue may occur after acute exercise in
patients with chronic obstructive pulmonary disease (COPD) and
may limit exercise performance. However, the effect of a training
session on contractile fatigue is still unknown and could influence
the response to rehabilitation in patients with COPD. The purpose
of this study was to determine whether contractile muscle fatigue
occurs after a training session in patients with COPD. RELEVANCE:
A clinical perspective of this study is to investigate the prevalence and
the role of muscle fatigue during a rehabilitation program in COPD.
PARTICIPANTS: Fourteen patients with moderate to severe COPD
(FEV1: 39±17% of predicted) involved in an outpatient rehabilitation
program for one month performed a standard rehabilitation training
session including walking, knee extension, stair climbing and cycling.
METHODS: Maximal voluntary contraction (MVC) and quadriceps
potentiated twitch force (Twq) measured by magnetic stimulation,
were evaluated before and 15 minutes after training session. Muscle
fatigue was defined as a fall in Twq15% baseline value. ANALYSIS:
Results are reported as mean ± SD. A statistical level of significance
of 0.05 was used for all analyses. A paired t-test was used to
test the significance of changes in MVC and Twq with training.
Association between variables was evaluated using a Pearson’s
WCPT 2007, Research Reports
correlation. RESULTS: Compared to baseline value, a significantly
decrease of MVC (27.4±7.1 Kg vs 26.5±7.1 Kg, p < 0.001) and
Twq (12.6±2.6 Kg vs 10.0±2.5 Kg, p < 0.001) were observed after
the training session. A significant correlation was found between
MVC and Twq at baseline (0.762, p < 0.001) and between the fall
in MVC and the fall in TWq 15 minutes post training (r = 0.688,
p < 0.05). Nine patients (±64%) developed contractile fatigue after
training. In these patients, MVC and Twq were significantly decreased
after training (14±5% and 26±6%, respectively p < 0.001). Training
session failed to induce contractile fatigue in five patients. In these
patients, it was no significant difference in MVC pre-post training
and Twq was significantly decreased after training session(10±14%
p < 0.05). CONCLUSIONS: We conclude that contractile fatigue may
occur after a standardized training session in some patients with
COPD but not in all. IMPLICATIONS: The absence of contractile
fatigue during training in ±35% of patients could explain why, in some
patients with COPD, rehabilitation fails to improve exercise tolerance.
KEYWORDS: Pulmonary, Exercise, Musculo-skeletal. FUNDING
ACKNOWLEDGEMENTS: D.S is a postdoctoral fellow of IRSC
Canada and T.T. is a postdoctoral fellow of F.W.O. Vlaanderen.
CONTACT: Didier.Saey@med.kuleuven.be
ETHICS COMMITTEE: ethics committee of Gashuisberg hospital
(Universitaire ziekenhuizen leuven, Belgium)
Research Report Poster Display
02-19 Monday 4 June 10:30
VCEC Exhibit Hall B & C
SHORT AND LONG TERM OUTCOME OF CARDIAC
REHABILITATION PROGRAM: A PROSPECTIVE COHORT STUDY
Neeleman-van der Ste K1,2 , Hendriks H1,2 , Hoeps K3 ,
Schieferstein J3 , Bernards A1,3 , de Bie R2 ; 1 Dutch Institute of Allied
Health Care (NPi); 2 Centre for Evidence Based Physiotherapy
(CEBP) Maastricht University, Department of Epidemiology;
3 University of Arnhem and Nijmegen (HAN), Department Physical
Therapy
PURPOSE: To determine short and long term benefit of physical
therapy care as part of a multiprofessional cardiac rehabilitation
program according the Dutch multi- and monodisciplinary clinical
practice guidelines. RELEVANCE: Cardiovascular diseases are the
number one cause of death in the Netherlands. The amount of
patients to be referred to a multidisciplinary cardiac rehabilitation
program increases enormously in the last decade. The benefits
of exercise training for subjects with cardiac problems short time
after surgery are well established in general, but little is known
about effects of rehabilitation for subjects treated according the
Physical Therapy Guidelines on short as well as long term
after the program. PARTICIPANTS: Subjects older than 18 years
with (acute) myocardial infarction, coronary artery bypass grafting,
percutane transluminal coronary angioplasty, heart valve surgery and
corrected congenital cardiac diseases, referred for phase II cardiac
rehabilitation were included. Exclusion criteria were: other cardiac
diseases, insufficient knowledge of Dutch language and not able to
conduct ergometry or treadmill testing. Permission was obtained by
written informed consent. METHODS: Immediately after publication
the Dutch Clinical Practice Guidelines for Physical Therapy in Cardiac
Rehabilitation, they were implemented in five cardiac rehabilitation
centers by two-day training sessions. Subjects were asked to
participate directly after referral. Physical therapy treatment was
based on patient specific purposes and consists of one or more
modules following the guidelines (exercise, information, psycho-
educational, relaxation). Data (subject characteristics, diagnosis
including risk factors treatment, post-rehabilitation, after care and the
Patient Specific Complaints questionnaire (PSC)) were collected at
the start of rehabilitation (T0), end of the rehabilitation program (T1;
short term) and three years after rehabilitation (T2; long term). A PSC
consist of three visual analogue scales. Subjects choose three daily
activities (in which they are most limited at T0) to score at T0, T1
Poster Displays, Monday 4 June
and T2. ANALYSIS: Collected data are described presenting means
± SD. Differences are analyzed using paired t-tests. RESULTS:
Participants (n=88) mean treatment duration was 7.5±3.5 weeks (T0-
T1) and mean follow up was 3.2±0.3 year (T1-T2). PSC-scores were
3.1 better at T1 than T0 (2.6±1.7 versus 5.7±2.3: p0.05). Long
term result slightly decreased 0.6 (T2: 3.2±2.2) (P0.05). Subjects
with many (3-7) risk factors tend to have worse long term PSC-
scores than subjects with few (0-2) (T2: 3.9±2.8 versus 3.3±2.6), but
differences are not significant. Subjects with Diabetes (4.3±2.5) and
inactive subjects (4.2±2.4) have worse PSC-scores than subjects
without Diabetes (2.9±2.1) and active subjects (2.8±2.1) (p0.05).
CONCLUSIONS: Subject specific activities at long term follow up
are strongly better than at the start of rehabilitation, however, they
rather decrease at long term compared to short term outcome, but
are still considerable and significant. Subjects with many risk factors
have worse long term results than patients with few. Maintenance of
active lifestyle is major factor for long term success. IMPLICATIONS:
Health care providers role in after care programs is to inform and
educate subjects about the impact of risk factors on health, the
importance to continue risk management, including advise and assist
about movement programs, and to monitor sudden decreases in
individual complaints and activities. KEYWORDS: Cardiac rehabil-
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
Hospital and Rehabilitation Foundation Limburg/Hoensbroeck Reha-
bilitation Centre granted permission.
Research Report Poster Display
02-23 Monday 4 June 10:30
VCEC Exhibit Hall B & C
THE EFFECT OF MOBILISATION ON THE MANAGEMENT OF
PATIENTS FOLLOWING OSEAPHAGECTOMY
Ogiso H, Takagi M, Ishii Y, Sibuya T, Suzuki K, Masuda T;
Shizuoka General Hospital, 4-27-1 Shizuoka City 4200881, Japan
PURPOSE: To compare the outcomes of early mobilization in
addition to chest physiotherapy with chest physiotherapy alone in
the management of patients post oesaphagectomy. RELEVANCE:
The establishment of an effective method to reduce compli-
cations is regarded as an important problem in physiotherapy.
PARTICIPANTS: Random sampling. Patients have randomized by
surgeon. METHODS: Forty patients undergoing oesaphagectomy
were enrolled into a prospective randomized controlled study. There
were no differences in mean age, preoperative respiratory function
tests, body mass index or time under anaesthetic. All patients
received standardised instructions on deep breathing exercises and a
demonstration of post-operative chest physiotherapy. Post-operative
chest physiotherapy consisted of modified postural drainage and
breathing exercises. Twenty patients (Group A) had post-operative
chest physiotherapy supervised twice daily by the physiotherapist.
The other 20 patients (Group B) were randomised to receive the
chest physiotherapy twice a day as well as instructions on the
importance of early mobilisation and high sitting at 70º for 30
minutes at a time. Mobilisation and high sitting was done twice in
the morning and twice in the afternoon. We made a guideline for
early mobilisation and high sitting at 70º. This guideline consist of
vital signs (ECG,BP,SpO2,dizziness, etc) Outcome measures were,
the ratio of partial pressure of arterial oxygen/oxygen concentration
(PaO2/FiO2) taken early morning on postoperative day 3; time on
oxygen; incidence of atelectasis noted on chest X-ray; and days
to discharg.The time taken to the walking for 20m. ANALYSIS: A
non-paired Student’s t-test was used to compare the data between
the two groups. Significance was set at p < 0.05. RESULTS: The
PaO2/FiO2 ratio (mean ± standard deviation) was significantly higher
for Group B (164.1±49.8) than for group A (148.7±64.8) p < 0.02.
The duration of supplemental oxygen was shorter for Group B
S217
(6.0±3.8 days) than for Group A (6.7±4.8 days). The time taken
to the walking for 20m was shorter in Group B (4.25±1.0days)
than for Group A (4.76±1.0days).There was no significant difference
between the groups for the number of patients with atelectasis
or the length of hospital stay. CONCLUSIONS: The addition of
early mobilisation to chest physiotherapy had a beneficial effect
on reducing the need for supplemental oxygen in these patients.
These outcomes support the benefits of early mobilization as part of
post operative physiotherapy management. IMPLICATIONS: Early
mobilisation is effective for oxygenation. This effect will reduce
chest complications.We are confident that the further study for
physiotherapy undergoing major surgery patients will prove the result
of this syudy. We will research increase number of patients further.
KEYWORDS: postoperative physiotherapy, mobilisation, esophagec-
tomy. FUNDING ACKNOWLEDGEMENTS: The author would like to
thank Chief surgeon.Masakazu Takagi,Shizuoka General Hospital,for
his advice. CONTACT: hiogiso@fj8.so-net.ne.jp
ETHICS COMMITTEE: The present study was approved by
the Shizuoka General Hospital Institutional Committee on Human
Research.
Research Report Poster Display
04-03 Monday 4 June 10:30
VCEC Exhibit Hall B & C
EXPECTATIONS OF CLINICAL INSTRUCTORS WITH REGARDS
TO STUDENT CLINICAL PERFORMANCE
Reus L; University of Puerto Rico
PURPOSE: Describe expectations and experiences of clinical
instructors with regards to the clinical performance of master’s entry-
level students enrolled in a physical therapy program. RELEVANCE:
Research findings based on the clinical faculty perceptions are
fundamental for the development, design and implementation of the
clinical education component of the curriculum. PARTICIPANTS:
Nineteen active clinical instructors who complied with established
eligibility criteria participated in the study. METHODS: A qualitative
design was used. Four focus groups were conducted following a
systematic protocol: demographic data was collected from each
participant; all sessions were recorded with additional notes taken by
an assistant moderator; questions were sequenced by the moderator
to allow maximum insight; a recall of the performance instrument
components and dimensions was done by the moderator; electronic
recordings were transcribed to allow for reconstruction of critical
parts of the focus groups during the analysis phase; debriefing
between moderator and assistant moderator ocurred immediately
after the interviews; the researcher shared preliminary reports with
participants. ANALYSIS: A transcript-based analysis was used and
consisted of examining and categorizing the evidence and identifying
important themes expressed by participants. The transcripts, coupled
with the observer notes, provided rich descriptions of constructs
verified by participants. RESULTS: Important themes emerged from
the analysis: Students exhibit appropriate theorical foundations
and require supervision with regards to clinical skills and the
psychomotor domain irrespectively of the level of clinical practice.
Clinical instructors described and contextualized different levels
of supervision of the students’clinical performance. Contextual
descriptions and differentiations by clinical instructors were related
to performance areas such as safe practice, needed levels of
supervision and complexity of the enviornment. Students require
clinical instruction and supervision in particular areas unknown to
them or with limited exposition. A consensus was evidenced with
regards to changes in degree of monitoring as student progresses
through-out the clinical education experience. Clinical instructors
expressed high expectations with regards to red flag items labeled
in the clinical performance instrument; they allow for student skill
development through-out the clinical experience. Upon the students’
final week of clinical practice, irrespectively of the level of practice, the
clinical instructors’ expectations reflected an entry-level performance,
S218
particularly in the areas of education, patient management and
professional conduct. The development of patient goals is a critical
area which requires close supervision during the first three to four
weeks of full-time clinical practices, and guidance during the final
week of the clinical experiences. The performance dimensions of
quality, supervision, efficiency and complexity of tasks emerged as
the most discussed dimensions. A consensus was evidenced with
regards to the use of support personnel; students must delegate
tasks to enhance effective, efficient and safe physical therapy
patient care. CONCLUSIONS: The contextual aspects emerged as
fundamental in the exploration of the clinical performance evaluation
of master’s entry-level students. Rich descriptions of critical and
essential expected behaviors during clinical education experiences
emerged. IMPLICATIONS: Delivery of physical therapy services
to particular populations and its relationship with specific contexts
require further research to allow more profound discussion with
regards to students’clinical performance and challenges of the
clinical education experiences as perceived by clinical educators.
KEYWORDS: Expectations; clinical performance evaluation; clinical
instruction. FUNDING ACKNOWLEDGEMENTS: The research was
sponsored by the Uiversity of Puerto Rico College of Health Related
Professions at the Medical Sciences Campus.
ETHICS COMMITTEE: Institutional Review Board of the Office of
Research at the University of Puerto Rico Medical Sciences Campus
Research Report Poster Display
04-07 Monday 4 June 10:30
VCEC Exhibit Hall B & C
AN EXPLORATION OF THE CONSTRUCT OF MASTERS LEVEL
CLINICAL PRACTICE
Rushton A; University of Birmingham, Birmingham, UK
PURPOSE: This study explored the behaviours indicative of the
construct of Masters level clinical practice. RELEVANCE: Growing
emphasis on Masters level provision worldwide continues to be
facilitated by the migration of education into Universities and the
requirement for Continuing Professional Development. Paralleling
this has been the development of specialisation in clinical practice.
These factors have contributed to a proliferation of Masters courses
aiming to develop specialist clinical practice. PARTICIPANTS: A total
population sample of all course leaders of Masters courses in the
UK assessing clinical practice (n=48) were invited to participate in
a Delphi survey, with 38 participants agreeing. Purposive sampling
selected the ‘case’ of a specialist physiotherapy course within one
university. METHODS: The study is framed within the philosophical
tradition of phenomenology. It used a mixed methods approach
combining quantitative and qualitative data, using methodological
triangulation to contribute to an understanding of the construct.
The conceptual framework was informed by two prior stages:
a critical analysis of the literature relating to clinical education,
and a descriptive survey of current practice in Masters courses
aiming to develop clinical expertise. Consensus of Masters level
behaviours indicative of the construct was explored through a
Delphi survey. Round 1 asked for behaviours indicative of the
construct. In addition, an in-depth case study using multiple methods
from the qualitative paradigm, including documentary analysis, semi
structured interviews, and participant observation was employed.
ANALYSIS: Data from round 1 of the Delphi were analysed through
content analysis, which subsequently informed the behaviours in
round 2, where participants rated the importance of each behaviour
on a scale of 1-5. Round 3 asked participants to rank the importance
of the different behaviours to the construct. Descriptive analysis and
the use of Kendall’s coefficient of concordance enabled interpretation
of consensus in rounds 2 and 3. For the case study, analytic
categories were derived from the data using a constant comparative
process until saturation of the data were achieved. Theoretical
propositions were then developed. RESULTS: The response rate
for the Delphi study was very good. There was good consensus
WCPT 2007, Research Reports
amongst the 28 behaviours received for round 1. Round 2 achieved
good consensus enabling 21 agreed very important behaviours to
be taken into round 3. The ranking process in round 3 afforded good
consensus(W=0.200, df20, p < 0.001)and highlighted the importance
of for example, a critical approach to practice. The case study
facilitated further insight into the construct by identifying advanced
clinical reasoning as the most important behaviour for the specialist
physiotherapy. This was then subdivided into core components for
example, adaptability of practice. CONCLUSIONS: The general
behaviours agreed by course leaders were also reflected in the
findings from the case study, with the case study data exploring
the key behaviours further as specific components of specialist
practice. IMPLICATIONS: Through methodological triangulation, this
study has identified behaviours indicative of the construct of Masters
level clinical practice in general terms and for a specialist area. It
would be valuable to develop this work further by exploring several
cases to enable analytic generalization, and to evaluate the variation
across different specialities and different countries. KEYWORDS:
Masters, specialist, clinical. FUNDING ACKNOWLEDGEMENTS:
School of Health Sciences, University of Birmingham, UK and Ma-
nipulation Association of Chartered Physiotherapists, UK. CONTACT:
a.b.rushton@bham.ac.uk
ETHICS COMMITTEE: School of Health Sciences, University of
Birmingham, UK
Research Report Poster Display
04-11 Monday 4 June 10:30
VCEC Exhibit Hall B & C
IMPLEMENTATION OF NEEDS-BASED INTERACTIVE
CONTINUING EDUCATION FOR RURAL PHYSIOTHERAPISTS
WITH ENHANCED ACCESS: A CASE STUDY
Schoo A1 , McNamara K2 , Stagnitti K3 , Dunbar J1 ; 1 Greater
Green Triangle University Department of Rural Health, Flinders
and Deakin Universities; 2 School of Pharmacy, Monash University;
3 Occupational Science and Therapy, Deakin University
PURPOSE: This study evaluated the usefulness of a rural Continuing
Education (CE) program that incorporated interactivity as well as
the delivery of education. RELEVANCE: Mandatory professional
development, effective and evidence-based practicing, enhanced
rural career options and workforce retention require access to CE.
Interactive and adult learning formats have been effective for CE.
PARTICIPANTS: All physiotherapists (n = 75) in south west Victoria
were invited to participate in the CE program. The 2004/2005 CE
program for physiotherapists was developed on the basis of findings
of two professional needs surveys. Results showed preference for
CE on Wednesdays early in the evening and for musculoskeletal
topics more than neurological or cardiothoracic topics. In addition to
a workshop program conducted in a central regional town, evidence-
based research skills and clinical management training was also
offered on-site. The 2005/2006 program offered access to video
conferencing technology (VCT) with 384kbps-bandwidth. METHODS:
A questionnaire was sent to each physiotherapist to assess the
relevance of the 2004/2005 program. Primary outcomes were
attendance, perceived clinical relevance and efficacy. A secondary
outcome was the perceived effect on clinical skills. Each CE session
was evaluated using 7-point Likert scales. VCT users (n-15) during
2005/2006 were sent a fourth survey to explore acceptance of
VCT for the delivery of CE. ANALYSIS: Descriptive statistics using
Excel (Microsoft) and SPSS statistics packages. RESULTS: Modes
and median scores were 7, with seven being rated as highly
successful. Measurement of attendance showed that more than
two-thirds (68.6%) attended at least one workshop conducted in a
local clinic, 57.2% attended four or more sessions in the centre
of the region and 22.9% attended at least one of the two courses
conducted in 2004/2005. Moreover, 68.6% reported that attending
the program had made some effect on their therapeutic skills
and 20% perceived a large effect. The fourth survey (2005/2006
Poster Displays, Monday 4 June
VCT users) showed that most participants reported increased CE
participation rates due to VCT and 4-5 CE sessions were attended
(mean 4.7) using this medium. The maximum distance prepared
to attend CE by VCT (20-100km) and proportion of CE requested
via VCT (20-80%) varied. There was 100% agreement on the
satisfactory standard of CE via VCT and participants intended to
increase utilisation of VCT. Some found that face-to-face attended
CE was slightly more beneficial than VCT, others perceived no
difference. Reported VCT problems relate to sound, overheads, and
learning practical skills. CONCLUSIONS: Needs based interactive
CE was well supported by the rural physiotherapists and perceived
as clinically useful. VCT was perceived as an acceptable method
to increase attendance. IMPLICATIONS: Use of adult learning
principles, an interactive workshop format, VCT broadcasts at a
minimum frequency of 384kbps, and including VCT users seem
to have benefited the rural physiotherapists. Further studies are
needed to establish the effect of CE on clinical practice. Findings
can not be generalised to other professions or to physiotherapists in
non-rural areas. KEYWORDS: Continuing education, adult learning,
videoconference technology. FUNDING ACKNOWLEDGEMENTS:
Victorian Department of Human Services in Australia. CONTACT:
adrian.schoo@flinders.edu.au
ETHICS COMMITTEE: Flinders University Social and Behavioural
Research Ethics Committee
Research Report Poster Display
07-07 Monday 4 June 10:30
VCEC Exhibit Hall B & C
IMPACT OF AN ELECTRONIC REFLECTIVE PRACTICE
EXERCISE ON SELF-DIRECTED LEARNING AMONG PHYSICAL
THERAPY STUDENTS
Mori B1,2 , Batty H2,3 , Brooks D1 ; 1 Department of Physical
Therapy, University of Toronto, Toronto, Canada; 2 Centre for Faculty
Development, University of Toronto, Toronto, Canada; 3 Department
of Family and Community Medicine, University of Toronto, Toronto,
Canada
PURPOSE: To evaluate the feasibility of an electronic reflective
practice exercise during a clinical internship and assess its effect
on students’ reflective practice skills and self-directed learning
readiness. RELEVANCE: A goal of Physical Therapy curricula is
to facilitate development of future health care professionals who
will demonstrate reflective practice, as demonstrated by their ability
to accurately self-assess, identify their learning gaps and direct
their own learning. Students need the opportunity to develop these
skills during their curriculum. PARTICIPANTS: Eighty-four MScPT
Physical Therapy students completed a weekly reflection paper
within their first 3 week clinical internship. METHODS: Following
ethics approval from the University of Toronto Health Sciences II
Research Ethics Board, a pre-post intervention study was employed.
Students were asked to write a reflective piece and submit it
electronically on three occasions: week 1, week 2, and week
3. The first reflection was reviewed by faculty, the second by
a peer, and the third was self-reviewed. Three main outcomes
were assessed: first, faculty rated the depth of reflection papers;
second, a reflective practice exercise survey was completed by the
students upon completion of the internship; third, the self-directed
learning readiness scale (SDLRS) was completed pre- and post-
internship. ANALYSIS: Frequency distributions were used to analyse
the results from the survey. A paired t-test was used to analyse
the results from the SDLRS. RESULTS: All 84 students completed
the reflective practice exercise. Sixty-six students completed the
survey and 17 completed the SDLRS pre- and post-internship. Initial
reflection papers were rated at a descriptive (23%), descriptive-
analytical (28%) or analytical level (33%). Eighty-six percent rated
faculty feedback as helpful and 92% rated peer feedback as helpful.
Students reported they were confident (99%) with the reflective
practice process for their third reflection. Importantly, 97% of students
S219
reported they followed through on some or all of the items on their
reflection learning plans. A small percentage, (12%) disagreed that
the exercise of completing weekly reflections facilitated their ability
to direct their own learning and improve their performance. The
SDLRS significantly improved over the internship (mean difference
6.8±9.9; p<0.05). It took an average of 7 minutes for faculty
to review each student’s reflection and the students reported no
significant electronic difficulties during the study. CONCLUSIONS:
This study demonstrated that an electronic reflective practice exercise
during a 3 week clinical internship was feasible and positively
impacted the learners’ perceived reflective practice skills and self
directed learning readiness. Future directions include following
the depth of their reflections and SDLRS measure across the
curriculum. IMPLICATIONS: Simple electronic reflective practice
exercises can benefit reflective practice skill development as required
for practice. Feedback from students’ peers can be utilised to facilitate
reflective practice skill development in students. KEYWORDS:
reflective practice, education. FUNDING ACKNOWLEDGEMENTS:
This project was supported by the Department of Physical Therapy.
Dina Brooks is supported by the CIHR New Investigator Award.
CONTACT: brenda.mori@utoronto.ca
ETHICS COMMITTEE: University of Toronto Health Sciences II
Research Ethics Board
Research Report Poster Display
08-15 Monday 4 June 10:30
VCEC Exhibit Hall B & C
LOW-LEVEL LASER IRRADIATION PROMOTES THE RECOVERY
FROM DISUSE MUSCLE ATROPHY IN RATS
Nakano J1 , Okita M2 , Araki K3 , Kataoka H4 , Sakamoto J4 ,
Yoshimura T1 ; 1 Nagasaki University Graduate School of Health
Sciences, Nagasaki, JAPAN; 2 Faculty of Care and Rehabilitation,
Seijoh University, Nagoya, JAPAN; 3 Department of Rehabilitation,
Nagasaki KITA Hospital, Nagasaki, JAPAN; 4 Department of
Rehabilitation, Nagasaki Memorial Hospital, Nagasaki, JAPAN
PURPOSE: It is known that Low-level laser (LLL) irradiation
promotes the regeneration of blood capillaries. Recent research has
demonstrated that LLL irradiation also induces muscle satellite cell
proliferation in vitro. Muscle satellite cells and capillaries play an
important role in the growth and regeneration of muscle. The aim
of this study was to investigate the effect of LLL irradiation on the
recovery from disuse muscle atrophy in a rat model. RELEVANCE:
The biostimulating effects of LLL irradiation, particularly on muscle
tissue, are still unclear. This study provides information on the effects
of LLL irradiation on muscle tissue. PARTICIPANTS: Ten adult male
rats, aged seven weeks, were randomly divided into two groups: the
normal condition (NC, n = 5) group and the hindlimb suspension
(HS, n = 5) group. METHODS: In the HS group, disuse muscle
atrophy was induced by HS for 14 days. Over the same period,
the rats of the NC group were raised normally. After 14 days, the
HS treatment was discontinued. All the rats in both groups then
received LLL irradiation to the right gastrocnemius (experimental
side) through the skin, whilst under anesthesia. The LLL irradiation
(Ga-Al-As; 830 nm, 60 mW, 3 min) was repeated daily during
normal rearing over 14 days. One hour before the administration
of LLL irradiation, 5-bromo-2’-deoxyuridine (BrdU, 40 mg/kg) was
injected subcutaneously for the labeling of the nuclei of proliferating
cells. The left gastrocnemius (control side) was treated as the
control in both groups. At the end of the experimental period, the
gastrocnemius were extracted. The muscle tissue was divided into
red gastrocnemius (deep layer) and white gastrocnemius (superficial
layer) and these were examined separately. In a histochemical
examination, the muscle fiber diameters of each fiber type were
measured and the number of capillaries was counted. The nuclei
that incorporated BrdU were localized by immunohistochemistry
and the BrdU-positive nuclei of the muscle cells and satellite cells
were counted. The experimental protocol was approved by the
S220
Ethics Review Committee for Animal Experimentation of Nagasaki
University (Nagasaki, Japan). ANALYSIS: Statistical analyses were
performed using a one-way analysis of variance with multiple
comparisons. RESULTS: In the white gastrocnemius of the HS and
NC groups, the number of capillaries on the experimental side had
increased significantly compared with that on the control side. In the
red gastrocnemius of the HS group, the number of BrdU-positive
nuclei on the experimental side had increased significantly compared
with that on the control side. In the red and white gastrocnemius
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
recovery from disuse muscle atrophy and that this mechanism is
related to the proliferation of muscle satellite cells and capillaries.
IMPLICATIONS: Low-level laser therapy can be considered as one
of the potential approaches to the treatment of atrophied muscles.
KEYWORDS: Low-level laser, muscle, disuse atrophy. FUNDING
ACKNOWLEDGEMENTS: The funding source of this study was the
General Research Fund of Nagasaki University (Nagasaki, Japan).
CONTACT: nakano-j@nagasaki-u.ac.jp
ETHICS COMMITTEE: Our experimental protocol was approved
by the Ethics Review Committee for Animal Experimentation of
Nagasaki University (Nagasaki, Japan).
Research Report Poster Display
08-19 Monday 4 June 10:30
VCEC Exhibit Hall B & C
EFFECTS OF LOW-LEVEL LASER THERAPY IN THE
MANAGEMENT OF LATERAL EPICONDYLITIS: A RANDOMIZED
CONTROLLED TRIAL
Cheing G1 , Lam L2 ; 1 Department of Rehabilitation Sciences, The
Hong Kong Polytechnic University; 2 Physiotherapy Department,
Queen Elizabeth Hospital, Hong Kong
PURPOSE: Lateral epicondylitis is a common musculoskeletal
pain condition characterized by inflammatory response induced by
overuse of the tendon with an association of fibroblastic and vascular
degeneration. The clinical features are pain and tenderness over
the lateral elbow, which may also result in reduction in grip strength
and impairment in physical function. The objective of the study was
to examine the effectiveness of 904nm low-level laser therapy in
the management of lateral epicondylitis. RELEVANCE: Low level
laser therapy (LLLT) has been shown effective in its therapeutic
effects in tissue healing and pain control. Recent clinical trials also
showed its efficacy in the management of this condition in reducing
pain and improving grip strength and subjective rating of physical
function. Various studies have been done but controversial findings
were reported. In particular, there is a lack of common consensus on
the choice of optimal treatment parameters. PARTICIPANTS: Thirty-
nine subjects suffering from lateral epicondylitis were recruited in
the study. METHODS: A randomized, single-blind, placebo-controlled
clinical trial was carried out. Subjects were randomly assigned to
receive either active (laser group) or sham irradiation (placebo group)
treatment for 9 sessions. All subjects received a standardized home
exercise program. The outcome measures including mechanical pain
threshold, maximum grip strength, pain at maximum grip strength
using Visual Analogue Scale (VAS) and the subjective rating of
physical function using the Disabilities of the Arm, Shoulder and
Hand (DASH) questionnaire were assessed at Session 1 (baseline),
Session 5, Session 9 (last treatment session) and 3 weeks after the
treatment completed. ANALYSIS: Repeated measures ANOVA was
used. RESULTS: Significantly greater improvements were seen in
all outcome measures with the laser group than with the placebo
group in all subsequent sessions (p < 0.0125), except in the two sub-
sections of DASH, which was found no significant difference until
at the 3-week follow-up session (p = 0.002). CONCLUSIONS: This
WCPT 2007, Research Reports
study revealed that nine sessions of LLLT in addition to exercise
is effective in the management of lateral epicondylitis in pain relief
and improving the grip strength and subjective rating of physical
function in short term and 3-week follow-up period. IMPLICATIONS:
This study provides evidence that LLLT is effective for the
management of lateral epicondylitis. KEYWORDS: low level laser
therapy, lateral epicondylitis. FUNDING ACKNOWLEDGEMENTS:
None. CONTACT: rsgladys@polyu.edu.hk
ETHICS COMMITTEE: The Hong Kong Polytechnic University
Research Report Poster Display
10-03 Monday 4 June 10:30
VCEC Exhibit Hall B & C
ELECTROMYOGRAM IN MANUAL MUSCLE TESTING OF A
TRUNK FLEXOR
Kasahara S1 , Ishigaki T2 , Takahashi M1 , Miyamoto K1 ; 1 Dept. of
Health Sci., Hokkaido Univ. Sch. of Med.; 2 Dept. of Rehabiritation,
YamanotedoriYagi Hospital
PURPOSE: Muscle strength in patients with the physical impairment
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
limbs. To clarify the evidence of the grading of the trunk flexor in
MMT, we examined by the analysis with electromyogram (EMG).
RELEVANCE: This study relates to the physical therapy practice
based on the evaluation of muscle strength. PARTICIPANTS: Ten
healthy volunteer males with a mean age of 20 years participated.
Informed consent was obtained from each subject. METHODS: The
surface EMG activity was recorded from rectus abdominis (RA).
In current study we examined three gradings of the trunk flexor
during using Daniel’s method and Kendall’s method: (1) Normal,
(2) Good, and (3) Fair. ANALYSIS: The raw data of EMG from
RA was rectified and calculated the integration value (IEMG). Then
the percentage of the maximum voluntary contraction (%MVC) was
calculated. The muscle activity of Rectus femoris (RF) in MMT also
were calculated to compare with that of RA. Sampling rate was
1Kz. The mean and standard deviation was compared between
gradings of each method. Student-t test was used to compare
the significant difference. The required %MVC for each grading
was compared with one-way ANOVA. The significant level was
p < 0.05. RESULTS: The value of %MVC during using Daniel’s
method was 64.4±18.5 (Normal), 54.6±20.9 (Good), and 50.5±20.5
(Fair). The value of %MVC during using Kendall’s method was
32.7±14.1 (Normal), 36.0±13.5 (Good), and 30.9±16.9 (Fair). In
both methods there was no significant difference for the value of
%MVC between grading of the trunk flexor. The value of %MVC
during using Daniel’s method consistently showed larger than that
during using Kendall’s method (p < 0.05). There was a significant
difference for the value of %MVC between grading in RA and
RF (p < 0.05). CONCLUSIONS: This research verified evaluation of
the trunk flexor in MMT using EMG for the healthy youth male.
From these results, it is shown that there is no change of the
muscle activity in the grading of MMT used for the muscle strength
evaluation of the trunk flexor in the youth male. Clinicians should
carefully estimate the muscle weakness in the trunk flexor using MMT.
IMPLICATIONS: This study provided a problem as estimating the
trunk muscle weakness by using the clinical method. Therefore,it is
possible that the muscle strength evaluation by using MMT affect the
plan and effect of physical therapy training. KEYWORDS: MMT, Trunk
Flexor, Evaluation. FUNDING ACKNOWLEDGEMENTS: Unfunded.
CONTACT: kasahara@cme.hokudai.ac.jp
ETHICS COMMITTEE: The Ethical Committee of the College of
Medical Technology at Hokkaido University.
Poster Displays, Monday 4 June
Research Report Poster Display
10-07 Monday 4 June 10:30
VCEC Exhibit Hall B & C
GLUTEUS MAXIMUS ACTIVATION DURING FOUR MODALITIES
OF THERAPEUTIC EXERCISE
Teixeira-Salmela L, Sakamoto A, Goulart F, Faria C, Guimarães C,
Gomes P; Department of Physical Therapy, Universidade Federal
de Minas Gerais
PURPOSE: To evaluate the electromyographic (EMG) activity of
the gluteus maximus muscle during four modalities of therapeutic
exercise, often employed in clinical practice. RELEVANCE: The
gluteus maximus acts effectively in the transfer of loads from the
pelvis to the lower limbs, contributing to the stability of the sacroiliac
joint. Many studies have shown reduced activity of this muscle in
patients with low back pain. Therefore, it is important to know which
are the best exercises to activate this muscle. PARTICIPANTS:
Thirty-one healthy young subjects (16 men and 15 women, aged
24.5±3.47 years) were recruited from the community. METHODS:
EMG activity of the gluteus maximus was recorded as the subjects
performed four modalities of therapeutic exercise, involving active
prone hip extension at four positions: with knee extension, knee
flexion, lateral hip rotation and knee extension, and lateral hip
rotation and knee flexion. All exercises were randomly assigned and
three trials were obtained for each modality with a two-minute rest
interval between trials. The amount of EMG activity of the gluteus
maximus was recorded with active, bipolar surface electrodes. The
EMG signals were full wave rectified and low-pass and high-pass
filtered with cut-off frequencies of 500 and 10Hz, respectively, and
were recorded at the sampling rate of 1,000Hz. The maximum
voluntary isometric contraction (MVC) from the gluteus maximus was
used to normalize EMG data. ANALYSIS: Descriptive statistics and
tests for normality and homogeneity of variance were calculated
for all outcome variables. Repeated measures ANOVAs followed
by pre-planned contrasts were used to investigate differences in
the amount of gluteus maximus activity (%MVC) during the four
modalities of exercise, at a significance level of a<0.05. RESULTS:
The analysis revealed that the gluteus maximus showed the highest
MVC activity during the exercises performed with knee flexion
(23.1±21.2%), followed by those associated with lateral hip rotations
with both knee extension (22.5±10.3%) and flexion (21.2±11.9%).
The exercises performed with knee extension were the ones which
showed the lowest levels of EMG activity (12.7±8.6%). In addition,
significant differences were found only for exercises performed
with knee extension, when compared to those with knee flexion
(p = 0.04), lateral hip rotation and knee extension (p < 0.0001), and
lateral hip rotation and knee extension (p = 0.013). These findings
indicated that both the addition of knee flexion and/or lateral rotation
were effective in activating the gluteus maximus. CONCLUSIONS:
Exercises performed with knee flexion or lateral rotation, or their
combination, may be effective choices for activating of the gluteus
maximus muscle. The gluteus maximus showed the lowest activation
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
contribute to future directions of physical therapy in clinically-based
practice. KEYWORDS: Gluteus maximus, therapeutic exercises,
electromyography. FUNDING ACKNOWLEDGEMENTS: Brazilian
Government Agency (CNPq). CONTACT: lfts@ufmg.br
ETHICS COMMITTEE: Ethics Board Committe of the Universidade
Federal de MInas Gerais
S221
Research Report Poster Display
10-11 Monday 4 June 10:30
VCEC Exhibit Hall B & C
COMPARISON OF FOOT-GRASPING FUNCTION AND
QUADRICEPS FEMORIS MUSCLE FUNCTION BETWEEN THE
DOMINATE AND NON-DOMINANT LEG
Tanaka S1 , Murata S2 , Kai Y3 ; 1 kokura Rehabilitation School;
2 Department of Physical Therapy, Faculty of Health Care Science,
Himeji Dokkyo; 3 Technical School of Medical and Welfare
Ryokuseikan
PURPOSE: While the superiority of the dominant hand is obvious,
evaluation of the superiority of the dominant foot or leg has been
insufficient. In this study, we defined the leg with which one kicks
the ball (functional limb) or takes off in the broad jump (weight-
bearing limb) as the dominant limb, and the quadriceps femoris
muscle strength, foot-grasping strength, and times to their peaks
were compared between the dominant and non-dominant legs.
RELEVANCE: Comparison of the lower limb functions between the
dominant and non-dominant legs clarifies the objective of lower limb
physiotherapy, and makes effective physiotherapeutic approaches
possible. PARTICIPANTS: Thirty bilateral lower limbs of 15 healthy
adult males (mean age22.4±5.7years, mean height 170.2±5.4 cm,
mean weight62.3±8.7kg) were studied. METHODS: The quadriceps
femoris muscle strength and time to its peak were measured using a
BIODEX3 (Sakai Medical Co., Ltd.). The foot-grasping strength and
time to its peak were measured with our original foot-grasping force
meter (ICC = 0.953). ANALYSIS: The quadriceps femoris muscle
strength, foot-grasping strength, and times to their peaks were
compared between the dominant and non-dominant legs by paired
t-test. RESULTS: Comparison between the functional and non-
functional limbs showed no significant difference in the quadriceps
femoris muscle strength (147.7±26.5Nm, 137.3±24.5Nm) or time to
its peak (0.24±0.08sec, 0.23±0.06sec). There was also no significant
difference in the foot-grasping strength (17.3±4.9kg, 17.4±5.1kg)
or time to its peak (0.7±0.3sec, 0.6±0.2sec). Comparison between
the weight-bearing and non-weight-bearing limbs showed no sig-
nificant difference between the quadriceps femoris muscle strength
(142.2±24.6Nm, 142.7±27.5Nm), time to its peak (0.22±0.06sec,
0.25±0.08sec), foot-grasping strength (16.8±5.35kg, 17.9±4.5kg),
or time to its peak (0.59±0.3sec, 0.7±0.3sec). CONCLUSIONS:
The absence of a significant difference in the foot-grasping function
or quadriceps femoris muscle function between the dominant and
non-dominant lower limbs suggests that the necessary to consider
the effect of dominance is small in physiotherapeutic assessment
or treatment of the lower limbs. IMPLICATIONS: In patients with
unilateral lower limb dysfunction, restoration of the function of the
affected limb to the level of the intact limb was suggested to
be a valid treatment objective. KEYWORDS: dominant legs,foot-
grasping function,quadriceps femoris muscle function. FUNDING
ACKNOWLEDGEMENTS: This study was unfunded. CONTACT:
t.shin@kokura-reha.jp
Research Report Poster Display
11-15 Monday 4 June 10:30
VCEC Exhibit Hall B & C
THE CONTRIBUTION OF GOLF TO DAILY PHYSICAL ACTIVITY
RECOMMENDATIONS
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
S222
that regular golf participation may enhance fitness. Quantifying
the number of steps adults take in a typical 18-hole round will
assist golfers and health care practitioners in the integration of golf
participation into daily physical activity totals in the fight against
obesity. PARTICIPANTS: Forty-two subjects at least 18 years of
age, (12 men and 30 women) aged 30 to 80 years (mean ±SD
age, 55±13 years)with an established United States Golf Association
(USGA)-certified handicap with no medical conditions that precluded
normal golf participation or completion of the study walked three
municipal golf courses. METHODS: During each round of golf,
subjects wore an electronic pedometer (Omron HJ105, Healthcare,
Inc, Bannockburn, Ill) on the subject’s belt or waistband of their
slacks or shorts. The pedometer was set at zero on the first tee,
and a reading was recorded after the golfer exited the 9th green.
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
statistical analysis was performed using a mixed-model analysis of
variance to determine whether step counts might vary significantly by
course, age, sex, or handicap. RESULTS: The mean ±SD number
of steps taken per 18-hole round of golf for all 3 courses was
11,948±1781. CONCLUSIONS: Although individuals vary in their
risk factors for disease and daily activity requirements, accumulating
10,000 steps per day while consuming a nutritious diet is likely to lead
to improved health. IMPLICATIONS: Despite the observation that
previous research has questioned the intensity of golf in the context
of physical exercise, our data clearly indicate that golf partication
can contribute considerably to an overall daily physical activity plan.
KEYWORDS: golf, exercise. FUNDING ACKNOWLEDGEMENTS:
Funding for the pedometers was provided by the Mayo Clinic Sports
Medicine Center.
ETHICS COMMITTEE: Mayo Foundation Institutional Review Board
Research Report Poster Display
11-23 Monday 4 June 10:30
VCEC Exhibit Hall B & C
THE EFFECTS OF QI GONG IN PERSONS WITH BURNOUT
Stenlund T1 , Slunga Birgander L1 , Lindahl B2 , Ahlgren C3 ;
1 Department of Public Health and Clinical Medicine, Occupational
Medicine, Umeå University, Sweden; 2 Department of Public Health
and Clinical Medicine, Behavioral Medicine, Umeå University,
Sweden; 3 Department of Community Medicine and Rehabilitation,
Physiotherapy, Umeå University, Sweden
PURPOSE: The aim of this study was to evaluate the effectiveness
of Qi Gong in rehabilitation for persons with burnout. RELEVANCE:
Qi Gong is a complementary therapy, used by physiotherapists in
rehabilitation programs for different conditions, e.g. in the care for
the elderly. Persons with burnout report both psychological and
physical exhaustion. Therefore, Qi Gong could be a useful measure
to enhance both their mood and their physical activity. To our
knowledge, no studies have evaluated Qi Gong for persons with
burnout. PARTICIPANTS: One hundred and thirty-six persons (96
women and 40 men) with a mean age of 41.6 ±7.4 years and
with documented stress related disease and burnout, were invited
to participate in a randomized controlled study – REhabilitation for
STress related disease and burnout (REST). To be included in
the REST study, participants should be 25-55 years of age, have
been on sick leave for burnout 25% of their working hours during
3-24 months previous to inclusion, and have an average score
4.6 on the Shirom-Melamed Burnout Questionnaire. METHODS:
Qi Gong in groups, led by a physiotherapist trained in Qi Gong,
were held once a week during one year. Data on burnout, sleep
disturbances and physical variables were assessed at baseline
and after the intervention period. ANALYSIS: Difference between
baseline data and data after the rehabilitation period were analyzed
using Students paired T-test. The level of significance was set
WCPT 2007, Research Reports
to 0.05. RESULTS: After the intervention period, the persons
with burnout had significantly improved their balance and walking
capacity. In addition, significantly lower burnout scores and less sleep
disturbances were found. CONCLUSIONS: Qi Gong seems to be
reasonably efficient in order to improve physical and psychological
variables in persons with burnout. IMPLICATIONS: Qi Gong can
be used by physiotherapists, as a part of rehabilitation program
for persons with burnout. KEYWORDS: Burnout, physical therapy,
complementary therapies. FUNDING ACKNOWLEDGEMENTS: This
study was funded by the Swedish Council for Working Life and Social
Research, the Västerbotten’s County Council and the Swedish Social
Insurance Agency. CONTACT: therese.stenlund@vll.se
ETHICS COMMITTEE: The Research Ethics Committee of Umeå
University approved of the study (Um dnr 02-311)
Research Report Poster Display
13-03 Monday 4 June 10:30
VCEC Exhibit Hall B & C
DOES THE DIFFERENCE IN CRUTCH LENGTH MAKE ANY
EFFECTS ON ENERGY CONSUMPTION AND HANDLING
DIFFICULTY?
Kurosawa K1 , Ohta H2 , Okuyama F3 , Maruyama H4 ; 1 School
of Nursing and Rehabilitation Sciences at Odawara,International
University of Health and Welfare,Kanagawa Japan; 2 Sakura Hospital,
Aichi, Japan; 3 Hasuda Nursing Home; 4 School of Health Sciences,
International University of Health and Welfare, Tochigi, Japan
PURPOSE: In three-point gait and non-weight-bearing (NWB) gait
using standard crutches (Japanese crutch), the experiment was
undertaken to understand the effect of changes in crutch length
on Physiological cost index (PCI: indicator of efficiency), probe
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
that length ±2.5cm. Effects of changes in lengths were studied,
in terms of Probe RT as well as PCI and Borg scale, by making
the length difference of ±4 cm for crutches commonly used in
Japan. RELEVANCE: The study will make an important reference
material on determining the length of crutches in clinical area.
PARTICIPANTS: Eleven healthy college students (11 males 19 to 26
years old) participated in the present study. All were free of neurolog-
ical and orthopaedic disorders. METHODS: Three-point gaits were
done with crutches in standard length and those in standard length
±4cm on treadmill in constant speed (2.5km/hr). The subjects were
instructed to walk on a treadmill and to say “pa” immediately on recog-
nizing photo-stimulation (Nihon Koden.co SMP-3100) given from the
front. Probe-RT was measured at the time interval between the photo-
stimulation and vocal response. PCI was calculated by dividing, by
walking speed, the difference between heart rate on exercise during
walking on treadmill and the heart rate at rest before starting the task.
The heart rate was determined by using a Nihon Koden.co.CEC6301
heart monitor and counting R-R intervals for 15 seconds, from 3
minutes 45 seconds to 4 minutes after the start of walking, and
the converted value per minute was used as representative value.
ANALYSIS: Effects of differences in lengths of crutches on PCI,
Probe RT and Borg score respectively were analyzed using variance
analysis of repeated measurement. RESULTS: No significant effect
of lengths of crutches was observed on PCI (F=0.64, p > 0.01),
Probe RT (F=2.34, p > 0.01) and Borg score (F-3.24,p > 0.01).
CONCLUSIONS: It was shown that the length difference of ±4cm in
crutches did not have the effect on efficiency and psychological cost.
It is clarified that it is important, in applying crutches to patients,
to adjust crutch height for patients to handle easily, but that some
centimeters difference in the height does not have to be cared.
IMPLICATIONS: These are profitable information for the selection of
crutches in clinical. KEYWORDS: crutch length; attentional demand;
PCI. FUNDING ACKNOWLEDGEMENTS: The authors would like to
thank the subjects for their participation in this study.
Poster Displays, Monday 4 June
Research Report Poster Display
13-07 Monday 4 June 10:30
VCEC Exhibit Hall B & C
DEVELOPMENT AND TESTING OF A NOVEL GAIT ANALYSIS
SYSTEM USING WIRELESS TRI-AXIAL ACCELEROMETRY AND
EMG IN A PORTABLE SYSTEM
Castel C1 , Fujiwara T2 , Palermo F3 , Morozumi K4 , Draper D5 ;
1 Accelerated Care Plus Reno NV, USA; 2 The Koriyama Institute
for Health Sciences, Koriyama, Japan; 3 Washoe Medical Center
Rehabilitation Hospital, Reno NV, USA; 4 Hachiohji Health
Cooperative Shiroyama Hospital, Tokyo, Japan; 5 Brigham Young
University, Provo, UT, USA
PURPOSE: A wireless, easy to use gait analysis system, not
requiring video analysis or force plates, has the potential to provide
an easy to use tool for routine clinical rehabilitation use. We have
developed a wireless tri-axial accelerometer and EMG system with a
sampling frequency of 1 KHz which can be placed on body for gait
and movement analysis. The project is a joint collaboration between
The Research Institute of Health Science & Education, Japan and
Accelerated Care Plus Corp., USA. The purpose of this study is to
develop the instrument and investigate the test-retest reproducibility
of gait analysis using new wireless type equipment. RELEVANCE:
Physical Therapy evaluation for movement and gait is changing from
static to dynamic, and from two to three dimensions. The need for a
portable telemetry system, which can data download into portable
recording media through Bluetooth, was also identified. Tri-axial
accelerometry has been used for movement analysis in the research
literature, however, a wireless tri-axial accelerometer combined with
EMG and a heel pressure sensor is novel. PARTICIPANTS: 5 healthy
male subjects (24-36 years old) participated in this pilot study. We
obtained the informed consent from all subjects (in accordance
with the ethical standards for human medical studies laid down in
Declaration of Helsinki). METHODS: 5 subjects were measured at
three different gait speeds over a fixed distance during two trials
on sequential days. Each subject was prepared for measurement
and the equipment installed. A smooth 12 meter surface was used
with three meters at beginning and end of the track to allow for
acceleration and deceleration. EMG was measured on the right-
side Vastus medialis and Biceps femoris long head. The calcaneal
pressure sensor used a make and break foot switch. The Tri-
axial wireless accelerometer was secured on the Lumbar spine
third and right knee patellar tendon. The subjects were instructed
to walk 12 meter track four times with a fast, intermediate, and
slow speed, for a total of 12 tests. The data was transferred to
Notebook-size personal computer (Bioelectric Information Multi-Task
Analysis Research Program BIMUTAS KISSEI COMTEC Co., Ltd
Japan Installed) with a Bluetooth wireless device. Data analysis was
carried out by evaluating RMS accelerometry, as well as single cycle
vertical and lateral RMS accelerometry data averaged over ten gait
cycles at each speed. RMS and integrated EMG data was evaluated
over the same parameters. ANALYSIS: The Interclass correlation
coefficient by SPSS for Windows Ver 12.0 was used for the data
analysis RESULTS: The test-retest reproducibility was compared.
The wireless type 3-axis accelerometer and EMG equipment data
is reliable and reproducible and gait speed and stride length can be
assessed. The system may also be used to evaluate dynamic balance
based on our initial findings. CONCLUSIONS: It is possible to have
high reliability for practical clinical assessment of gait without force
plate and video technology. IMPLICATIONS: We developed a new
wireless type tri-axial accelerometer and EMG system with a high
sampling frequency of 1 kHz that may provide a low cost reliable
gait assessment method for clinical use. KEYWORDS: Wireless;
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.
S223
Research Report Poster Display
13-11 Monday 4 June 10:30
VCEC Exhibit Hall B & C
ALTERATION IN LOWER LIMB KINEMATICS AND KINETICS IN
INDIVIDUALS WITH KNEE OSTEOARTHRITIS DURING STAIR
CLIMBING
Protopapadaki A1 , Drechsler W1 , Cramp M1 , Coutts F2 , Scott O1 ;
1 University of East London, London, UK; 2 Queen Margaret
University College, Edinburgh, UK
PURPOSE: This study investigated lower limb kinematics and
kinetics during stair ascent and descent in knee osteoarthritic
patients. It was anticipated that individuals with knee osteoarthritis
(OA) would have altered joint kinematics and kinetics during stair
ascent and descent. RELEVANCE: Comprehensive analysis of knee
OA on functional mobility is required to establish primary changes
that affect joint function and secondary compensatory actions in
the lower limb. To date, few studies have investigated knee kinetics
and kinematics (Hinman et al., 2002; Kaufman et al., 2001 in
knee OA patients. The aim of this ethically approved study was
to monitor changes in hip, knee and ankle angles and moments
during stair ascent and descent in knee OA. PARTICIPANTS:
Fourteen patients with knee OA; 6M, 8F, mean (SD), age 66.71
(6.93) years and fourteen elderly healthy subjects 5M, 9F, age 67
(7.58) years with no history of lower limb injuries, back or pelvis
pathology, systemic or neuromuscular disease participated in the
study. All were able to go upstairs and down stairs without using
a handrail. METHODS: The stair case consisted of four steps
(rise height 18 cm, tread length 28.5 cm). Kinematic and kinetic
data of the lower limb was collected using a ten camera Vicon
motion analysis system (Oxford Metrics LTD, UK) and one Bertec
Force Platform (Model MIE Ltd, Leeds, UK) positioned on the
second stair step. ANALYSIS: Key variables included for analysis
were: temporal characteristics, hip/knee/ankle angles, and external
hip/knee/ankle moments, during stair ascent and stair descent.
One way ANOVA was performed to determine possible significant
differences between knee OA patients and controls. Statistical
significance was defined as p < 0.05. RESULTS: During stair ascent,
subjects with knee OA showed: significantly reduced knee flexion
angles (p < 0.05), external knee extension moment (p < 0.05), external
ankle dorsiflexion moment (p < 0.0001) and stride velocity (p < 0.001)
and significantly increased stride time (p < 0.001), weight acceptance
(p < 0.001) and stance phase (p < 0.001). During stair descent,
subjects with knee OA showed: significantly reduced knee flexion
angles (p < 0.001), external ankle dorsiflexion moment (p < 0.05) and
stride velocity (p < 0.0001) and significantly increased stride time
(p < 0.0001), weight acceptance (p < 0.001), stance phase (p < 0.001)
and single support phase time (p < 0.05). CONCLUSIONS: Indi-
viduals with knee OA showed marked differences in knee joint
angles, knee joint moments, ankle joint moments and temporal
characteristics during stair climbing when compared with healthy
age and gender-matched control subjects. The results of this study
demonstrated that knee OA patients alter their stair climbing patterns
possibly to meet the increased demands of stair locomotion that
occurs as a result of the disease. IMPLICATIONS: The data
provided in this study may serve as guidance to develop effective
rehabilitation protocols to restore optimal locomotor function for knee
OA patients. KEYWORDS: Kinematics; kinetics; knee; osteoarthritis;
stair climbing. FUNDING ACKNOWLEDGEMENTS: Funding from
State Scholarship Foundation of Athens (Greece) supported this
study. CONTACT: a.protopapadaki@uel.ac.uk
ETHICS COMMITTEE: NHS Research Ethics Committee and the
University of East London research Ethics Committee.
S224
Research Report Poster Display
14-15 Monday 4 June 10:30
VCEC Exhibit Hall B & C
RANGE OF MOTION AND ITS RELATION TO AGE AND BODY
SIDE
Macedo L1,2 , Magee D1 ; 1 University of Alberta; 2 University of Sydney
PURPOSE: The objectives of this study were to compare the range
of motion (ROM) between 4 different age groups: 18 to 29, 30 to
39, 40 to 49, and 50 to 59 and to compare the range of motion
between body sides (right and left). RELEVANCE: ROM is generally
assumed to reduce with age because of numerous changes occurring
during the aging process. There is sufficient data in the literature to
conclude that there is a decrease in ROM from birth to 18 years of
age. However, there is not insufficient data on the changes occurring
after maturity. The findings in the literature regarding the difference in
range of motion between sides are controversial. Many papers have
found differences in ROM between sides but these differences have
been minimal or are not consistent between studies. PARTICIPANTS:
Ninety “healthy” Caucasian women were assessed in this study.
There were 30 in the 18 to 29 group, and 20 in the other groups (30 to
39, 40 to 49 and 50 to 59) The sample size calculation was performed
using a= 0.01, effect size= 0.25 and power = 0.96. METHODS: The
ROM was measured for ankle, knee, hip, shoulder, elbow and wrist
using the protocol of Norkin and White and a standard goniometer.
The order of the joints, motion, sides and active or passive motion
tested were randomly selected. All measurements were taken once
actively and once passively for each joint on each side. ANALYSIS:
A ROM analyses between body sides and age groups was performed
using a two-way ANOVA with a Tukey post hoc test. A conservative
value of p < 0.01 was used to avoid a type error I. RESULTS:
There was no difference in active and passive ROM between age
groups. However, there was a decrease of range of motion with age
for: hip flexion, hip external rotation, shoulder external rotation and
elbow extension especially when comparing the younger group (18-
29) with the older group (50 to 59). The results of the differences
between sides showed a statistical significant difference for 29 of
the 60 motions measured. CONCLUSIONS: There was a significant
decrease in ROM for some motions and even though there was not
a significant difference between all age groups, a trend towards a
decrease in ROM with age could be seen. A significant difference
was present when comparing the younger age group with the older
age group. The results regarding differences between sides lead
to the conclusion that there is a significant difference between
sides for some specific ROM, however, the implications of these
changes are still unknown. Clinical studies are needed to define
the clinical implications of the ROM changes between age groups
and between sides. IMPLICATIONS: The significant decrease in
ROM with age should be taken in consideration when treating
patients in the older age groups. The use of the opposite side as
reference for comparisons in clinical practice may be inappropriate
and alternatives such as normative databases should be taken
in consideration. KEYWORDS: range of motion, goniometer, age,
body sides. FUNDING ACKNOWLEDGEMENTS: None. CONTACT:
lmacedo@ualberta.ca
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
VCEC Exhibit Hall B & C
DYNAMIC ANTERO-POSTERIOR STABILITY AT THE SHOULDER
JOINT – WHAT IS THE PRECISE ROLE OF THE ROTATOR CUFF
MUSCLES?
Ginn K1 , Boettcher C1 , Cathers I2 ; 1 Faculty of Medicine, University
of Sydney; 2 Faculty of Health Sciences, University of Sydney
PURPOSE: To investigate the role of the rotator cuff (RC) muscles
in maintaining antero-posterior stability at the shoulder joint during
WCPT 2007, Research Reports
active conditions. RELEVANCE: Antero-posterior translation of the
humeral head on the glenoid fossa occurs during passive shoulder
flexion and extension. The direction of this translation is in the
direction of movement of the humerus i.e. anterior translation
occurs during shoulder flexion and posterior translation during
extension. The magnitude of humeral head translation decreases
during active flexion and extension resulting in the shoulder joint
being more centred and, seemingly reinforcing the relevance of
neuromuscular control in providing shoulder joint stability. However,
simulated muscle forces of moderate magnitude have been unable
to prevent antero-posterior translation of the humeral head in ‘in
vitro’ studies. ‘In vivo’ studies are required to determine the precise
role of shoulder muscles in maintaining dynamic antero-posterior
stability at the shoulder. PARTICIPANTS: The dominant shoulder
of 15 normal subjects (18 to 50 years)was tested. Normal shoulder
function was defined as: 1) no shoulder symptoms in the past two
years 2) no treatment for shoulder symptoms 3) normal range of
motion and scapulohumeral rhythm 4) symptom-free on maximal
isometric rotation strength testing. METHODS: Electromyographic
(EMG) activity was recorded from supraspinatus, infraspinatus and
subscapularis using bipolar intramuscular electrodes. RC muscles
were chosen because of their significant role in providing dynamic
stability at the shoulder joint. Eight maximal, voluntary, isometric
contractions into shoulder flexion, extension, internal and external
rotation were performed in random order. Resistance was provided
manually for a period of 5 seconds and each test was performed
three times. ANALYSIS: The mean across the three trials of the
maximum of the rectified and low pass filtered EMG for each test
for each subject was determined. The mean EMG activity for each
muscle in each test position for all subjects was then calculated.
RESULTS: Activity levels in subscapularis during the maximum
isometric extension test were similar to those during maximum
isometric internal rotation, with minimal activity in supraspinatus
and infraspinatus. Activity levels in infraspinatus and supraspinatus
during the maximum isometric flexion tests were similar to those
during maximum isometric external rotation, with minimal activity in
subscapularis. CONCLUSIONS: The high activity in posterior RC
muscles during maximal flexion tasks suggests that these muscles
are functioning to prevent the anterior translation of the humeral
head that accompanies shoulder flexion when performed passively.
Similarly, the anterior portion of the RC is functioning to prevent
posterior humeral head translation during active extension. Contrary
to the results of ‘in vitro’ studies these results suggest that RC
muscles have a major role to prevent sagittal plane torque producers
from destabilizing the shoulder joint in the antero-posterior direction.
IMPLICATIONS: The results of this study indicate that: 1) high load
shoulder flexion and extension tasks require levels of activity in
the RC muscles similar to high load rotation tasks; 2) RC muscles
on the side away form the direction of movement prevent antero-
posterior translation at the shoulder joint; 3) abnormal RC activity
patterns are likely to play a major role in antero-posterior instability
at the shoulder. KEYWORDS: shoulder, rotator cuff, emg, shoulder
instability. FUNDING ACKNOWLEDGEMENTS: None. CONTACT:
K.Ginn@fhs.usyd.edu.au
Research Report Poster Display
14-23 Monday 4 June 10:30
VCEC Exhibit Hall B & C
PILLOW SHAPE AND CERVICO-THORACIC SPINE POSTURE IN
SIDE SLEEPERS
Gordon S1,2 ; 1 University of South Australia, Adelaide, Australia;
2 James Cook University, Townsville, Australia
PURPOSE: To determine how foam pillows of the same content
but different shape, contour or regular, support the cervical spine
in the side lying position. RELEVANCE: Despite many anecdotal
recommendations for the use of contour pillows, to support the
cervical spine at night, no known previous studies have investigated
Poster Displays, Monday 4 June
the effect of contour pillow shape on the posture of the cervical
spine in the side lying position. A previous study identified that
76% of foam contour pillow users reported preference for the side
sleep position (Gordon unpublished thesis). PARTICIPANTS: Ninety-
five subjects who reported preference for the side sleep position
with one pillow who were aged over 18 years were recruited for
the study. METHODS: Subjects were required to lie on their side
in a standardized position on an innerspring mattress. Reflective
markers were placed on the external occipital protuberance and
the spinous processes of C2, C4, C7 and T3. Digital images
were recorded at zero and 10 minutes whilst supported by a
foam regular shaped pillow and then by a foam contour pillow.
ANALYSIS: All anatomical landmarks in each digital image were
digitised using the Image Tool (UTHSCSA) program. Descriptive
statistics (mean, range and standard deviation) were used to
describe the slope and angle measures at zero and 10 minutes.
Comparative statistics (t-tests and univariate ANOVA) were used
to determine relationships between slope and angle measures
and pillow shape. RESULTS: Although the foam contour pillow
produced steeper slopes at each spinal segment than the foam
regular pillow these differences were not significant. Nor were
significant differences identified in the angles produced at adjacent
spinal segments when comparing these pillows. CONCLUSIONS:
Regular and contour shaped pillows of the same foam do not
support the cervical spine in a significantly different manner while
side lying. IMPLICATIONS: The choice between a foam contour
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:
susan.gordon2@jcu.edu.au
ETHICS COMMITTEE: Ethics approval supplied by the ethics
committee of the University of South Australia.
Research Report Poster Display
16-03 Monday 4 June 10:30
VCEC Exhibit Hall B & C
MOVEMENT DISCRIMINATION AFTER INTRA-ARTICULAR
LOCAL ANAESTHETIC AT THE ANKLE JOINT
Waddington G1 , Adams R2 , Down S3 ; 1 University of Canberra;
2 University of Sydney; 3 Australian Institute of Sport
PURPOSE: To determine the effect of intra-articular local anaesthetic
on movement discrimination at the ankle joint related to potential
proprioceptive safety issues. RELEVANCE: The impact on clinical
safety of dampening articular mechanoreceptor feedback at the
ankle is unknown. Athletes receiving intra-articular local anaesthetic
may be at increased risk of sustaining further ankle injury when
undertaking exercise after joint injection. PARTICIPANTS: Twenty-
two subjects (44 ankles) aged 18-26, from tertiary education
institutions and AIS staff. METHODS: Measurements of active
movement discrimination were recorded for both ankles before and
after injection of either local anaesthetic (lignocaine hydrochloride
2% without adrenaline – intervention arm) or normal saline (control
arm). ANALYSIS: Using the ROC subroutine in SPSSv.13 for
Windows, ROC curves were drawn with the stimulus pair entered
as the state variable and the response given entered as the
continuous variable. Mean area under these curves was used as
a discrimination score, with a possible maximum of 1.0 for perfect
discrimination, and 0.5 representing chance responding. A repeated
measures analysis of variance (ANOVA) was undertaken on the
data, examining differences between the conditions, between left
and right ankles, and for any interactions. RESULTS: There was
no significant difference in mean discrimination scores between
left and right ankles after the three occasions. [F(1,20) = 0.46,
p = 0.51]. There was a rise of 0.028 AUC units [F(1,20) = 8.52,
p = 0.008] in mean scores between the initial and second visits,
implying a learning effect after which on occasions two and three
S225
the scores were stable. The mean discrimination score following
injection of local anaesthetic was 0.689, which was almost identical
to that found for the control leg (0.687), and this difference was
not significant (t 20 df = 0.17, p = 0.87). Following injection of
normal saline, the mean discrimination score was 0.674, (0.682
in the control leg), the difference again not being significant (t
20 df = −0.25, p = 0.80). There was no significant difference in
control for saline versus control for local anaesthetic (means 0.682
and 0.687 respectively), and saline versus local anaesthetic mean
discrimination scores (0.674, 0.689) were also non-significant (t =
−1.1, p = 0.275). CONCLUSIONS: At commonly used doses and
volumes, there does not appear to be any deleterious effects of intra-
articular local anaesthetic or capsular distension (2mls) on movement
discrimination at the ankle joint, implying the absence of detectable
proprioceptive risk associated with the use of local anaesthetic in the
clinical setting. IMPLICATIONS: The confirmation of intra-articular
injections utilising ultrasound guidance and at clinically relevant
doses and volumes, suggests that there is little impact from this
procedure on the angular discrimination function of the ankle joint.
Where exercise interventions or sports performance may take place,
ankle joint anaesthesia appears to have no effect on proprioception
in movement discrimination. KEYWORDS: Ankle injury, propri-
oception, local anaesthetic. FUNDING ACKNOWLEDGEMENTS:
Australian Sports Commission, Canberra Australia. CONTACT:
gordon.waddington@canberra.edu.au
ETHICS COMMITTEE: Australian Institute of Sport Ethics Committee
Research Report Poster Display
16-07 Monday 4 June 10:30
VCEC Exhibit Hall B & C
EFFICIENCY OF IMMEDIATE POSTOPERATIVE INPATIENT
PHYSICAL THERAPY FOLLOWING TOTAL KNEE
ARTHROPLASTY: AN RCT ISRCTN49658674
Lenssen T1 , Crijns Y1 , Waltje E1 , van Steyn M2 , Geesink R2 ,
van den Brandt P3 , de Bie R3 ; 1 department of physical
therapy, Maastricht University Hospital, Maastricht, Netherlands;
2 department of Orthopaedics, Maastricht University Hospital,
maastricht, Netherlands; 3 depasrtment of epidemiology, Maastricht
University, Maastricht, Netherlands
PURPOSE: The main goal of physical therapy treatment (PT) in the
clinical stage following total knee arthroplasty (TKA) is to prepare
patients for discharge from the hospital as soon as possible after
their operation. Although aggressive rehabilitation is believed to
be important, evidence of effects of different exercise programmes
following TKA is limited. This led to the question whether the
intensity of PT (once versus twice daily) following TKA affects
short-term recovery, measured as range of motion. RELEVANCE:
Various authors have described aggressive rehabilitation schemes
incorporating more than one PT treatment session per day in the
clinical phase following total knee surgery. Aggressive rehabilitation
is believed to be important in preventing postoperative contracture of
the soft tissue and in gaining better range of motion. Nevertheless
evidence of effects of different exercise programs following TKA
is limited. PARTICIPANTS: A consecutive series of 43 patients
who received a primary TKA at the University Hospital Maastricht,
the Netherlands, was invited to participate between 1 January
and 1 June, 2004. Subjects were considered eligible for the study
if they signed an informed consent form. Patients undergoing
knee revision surgery were excluded as were patients over 85
years of age, patients with co-morbidity influencing gait and
patients who did not understand or speak Dutch. METHODS: A
randomised controlled trial (ISRCTN49658674)compared an exercise
regimen of two physical therapy sessions per day with a similar
programme administered once daily. Primary outcome measure was
ROM. ANALYSIS: Statistical analyses were blinded and performed
according to the ‘intention-to-treat’ principle. Post treatment scores
as well as differences between pre- and post treatment scores were
S226
compared with regard to all outcome measures. Group differences
and 95% confidence intervals (CI) were computed for all outcome
measures. Student’s t-test was used for continuous data to determine
differences between the two treatment groups. Chi-square tests were
used for analyses of categorical data and when continuous data
were not normally distributed. RESULTS: Of the 55 subjects who
were scheduled for surgery between January and June 2004, 43
were included in the study. 9 patients refused to participate and 3
were excluded because they had relevant co-morbidities. Twenty-one
patients were randomly assigned to the experimental group, 22 to
the control group. At the time of hospital discharge, there was no
detectable difference between the experimental and control groups
in range of motion nor on any of the secondary outcome measures
(functional status, length of stay after surgery, pain over the last 24
hours, satisfaction with treatment, satisfaction with the intermediate
treatment results and global perceived effect). CONCLUSIONS: This
study shows that in our setting twice daily PT sessions do not
produce different results as daily PT sessions. It may be questioned
whether multiple daily therapy sessions are needed as an in-hospital
PT regimen in OA total knee patients. Future research needs to
focus on the detection of subgroups of patients that may need more
care. IMPLICATIONS: In our Hospital standard twice daily visits were
changed into once daily PT sessions. Further PT care is tailored to
individual patients needs. KEYWORDS: Total knee arthroplasty; in
hospital treatment; efficiency; randomised controlled trial. FUNDING
ACKNOWLEDGEMENTS: The study was not externally funded.
CONTACT: alen@pmzl.azm.nl
ETHICS COMMITTEE: Masstricht hospital and Maastricht University
medical ethics committee
Research Report Poster Display
17-15 Monday 4 June 10:30
VCEC Exhibit Hall B & C
RELATIONSHIP BETWEEN PHYSICAL ACTIVITY AND QUALITY
OF LIFE IN OSTEOARTHRITIS OF THE KNEE
Watanabe H1 , Kamiya K2 , Hamazaki N2 , Kazumasa M2 , Suda K2 ,
Obara S2 , Hendona T2 , Aikawa J3 , Fujita M3 , Urabe K3 , Itoman M3 ;
1 Kitasato University School of Allied Health Sciences Faculty of
Rehabilitation, Sagamihara, Kanagawa, Japan; 2 Department of
Rehabilitation, Kitasato University Hospital, Sagamihara, Kanagawa,
Japan; 3 Department of Orthopaedic Surgery, Kitasato University
School of Medicine, Sagamihara, Kanagawa, Japan
PURPOSE: Osteoarthritis of the knee is one of the most common
diseases in elderly women. Osteoarthritis of the knee is characterized
by pain, disability and loss of physical function. However, there are
few reports on the relation between physical activity and activities
of daily living (ADL) or quality of life (QOL) in individuals with
osteoarthritis of the knee.This study evaluated physical activity in
osteoarthritis of the knee with gonalgia and showed the relationship
between physical activity and QOL. RELEVANCE: Recently, the
clinical outcome after physical therapy is not only an improvement
of physical function but also QOL in my own lifestyle is needed. We
consider being important to evaluate relationship between physical
activity and QOL as aspect of physical therapy. PARTICIPANTS:
Participants were 19 elderly women who got the content to physical
activity evaluation in the participant in the Kitasato Knee classroom
in 2005. METHODS: Evaluation contents were physical function
(extension strength of the knee, range of motion of the knee,
10m gait time, knee alignment), body composition (body mass
index, %body fat, lean body mass), disease severity and physical
activity using the accelerometer monitoring system (lifecorder EX).
The physical activity was calculated as a net energy expenditure,
movement volume and step counts. QOL was evaluated using
the Japan Knee Osteoarthritis Measure (JKOM). ANALYSIS: We
calculated a spearman correlation coefficient using the Stat View
Ver5 and analyzed the correlation between the physical activity
and JKOM score. The significance defined as p < 0.05. RESULTS:
WCPT 2007, Research Reports
The breakdown of disease severity was Stage 1 in 1 case, Stage
2 in 16 cases, and Stage 3 in 2 cases according with the
osteoarthritis of the knee classification of Yokohama City University.
The average value of physical activity by acceleration intensity
was net energy expenditure (1653.7±122.6 Kcal/day), movement
volume (189.9±92.4 Kcal/day), and step counts (8253.3±3799.4
steps/day). The JKOM score correlated with physical activity; net
energy expenditure (r = −0.64), movement volume (r = −0.62) and
step counts (r = −0.63). CONCLUSIONS: In general, although the
knee extension strength for the walking of healthy people was
considered to be 40% or more, subject’s knee extension strength was
approximately 37%. Women with osteoarthritis of the knee had loss
of extension strength of the knee, and had step counts higher than
age-matched healthy women. These results suggest that decreased
extension strength of the knee and high step counts were considered
as a characteristic of early stage osteoarthritis of the knee. We
conclude that decreased extension strength of the knee and high
step counts may be an exacerbation factor in osteoarthritis of the
knee. IMPLICATIONS: Even if an improvement of symptoms by
treatment is obtained, QOL is not necessarily high. In management
after treatment, it is important to evaluate the physical activity and
to make an improvement of QOL. KEYWORDS: physical activity, os-
teoarthritis of the knee, QOL. FUNDING ACKNOWLEDGEMENTS:
N.A. CONTACT: hw@ahs.kitasato-u.ac.jp
Research Report Poster Display
17-19 Monday 4 June 10:30
VCEC Exhibit Hall B & C
ANALISYS OF PASSIVE AND ACTIVE ANTERIOR TIBIAL
TRANSLATION AND ISOMETRIC PEAK TORQUE IN SUBJECTS
WITH AND WITHOUT ACL INJURY
Vasconcelos R3,4 , Arakaki J3 , Simão A3 , Oliveira A1 , Paccola C1 ,
Bevilaqua-Grossi D2 ; 1 Associate Professor, Department of
Biomechanics, Medicine and Rehabilitation of Locomotor Apparatus,
Ribeirão Preto School of Medicine, University of São Paulo
(FMRP-USP), Ribeirão Preto, SP, Brazil; 2 Full Professor, Department
of Biomechanics, Medicine and Rehabilitation of Locomotor
Apparatus, Ribeirão Preto School of Medicine, University of São
Paulo (FMRP-USP), Ribeirão Preto, SP, Brazil; 3 PhD Candidate,
Department of Biomechanics, Medicine and Rehabilitation of
Locomotor Apparatus, Ribeirão Preto School of Medicine, University
of São Paulo (FMRP-USP), Ribeirão Preto, SP, Brazil; 4 Orthopaedic
Physical Therapist, Orthopaedic Departament, knee and shoulder
surgery group, Celso Pierro Hospital, Campinas, SP- Brazil
PURPOSE: The aim of this study was to evaluated the anterior tibial
translation (ATT) and isometric peak torque in individuals with acl
rupture performing isometric contraction in open kinetic chain in a
angle that provoke substantial ATT. RELEVANCE: There is a lack
of studies reporting the simultaneously measurement of ATT and
isometric peak torque in subjects with acl injury PARTICIPANTS:
It was evaluated 20 male subjects (31.1±7.45 years) with acl total
rupture and 20 control subjects (22.2±3.15 years). The subjects
was divided in 4 groups ACLD (acl deficient knee), ACLC (acl
contralateral knee), DOM (dominant leg control group), NDOM (non
dominant leg control group). METHODS: To measure the passive
knee laxity of all groups the manual maximum test (MMT) was
performed using a kt 1000. The kt 1000 also was used to measure the
amount of (ATT) while the subjects perform three maximum isometric
voluntary contractions at 30 o (MIVC) in a Isokinetic dynamometer
The knee extension isometric peak torque data was simultaneosly
collected from all groups during the MVIC at 30 o ANALYSIS:
Students t tests was used to evaluate differences between the
four groups in the ATT obtained during passive knee laxity. To
evaluate differences in the peak torque and active anterior translation,
intergroup statistical analyses were performed by the method of
analysis of variance (ANOVA) with repeated measurements and,
if necessary, the technique of contrast formation in data analysis.
Poster Displays, Monday 4 June
A p  0.05 significance level was adopted. RESULTS: The results
demonstrated that significant greater passive (15.91±2.82 SD), and
active (11.21±2.4 SD) ATT was observed in the ACLD group
compared with the ACLC (7.74±2.04 SD), (7.13±2.3 SD), DOM
(7.42±2.18 SD), (7.08±2.3 SD) and NDOM (7.39±2 SD), (7.04±2.1
SD) Groups. The passive ATT values were significant greater than
the active ATT in the ACLD group (p < 0.05). The isometric peak
torque at 30º was significant lower (p < 0.05) in the ACLD group
(100.32±20.36) compared with the ACLC (112.17±24.65), DOM
(111.54±28.80), NDOM (109.77±32.66) groups. CONCLUSIONS:
The greater values of ATT observed in the passive knee laxity
compared with the active knee laxity associated with decreased
peak torque values in the ACLD group at 30º could be due to a
protective mechanism caused by chances in coactivation patterns
of the quadriceps and hamstrings in subjects sustaining acl injury
IMPLICATIONS: The Knowledgement acquire with this data could
provide insights for the development of acl reabilitation protocols
because different artrokinematics was observed in the angle of 30 o
of knee flexion possible causing overloads in secondary restraints
in acl deficient knees performng open kinetic chain exercises
KEYWORDS: knee, electromyography, acl, exercise. FUNDING
ACKNOWLEDGEMENTS: This work was supported through grants
conferred to the authors by the Brazilian government agency, CAPES.
CONTACT: rodvasconcelos@hotmail.com
ETHICS COMMITTEE: The study was approved by Human subjects
Review board Ribeirão Preto School of Medicine, University of São
Paulo
Research Report Poster Display
17-23 Monday 4 June 10:30
VCEC Exhibit Hall B & C
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 ,
Oldham J2 ; 1 Department of Physiotherapy, Technological
Educational Institute (T.E.I.) of Lamia, Greece; 2 Centre for
Rehabilitation Science, The University of Manchester, UK;
3 Warwick Emergency Care and Rehabilitation, UK; 4 Department
of Physiotherapy, Technological Educational Institute (T.E.I.) of
Patras, Aigion, Patras, Greece; 5 National School of Public Health,
Athens, Greece
PURPOSE: The main purpose was to develop a list of clinical
features for the assessment of low back pain (LBP) patients among
Greek health professionals which are believed to be discriminatory
in identifying different LBP subgroups. A secondary aim was to
yield any cultural factors that appear important in diagnostic practice
within Greece. RELEVANCE: Identifying homogenous subgroups of
LBP patients is considered a priority in physiotherapy. In achieving
this, the specific features facilitating clinical discrimination across
LBP patients need to be identified. PARTICIPANTS: A convenience
sample of 18 physiotherapists (PTs) and 5 doctors participated in
the focus groups, and a random sample of 150 physiotherapists
stratified according to geographical area and work status participated
in the Delphi survey. METHODS: Three focus groups followed by
two Delphi rounds were conducted. Ethical approval was obtained
from the Ethical Committee of the Technological Educational Institute
of Lamia, Greece. The focus groups consisted of 11 PTs, 7 PTs
specialized in LBP, and 5 doctors and focused in developing a
list of evaluating features utilized in their diagnostic practice for
patients with mechanical LBP, so as to distinguish different clinical
subsets. The focus groups’ resulting items were transformed into
the first round of a Delphi, to obtain consensus and hierarchy the
most important of these classified factors. Altogether there were 80
clinical and 26 cultural items. In both rounds PTs were asked to vote
whether to include or exclude each item from the examination list
(whether it is an important ‘classification’ item). ANALYSIS: Content
S227
analysis for the focus groups was conducted by two researchers
independently. The Delphi was analysed by percentage agreements.
The level of agreement was set at 70% and a 5% above and below
was re-considered based on analysis via Kendall’s coefficient of
concordance. Items over 75% agreement (categories of Agree and
Strongly Agree) were included, items below 65% were excluded,
and items between 65-75% agreement were re-considered in the
second round. RESULTS: 3 sections were identified in all focus
groups; History, Physical Examination and Cultural Features. 5
categories from History were developed (Present Symptoms, History
of Symptoms, Function, Psychosocial, Medical History), 7 categories
from Physical Examination (Observation, Neurological Examination,
Active & Passive Movements, Muscle Features, Palpation, Special
Tests), and 3 Cultural categories (Health Professionals’ Attitudes,
Patients’ Attitudes, Health System). Regarding the Delphi, 125
questionnaires were returned in the first and 111 in the second
round (83% & 74% response rate respectively). CONCLUSIONS:
66 clinical features rated by the sample as important discriminatory
items in LBP assessment, and another 10 important in diagnostic
practice cultural features were obtained. IMPLICATIONS: It may
be that these clinical features are ‘discriminatory’ for different LBP
subsets. To verify this, these clinical items should be tested in
a Greek LBP sample and attempt to statistically identify whether
any subgroups are formed. As for the cultural factors, whether the
elements identified possess a strong cultural impact across Greece
remains to be seen. KEYWORDS: Classifying low back pain, clinical
factors, cultural factors. FUNDING ACKNOWLEDGEMENTS: This
research was funded with the MACP’s Elsevier Science Award for
Research in Manipulative Physiotherapy. CONTACT: billis@teilam.gr
ETHICS COMMITTEE: Ethical Committees of a) Technological
Educaitonal Institute (T.E.I.) of Lamia, Greece & b) University of
Manchester, UK.
Research Report Poster Display
19-07 Monday 4 June 10:30
VCEC Exhibit Hall B & C
DEVELOPMENT OF A MANUAL THERAPY TOOL WHICH
COULD FACILITATE APPLIED FORCE CONTROL WHILE
MAINTAINING SENSITIVITY
Diong J1 , Waddington G2 , Adams R3 ; 1 Liverpool Hospital, NSW,
Australia; 2 Physiotherapy School of Health Sciences, University
of Canberra, ACT, Australia; 3 School of Physiotherapy, University
of Sydney, NSW, Australia
PURPOSE: During manual therapy, the hands are used to assess
and reassess stiffness in the spine, and mobilization forces are
both applied and absorbed by the hands. Therefore, factors that
alter the force produced when force constancy is intended are
important, because unintentionally high force could injure the hands.
Accordingly, a manual therapy/mobilization tool was designed, to
better spread these forces over the hands, and to show the amount
of force being applied. RELEVANCE: Although therapist and patient
positioning within the clinic is variable, effects of therapist posture
on control of applied force are unknown. The tool was thus used to
determine whether (i) sensitivity to differences in stiffness when using
the device is changed from the same stiffness assessment conducted
with the hands alone, and (ii) force constancy can be maintained
with variations in posture. PARTICIPANTS: A convenience sample
of 30 subjects recruited from the third-year undergraduate and
postgraduate student body of the University of Sydney’s Faculty of
Health Sciences participated in the study. METHODS: Subjects were
tested to measure their discrimination, without feedback, between
different elastic stiffnesses. Stiffness assessment was conducted
when using the manual therapy tool and also with the hands alone.
In addition, subjects attempted to maintain force constancy during
a series of Grade II and IV mobilizing forces applied using the
mobilizing tool on a plinth. The point of application of these forces
was at varying distances from the body, and no feedback was
S228
given. ANALYSIS: A matched pairs t test was used to compare
sensitivity of stiffness discrimination with and without the use of
the mobilizing dynamometer. To examine the effect of posture
on force application, a repeated-measures analysis of variance
was used. RESULTS: Stiffness discrimination was not significantly
different whether the hands or the device was used (t 29 = −0.986,
p = 0.332). Also, force constancy was maintained at Grade II when
the point of force application was moved away from the body,
but subjects were unable to replicate their Grade IV mobilization
forces in similar postures, despite an increase in perceived effort
(F1,29 = 18.622, p < 0.001). Both within and between subject variation
in force produced for both grades of mobilization was substantial,
although subjects were trying to produce the same force for each
grade. CONCLUSIONS: Subjects are equally good at discriminating
between different stiffness levels whether the hands or the tool is
used. Also, consistency of application of force cannot be maintained
with changes in posture. IMPLICATIONS: Variations in applied force
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,
Mobilization, Tool use. FUNDING ACKNOWLEDGEMENTS: Not
applicable. CONTACT: Gordon.Waddington@canberra.edu.au
ETHICS COMMITTEE: University of Sydney Human Ethics Research
Committee
Research Report Poster Display
19-11 Monday 4 June 10:30
VCEC Exhibit Hall B & C
QUANTITATIVE ANALYSIS OF DISTAL TIBIOFIBULAR JOINT
MOBILIZATION: A CADAVER STUDY
Fujii M1 , Miyamoto S2 , Muraki T1 , Suzuki D3 , Teramoto A4 ,
Uchiyama E3 , Aoki M2 ; 1 Graduate School of Health Sciences,
Sapporo Medical University, Sapporo, Japan; 2 Department of
physical therapy, Sapporo Medical University, Sapporo, Japan;
3 Department of anatomy, Sapporo Medical University, Sapporo,
Japan; 4 Department of orthopedic, Sapporo Medical University,
Sapporo, Japan
PURPOSE: Although joint mobilization is an effective treatment
procedure for limited range of ankle dorsiflexion, selection of an
appropriate joint mobilization technique remains controversial. This
research aims to evaluate the relationship between the directions
of application of the mobilization force on the distal fibula and
the amount of distal fibular motion. RELEVANCE: It is critical to
assess the joint movement when mobilizing the distal tibiofibular
joint because selection of an appropriate mobilization technique
may facilitate adequate distal tibiofibular joint play. PARTICIPANTS:
Seven normal frozen-thawed cadaver legs (5 males, 2 females;
mean age of the specimens, 79.9 years, range 67-98) were used.
METHODS: Each foot was fixed on a jig at 10º plantar flexion. All
measurements are monitored by 3Space tracking system (Polhemus,
USA). Prior to the experiment, the range of ankle motion and
the fibular movements were measured. Subsequently, the distal
fibula was mobilized in four directions (posterior, posterosuperior,
posterolateral, and superior). For simulating mobilization techniques,
a 19.6N traction force was applied to the distal fibula by inserting
a bone anchor into the lateral malleolus. Displacements along the
coordinate axes of the fibula (X, anteroposterior; Y, mediolateral; and
Z, superoinferior) were measured while the traction force was applied.
ANALYSIS: Data analysis was performed using the two-way analysis
of variance with repeated measures. Bonferroni’s correction was
used for conducting multiple comparisons. RESULTS: Application
of the traction in the posterior, posterosuperior, posterolateral, and
superior directions caused displacements of 0.07±0.04, 0.05±0.05,
0.20±0.09 and 0.03±0.02mm, respectively, along the Z axis. The
displacement caused by applying traction in the posterolateral
direction was significantly larger than those caused by applying
WCPT 2007, Research Reports
traction in the other directions (p < 0.01). There was no significant
difference between any directions with regard to the distal fibular
displacements along the X and Y axes. CONCLUSIONS: In this
experiment, the distal fibula moved toward similar directions during
ankle dorsiflexion. While applying tractions that simulate mobilization
techniques, significant amount of fibular displacement was achieved
by applying tractions in posterolateral. Therefore, it was proved
that posterolateral traction had certain beneficial effects on joint
play restriction, thereby improving the range of ankle dorsiflexion.
IMPLICATIONS: Our findings would be useful to treat limited range
of ankle dorsiflexion caused by the contracture of the distal tibiofibular
joint. KEYWORDS: Distal tibiofibular joint, Joint mobilization, Limited
range of dorsiflexion. FUNDING ACKNOWLEDGEMENTS: No
grant or funding was received for this project. CONTACT: m-
fujii0120@hotmail.co.jp
ETHICS COMMITTEE: Institutional Review Board of Sapporo
Medical University
Research Report Poster Display
21-03 Monday 4 June 10:30
VCEC Exhibit Hall B & C
PHYSICAL ACTIVITY IN PATIENTS WITH SYSTEMIC LUPUS
ERYTHEMATOSUS
Boström C1 , Karreskog H1 , Svenungsson E2 ; 1 Division of
physiotherapy, Department of Neurobiology, caring sciences and
society, Karolinska Institutet; 2 Unit of rheumatology, Division for
medicine, Karolinska university hospital/Karolinska Institutet
PURPOSE: The aim of this study was to 1) test aspects of reliability
and validity of designed questions about self-reported physical
activity and to 2) describe the physical activity in a cohort of
patients with systemic lupus erythematosus (SLE). RELEVANCE:
Cardiovascular disease is the major cause of death in patients
with SLE. As physical activity reduces the risk for cardiovascular
disease in the general population it is important to investigate the
impact of SLE on physical activity. In order to do that, reliable
and valid measurement instrument are needed. PARTICIPANTS:
Two hundred-three patients with SLE answered 11 questions about
physical activity and physical fitness and thirty-two of these were
consecutively selected for the test of the reliability and validity
of the questions. METHODS: This is a cross-sectional study with
preliminary results concerning physical activity. The 32 selected
patients answered the questions about physical activity twice, during
a period of one to three weeks. At the second measurement
the patients also answered four questions about their view of
the questions about physical activity. ANALYSIS: The analysis is
mainly quantitative using descriptive statistics, sign test and weighted
kappa coefficients. RESULTS: 1) No systematic, statistical difference
between the first and the second measurement was observed. One
of the questions had “moderate” agreement while the remaining
had “substantial” or “almost perfect”. The majority of the patients
reported that the questions were easy to understand and completely
or partly reflected their physical activity and physical fitness. None
wanted to exclude any question, eight wanted to add questions
and 16 gave further opinions. 2) One hundred-seventeen/188 (62%)
patients answered that they had reduced their physical activity since
they have got SLE. One hundred-one/203 (50%) answered that
they had, never or once a week, been physically active on a high
exertion level the latest six months. Ninety-six/195 (49%)patients
answered that they had never or irregularly done physical exercises
the latest year and 31 (16%) once a week. Fifty-six/196 (29%)
patients could run 2 km or more, with or without little rest periods,
and the majority (125) of the patients believed that reduced physical
capacity was due to reduced physical fitness. CONCLUSIONS: The
majority of the designed questions were reliable enough, according
to interpretation of sign test and weighted kappa, to describe physical
activity and physical fitness in patients with SLE. The questions were
also valid according to the patients point of view, however further
Poster Displays, Monday 4 June
studies are needed to describe more aspects of validity. The results
from this study also show that patients with SLE are not physically
active enough to prevent cardiovascular diseases. IMPLICATIONS:
Designing reliable and valid questions concerning physical activity
and physical fitness is of great relevance for physical therapists.
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
patient in this behaviour. KEYWORDS: Exercise, physical activity,
rheumatological diseases. FUNDING ACKNOWLEDGEMENTS: Un-
funded. CONTACT: carina.bostrom@ki.se
ETHICS COMMITTEE: Karolinska university hospital Solna Stock-
holm Sweden
Research Report Poster Display
21-07 Monday 4 June 10:30
VCEC Exhibit Hall B & C
DOSE-RESPONSE EFFECT OF MEDICAL EXERCISE THERAPY
IN PATIENTS WITH SUBACROMIAL PAIN. CONTROLLED TRIAL
WITH 6 MONTHS FOLLOW UP
Torstensen T1 , Østerås H2 , Østerås B2 , Haugerud L3 ,
Harms-Ringdahl K4 ; 1 Holten Institute AB, Stockholm, Sweden;
2 Sør-Trøndelag University College, Faculty of Health Education and
Social Work, Department of Physical Therapy, N-7004 Trondheim,
NORWAY; 3 Moholt Fysioterapi, Trondheim, Norway; 4 Karolinska
Institutet, Stockholm, Sweden
PURPOSE: To compare two different types of exercise programs
in relation to dose response effects in patients with long lasting
subacromial shoulder pain. RELEVANCE: There is increasing
evidence that exercise therapy is effective for this patient category,
but no evidence regarding what type of exercises and dosage is most
effective. PARTICIPANTS: 61 patients with unilateral subacromial
pain. METHODS: Multi center, randomized controlled trial, where
patients were randomly assigned either to a high dosage (HD)
medical exercise therapy group (n=30) or to a low dosage (LD)
exercise therapy group (n=31). Patients in the (HD) group performed
a total of 11 exercises consisting of 3 global exercises using a
stationary bike and 8 semiglobal and local exercises doing 3 sets
of 30 repetitions of each exercise, a total of 80-90 minutes. The (LD)
group performed a global exercise once for 10 minutes and performed
5 semiglobal and local exercises doing 2 sets of 10 repetitions of
each exercise, a total of 20–30 minutes. Both groups received 3
treatments a week over 3 months. The difference between the groups
were time performing aerobic global exercises, number of exercises,
repetitions and number of sets. The patients were supervised and
the exercises were individually tailored and graded according to the
clinical picture. Patients were assessed at inclusion, end of treatment
and at 6 months follow up where pain was measured using a visual
analogue scale (VAS), function was registered using the Shoulder
Rating Questionnaire (SRQ). ANALYSIS: Differences between the
groups were analyzed using a one-tailed Independent-Sample T-
Test. RESULTS: There were no statistical difference between the
two groups at inclusion. During treatment 5 patients (8%) dropped
out. At end of treatment the (HD) medical exercise therapy group
came out significantly (p < 0.05) better compared to the (LD) group
with less pain and improved function. The difference between
groups had increased at 6 months follow up. CONCLUSIONS: In
patients with long lasting uncomplicated subacromial pain, (HD)
medical exercise therapy is an efficient treatment approach and
significantly better compared to a (LD) program IMPLICATIONS:
Health professions should be aware that there is a dose response
effect using exercise therapy treating patients with unilateral long
lasting subacromial shoulder pain. To obtain good clinical results for
this patient category therapists using (LD) exercise programs need
to increase the exercise dosage. The therapist must supervise the
patient constantly progressing the exercises according to the patients
S229
clinical picture. KEYWORDS: Shoulder pain, exercise therapy,
randomized controlled trial. FUNDING ACKNOWLEDGEMENTS:
none. CONTACT: tom.torstensen@holteninstitute.com
ETHICS COMMITTEE: Human Review Committee (Trondheim,
Norway)
Research Report Poster Display
22-11 Monday 4 June 10:30
VCEC Exhibit Hall B & C
THE JOINT CONTRIBUTION OF PARTICIPATION/ AUTONOMY
AND NEUROLOGICAL DISABILITY FOR QUALITY OF LIFE IN
PEOPLE WITH MULTIPLE SCLEROSIS
Pedro L1 , Pais Ribeiro J2 ; 1 Centro Hospitalar Lisboa/Faculdade
psicologia Ciências Educação – U.Porto; 2 Faculdade Psicologia
Ciencias da Educação- U.Porto
PURPOSE: New technologies allow medical staff to identify at
early stages patients with multiple sclerosis. It is a chronic
neurological disease, characterized by demyelisation, linked with a
broad spectrum of physical, emotional and social impairment. The
combination of a progressive and unpredictable disease process is
a strong stressor, which powerfully impacts upon the quality of life
of patients with multiple sclerosis. RELEVANCE: The purpose of the
present study is to explore the joint contribution of neurological, and
autonomy and participation variables, and to identify the variables
that contribute to the overall quality of life in patients with MS
PARTICIPANTS: 280 patients with multiple sclerosis were recruited
via their physician at a neurology department of a central hospital
in Lisbon. They were eligible for inclusion in the study if they met
the following criteria: diagnosis according to relevant medical criteria,
between 18 and 65 years, being diagnosed at least 1 year ago,
EDSS score under 7. The mean age was 40 years (range 18-
65), 71.3% were women, 61.1% were married, 63% active workers,
mean school level of 12 years, and the mean score of EDSS
is 2.8. METHODS: the study was explorative and descritive the
patients diagnosed with definite MS in contact with Centro Hospitalar
Lisboa Ward or a consultant in neurology, betwwen 16 April 2005
and 30 Marc 2006. ANALYSIS: Measures: two items for Overall
quality of life (OQOL), belonging to the Multiple Sclerosis Quality
of Life scale (MSQol-54), that taps global subjective assessment
of overall quality of life. Expanded Disability Status Scale (EDSS)
is a method of quantifying disability in multiple sclerosis. The
questionnaire IPA (Impact on Participation and Autonomy) measures
several aspects of participation and autonomy. The IPA can make
a unique and fundamental contribution since it examines autonomy
as opposed to dependency. The IPA addresses autonomy and
participation in 5 domains: autonomy indoors, family role, autonomy
outdoors, social relations, and work and educational opportunities.
RESULTS: The mean score for the variables are the following:
OQOL (M=11.79; SD=2.98) EDSS (M=2.55; SD=1.75), 5 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
(M=10.86; SD=4.26), Work and Educational Opportunities (M=15.56;
SD=6.74). Correlation between OQOL and domains of IPA are
moderate (Autonomy Indoors r= −0.45, p < 0.0001), (Family Role
r= −0.52, p < 0.0001), (autonomy outdoors, r = −0.56, p < 0.0001),
(social relations, r= −0.54, p < 0.0001), (Work and Educational
Opportunities, r = −0.55, p < 0.0001). The correlation between OQOL
and EDSS score r= −0.36, p < 0.0001: better OQOL better autonomy
and participation and better scores on EDSS. Linear regression
analysis stepwise method, where OQOL is the dependent variable
and the EDSS score more the five domains of the IPA the
independent variables, shows a unique contribution of the “social
relations” and the “Work and Educational Opportunities”, both,
dimensions of the IPA, to the explanation of the variance of
OQOL (adjusted R2=0.40). CONCLUSIONS: The present study
shows that autonomy and participation (“social relations” and
“Work and Educational Opportunities”)are important variables for
S230
patients with MS. IMPLICATIONS: This is important information for
physiotherapists because it helps to focus on better outcomes for
rehabilitation. KEYWORDS: autonomy and participation, quality of
life,multiple sclorosis. FUNDING ACKNOWLEDGEMENTS: None.
CONTACT: luisapedro@netcabo.pt
Research Report Poster Display
22-15 Monday 4 June 10:30
VCEC Exhibit Hall B & C
SENSE OF COHERENCE, LIVING WITH PARTNER AND WORK
STATUS PREDICT PERSISTENT OR INCREASED FATIGUE IN
MULTIPLE SCLEROSIS, A LONGITUDINAL STUDY
Johansson S1,2 , Ytterberg C1 , Widén Holmqvist L1,2 , von
Koch L1 ; 1 Division of Neurology, Department of Clinical
Neuroscience, Karolinska Institutet, Stockholm, Sweden; 2 Division
of Physiotherapy, Department of Neurobiology, Care Sciences
and Society, Karolinska Institutet, Stockholm, Sweden
PURPOSE: To a) describe the perceived level of energy in persons
with multiple sclerosis (PwMS) every six months and changes
over time during a two year period, and to b) explore the
predictive capacity of some personal (sex, age, sense of coherence
[SOC]) and environmental factors (living with a partner, living
with children, work status, ongoing immune-modulating treatment),
disease-related characteristics (disease severity, disease course,
time since diagnosis) and time, during the two years. RELEVANCE:
Fatigue, a subjective lack of physical and/or mental energy interfering
with usual and desired activities, is the most frequently reported
symptom in PwMS. Knowledge regarding how the perceived level
of energy varies over time, as well as factors contributing to
fatigue are needed, in order to supply appropriate treatments
e.g., physical therapy. PARTICIPANTS: A cohort of 219 PwMS,
outpatients at a MS specialist clinic. METHODS: An observational
study was carried out during two years. Perceived level of energy
was assessed every six months with the Fatigue Severity Scale
(FSS), categorized into non fatigue, border fatigue and fatigue. Data
regarding the independent variables were collected at baseline,
except for the SOC which was collected at 6 or 12 months.
ANALYSIS: Descriptive statistics was used to explore the perceived
level of energy. Friedman ANOVA was used for analysis of changes in
FSS scores during the study period. Predictive capacity was explored
with Generalized Estimating Equations employing proportional odds
models. RESULTS: At inclusion 50% were fatigued and 33% non
fatigued. Throughout the two year observation time 54% varied
FSS category, 27% were persistent fatigued and 19% non fatigued.
FSS scores varied significantly, p = 0.02. SOC was the strongest
independent predictor for an increase in or persistent fatigue,
followed by living with a partner and not working. PwMS with
moderate disease severity, and relapsing remitting disease course
or >10 years since diagnosis, were at particular risk for increase in
or persistent fatigue. CONCLUSIONS: Every second PwMS changed
FSS category and every fourth experienced persistent fatigue over
two years. SOC, living with a partner and work status were major
predictors for increase in or persistent fatigue. IMPLICATIONS: The
variation in perceived level of energy over time in the majority of
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
WCPT 2007, Research Reports
Neurologically Disabilities, Swedish Research Council. CONTACT:
sverker.johansson@ki.se
ETHICS COMMITTEE: The study was approved by the ethical com-
mittee at the Karolinska University Hospital, Huddinge, Stockholm,
Sweden, Nr 449/01.
Research Report Poster Display
22-19 Monday 4 June 10:30
VCEC Exhibit Hall B & C
SELF- EFFICACY OF PATIENTS WITH PARKINSON’S DISEASE:
IMPLICATIONS FOR THE CLINICIAN
Lopez Rosado R, Bevins S, Bevins T; Department of Physical
Therapy and Human Performance, Florida Gulf Coast University,
Fort Myers, FL USA
PURPOSE: The purpose of this study was to determine if self-
efficacy in patients with Parkinson’s disease differs based on
sex or age. It was postulated that younger female patients with
PD would score higher than males on the self-efficacy ques-
tionnaire. RELEVANCE: This study provides valuable information
when conducting a proper needs assessment of the patient with
PD. It also provides a more clear expectation of the patient’s
commitment to and cooperation with his/ her rehabilitation program.
PARTICIPANTS: A total of 40 surveys were collected in a period of
3 months. METHODS: The instrument used in this study was the
General Perceived Self-Efficacy Questionnaire (GPSEQ), developed
by Schwarzer and Jerusalem. The original GPSEQ consisted of
10 questions. A modified version of the questionnaire was utilized,
including 5 additional statements related to motivation and adherence
to a rehabilitation program. A convenience sampling method was
used; patients with PD were identified in clinical settings located in
Southwest Florida. Participants were classified by sex (male/female)
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
administer and collect the questionnaires. The research protocol
and modified questionnaire were approved by the FGCU Institutional
Review Board. ANALYSIS: Descriptive statistical analysis was
performed in order to determine significant differences among
groups. RESULTS: The modified version of the GPSEQ was found
to have excellent internal reliability, based on the Cronbach’s alpha
obtained (R = 0.936). No significant difference among sex or age
groups in self-efficacy scores (p = 0.356 and 0.578, respectively)
were found. CONCLUSIONS: There was a high correlation between
the motivation items added to the GPSEQ and the original 10
items. Data suggested that there was no significant variability in
self-efficacy scores based on sex and age groups. Total GPSEQ
scores of all participants suggested a possible ceiling effect with
the majority of the total scores clustered in the high value range.
IMPLICATIONS: Although the younger female population is often
found to obtain higher scores in self-efficacy questionnaires among
the general population, this study found no significant differences
in either sex or age groups. Some limiting factors of this study
include the sample size and its homogeneity. Future research
could focus on significant differences in ethnic backgrounds and
other adjacent geographical regions. KEYWORDS: Self-Efficacy,
Parkinson’s Disease. FUNDING ACKNOWLEDGEMENTS: Private
funds. CONTACT: rlopez@fgcu.edu
ETHICS COMMITTEE: Institutional Review Board of Florida Gulf
Coast University
Poster Displays, Monday 4 June
Research Report Poster Display
23-23 Monday 4 June 10:30
VCEC Exhibit Hall B & C
ENVIRONMENTAL FACTORS IMPACTING PARTICIPATION IN
COMMUNITY MOBILITY FOLLOWING STROKE
Matsuda P, Robinson C, Ciol M, Beaverson J, Soine S, Flemming A,
Shumway-Cook A; Department of Rehabilitation Medicine
PURPOSE: Community mobility, defined as the ability to walk safely
and independently in a community environment, is a critical factor in
maintaining independence. Mobility limitations can restrict participa-
tion, and lead to social isolation, anxiety and depression. There is
limited evidence to suggest that participation in community mobility
may be restricted following stroke, however, the factors influencing
participation remain unclear. Among older adults, limited participation
in community mobility results from an interaction between personal
and environmental factors, and the specific environmental features
critical to disablement vary across individuals. This study examined
the level of participation in community mobility following stroke,
and used a person-environmental interaction model to determine
the relationship between the physical environment and level of
participation in community mobility following stroke. RELEVANCE:
Stroke is the leading cause of serious, long-term disability in the
United States. Despite the fact that 80% of individuals post stroke are
discharged home, most receive little to no community mobility training
(Latham et al, 2005). PARTICIPANTS: Twenty-five adults diagnosed
with stroke (mean age 68±9; mean time since stroke 40 mos) and
25 adults (mean age 68±11) without stroke participated. METHODS:
Level of community mobility participation was determined by self-
reported number of trips and walking related activities performed in
the community over a 4 week period (12 days sampled), and level of
satisfaction (1= not at all, 5=completely). The Environmental Aspects
of Mobility Questionnaire (EAMQ) was used to determine frequency
of encounter versus avoidance with 20 environmental features
impacting community ambulation. ANALYSIS: Comparisons between
control and stroke groups were performed using Mann-Whitney
and Chi-square tests for continuous and categorical variables,
respectively. Total number of trips and activities were analyzed using
negative binomial regression. Total number of features encountered
versus avoided were analyzed using a negative binomial regression,
and the effect of group (control or stroke), while adjusting for age and
sex was tested. RESULTS: Compared to controls, individuals with
stroke reported significantly fewer trips (p = 0.001), fewer walking-
related activities (p < 0.001), and had a lower level of satisfaction
with community mobility participation (p < 0.001). Compared to
adults without stroke, those who had a stroke had a significantly
lower rate of encounters (p < 0.001) and higher rate of avoidance
(p < 0.001) of physical features in the environment impacting gait.
After adjusting for age and sex, level of participation (including
total number of trips, total number of walking-related activities, and
ratio of walking-related activities performed per trip) was significantly
associated with rate of encounter (p = .03) and avoidance (p = .02).
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
of environmental factors on level of participation in community
mobility following stroke. Reduced participation was associated with
avoidance of some, but not all, physically challenging features
within the environment, suggesting that some environmental features
may limit community mobility more than others following stroke.
IMPLICATIONS: An increased understanding of the environmental
factors limiting participation will enhance rehabilitation strategies
for recovery of community mobility following stroke. KEYWORDS:
stroke, mobility, participation. FUNDING ACKNOWLEDGEMENTS:
This study was supported with funding from the Walter Stolov
Research Fund, Department of Rehabilitation Medicine, University
of Washington.
ETHICS COMMITTEE: Institutional Review Board, Human Subjects
Division, University of Washington, Seattle, WA
S231
Research Report Poster Display
24-03 Monday 4 June 10:30
VCEC Exhibit Hall B & C
USE OF FUNCTIONAL INDEPENDENCE MEASURE™ WITH
PATIENTS WITH STROKES IN VIETNAM
Binh N1 , Pechak C2 , Thompson M2 ; 1 Department of Rehabilitation
Medicine, Hospital C, Danang Vietnam; 2 Texas Woman’s University,
Dallas, USA
PURPOSE: The purpose of this study was to describe the
characteristics and functional recovery of patients with strokes
that were treated between 2000 and 2004 in the Department of
Rehabilitation Medicine of Hospital C in Danang, Vietnam using
Functional Independence Measure (FIM™) scores and compare to
available USA data. RELEVANCE: Despite the expectation that the
impact of stroke will increase as the economy develops and the
population ages, few data are available in the English language
literature regarding the scope of the problem in Vietnam. No study
is available in the English language or Vietnamese literature that
has documented the use of the FIM™ in Vietnam. In order to build
evidence-based practice and promote rehabilitation research in Viet-
nam, problems must be defined and outcome measures employed.
Dissemination of the data in the English language increases network-
ing and research opportunities between rehabilitation professionals
in Vietnam and their international colleagues. PARTICIPANTS: All
patients with strokes that were treated between 2000 and 2004 in
the Department of Rehabilitation Medicine of Hospital C in Danang,
Vietnam. METHODS: Data were collected retrospectively from
medical records, and included: gender, age, body side affected by
stroke, onset of stroke to start of rehabilitation interval, average length
of stay in rehabilitation in days, and FIM™ scores on admission and
discharge. The internationally accepted FIM™ instrument is an 18-
item ordinal scale used for rating independence in self-care, sphincter
control, mobility, locomotion, communication, and social cognition.
ANALYSIS: Descriptive analysis was performed; mean FIM™ scores
upon admission and discharge, and mean FIM™ change scores
were calculated. RESULTS: The majority of the patients (69%) were
men with a mean age of 60. Most of the patients with stroke had
right hemiparesis (53.5%), and most of the patients (53%) initiated
rehabilitation between one week and four weeks post-stroke. The
researchers report an average FIM™ gain of 21.0 from admission
to discharge. CONCLUSIONS: This study highlights the potential
of clinical researchers in Vietnam to utilize internationally accepted
outcome measures and to contribute towards the currently very
limited data on patients with stroke and their rehabilitation in Vietnam.
IMPLICATIONS: Outcome measures can and should be incorporated
in physical therapy practice in developing countries. Sharing a
common language of outcome measures will promote evidence-
based practice and research in rehabilitation at the international level.
KEYWORDS: stroke, Vietnam, Functional Independence Measure
(FIM™). FUNDING ACKNOWLEDGEMENTS: none. CONTACT:
pechak@tyler.net
Research Report Poster Display
24-07 Monday 4 June 10:30
VCEC Exhibit Hall B & C
EARLY DISCHARGE TO THERAPY-BASED REHABILITATION AT
HOME IN PATIENTS WITH STROKE. A SYSTEMATIC REVIEW
Winkel A1 , Ekdahl C, Stig Jørgensen H, Gard G; 1 The unit for
neurology and rehabilitation, Hillerød, Denmark
PURPOSE: Early discharge and home rehabilitation for stroke
patients is in many countries explored as an alternative to
rehabilitation in stroke units. There is some evidence that this
rehabilitation scheme reduces length of stay, improves independence
and quality of life and might reduce costs. The objective of this study
is to review the effects of early discharge on home rehabilitation in
stroke patients RELEVANCE: Stroke is the most frequent cause of
S232
disability and the third most frequent cause of death in Denmark.
Prevalence is 13.000 inhabitants pr year entailing great expenses
for treatment and rehabilitation. PARTICIPANTS: studies with stroke
patients over 18 years included METHODS: Randomized controlled
trials published between 1980 and 2005 were identified in Medline,
Chinal, Embase, Cochrane Library and PEDro databases. After
exclusion 17 studies with stroke patients, which compared early
discharge to home rehabilitation with rehabilitation at hospital were
included. Methodological quality was rated using PEDro scale.
ANALYSIS: The results of the quality assessment were summarized
using a rating system consisting of the adapted criterion from
Sackets rules of scientific evidence. Characteristics of the patients,
settings, interventions, physiotherapy and outcome measures used
in the included studies were described. RESULTS: There was a
compelling evidence, that early discharge to home rehabilitation can
reduce length of stay in hospital for patients with stroke. Three
intervention groups were identified: 1. Outgoing early supported
discharge services from hospital, 2. Outgoing early supported
disharge teams from hospital, who do not provide rehabilitation
services and 3. Community based rehabilitation services after early
discharge. Isolated description of the physiotherapy intervention
revieled, that home rehabilitation has advantage to rehabilitation in
hospital in respect of making use of patients coping capacities. If
patients’ coping capacities were taking into consideration a positive
effect on basic activities was seen at six months and one year, and
on instrumental activites at one year in intervention group I. Some
positive effects of home rehabilitation on instrumental activities were
found at 1, 3, 6 months, and at one and five years in intervention
group I og II, on health and quality of life of patient at 3 months
in intervention group I and II, and at 6 months and 1 year in
intervention group II. Less costs of the home rehabilitation was
found in intervention group I. CONCLUSIONS: Early discharge and
home rehabilitation of stroke patients can reduce length of stay at
hospital, might improve patients’ basic activities, but is more liable
to improve the instrumental activities. The home intervention seem
to be cost effective but could be discussed. The physiotherapy
intervention at home differs from the rehabilitation at hospital
making the context and patiens coping capacities the core issue.
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
Danish Physiotherapy Association and the County of Frederiksborg.
CONTACT: awi@fysio.dk
Research Report Poster Display
25-11 Monday 4 June 10:30
VCEC Exhibit Hall B & C
THE RELATIONSHIP OF SELF-REPORT AND SELF-EFFICACY
MEASURES TO AMBULATORY PERFORMANCE AND FALLS
HISTORY IN COMMUNITY-DWELLING PEOPLE WITH STROKE
Beninato M, Sullivan P, Belgen B, Narielwalla K; MGH Institute,
Boston MA, USA
PURPOSE: To examine relationships among self-report measures of
balance confidence, falls self efficacy, fear of falling and functional
performance, with performance-based measures of balance and
mobility in community-dwelling stroke survivors and to examine if
these measures categorize faller status. RELEVANCE: Identifying
measures to determine those who fall may provide a basis for
determining those at risk. PARTICIPANTS: 32 subjects with stroke
living in the community. METHODS: Subjects were examined during
a single session. Questionnaire assessed falls history. Self reported
(SR) measures included the Falls Efficacy Scale [FES(S)], the
Activities Balance Confidence (ABC) scale, fear of falling (FOF) a 1-
10 scale, and physical function subscale of the Stroke Impact Scale
(SIS-16). Performance-based (PB) measures were the Berg Balance
Scale (BBS) and Timed Up and Go (TUG). ANALYSIS: Descriptive
WCPT 2007, Research Reports
statistics and Spearman Rho correlation coefficients were calculated
(sig p < 0.05). Subjects were categorized as having had more than
one fall or as having no or one fall in the prior six months. Receiver
operating characteristic (ROC) curves were generated to measure
the ability of each variable to categorize subjects based on faller
status. RESULTS: Subject demographics were: mean age = 58.1
years (+/−12.39; range 35-83); 53% male; 50% right and 50% left
sided stroke; mean time since stroke. = 55.1 months (+/− 66.7, range
3-312); 44% had fallen in the prior 6 months and 28% reported
multiple falls. 94% reported independent community ambulation; 50%
used no assistive device. SR measures correlations were: FES(S)
and ABC (r = −0.81); FES(S) and ABC correlated with self reported
function SIS-16 (r = −0.77 and 0.78), FES(S) with FOF (r = 0.44), the
ABC and FOF (r = −0.32). SR were correlated with PB measures:
FES(S) and ABC correlated with BBS (r = −0.49 and 0.53), only the
ABC correlated with the TUG (r = −0.49). The PB, TUG and BBS
were highly correlated (r =-.65). The SIS-16 best categorized falling
status of subjects with an area under the curve of 0.82, then the
ABC (area = 0.81), the BBS (area = 0.76) and the FES(S) (area =
0.72.) The TUG was less effective (area = 0.65). CONCLUSIONS:
The single and multiple fall rates were high in this functionally
independent sample of persons with stroke. A strong relationship
existed between confidence in performing a task without losing
balance and in performing the task without falling. Subjects’ ratings
of balance and falls self-efficacy were more strongly related to other
self report variables than to performance of balance and mobility.
Self-reports of function and balance self-efficacy identified multiple
fallers better than performance-based measures. IMPLICATIONS:
The high rate of falls suggests that continued care in this population
is needed. Self-report measures of function and balance self-
efficacy are good tools for identifying those who have a history of
multiple falls. It is recommended to add these measures to fall risk
screening as they may assess different aspects of overall status
than performance-based measures. KEYWORDS: stroke, clinical
measures, faller status. FUNDING ACKNOWLEDGEMENTS: N/A.
CONTACT: psullivan8@mghihp.edu
ETHICS COMMITTEE: Partners Health Care, Spaulding Hospital
IRB
Research Report Poster Display
25-15 Monday 4 June 10:30
VCEC Exhibit Hall B & C
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;
2 University of Illinois at Chicago, Chicago IL, USA
PURPOSE: The important work of healthcare providers has long
been associated with high rates of work-related musculoskeletal
disorders (WRMSDs). Epidemiological and biomechanical research
suggests the tasks and activities inherent in manually caring for
patients involve significant exposure to physical job risk factors of
non-neutral postures and heavy loads. The goal of this study was
to observe the work of physical therapists in real-time settings
to obtain objective information about exposure to risk factors
for WRMSDs in physical therapy practice. RELEVANCE: There
are a limited number of studies on WRMSDs among physical
therapists. The studies all collected self-reported measures of work
exposures and health outcomes among those reporting disorders.
Overall, these studies suggest that physical therapy work is indeed
associated with WRMSDs and that some settings (neurological
rehabilitation, pediatrics, geriatrics) and activities (patient handling
such as transfers, performing manual therapy) are particularly related
to reports of these conditions. More objective information would
assist in interpreting such results. PARTICIPANTS: Subjects were
13 physical therapists (11 female; 2 male) employed full-time at a
University-associated major medical center in a large Midwestern
Poster Displays, Monday 4 June
city. Five therapists were observed in the in-patient setting, five in out-
patient, and three in pediatrics. METHODS: An established method
of observational work sampling called PATH (Posture, Activity, Tools,
Handling) was used to collect data. Based in part on the Guide to
Physical Therapist Practice, a taxonomy of physical therapy work
was created and used to design the template for data collection.
Major task categories were evaluation, treatment, administration,
and other. Categories for specific patient-related activities were
therapeutic exercise, manual therapy, gait training, patient handling,
education, and physical agents. Codes for shoulder, elbow, trunk, and
leg postures were defined as were codes for loads handled, settings,
and equipment. Instances where forces were applied through the
thumb or finger were also noted. Each subject was observed for about
4 hours doing their usual work; every 60 seconds observations were
recorded on the template. ANALYSIS: Frequencies of observations
were calculated for all categories. Cross-tabulations were done
to compare exposure to individual risk factors of posture and
load with key tasks and activities. Summary scores were created
for each observation to capture information about simultaneous
exposure to posture*load. Analysis of variance was used to compare
scores for tasks, activities, settings, and other categories of interest.
RESULTS: Subjects were involved with direct patient care (evaluation
or treatment) approximately 2/3 of the time observed. The greatest
frequency of non-neutral shoulder and trunk postures occurred while
treating patients. Activities of greatest risk were manual therapy,
patient handling, and therapeutic exercise. The setting with greatest
risk was pediatrics. Other results will be displayed. CONCLUSIONS:
Physical therapists are indeed exposed to physical job risk factors
for WRMSDs in the course of daily work tasks and activities.
IMPLICATIONS: This research provides an objective estimate of
exposure to ergonomic risk factors in the practice of physical therapy
and will assist efforts to design implement, and evaluate interventions
to improve the work environment and decrease risks for WRMSDs.
This information may also have important implications for entry-
level professional physical therapy education. KEYWORDS: Work-
related musculoskeletal disorders; Physical job risk factors; Exposure
assessment; Physical therapy. FUNDING ACKNOWLEDGEMENTS:
This resarch was supported by Grant # T42OH008672-01 from
the National Institute for Occupational Safety and Health (NIOSH).
Its contents are solely the responsibility of the author and do
not necessarily represent the official views of NIOSH. CONTACT:
krockefe@health.usf.edu
ETHICS COMMITTEE: Institutional Review Board at University of
Illinois at Chicago
Research Report Poster Display
25-19 Monday 4 June 10:30
VCEC Exhibit Hall B & C
FEAR-AVOIDANCE BELIEFS, PAIN AND PERCEIVED DISABILITY
IN PATIENTS WITH WORK-RELATED LOW BACK PAIN
Mngoma N1,2 , Symes A2 , Stevenson J1 , Tripp D1 , Faris M1,2 ,
Hopman W1,3 ; 1 Queen’s University, Kingston, Ontario, Canada;
2 Providence Continuing Care Centre, Kingston, Ontario, Canada;
3 Kingston General Hospital, Kingston, Ontario, Canada
PURPOSE: The objectives of this study were to 1) determine fear-
avoidance beliefs about physical activity in patients with low back
before and after rehabilitation, and 2) explore associations between
fear-avoidance beliefs, perceived disability, and pain. RELEVANCE:
There is growing evidence that fear-avoidance beliefs are associated
with persistent low back pain and pain-related disability (Crombez
et al, 1999; Vlaeyen & Crombez, 1999). For example, Fritz and
George (2002) found that in a group of patients with acute work-
related low back pain, the psychosocial factor most predictive of
return to work was fear-avoidance beliefs about work. Woby et
al. (2004) reported that reductions in fear-avoidance beliefs were
associated with reductions in disability even when reductions in
pain intensity, age and sex were controlled for. In a recent report,
S233
Fritz and George (2006) found that significant amounts of variance
in change in disability could be explained by changes in fear-
avoidance beliefs, even after controlling for changes in pain intensity.
Therefore, it is important for clinicians to determine and address fear-
avoidance beliefs in low back pain in order to minimize pain-related
disability and improve chances of return to work. PARTICIPANTS:
Patients with subacute low back pain referred to an outpatient
rehabilitation program participated in this study. The average age
for the group was 39 years, and more than half (54.2%) were
women. Forty patients available to provide complete pre and post
data were included in the analyses. METHODS: A pretest-posttest
design was used within a randomized clinical trial of a cognitive-
behavioural disability management program. In addition to standard
physiotherapy for low back pain, the intervention group participated
in an individualized cognitive-behavioural type intervention. The fear-
avoidance beliefs questionnaire was used to measure beliefs about
physical activity (Crombez, 1999). The pain disability index was used
to measure perceived disability (Tait et al., 1991), and the McGill Pain
Questionnaire current pain intensity subscale was used to measure
pain (Melzack, 1987). ANALYSIS: t-tests (p < 0.05) used to determine
if there were differences between the intervention and control group
showed that there were no significant differences. The groups were
therefore combined for subsequent analyses. t-test were used to
detect pretest-posttest differences and Pearson correlations were
used to explore associations between the measures. RESULTS:
There were statistically significant improvements (t-tests; p < 0.05)
in all measures (FAB, pain and PDI scores) pre- to post-test.
The poster will describe the associations found between the
measures, and implications for clinical practice and future research.
CONCLUSIONS: Fear-avoidance beliefs can be significantly reduced
in rehabilitation programs tailored to address such fears. Fear-
avoidance beliefs are associated with pain reports and perceived
disability. IMPLICATIONS: Fear-avoidance beliefs have to be ad-
dressed in order to prevent prolonged pain-related disability, including
work absence. Physiotherapists are best positioned to provide
reassurance to individuals with low back pain. KEYWORDS: fear-
avoidance beliefs, low back pain, pain-related disability. FUNDING
ACKNOWLEDGEMENTS: This Project was funded by a research
grant provided by the Workplace Safety and Insurance Board
(Ontario). The authors wish to acknowledge the support provided by
Providence Continuing Care Centre, Kingston, Ontario. CONTACT:
mngoma@post.queensu.ca
ETHICS COMMITTEE: Queen’s University and Affiliated Hospitals
Research Ethics Board, Kingston, Ontario, Canada
Research Report Poster Display
26-23 Monday 4 June 10:30
VCEC Exhibit Hall B & C
TRUNK POSITION SENSE AND FUNCTIONAL MOBILITY IN
OLDER TAI CHI SWORD PRACTITIONERS
Tsang W, Fu S, Hui-Chan C; Department of Rehabilitation
Sciences, The Hong Kong Polytechnic University, Hong Kong, China
PURPOSE: The objectives of this study were to examine whether
older Tai Chi sword practitioners developed better trunk position
sense and faster timed up-&-go (TUG) score than healthy control
subjects, and to determine the extent of correlation between these
two measures. RELEVANCE: Joint position sense and mobility are
known to deteriorate in older adults. Tai Chi training has been found
to improve the knee joint proprioceptive acuity and static balance
control. The results of this cross-sectional study will delineate the
specific therapeutic value of an advanced form of Tai Chi using sword
on trunk position sense and functional mobility. PARTICIPANTS:
Tai Chi sword practitioners and control subjects through convenient
sampling (all females; n = 16 aged 69.0±5.2 years, and n = 11
aged 72.1±8.2 years, respectively) similar in age, gender, cognitive
abilities, and physical activity level were examined. METHODS:
Active trunk repositioning was used to test trunk proprioceptive
S234
acuity in three movement directions: forward flexion, rotation to the
right, and rotation to the left. The TUG was employed to assess
functional mobility. ANALYSIS: Independent t-test was employed
for comparing the TUG scores of the Tai Chi sword practitioners
and control subjects. Multivariate analysis of variance was used
to compare the absolute angle errors obtained in the active trunk
repositioning test during trunk forward flexion, rotation to the right
and rotation to the left. A Pearson product-moment coefficient of
correlation was used to correlate the absolute angle error obtained
in the active trunk repositioning test and the TUG scores. RESULTS:
Tai Chi sword practitioners made significantly smaller absolute angle
errors (2.2±0.9º) than control subjects (4.4±2.7º, P = 0.006) in trunk
rotation to the left, and to the right (2.1±0.9º versus 4.2±2.9º of
control; P = 0.012), but negligible improvements in trunk forward
flexion (respectively, 3.9±3.0º and 4.8±3.0º; P = 0.462). In addition,
Tai Chi practitioners completed the TUG (9.2±1.0s) significantly
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
can be introduced to older adults as a low cost health promotion
program. It also provides the basis for a prospective randomized
control clinical trial. KEYWORDS: Aging, Trunk proprioception,
Health Promotion. FUNDING ACKNOWLEDGEMENTS: The authors
thank The Hong Kong Polytechnic University for financial support
of this study through an Area of Strategic Development Grant
to C.W.Y. Hui-Chan, W.W.N. Tsang, and S.N. FU. CONTACT:
rswtsang@polyu.edu.hk
ETHICS COMMITTEE: Ethics Committee of The Hong Kong
Polytechnic University
Research Report Poster Display
27-03 Monday 4 June 10:30
VCEC Exhibit Hall B & C
AGE AND NECK PROPRIOCEPTION RELATED CHANGES OF
EYE MOVEMENT STABILITY
Wang S1 , Lin Y1 , Wu J1 , Young Y2 ; 1 School and Graduate Institute
of Physical Therapy, College of Medicine, National Taiwan University;
2 Department of Otolaryngology, National Taiwan University Hospital
and National Taiwan University College of Medicine, Taipei, Taiwan
PURPOSE: Eye-head coordination involved the motor control of two
subsystems of eye and head, and the integration of multiple afferents
from cervical, vestibular and vision. However, whether these systems
were affected by aging and cervical afferents remained unknown.
The aims of this study are to examine whether the changes of the
parameter of eye movement was associated with cervical range of
motion (ROM), body mass index (BMI), age, or neck proprioception.
RELEVANCE: The significance of incoordination of eye-head system
has been showed to be related to the balance control and
the fall incidence in previous study. PARTICIPANTS: Forty-five
asymptomatic women (age 46.1±13.8 year old) participated in this
study. METHODS: Cervical ROMs were recorded by an ultrasound-
based motion analysis system (Zebris system, Medizintecknik GmbH,
Tubingen Germany). The eye movements were recorded in various
(neutral and rotated) head conditions when the subjects were asked
to follow a horizontal moving target with a video-based eye movement
recording system (VNG). The ratio (gain) of instantaneous speed of
eye and target during eye tracking; and within subject CV of the gain
from different trials were measured. ANALYSIS: Linear regression
model was used to analyze the relationship of eye movements with
the possible factors, including age, BMI, previous history of neck
pain, ROM and neck reposition error. RESULTS: The gain while
eye tracking toward right side in head neutral position (NR) was
related to target reposition error toward extension (p = 0.008). The
gain during eye tracking toward right side in head rotated position
WCPT 2007, Research Reports
(RR) was related to age (p = 0.015). CV of the gain of eye tracking
toward left side in head neutral position (NL CV) was related to
age (p = 0.044). CV of the gain of eye tracking toward left side
in head rotated position (RL CV) was related to the reposition
error from left rotated position to neutral head position (p = 0.002).
CONCLUSIONS: The parameters of eye movement are associated
with increased age and neck proprioception error. These changes
of eye movement control were demonstrated in both accuracy
and stability of the control of eye movement. IMPLICATIONS: The
finding of eye movement related with age and neck reposition error
suggested the decreased ability to integrate eye and neck control with
aging. KEYWORDS: cervical proprioception, eye-head coordination,
age. FUNDING ACKNOWLEDGEMENTS: NSC-92-2320-B-002-109,
Taiwan, ROC. CONTACT: r95428002@ntu.edu.tw
ETHICS COMMITTEE: Human Study and Ethic Review Board of
National Taiwan University Hospital
Research Report Poster Display
27-07 Monday 4 June 10:30
VCEC Exhibit Hall B & C
CORRELATION AMONG BODY COMPOSITION, STRENGTH OF
LOWER EXTREMITY MUSCLES AND FUNCTIONAL CAPACITY
IN WOMEN OLDER THAN 50 YEARS
Converso M, Freitas Jr I, Rosa C; São Paulo State University –
Presidente Prudente – Brazil
PURPOSE: The six-minutes walk test (SMWT) is generally used
to evaluate the functional capacity of aged people, who, usually,
present some health problems such as arthritis and pulmonary,
cardiovascular, neuromuscular diseases, which limit the performance
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
these results can support the physiotherapist in the treatment of
patients. PARTICIPANTS: The sample was formed by 31 women,
aged 50-77 years. METHODS: Weight, height, sitting height, triceps,
suprailiac and thigh skinfold thickness, waist, hip, arm and thigh
circumferences, resistance and reactance were measured. Body
composition was estimated by anthropometry and bioelectrical
impedance (BIA). The sit-to-stand test was applied to assess the
lower extremity muscles and SMWT was applied to assess the
functional capacity. The amount of steps during the SMWT was
measured by pedometers (New Lifestyles, model NL-2000), which
were positioned on the waist of the subjects during the SMWT.
ANALYSIS: The association between the variables was evaluated
by Pearson correlation coefficient (p  0.05). RESULTS: The results
showed positive correlation between walked distance in the SMWT
and sit-to-stand (r = 0.68, p = 0.001), number of steps in the SMWT
and sit-to-stand (r = 0.75, p = 0.001), walked distance and number of
steps (r = 0.60, p = 0.001), and a negative correlation between number
of steps in SMWT and triceps (r = −0.45, p  0.05) and midaxillary
skinfolds (r = −0.40, p  0.05), and between body mass (r = −0.44,
p  0.05) and fat mass estimated by BIA (R = −0.39, p  0,05) with
the number of steps in SMWT. CONCLUSIONS: In this group of
women older than 50 years, those who presented the best results
in the sit-to-stand, also presented best results in the SMWT, and for
those who presented the highest amount of body fat, presented the
lowest number of steps in the SMWT and the lowest performance
in the sit-to-stand. IMPLICATIONS: if the physiotherapist to intensify
exercises for strength of lower extremity muscles will be improving
the functional capacity of aged people and with this minimizing the
effect of the associates diseases. KEYWORDS: body composition,
women. FUNDING ACKNOWLEDGEMENTS: None. CONTACT:
converso@fct.unesp.br
Poster Displays, Monday 4 June
Research Report Poster Display
28-11 Monday 4 June 10:30
VCEC Exhibit Hall B & C
FALLS AMONG COMMUNITY-DWELLING ELDERLY PEOPLE IN
NORTHERN JAPAN
Kojima S1 , Furuna T1 , Ikeda N2 , Nakamura M2 , Sawada Y2 ;
1 Department of Physical Therapy, School of Health Sciences,
Sapporo Medical University, Sapporo, Japan; 2 Department of
Occupational Therapy, School of Health Sciences, Sapporo Medical
University, Sapporo, Japan
PURPOSE: Hokkaido is the northernmost island of Japan. Due to
heavy snowfall during winter, it is covered with snow or ice for
one-third of the year. Therefore, many elderly people suffer from
falls or fall-induced injuries every year. However, little epidemiologic
data exist on falls among community-dwelling elderly people in
the northern regions of Japan, where the winters are long and,
consequently, the ground is slippery with ice and snow. The purpose
of this study is to investigate the circumstances and consequences
of falls among community-dwelling elderly people in northern Japan.
RELEVANCE: Physical therapy plays an essential role in preventive
intervention for falls. Epidemiological information on falls would aid
physical therapists in providing an effective therapeutic program
for fall prevention. PARTICIPANTS: The population of Hokkaido is
5.63 million, of which 20.9% constitutes people over 65 years of
age. Residents of this description who were living at home were
contacted by telephone and recruited in this study. In all, 1,000
subjects participated in this study. METHODS: A self-administered
questionnaire was used to obtain information concerning health
status, lifestyle, activity levels in daily life, and history of falls.
Questions regarding the falls experienced included the number
of falls, the season and place of occurrence, the cause of the
falls, and the types of injuries sustained in the previous year.
This questionnaire was mailed to the 1,000 subjects. The study
was approved by the Sapporo Medical University Research Ethics
Committee. ANALYSIS: Statistical analysis was performed using
the chi-square test for categorical variables. RESULTS: Of the
1,000 subjects, 860 (441 men and 419 women, mean age 73.0
years) completed the questionnaire. Two hundred and eighty-four
of them (33.0%) fell at least once during the year. Of those who
fell, 158 subjects (55.7%) experienced two or more falls. The fall
rates increased with age and were higher for women than for men.
Falls occurred more frequently outdoors than indoors. In addition,
60% of the falls occurred during winter. However, the proportion of
falls occurring outdoors during winter decreased with age. Slipping
(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
the rate of injurious falls. Compared to men, women had a higher
rate of injurious falls. CONCLUSIONS: The present study identified
the characteristics of falls among the community-dwelling elderly in
northern Japan. IMPLICATIONS: Based on the results of this study,
special attention should be directed to evolve strategies for avoiding
slip-related falls during winter in northern Japan. KEYWORDS:
Fall, Elderly, community. FUNDING ACKNOWLEDGEMENTS: This
study was supported by the Hokkaido Shimbun Press. CONTACT:
skojima@sapmed.ac.jp
ETHICS COMMITTEE: Sapporo Medical University Research Ethics
Committee
S235
Research Report Poster Display
28-15 Monday 4 June 10:30
VCEC Exhibit Hall B & C
RELATIONSHIP BETWEEN LOWER-EXTREMITY MUSCLE
STRENGTH AND FALLS AMONG COMMUNITY-DWELLING
ELDERLY PEOPLE
Ishii M1 , Hiroyuki S2,5 , Makizako H3 , Katoh H4 , Yoshida H5 ,
Suzuki T5 ; 1 Tsukui Corporation; 2 Research Fellow of the Japan
Society for the Promotion of Science; 3 Waseda University; 4 Gumma
Paz College; 5 Tokyo Metropolitan Institute of Gerontology
PURPOSE: This study was intended to determine the cut-off value
of lower-extremity muscle strength for predicting falls. RELEVANCE:
Fracture-inducing falls among elderly people have been recognized
as a major reason for use of care insurance for disabled elderly
people in Japan. A cut-off value for population-based studies is
elusive. PARTICIPANTS: Subjects were 1429 (female 846, mean
age 75.7 years) community-dwelling elderly people who had attended
a medical check in Tokyo, Japan. Exclusion criteria were 69 years
old and under, MMSE < 24, with a history of stroke. METHODS:
We measured isometric muscle strength of the dominant leg (hip
and knee joint set at 90 degrees) using a masculator (Nihon
Kohden Corp., Tokyo, Japan). History of a fall in the preceding
year was obtained from individual subjects through interviews.
ANALYSIS: Multiple logistic regression analysis was used to assess
the relationship between falls and muscle strength. Tukey’s test
was used to compare the occurrence of falls among quartiles of
muscle strength values. RESULTS: The fall rate in the preceding
year was 18.5% for all subjects. Multiple logistic regression analysis
revealed a significant relationship between falling and lower-extremity
muscle strength (Odds ratios: 1.59, 95% CI: 1.09–2.32, p < 0.05).
The quartile values of muscle strength were 0.82 (Nm/kg) and
under, 0.83–1.06 (Nm/kg), 1.07–1.33 (Nm/kg), and 1.34 and over
(Nm/kg), and the respective fall rates were 22.3%, 21.7%, 15.5%,
and 14.4%. The fall rates were significant different for the lower
group of 0.82 (Nm/kg) and under and the group of 1.34 and
over (Nm/kg). CONCLUSIONS: A significant relationship was found
between falls and lower-extremity muscle strength. We considered
that 0.82 Nm/kg of knee extension was the criterion value in risk
of falling in community-dwelling elderly people. IMPLICATIONS:
For physical therapy practice KEYWORDS: Falls, muscle strength,
predictor. FUNDING ACKNOWLEDGEMENTS: Work for this study
was supported by a Grant-in-Aid from the Ministry of Health, Labour
and Welfare, Japan. CONTACT: m_ishii@tsukui.net
ETHICS COMMITTEE: Tokyo Metropolitan Institute of Gerontology
Research Report Poster Display
28-19 Monday 4 June 10:30
VCEC Exhibit Hall B & C
FALLS AND FUNCTIONAL PERFORMANCE IN ELDERLY
WOMEN WITH OSTEOARTHRITIS OF THE KNEE
Dias R1 , Dias J1 , Mitre N2 ; 1 Physical Therapy Department, Federal
University of Minas Gerais, Belo Horizonte, Brazil; 2 Physical
Therapy Department, Itauna University, Itauna, Brazil
PURPOSE: Knee osteoarthritis (OA) is a prevalent rheumatic
disease in the elderly individuals, mainly in females. There is
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
S236
and to assess their functional performance the Western Ontario
McMaster Universities Osteoarthritis Index (WOMAC) and the
Physical Performance test Modified (PPTM) were used. ANALYSIS:
Spearman correlation coefficient, multivariate binary logistic analyses
(step-wise), qui-squared test, at the significance level at 5% and
95% CI. RESULTS: 46 elderly women between 60 and 84 years
(68.5±6.09 years) were assessed. Median age for the non-faller
group (n=23) was 67.87±6.42 years and for the faller group (n=23)
was 69.13±5.83 years. For the non-faller group there was a negative
correlation between the PPTM item “go up” and WOMAC pain,
stiffness and physical function subscales, between “spinning” and
pain and physical function subscales, and between “walking” and
physical function subscale. In the faller group, there was a negative
correlation between “go up” and pain subscale, “book” and “go up/go
down” and physical function subscale. The report of falling was
correlated to “spinning” (p = 0.05) and pain subscale (p = 0.01). There
was a statistical significant correlation between falls and WOMAC
pain subscale (X2 = 7.72; p = 0.05). A multivariate binary logistic
analysis (step-wise) was used to examine the correlation between
falls and the PPTM items. The variables selected to enter the
model were “spinning”, “go up”, “Romberg” and “book”. Considering
the correlation coefficient and the p-value, “spinning” is inversely
correlated with falls (p = 0.03). The odds ratio demonstrated that an
elderly woman who has one point less than other, had two times
more cumulative chance to be a faller (1/0.52 = 1.92 ≈ 2). There was
no statistically significant difference between groups when PPTM
items and falls were compared, neither for the PPTM total score
difference between groups. CONCLUSIONS: Even though there
was no significant difference between groups in the functional items
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
falling. IMPLICATIONS: Knee OA women with cumulative chances
of falling need Physical Therapy management with pain control
modalities and functional exercise training to enable them to avoid
falls. Since this study has investigated only individuals with knee
OA, future studies should consider other important variables, such
as balance and proprioception and include a control group for better
comparisons. KEYWORDS: elderly, osteoarthritis, falls. FUNDING
ACKNOWLEDGEMENTS: This work was unfunded. CONTACT:
rcd@ufmg.br
ETHICS COMMITTEE: Ethics Committee: UFMG ETIC 234/05
Research Report Poster Display
29-23 Monday 4 June 10:30
VCEC Exhibit Hall B & C
APPLICABILITY OF THE PEDIATRIC EVALUATION OF
DISABILITY INVENTORY (PEDI) IN DENMARK FOR NON-
DISABLED CHILDREN AGED 1.5−2 YEARS AND 5−5.5 YEARS
Stahlhut M; Copenhagen College of Physiotherapy, Copenhagen,
Denmark
PURPOSE: The purpose of this study is to compare the values from
non-disabled Danish children aged 1 21 -2 years and 5-5 12 years with
the American normative reference values of the Pediatric Evaluation
of Disability Inventory. If discrepancies occur possible explanations
must be discussed. Furthermore, any differences of the childrens’
skills, as according to gender or first/second-born status, must be
examined. RELEVANCE: The PEDI has been translated into Danish
as a questionnaire in 2005. PEDI evaluates functional status in
disabled children aged 6 months to 7 12 years. In Denmark only
few translated and standardized outcome measures exist in the field
of pediatric rehabilitation. To document outcomes after intervention
and to support an evidence-based practice it is very important
to use relevant outcome measures. PARTICIPANTS: Due to time
constraints, only two age groups have been included. Convenience
sampling is used to select the sample. Data from 32 non-disabled
WCPT 2007, Research Reports
Danish children, 16 in each age group, has been collected. The
sample consists of 13 first-born children and 19 second-born children
and each age group consists of 7 girls and 9 boys. METHODS: In
this study the PEDI is administered as a questionnaire completed
by the parents. General recommendations have been followed to
increase the return rate. ANALYSIS: To conduct statistical analyses
the software package SAS 6.0.0 is used. Student’s t-test is used
to compare the Danish mean values with the American reference
mean of 50. Independent samples t-tests are used to compare
the results between the sexes and between first-born and second-
born children. A p-value equal to or less than 0.05 is considered
statistically significant. RESULTS: Significant differences are found
in the oldest age group on the caregiver assistance scale in the self-
care and social function domain (p = 0.03, p = 0.01). The girls score
significantly higher on the caregiver assistance scale in the self-care
domain (p = 0.0017). No significant differences are found between
first-born and second-born children. CONCLUSIONS: In general, this
sample shows good correspondence between Danish values and
the American normative reference values. It is argued that the few
discrepancies, most likely, are due to cultural differences connected
to specific items. It is recommended to carry out a Rasch analysis
on a random national sample for all age groups in the PEDI. Studies
of reliability and validity of Danish version of the PEDI are also
relevant. IMPLICATIONS: This study suggests that the American
normative data are most likely to be appropriate for reference
purposes in Denmark. However further studies must be carried out
before it is used as an functional assessment instrument in Denmark.
KEYWORDS: PEDI, functional assessment, disability. FUNDING
ACKNOWLEDGEMENTS: Copenhagen College of Physiotherapy.
Research Report Poster Display
30-03 Monday 4 June 10:30
VCEC Exhibit Hall B & C
BEHAVIOR OF PRETERM NEWBORN DURING CHEST
PHYSIOTHERAPY
Lanza F1,2 , Gazzotti M1,2 , Luque A1,2 , Herrera G1,2 , Giovannetti A2 ;
1 Federal University of São Paulo/UNIFESP, Sao Paulo-Brazil; 2 São
Camilo University Sao Paulo-Brazil
PURPOSE: The purpose is to evaluate pain among NBPT during
chest physiotherapy in neonatal intensive care unit (NICU). The
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
of them. RELEVANCE: Many clinical researches have already been
developed about pain in medical and nursing procedures, even
though in physiotherapy there is not a consensus about pain during
non-invasive procedures among NBPT as desobstruction techniques.
There are scales capable of diagnosing pain among preterm, one of
them is Premature Infant Pain Profile (PIPP), specific to PTNB. This
scale consists of the follow topics: gestational age (GA), cardiac rate,
face and eye aspects and oxigenation. Each variable has a score
between 0 and 3, the highest sum is 21. Scores below 6 mean no
pain, higher than 12 moderated and stronger pain. PARTICIPANTS:
It was observed PTNB with GA between 29 and 32 weeks. Weight
born between 1500 and 2500gr. METHODS: The babies had not
used any vasoative drugs, invasive nor non invasive mechanical
ventilation, sedation or painkillers. The desobstruction technique
used was vibration and it was performed during 5 minutes on the
newborn’s chest. The PIPP scale was performed in 4 phases/stages:
before, during, immediately after and 15 minutes after the application
of the technique. ANALYSIS: Statistical analysis was performed
by repeated ANOVA, statisticaly significance: p < 0.05. RESULTS:
8 patients were studied, 5 females. There was an increase of
PIPP score during the application of chest physiotherapy (7.61+0.88)
meaning minimal pain. Before and after the technique the scores
were 4.24 and 4.35 respectively. During the last phase, after 15
min, when the patient was positioning, the PIPP was the lowest,
Poster Displays, Monday 4 June
2.36 p < 0. 05. CONCLUSIONS: We observed the lowest scores of
PIPP pain scale in PTNB when non invasive chest physiotherapy
technique (vibration) was applied. IMPLICATIONS: The vibration
technique, non invasive and conventional technique to mobilizate
secretion in PTNB, does not cause pain. This may increase the
application of chest therapy in NICU. KEYWORDS: preterm newborn,
chest physiotherapy, vibration. FUNDING ACKNOWLEDGEMENTS:
None. CONTACT: Fernanda Lanza e-mail: fclanza@yahoo.com.br
ETHICS COMMITTEE: Ethical committee of General Hospital
Pedreira, Sao Paulo-Brazil
Research Report Poster Display
30-07 Monday 4 June 10:30
VCEC Exhibit Hall B & C
POSTURAL ADJUSTMENTS DURING REACHING IN CHILDREN
WITH SEVERE SPASTIC DIPLEGIA WEARING DAFOS
Näslund A1 , Sundelin G2 , Hirschfeld H3 ; 1 Department of
Health Science, Luleå University of Technology, Luleå, Sweden;
2 Department of Community Medicine and Rehabilitation, Division
of Physiotherapy, Umeå University, Umeå, Sweden; 3 Motor Control
and Physical Therapy Research Laboratory, NVS Department,
Division of Physiotherapy, Karolinska Institutet, Stockholm, Sweden
PURPOSE: The aim of this study was to investigate the coordination
between reaching kinematics, ground reaction forces and muscle
activity in standing in children with severe spastic diplegia wearing
dynamic ankle-foot orthoses (DAFOs) and compare the results to
age matched non-disabled children. RELEVANCE: Assessment and
evaluation are essential because children with spastic diplegia,
classified at level III-IV according to GMFCS (Gross Motor Function
Classification System), often recieve DAFOs as an adjunct to
physiotherapy in order to improve sitting, standing and walking.
PARTICIPANTS: All children with spastic diplegia using DAFOs
in a county in northern Sweden and had regular follow-ups of
their ortohoses, were invited. Six participants at GMFCS level III-IV
formed the study group and six age- and sex-matched children with
normal motor development served as a control group. METHODS:
Bilateral ground reaction forces and ankle muscle activity as well
as the reach hand kinematics were investigated by means of two
AMTI force plates, surface electromyography (EMG) and a two-
camera optoelectronic system (ELITE). Kinematic, EMG and force
plate signals were recorded simultaneously. The children reached
for a cup filled with candy while standing on two force plates.
Reflective markers were placed on the hand and cup. In this study,
standing support provided by the parent on the pelvis or by contact
of the non-reach hand on the table was necessary during the
standing task. ANALYSIS: Because of the small participant number
and the heterogeneity of the group with pronounced difficulties
in locomotion, the results are presented on group as well as
on subject level. RESULTS: Children with severe spastic diplegia,
wearing DAFOs, demonstrated that movement quality of upward
and forward reach velocity differed regarding temporal phasing and
amplitudes of velocity peaks compared to the controls. Furthermore,
children with severe spastic diplegia, wearing DAFOs, lacked a
coordinated muscle activity pattern and made use of postural
adjustments characterized by co-activation of agonist and antagonist
muscles. However, the controls demonstrated coordinated muscle
activity and interplay of the ground reaction forces on the reaching
and non-reaching side. CONCLUSIONS: In conclusion DAFOs
appear to provide some benefit for children with spastic diplegia
GMFCS, level III-IV, by improving the use of postural adjustments
for balance control during a reaching movement in standing. An
intervention study would be of interest, to assess whether DAFOs
could be valuable in the learning of processes regarding postural
adjustments, since postural control is a result of both maturation
and learning. IMPLICATIONS: Children with severe spastic diplegia
wearing DAFOs can, despite different support conditions, practice
reaching while standing and thereby promote motor learning of
S237
postural adjustments to improve the ability to use the hands in
daily standing activities. KEYWORDS: Spastic diplegia, orthoses and
postural adjustments. FUNDING ACKNOWLEDGEMENTS: Funding
for this project was provided by the Norrbacka-Eugenia Foundation.
CONTACT: annika.naslund@ltu.se
ETHICS COMMITTEE: The ethics committee at Umeå university,
Dnr-00-022.
Research Report Poster Display
31-11 Monday 4 June 10:30
VCEC Exhibit Hall B & C
LOWER EXTREMITY ISOMETRIC STRENGTH IN CHILDREN
WITH CEREBRAL PALSY OR JUVENILE IDIOPATHIC ARTHRITIS
Saarinen J1 , Lehtonen K1 , Lahdenne P1 , Autti-Rämö I2 , Mälkiä E3 ;
1 Helsinki University Central Hospital for Children and Adolescent;
2 Stakes National Research and Development for Welfare and
Health; 3 University of Jyväskylä, Finland
PURPOSE: There are few reports published on muscle strength
in children with a chronical disease. It has been studied at least
in children with acute lymphoblastic leukemia, children with cystic
fibrosis and in children and adolescents with Down Syndrome.
Muscle weakness was found in these diagnostic groups when
compared to healthy controls. Muscle strength in children has been
studied more in children with juvenile idiopathic arthritis (JIA) and
cerebral palsy (CP). Muscle strength in JIA has been assessed in a
few studies with different methods, e.g. an isokinetic dynamometry, a
hand-held dynamometry and a computerized dynamo-meter. These
studies have suggested that children with JIA have reduced muscle
strength. On the other hand one study reported no difference in
muscle strength between children with JIA and healthy controls. Also
in children with CP different methods has been used and muscle
weakness has been reported in hip, knee and ankle in children
with diplegia. In hemiplegia group weakness has been found on
the involved side with some changes on the uninvolved side. The
purpose of this study was to compare muscle strength in children
with various degrees of physical disorder. RELEVANCE: Muscle
strengthening is often used in physiotherapy. It is important to spesify
the treatment plan for different kind of patients. PARTICIPANTS:
The participants were patients with JIA (n=25) or CP (n=47) of
Hospital for Children and Adolescents, Helsinki University Central
Hospital (HUCH). All patients with JIA had lower extremity articular
involment with no active arthritis in lower extremities at the time of
testing. All children were on anti-rheumatic medication. All children
with CP could walk independently without a gait aid. The Gross Motor
Classification System (GMFCS) was used to classify the severity of
the disability, Level I and II were identified. A control group (n=25)
of age-, height- and gender-matched healthy children, most of them
children of HUCH hospital staff. METHODS: A dynamometer chair
(Good Strength, Mtitur Ltd., Finland) was used and maximal isometric
strength in knee and ankle was measured from both sides in a sitting
position. ANALYSIS: All analysis were done with SPSS 11.5 for
Windows. One-way ANOVA procedure and t-test were used in the
group comparisons and post hoc analyses were performed using
Tukey test. Force values normalized by body weigth (N/kg) were
used in all group comparisons. Zero values were not in analyzes.
RESULTS: Significantly different values were found in knee extension
and knee flexion between GMFCS Level II and all other groups
and in ankle dorsiflexio/plantarflexion between both CP groups and
other groups. In JIA knee extension was near tosignificantly different
(p = 0.52) compared to controls. CONCLUSIONS: The Level of
muscle strength is connected to the degree of the physical disorder.
In this study the muscle strength in JIA group was near to normal
but in GMFCS Level II significantly lower compared to other groups.
IMPLICATIONS: Adynamometer chair is well suited to measuring
pediatric patients and a good tool in assessment and planning of
treatment in physioterapy KEYWORDS: Children, mucsle strength,
fixed dynamometer. FUNDING ACKNOWLEDGEMENTS: This study
S238
was supported by Children’s castle Foundation and HUCH, Hospital
for children and adolescent donation fund and McDonalds.
ETHICS COMMITTEE: The Research Ethics Committee at the
HUCH Hospital for Children and Adolescent approved this study
Research Report Poster Display
31-15 Monday 4 June 10:30
VCEC Exhibit Hall B & C
EFFECTS OF EXPERIMENTAL SHOULDER MUSCLE PAIN ON
SHOULDER-ABDUCTION FORCE STEADINESS
Bandholm T1,2 , Rasmussen L1,2 , Aagaard P1,3 , Diederichsen L1 ,
Jensen B2 ; 1 Institute of Sports Medicine – Copenhagen, Bispebjerg
University Hospital, Copenhagen, Denmark; 2 Institute of Exercise
and Sport Sciences, Department of Human Physiology, University
of Copenhagen, Denmark; 3 Institute of Sports Science and Clinical
Biomechanics, University of Southern Denmark, Odense, Denmark
PURPOSE: We have previously demonstrated that shoulder sensory-
motor control expressed as abduction force steadiness is mildly
impaired in patients with subacromial impingement syndrome (SIS)
compared to a group of healthy matched persons, which might be
related to shoulder pain associated with SIS. The primary objective
of the present study therefore was to examine effects of experimental
shoulder muscle pain on shoulder sensory motor control in a group of
healthy persons previously matched to patients with chronic shoulder
pain (SIS) and to evaluate to which extend the experimental shoulder
pain model reflects key features of the SIS. RELEVANCE: In order to
investigate interactions between shoulder pain and shoulder sensory-
motor control in a clinically relevant model, the experimental pain
model needs to resemble key features of the pathology or syndrome
that it is supposed to model. PARTICIPANTS: Nine healthy, non-
medicated persons with ages ranging from 22 to 37 years (mean,
27.7 years) volunteered to participate in the study. Informed consent
was obtained in accordance with the Declaration of Helsinki and the
study was approved by our Local Ethics Committee. METHODS:
Measurements were performed before, during and after experimental
pain induction. Experimental muscle pain was induced by bolus
injections of hypertonic saline into the supraspinatus muscle to
mimic shoulder pain associated with SIS. The assessed parameters
were isometric and isokinetic (concentric and eccentric) shoulder-
abduction force steadiness at target forces (TF) corresponding to 20,
27.5, and 35% of the maximal shoulder-abduction torque expressed
as the standard deviation and coefficient of variation in exerted
force. Muscle activity during contractions was determined using
surface and intra-muscular electromyograms (EMG) obtained from
eight shoulder muscles. ANALYSIS: Two-way, repeated measures
ANOVAs were used to examine main effects of condition (pre, during
and post-pain) and load (TF) on the dependent force steadiness
and EMG variables. RESULTS: Experimentally induced muscle pain
impaired shoulder-abduction force steadiness on average 21% during
isometric contractions (P < 0.05) and tended (P = 0.081) to do so
also during concentric contractions. Middle deltoid muscle activity
during isometric contractions and infraspinatus and lower trapezius
muscle activity during concentric contractions increased during
experimental pain. CONCLUSIONS: The present data indicate that
experimental shoulder muscle pain impairs shoulder sensory-motor
control, expressed as shoulder-abduction force steadiness, during
isometric contractions in healthy persons. Few minor increases in
muscle activity were observed as a result of experimental pain
induction and these were not consistent across contraction types.
The experimental shoulder pain model seems to reflect some but
not all key features of the subacromial impingement syndrome.
IMPLICATIONS: Results obtained in experimental pain models
should be interpreted with caution when extrapolated to chronic
pain conditions. KEYWORDS: Pain, shoulder, steadiness. FUNDING
ACKNOWLEDGEMENTS: The study was supported in part by a
WCPT 2007, Research Reports
grant from the Danish Foundation for Research in Physiotherapy.
CONTACT: thomas.bandholm@hh.hosp.dk
ETHICS COMMITTEE: De Videnskabsetiske Komitéer for Køben-
havns og Frederiksberg Kommuner (ethical approval number KF 01-
383/97).
Research Report Poster Display
31-19 Monday 4 June 10:30
VCEC Exhibit Hall B & C
FUNCTIONAL OUTCOMES AND PHYSICAL THERAPY IN AN
INTERPROFESSIONAL CHRONIC PAIN TREATMENT PROGRAM
Hodgins I, Fast K, Wagenhoffer S, Tkachuk G, Olson P, Horlick A,
Woods M; Chronic Pain Centre, Saskatoon Health Region,
Saskatoon, Canada
PURPOSE: This research highlights the contribution of physical
therapy in the interprofessional treatment of chronic pain and the
use of functional outcome measures to evaluate clients’ physical
progress. RELEVANCE: Research indicates that an interprofessional
treatment program is the most effective treatment for chronic pain
clients. The addition of physical outcome measures to self report
questionnaires enhances the evaluation of chronic pain clients and
illustrates the role of physical therapists in an interprofessional
team. PARTICIPANTS: 104 clients (females 62.5%) with a mean
age of 45.85 (10.09), and an average pain intensity of 6.59
(1.66) on a 10 point scale completed treatment. 84.6% were
publicly funded and 15.4% were privately funded. 65.4% were on
opioids. Area of pain: musculosketal (74%), neuropathic (16.3%),
headache (3.8%), abdominal (2.9%) and pelvic (2.9%). METHODS:
The following 5 functional outcomes were administered before and
after treatment: 1 minute stair climb (n=101), 1 minute sit to
stand (n=101), 30 second single-leg standing balance (n=87), 20
meter speed walk (n=104), sit and reach (n=87). In addition, the
following 7 self-report questionnaires were administered: Canadian
Occupational Performance Measure (COPM)(n=98), Chronic Pain
Self-Efficacy Scale (CPSE) (n=104), Multidimensional Pain Inventory
(MPI) (n=85), Chronic Pain Acceptance Questionnaire (CPAC)
(n=84), Pain Catastrophizing Scale (PCS) (n=85), Tampa Scale
of Kinesiophobia (TSK) (n=85) and Beck Depression Inventory-II
(BDI-II) (n=83). Physical therapy included education sessions on
anatomy, posture, core stability and exercise. Treatment included
daily stretching, ball and core stability exercise twice weekly, graded
conditioning, specific exercise prescription and pool class once
weekly. Clients attended multidisciplinary treatment (occupational
therapist, pharmacist, physical therapist, psychologist, registered
nurse) half days, daily for 5 weeks of the 6 week program.
ANALYSIS: Paired t tests compared pre and post treatment scores
on the 5 functional outcomes and 7 self report questionaires.
RESULTS: There were statistically significant improvements in stair
climb (t=-8.71, p < 0.001), sit to stand (t=-6.42, p < 0.001), standing
balance (t=2.57, p = 0.012), speed walk (t=6.97, p < 0.001), flexibility
(t=-3.51, p = 0.001). In addition, there were statistically significant
improvements in COPM-Performance (t=-16.22, p < 0.001), COPM-
Satisfaction (t=-18.19, p < 0.001), self efficacy (t=-7.91, p < 0.001),
pain severity (t=4.65, p < 0.001), interference (t=5.99, p < 0.001),
life control (t=-5.66, p < 0.001), affective distress (t=3.81, p < 0.001),
acceptance (t=-7.48,p < 0.001), catastrophizing (t=9.00, p < 0.001),
fear of movement/reinjury (t=6.13, p < 0.001) and depressive symp-
toms (t=7.34, p < 0.001). CONCLUSIONS: The functional outcomes
indicated improvement in the clients’ physical abilites. These results
support the integral role of physical therapy and the use of both
functional and psychosocial outcomes when assessing the effec-
tiveness of a chronic pain treatment program. Future research can
include cross-validation studies among the physical and psychosocial
measures and the further development of clinically useful functional
measures for the interprofessional treatment of chronic pain.
IMPLICATIONS: As there are not widely accepted tools to assess the
physical functioning of chronic pain clients, this research highlights
Poster Displays, Monday 4 June
the usefulness of functional outcomes in a treatment program and
the need for their continued development. KEYWORDS: function,
pain, interprofessional. FUNDING ACKNOWLEDGEMENTS: none.
CONTACT: ivy.hodgins@saskatoonhealthregion.ca
ETHICS COMMITTEE: University of Saskatchewan Behavioral
research Ethics Board
Research Report Poster Display
32-23 Monday 4 June 10:30
VCEC Exhibit Hall B & C
KNOWLEDGE AND ATTITUDES TOWARDS OLDER PEOPLE
HELD BY HEALTH PROFESSIONAL STUDENTS AND
PRACTITIONERS
Stewart J1 , Giles L2,3 , Paterson J4 , Butler S4 ; 1 Physiotherapy
School, Faculty of Health and Environmental Sciences, Auckland
University of Technology, Auckland New Zealand; 2 Department of
Rehabilitation and Aged Care, Flinders University, South Australia;
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,
Faculty of Health and Environmental Sciences, Auckland University
of Technology, Auckland New Zealand
PURPOSE: Two studies investigated undergraduate health profes-
sional students’ knowledge and attitudes towards older people. Study
1 compared knowledge and attitudes held by final year occupational
therapy (OT) and physiotherapy (PT) students and their clinical
educators. Study 2 compared knowledge and attitudes held by
new entry nursing, OT and PT students. RELEVANCE: The rapidly
aging population in industrialized countries is leading to increasing
numbers of older adults requiring health care. Studies examining
knowledge and attitudes of health professionals towards older adults
suggest differences exist across professional groups of students
and practitioners. An understanding of students’ knowledge and
attitudes towards older adults is important in developing education
that adequately prepares future practitioners to deliver quality care
to this population. PARTICIPANTS: Study 1: Final-year PT (n=92)
and OT (n=59) students, and PT (n=136) and OT (n=163) clinical
educators participated. Study 2: First-year PT (n=140), OT (n=82)
and nursing students (n=153) were recruited during the first month
of their education. METHODS: A postal questionnaire was used
in these descriptive studies. Participants completed questionnaires
about their sociodemographic factors, experience and interaction
with older people. Kogan’s Attitudes Towards Older People Scale
(KAOP) and Palmore’s Facts on Aging Quiz (FAQ1) were used to
measure attitudes and knowledge about older adults. ANALYSIS:
KAOP negative scores were reversed then responses were summed.
Positive, negative and net bias percentages were derived from
incorrect FAQ1 responses. ANCOVAs were used with demographic
variables as covariates, to compare the KAOP and FAQ1 scores
of student groups and clinical educators. Alpha level was set
at 0.05. RESULTS: Study 1: Final-year PT and OT students
showed no difference in their overall knowledge and attitudes
towards aging (all p values >0.05). While Clinical Educators in both
professions showed more positive attitudes than students (p = 0.004)
they had no better knowledge about aging (p > 0.05). Further
analysis of knowledge showed that a greater percentage of students’
incorrect answers were negatively biased towards older adults in
comparison to clinical educators in both professions (p = 0.026).
Study 2: New entry nursing, PT and OT students did not differ on
KAOP or FAQ1 scores (all p values >0.05). When combining the
total sample, those with higher social contact showed significantly
less negative bias on incorrectly answered knowledge questions
(p = 0.004) while younger students had more negative attitudes
towards older adults (p = 0.001). Across both studies participants’
correct knowledge scores ranged from 42 to 52%. CONCLUSIONS:
Within each study students’ knowledge and attitudes towards aging
did not differ across disciplines. New entry students showed less
S239
positive attitudes and lower knowledge than final year students.
Knowledge scores of clinical educators and final year students
suggest that health professional education had little impact on
their knowledge of aging. As self-report questionnaires were used
these findings need to be interpreted cautiously. IMPLICATIONS:
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
adults before clinical experiences. KEYWORDS: Ageism education
health. FUNDING ACKNOWLEDGEMENTS: Auckland University
of Technology Contestable Research Fund (Grant no. 01/146).
CONTACT: jenny.stewart@aut.ac.nz
ETHICS COMMITTEE: Ethics approval was given by the Auckland
University of Technology Ethics Committee
Research Report Poster Display
35-23 Monday 4 June 10:30
VCEC Exhibit Hall B & C
NORMATIVE VALUES FOR THE HARRIS HIP SCORE: A
CROSS-SECTIONAL STUDY
Muscat I2 ; 1 School of Health Science and Social Work, University
of Portsmouth, Portsmouth. UK; 2 Portsmouth City Primary Care
Trust, Portsmouth. UK
PURPOSE: The purpose of the study was to provide normative
values for the Harris Hip Score (HHS) for a population aged 30-
100 years and explore the associations between age and HHS.
This study is responding to the need to provide normative values
for the HHS, as identified by Keener et al (2003), and in so doing
provides a more representative population for comparison with the
population who have undergone hip arthroplasty. RELEVANCE: Hip
outcome measures are essential in the field of orthopaedics and
physiotherapy to monitor performance and long term function in
people who have undergone hip arthroplasty. It is therefore important
that hip outcome measures are measuring what they are supposed
to be measuring i.e., demonstrating validity. A problem with the
HHS appears to be a decline in score with increasing age, despite
an adequately functioning total hip arthroplasty. PARTICIPANTS:
Three hundred and eighty one participants (aged between 30 and
100 years) were recruited between June and November 2006 from
various community groups in the Portsmouth and Chichester areas
of England, UK. A call for volunteers was made by displaying posters
and/or giving presentations to the relevant groups. Volunteers were
recruited from a variety of community groups such as churches, over
50’s exercise groups, social groups, work places, rest homes and
relatives/friends accompanying those attending hospital outpatient
departments. Potential participants were excluded if they had hip
pain, previous treatment for hip pain or pathology, were currently
under investigation for hip problem or had prior injury or known
pathology concerning the hip. METHODS: The study was of cross-
sectional, observational, analytic design. The data was gathered by
face-to face interview(n=46, 12%) and self-complete questionnaire
(n=335, 88%). ANALYSIS: Multiple regression was used to explore
the effect of the clinically relevant factors (predictor variables)
such as age, gender, ethnicity, socioeconomic status, alcohol
consumption, smoking history, number of musculoskeletal and
medical comorbid conditions on normal scores (HHS). RESULTS:
The results presented a demographic description of the study
population and normative values of the HHS for each decile of age
group between 30 and 100 years. A significant negative correlation
was found between age and the HHS [r = −0.41, p  0.0005]. Multiple
regression identified age, number of musculoskeletal and medical
comorbidities were significant predictors of HHS [adjusted R square =
0.414, p < 0.0005]. The relationship between age and HHS was
non-linear and the quadratic model provided the best estimation of
the curvi-linear effect. CONCLUSIONS: The results show that age,
number of musculoskeletal and medical comorbidities are significant
S240
predictors of the HHS. These results are supported by contemporary
research by Brinker et al (1996) and Ritter et al (2004). This study
provides substantial normative values for the HHS, which can be used
for future research comparing outcomes with a population who have
undergone hip arhroplasty. This is an area of much needed research.
IMPLICATIONS: This study provides new knowledge, which will
be used for providing fair comparison with the joint replacement
population and improve and produce more meaningful outcome
evaluations in this area. KEYWORDS: Hip outcome measure, hip
arthroplasty. FUNDING ACKNOWLEDGEMENTS: The study has
received a funding contribution from the Wessex Primary Care
Research Network (WReN).
ETHICS COMMITTEE: Isle of Wight, Portsmouth and South East
Hants Local Research Ethics Committee, England, UK. LREC no:
05/Q1701/37
Research Report Poster Display
36-03 Monday 4 June 10:30
VCEC Exhibit Hall B & C
OUTCOME MEASURES IN RANDOMISED CONTROLLED TRIALS
OF CONSERVATIVE INTERVENTIONS FOR ROTATOR CUFF
DISORDERS: A 15-YEAR AUDIT AND SYSTEMATIC REVIEW
McCreesh K; Dept. of Physiotherapy, University of Limerick,
Limerick, Ireland
PURPOSE: To establish current and recent practice in rotator cuff
research with regard to the use of outcome measures and to
determine if any recommendations can be made with regard to
optimal outcome measures for use in conservatively managed rotator
cuff disorders RELEVANCE: Clinicians and researchers involved
in managing rotator cuff disorders require outcome measures that
accurately reflect patient outcome PARTICIPANTS: N/A METHODS:
15 year audit (July 1990-2005) of randomised controlled trials of
conservative management of rotator cuff disorders to assess trends
in outcome measure use, followed by systematic review of properties
of outcome measures identified during the audit ANALYSIS: Out-
come measures were assessed against pre-defined quality criteria.
RESULTS: Eight different questionnaire based measures were
identified; with the Constant score the most commonly used. There
was limited patient involvement in development of the measures,
reducing content validity. The UCLA score, SDQ and Constant score
had limited evidence of reliability. Floor and ceiling effects were
poorly studied. The SRQ had limited evidence of validity. The ASES
form received the best ratings overall for its psychometric properties.
The widespread use of the Constant score was not substantiated
by review of its properties. CONCLUSIONS: Based on the criteria
used, the ASES form was the measure most strongly recommended
for use in populations with rotator cuff disorders. Further research
is required to examine the properties of commonly used shoulder
outcome measures. IMPLICATIONS: This work may assist clinicians
and researchers in their choice of outcome measures for use in
persons with rotator cuff disorders. The criteria list used may form
a basis from which outcome measures may be assessed in future
studies or by clinicians. KEYWORDS: outcome measure, rotator
cuff. FUNDING ACKNOWLEDGEMENTS: This work was unfunded.
CONTACT: karen.mccreesh@ul.ie
WCPT 2007, Research Reports
Research Report Poster Display
36-07 Monday 4 June 10:30
VCEC Exhibit Hall B & C
VALIDITY OF THREE PHYSICAL PERFORMANCE MEASURES
IN INPATIENT GERIATRIC REHABILITATION
Brooks D1−3,5 , Aileen D1,3 , Gary N1,3 ; 1 Graduate Department of
Rehabilitation Science, University of Toronto, Toronto, Canada;
2 Department of Physical Therapy, University of Toronto, Ontario;
3 Toronto Rehabilitation Institute, Toronto, Canada; 4 Baycrest Centre,
Toronto, Ontario; 5 West Park Healthcare Centre, Toronto, Ontario
PURPOSE: To evaluate the construct validity and the responsiveness
of three measures of physical performance measures as outcome
measures for frail older persons. RELEVANCE: Clinicians are often
faced with the dilemma of which physical performance measure
to use in different settings such as inpatient programs, outpatient
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;
age, 80 + 8 years). METHODS: Pre-post design was used with
measures at admission and discharge from three inpatient geriatric
rehabilitation programs. Physical performance measures were timed
up and go (TUG), two-minute walk test and functional reach.
Functional status was measured with the Functional Independence
Measure (FIM) and the modified Barthel Index. ANALYSIS: To
determine if performance measures define known groups of patients
according to their ambulatory status at discharge, a one-way ANOVA
was performed. To determine the relationship between performance
and functional status measures, correlation analysis was performed
using Pearson’s correlations, correlation analysis was performed
using Pearson’s correlations. The standardized response mean
was calculated by dividing the mean change by the standard
deviation of the change score. RESULTS: The TUG and two-minute
walk test scores were significantly different in groups of patients
using different ambulatory aids (p = 0.006), while no such difference
was observed for the functional reach (p = 0.4). The correlations
between the TUG/two-minute walk test and the FIM were −0.59 and
0.59 (p < 0.0001), respectively, at admission, and −0.42 and 0.47
(p < 0.04), respectively, at admission and discharge. The correlations
between functional reach and the FIM were not significant (p > 0.09).
Standardized response means were 1.1 for the TUG, 0.7 for the two-
minute walk test and 0.5 for functional reach. CONCLUSIONS: The
TUG and two-minute walk test are valid and responsive outcome
measures in older persons participating in geriatric rehabilitation.
Functional reach was a moderately responsive outcome measure,
but did not consistently reflect ambulatory or functional status.
IMPLICATIONS: Physical performance measures appear to provide
somewhat different information than functional status measures. The
strong correlation between the TUG and two-minute walk test suggest
a considerable overlap between these two measures. The TUG may
offer some advantages over the two-minute walk as an outcome
measure for this population. KEYWORDS: Geriatrics, physical
performance, walk test, exercise, function, walking, ambulation.
FUNDING ACKNOWLEDGEMENTS: Supported by grants from the
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:
dina.brooks@utoronto.ca
ETHICS COMMITTEE: Toronto Rehabilitation Institute, Baycrest and
West Park Research Ethics Committees
Poster Displays, Monday 4 June
Research Report Poster Display
37-11 Monday 4 June 10:30
VCEC Exhibit Hall B & C
WALKING ENDURANCE AND PROXIMAL COMPENSATION FOR
DISTAL WEAKNESS IN CHARCOT-MARIE-TOOTH DISEASE
Ramdharry G1 , Marsden J1 , Day B1 , Reilly M2 ; 1 Sobell Department
of Movement Neuroscience, Institute of Neurology, London, UK;
2 National Hospital for Neurology and Neurosurgery, London, UK
PURPOSE: This investigation aims to investigate factors limiting
walking distance in Charcot-Marie-Tooth disease (CMT). It has
been suggested that in the presence of distal weakness, the hip
flexor muscles are more active to compensate for reduced ankle
power at preswing and foot clearance during swing phase. The
hypothesis is that fatigue of the hip flexor muscles limits walking
endurance. RELEVANCE: People with CMT present with sensory
loss, weakness and musculoskeletal changes. The presence of
these characteristics lead to compensatory strategies to maintain
function. Understanding how impairments limit walking, and how
compensations maintain function will in turn allow the development
and investigation of specifically targeted rehabilitation approaches.
PARTICIPANTS: 14 people with CMT and 7 age, height and weight
matched healthy controls were recruited. METHODS: Study1: People
with CMT walked on a treadmill until they reached level 17 on the
Borg perceived exertion scale. Gait was analysed using 3D motion
analysis. The maximum voluntary contraction (MVC) of the hip flexors
was recorded before and after the walking task. Matched controls
walked at an identical speed, cadence and total time. Study 2:
People with CMT undertook a sub-maximal fatigue task to reduce
hip flexor MVC by 20%. Walking was assessed prior to and after the
fatigue task and the time taken to reach Borg level 17 determined.
ANALYSIS: The primary outcome measures of hip flexor MVC, hip
joint amplitude and velocity at pre-swing to swing were compared
using a general linear model ANOVA. Secondary outcome measures
were compared using the same test with a Bonferroni correction.
RESULTS: Study 1: People with CMT walked on the treadmill for
a mean time of 42 minutes before stopping. Controls reached a
median Borg level of 8 compared to 17 in the CMT group for
the same walking duration. After walking, all subjects significantly
reduced hip flexor MVC (P < 0.001) but the drop was greater in
people with CMT. The hip velocity decreased in people with CMT
and increased in controls (P < 0.006) and there was no significant
difference in hip amplitude. An increase in trunk coronal motion was
observed (P = 0.017). Study 2: Following isolated fatigue of the hip
flexors the walking time in the CMT group was reduced to 16 minutes
(P = 0.032). There was no difference in hip velocity and amplitude,
however there was a marked increase in trunk motion in the coronal
(P < 0.000) and horizontal planes (P = 0.007). CONCLUSIONS: Hip
flexor strength and velocity of hip motion decreases with prolonged
walking and specifically fatiguing the hip flexors markedly reduces
the time a person with CMT is able to walk. The observation of
increased trunk motion in both studies may indicate a secondary
compensation to maintain the forward progression of the limb in
swing phase when hip flexors are fatigued. IMPLICATIONS: If as
indicated the hip flexors do limit prolonged walking in people with
CMT, a specific hip flexor strengthening regime may help increase
walking endurance thus impacting on their functional mobility. The
nature of this regime requires further study. KEYWORDS: Charcot-
Marie-Tooth disease, walking endurance, compensation. FUNDING
ACKNOWLEDGEMENTS: Medical Research Council. CONTACT:
g.ramdharry@ion.ucl.ac.uk
ETHICS COMMITTEE: The National Hospital for Neurology and
Neurosurgery and the Institute of Neurology Joint Research Ethics
Committee
S241
Research Report Poster Display
37-15 Monday 4 June 10:30
VCEC Exhibit Hall B & C
FUNCTIONAL PERFORMANCE AND EXPERIENCED
LIMITATIONS OF DAILY LIFE IN PEOPLE WITH CHARCOT-
MARIE-TOOTH’S DISEASE
Eklund E, Svensson E, Häger-Ross C; Department of Community
Medicine and Rehabilitation Section of Physiotherapy, Umeå
university, Umeå, Sweden
PURPOSE: To evaluate possible correlations between hand function
in persons with Charcot-Marie-Tooth’s disease (CMT) and functional
performance in the lower extremities. Further, we aimed to investigate
how people with CMT experience their limitations of daily life,
and if this relates to functional performance of upper and lower
extremities. RELEVANCE: Charcot-Marie-Tooth is a peripheral
neuropathy causing progressive sensory loss, muscle atrophy and
weakness. The lower extremities are first affected and most studied
but to which extent this correlates to reduction in hand function is
poorly understood. CMT is the most common inherited neuropathy,
but research on physiotherapy is limited. It is essential to establish
good outcome measures that reflect function in daily life, i.e, in
relation to impairment as well as activity dimensions according to the
International Classification of Function (ICF), and that are reliable
and easy-to-use in clinic in the rehabilitation of these patients.
PARTICIPANTS: Twenty out of 24 persons with CMT registered
at the neurological clinics in three counties of northern Sweden
(~630,000 inhabitants, comparative to world reported incidence);
9 men, 11 women aged 24-73 years and all right handed.
METHODS: We examined functional performance using tests of
dexterity (Box and Block Test, BBT; Nine-Hole Peg test, NHP), grip
and pinch strength (Grippit® dynamometer), tactile sensation (Shape
Texture Identification test, STI) and function of the lower extremity
(Short Physical Performance Battery, SPPB). Disabilities of the
Arm Shoulder and Hand outcome questionnaire (DASH) was used
to estimate self-rated daily life function. ANALYSIS: Correlations
between performance in the lower extremities and hand function,
as well as between DASH and functional performance in both upper
and lower extremities, were evaluated using Pearson’s correlation
and Spearmans rank correlation. RESULTS: More reduced hand
function was observed in persons with poor functional performance
in the lower extremities, i.e. there was a correlation between all of
the hand function tests and SPPB, respectively. Likewise, persons
who experienced more limitations in daily life as measured by DASH
also had worse hand function. Preliminary analyses show that the
reduced functional performance in both upper and lower extremities
causes limitations in daily life for people with CMT. CONCLUSIONS:
A correlation existed between functional performance in the lower
extremities and hand function, and also between self rated limitations
of daily life and functional performance in both upper and lower
extremities. SPPB as well as DASH seem to be suitable as outcome
measures for evaluation of function in persons with CMT, but needs to
be evaluated in a larger population. IMPLICATIONS: Implementation
of outcome measures that can give insight into problems experienced
by people with CMT, especially due to reduced hand function. This is
important in order to develop evidence based physiotherapy manage-
ment of people diagnosed with CMT. KEYWORDS: Charcot-Marie-
Tooth’s disease, correlations, functional performance. FUNDING
ACKNOWLEDGEMENTS: Swedish Association of Persons with
Neurological Disabilities (NHR), Swedish Association of Registered
Physiotherapists’ minnesfond, Stiftelsen JC Kempes Stipendiefond
and Västerbotten County Council, Sweden.
ETHICS COMMITTEE: The Regional Ethical Review Board, Umeå,
Sweden.
S242
Research Report Poster Display
37-19 Monday 4 June 10:30
VCEC Exhibit Hall B & C
DEPRESSION AS EXPERIENCED BY FEMALE PATIENTS WITH
FIBROMYALGIA
Sallinen M; Satakunta University of Applied Sciences, Pori, Finland
PURPOSE: The purpose of this study was to describe and
analyze the experiences of depression among female patients with
fibromyalgia. RELEVANCE: Depression is one of the most common
symptoms associatede with chronic pain in fibromyalgia. Every third
patient with FM could also be diagnosed with clinical depression.
However, for the physiotherapist recognizing depressive symptoms
can be difficult. PARTICIPANTS: 5 middle aged female patients
with long history of FM were included in the study. Participants
were recruited from a aquatic exercise group for musculoskeletal
pain patients. Participation was based on voluntariness. METHODS:
A qualitative theme interview was used to collect the data. Each
patient was interviewed in a session of 1.5-2 hours. Interviews were
tape recorded and transcribed verbatim for the analysis. ANALYSIS:
The interviews were analysed using both phenomenographic and
narrative analysis. The narratives were analysed in perspective to
the storyline, highlights, the beginning and the end of the story,
as well as the roles that the patients gave to themselves, the
physiotherapists/doctors and to the pain. The phrases used by
the patients were categorised and analysed in-depth. RESULTS:
Although the experiences of disability varied from person to person
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
and experienced helplessness. The narratives could be labelled
as “princess-stories” or “hero-stories” depending on the roles
the patients took.The role of professional helpers was seen as
essential support in the recovery. CONCLUSIONS: Experience of
depression varies a lot, but in physiotherapy recognition of the
symptoms can be done through narratives. Understanding the
role of the patient is necessary in order to provide sufficient
and accurate mental support in physiotherapy. IMPLICATIONS:
More research is needed on the recovery process and the role
of physiotherapy in fibromyalgia. In pt-education the importance
of developing social skills and active listening should not be
underestimated. KEYWORDS: narrative research; chronic pain;
fibromyalgia. FUNDING ACKNOWLEDGEMENTS: unfunded.
Research Report Poster Display
38-23 Monday 4 June 10:30
VCEC Exhibit Hall B & C
SURVEY OF SEVERE INJURY IN ADOLESCENT SOCCER
PLAYERS: A PILOT STUDY
Celebrini R1,2 , MacIntyre D1,2 ; 1 School of Rehabilitation Sciences,
University of British Columbia, Vancouver, Canada; 2 Rehabilitation
Research Lab, GF Strong Rehab Centre, Vancouver, Canada
PURPOSE: The purpose of this pilot survey was to determine
the rate of severe injury (defined as greater than 8 weeks of
lost playing time in a season) among adolescent soccer players.
RELEVANCE: An understanding of severe injury rates and the nature
of these injuries is critical in the design of effective injury prevention,
rehabilitation, and training programs. The results of this survey will
add to our understanding of soccer related injuries and provide the
first insight into these injuries in British Columbia. PARTICIPANTS:
One hundred and three surveys were returned from community
soccer players in the lower mainland of British Columbia from Oct
2005 – April 2006. METHODS: Surveys that covered questions on
demographics, the nature of recent injuries, environmental factors
and exposure to soccer were distributed through the BC Soccer
Association and coaches to teams of players 14-18 years old at all
WCPT 2007, Research Reports
levels of soccer. ANALYSIS: Demographic data, injury information,
and soccer exposure were described as a percentage of the total
responses. RESULTS: Fifty three percent of the respondents were
males and 47% were females. The average age of respondents was
16 years; 73% played at the elite level (Metro), and 86% kicked
with their right leg. Seventy percent played soccer between 7–14
hours/week, and 71.7% played other sports up to 6 hours/week.
The most common playing surfaces were outdoor turf and grass.
Fifteen of the respondents indicated they had experienced a severe
injury (all of which were lower extremity) during the soccer season
(14.5%). Of those, 11 completed additional injury information. The
respondents also indicated that 15.3% played soccer with pain.
CONCLUSIONS: The incidence of severe injury in this survey is
higher than other epidemiological studies in the literature. Further
investigation with a greater number of respondents is warranted to
see if this higher incidence exists in British Columbia and, if so,
what the contributing factors may be that are unique to this area.
IMPLICATIONS: Sports injuries are a concern for the short and long
term health of our youth. Because each geographic and demographic
area brings with it a unique set of risk factors for injury, these
must be identified prior to the design of intervention programs. A
prospective survey and injury surveillance in British Columbia are
directions for future research. KEYWORDS: soccer; injury; incidence.
FUNDING ACKNOWLEDGEMENTS: Physiotherapy Foundation of
Canada. CONTACT: celebrini@telus.net
ETHICS COMMITTEE: Behavioural Research Ethics Committee,
University of British Columbia, Vancouver, Canada
Research Report Poster Display
39-03 Monday 4 June 10:30
VCEC Exhibit Hall B & C
THE CORRELATION OF LOWER EXTREMITY FLEXIBILITY
AND STRENGTH WITH BALANCE IN AN INTERNATIONAL
POPULATION OF SPECIAL OLYMPIANS
Adewunmi R, James T, Reicherter E, Kasior-Szerszen I; Howard
University, Washington DC, USA
PURPOSE: The purpose of this study was to assess the correlation
between lower extremity flexibility and strength measurements with
balance scores in Special Olympian men, women, and children
participating in the 2005 Nagano Japan Winter World Games.
RELEVANCE: Research has shown that individuals with intellectual
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
to address these health disparities. However, compared with other
populations, little is known about the relationship of strength and
flexibility as related to the balance of youth and adults with mental
retardation to guide clinicians in their efforts with this population.
PARTICIPANTS: A database including lower extremity strength and
flexibility and balance measures of 482 international participants
from the 2005 Winter World Special Olympics Games in Nagano,
Japan was utilized. Participants were of both genders; ages ranging
from 10–55 years. METHODS: The participants provided informed
consent before participating and institutional review board approval
was attained for the study. Utilizing the FUNfitness protocol, lower
quarter strength (sit to stand, abdominal crunch) and flexibility (hip
and knee extension, ankle dorsiflexion) and balance (functional
reach, single leg stance) were measured and recorded onto score
sheets by physical therapists. ANALYSIS: The data for each of
the strength and flexibility measures were compared to each of
the balance measures to identify the correlation between them. A
Pearson correlation was performed utilizing SPSS 13.0 statistical
software. RESULTS: The results from the data analysis found
statistically significant correlations amongst the strength, flexibility,
and balance measures. Increased time (seconds) to perform single
leg stance was inversely correlated to quickly perform sit-to-stand
(repetitions/minute); ranging from r = −0.26 to −0.52 (p  0.01) across
Poster Displays, Monday 4 June
age groups. Increased time to perform single-leg-stance was also
negatively correlated with ability to perform the Functional Reach
Test; ranging from r = −0.25 to −0.40 (p  0.01) across age groups.
To a lesser significance level (p  0.05), decreased ankle dorsiflexion
range-of-motion was negatively correlated with increased single leg
stance time in the older groups. CONCLUSIONS: The findings from
this study showed a highly significant correlation between decreased
lower extremity flexibility and poor balance in an international
Special Olympian population. To a lesser degree, lack of lower
extremity flexibility was correlated with poor balance, particularly
in the older athlete groups. IMPLICATIONS: The results of this
study found that even in an elite athletic population, lack of lower
extremity strength and flexibility can impair balance for persons
with intellectual disabilities. This implies that for these athletes
and for other persons with this disability, the increased risk of
falls and other injuries is significant. Physical therapists can play
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
this study was supported by a Howard University Fund for Academic
Excellence Grant and Center for Advancement of Service Learning
Grant. CONTACT: radewunmi2@yahoo.com
ETHICS COMMITTEE: Howard University Institutional Review Board
Research Report Poster Display
39-07 Monday 4 June 10:30
VCEC Exhibit Hall B & C
CHANGES IN DAILY FUNCTIONING AND PAIN INTENSITY
AFTER SPECIFIC EXERCISE FOR WOMEN WITH PERSISTENT
PELVIC PAIN POST PARTUM
Unsgaard-Toendel M, Vasseljen O, Fladmark A, Woodhouse A,
Mørkved S; Norwegian University of Science and Technology,
Faculty of Medicine, Department of Community Medicine and
General Practice
PURPOSE: The aim of this study was to assess the effect of an
intervention program, including the use of ultrasound as biofeedback,
to improve daily life functioning and reduce pain intensity in women
with persistent low back- and pelvic pain after pregnancy (PLPP).
RELEVANCE: PLPP is a considerable problem for many women. An
individually designed treatment program including specific stabilizing
exercises are recommended in European guidelines for treatment
of PLPP. The recommended intervention addresses training of both
global and local muscles. However, which of the treatment elements
are the most effective remains unknown. In the present study we
wanted to investigate possible correlations between changes in
Disability Rating Index (DRI) and VAS pain intensity scores and the
ability to perform an isolated muscle contraction. Ultrasound imaging
was used both as biofeedback when teaching isolated muscle activity,
and as an evaluating tool to study quality of muscle contractions and
thickness / lateral contraction of deep muscles. Women reporting
PLPP constitutes a heterogeneous group and there is a lack of
knowledge related to the effect of interventions on subgroups. Single
subject experimental design allows close study of single participants
in order to identify good responders. PARTICIPANTS: 13 women
mean age 31 (range 24-40), parity 1.7 (range 1-4) with persistent
low back- and pelvic pain after pregnancy at least 3 (range 3-81)
months after the last delivery was included. METHODS: A single
subject experimental ABA-design was used. Effect parameters were
DRI, VAS for pain intensity and ultrasound imaging of displacement
and cross-section in deep abdominal muscles. Tests were performed
once a week during 4 weeks for initial baseline, 16 weeks of treatment
and 4 weeks post treatment. The intervention consisted of relearning
strategies through ultrasound feedback to isolate muscle contraction
in transversus abdominis, stimulation of muscle-tendon-fascia-slings
that stabilises the low back-pelvic area, stretching and, when
considered necessary, manual therapy. Individual treatment was
S243
given once a week and additional home exercises performed daily.
ANALYSIS: The results were analysed by relevant methods in SPSS
and visual inspection. RESULTS: Results show that mean score on
the DRI and VAS pain intensity was significantly reduced from before
to after the intervention period for everyone. Significant correlation
was found between change in function and pain (r = 0.8). The analysis
of ultrasound data is in progress. CONCLUSIONS: In the present
study women with PLPP improved their function and obtained pain-
relief during the intervention period. IMPLICATIONS: This pragmatic
intervention seem to benefit women with persistent pelvic pain post
partum. Closer analysis may show which of the treatment elements
are most important for each of the patients. KEYWORDS: pelvic
pain, pregnancy, treatment. FUNDING ACKNOWLEDGEMENTS:
The Norwegian Fund for Postgraduate Training in Physiotherapy.
ETHICS COMMITTEE: Norwegian regional ethics committee;
Norwegian statistical database
Research Report Poster Display
01-13 Monday 4 June 14:00
VCEC Exhibit Hall B & C
EFFECTS OF POSITIONING OF NEONATES WITH UNILATERAL
LUNG DISEASE ON CARDIOPULMONARY PARAMETERS
Almazeedi S, Aytoughlo D; Farwania Hospital, Farwania, Kuwait
PURPOSE: To determine the effects of positioning of neonates
with unilateral lung disease on cardiopulmonary parameters.
RELEVANCE: Physical therapists have a great role in treating
neonates with unilateral lung disease in the NICU. Thus for safe and
proper treatments of neonates, the pyhisical therapist has to be aware
of the effects of different positions on ventilation, oxygenation and
other cardiopulmonary parameters such as heart rate and respiratory
rate. PARTICIPANTS: Nine neonates with left lung disease at
Farwania hospital’s NICU in Kuwait were included in the this study.
METHODS: Each neonate was turned from supine position to one
of the lateral positions (chosen at random), then turned to the supine
position and finally turned back to the supine position. Each position
was maintained for 10 minutes. For analysis, we recorded the values
for heart rate, respiratory rate, transcutaneous arterial oxygen and
carbon dioxide pressures and arterial oxygen saturation at one-
minute intervals during 10 minute period and then averaged the
results. ANALYSIS: Conventional statistical methods were employed
to determine means, standard deviation and standard error. Paired
t-tests were used to compare differences between the positions
for the dependent variables. RESULTS: Mean gestational age was
29 plusminus 5 weeks, mean birth weight was 1.86 plusminus
1 Kg. There were no statistical significant differences between
the positions regarding heart rate, respiratory rate, transcutaneous
arterial oxygen and carbon dioxide pressures and arterial oxygen
saturation. Heart rate during supine, right and left side lying positions
was 150 plusminus 12, 150 plusminus 14 and 152 plusminus 11
respectively (p. greatequal 0.05). Respiratory rate during supine,
right and left side lying was 50 plusminus 12, 54 plusminus 8 and
49 plusminus 14 respectively (p greatequal 0.05). Arterial oxygen
saturation during supine, right and left side lying was 94 plusminus 4,
95 plusminus 3 and 93 plusminus 3 respectively (p greatequal 0.05).
Transcutaneous arterial oxygen pressure during supine, right and left
side lying was 10 plusminus 7, 10 plusminus 6 and 11 plusminus
7 respectively (p greatequal 0.05). Finally arterial transcutaneous
carbon dioxide during supine, right and left side lying was 4 plusminus
3, 4 plusminus 4 and 4 plusminus 3 respectively (p greatequal 0.05).
CONCLUSIONS: The results of this study suggest that neonates with
unilateral lung disease can be turned safely on any position: Affected,
unaffected side or supine. However, even though the results were not
statistically significant, respiratory rate was lower and transcutaneous
arterial oxygen pressure was higher when the affected lung was
dependent and the good lung was uppermost. Replication of this
study is essential with inclusion of a larger sample size in order
to obtain statistical significance. IMPLICATIONS: The information in
S244
this study will encourage physical therapist working in the NICU to
monitor cardiopulmonary parameters closely with positional changes
of neonates. KEYWORDS: Heart rate, Respiratory rate, unilateral
lung disease, transcutaneous arterial oxygen and carbon dioxide
pressures. FUNDING ACKNOWLEDGEMENTS: This research study
was unfunded. However, We would like to thank Dr. Reema Alsawan
the head of the NICU for giving us the permission to conduct the study
on the neonates in her unit. Also we would like to thank the NICU
nursing staff for their great help and support with data collection.
ETHICS COMMITTEE: Farwania Hospital
Research Report Poster Display
01-17 Monday 4 June 14:00
VCEC Exhibit Hall B & C
EFFECT OF A THREE SECOND INSPIRATORY TIME ON
PATTERN OF VENTILATION AND SPUTUM CLEARED DURING
MANUAL HYPERINFLATION
Maxwell L, Ellis E; School of Physiotherapy, Faculty of Health
Sciences, University of Sydney
PURPOSE: The primary aim of this study was to compare the use
of a three second inspiratory time (TI ) during manual hyperinflation
on pattern of ventilation (volume delivered, peak inspiratory (PIFR)
and expiratory (PEFR) flow rates, inspiratory to expiratory (I:E)
flow rate ratio) and secretion clearance in intubated adult patients
in intensive care. RELEVANCE: Manual hyperinflation is used by
physiotherapists in many countries to prevent volume loss, reinflate
areas of atelectasis or collapse, and assist secretion removal. The
original two papers describing the technique have been interpreted
as recommending a slow inspiration over three seconds. The
effect of a three second TI on pattern of ventilation and secretion
clearance in the clinical setting has not been reported. In addition,
the research to date has used a set peak inspiratory pressure
(PIP) to standardise performance. The validity of using PIP to
for this purpose has not been evaluated. The findings of this
study have relevance for both clinical practice and future research
investigating the effects of manual hyperinflation. PARTICIPANTS:
intubated patients and 11 rotating physiotherapists from one principle
referral (A1) Australian hospital ICU were recruited. METHODS: A
double blinded, prospective, randomized, cross over, with-in subject
repeated measures design was used. Subjects were treated by
a physiotherapist trained to perform manual hyperinflation over
three seconds with an even rate of bag compression and an
“untrained” physiotherapist. The therapists performed six sets of
six manual hyperinflation breaths to a peak inspiratory pressure
of 40 cm H2 O, with a Mapleson-F circuit on the same patient on
two consecutive days. Pattern of ventilation [TI , volume delivered,
PIFR, PEFR] were recorded using a heated pneumotachometer,
pressure transducer and custom designed data acquisition and
analysis systems. The I:E flow rate ratio was manually calculated.
Sputum was collected in a trap and weighed. ANALYSIS: A 2x2
repeated measures ANOVA (variables – therapist and time of day)
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:
The trained therapist delivered a larger volume breath (p < 0.001),
generated a slower PIFR (p = 0.004) and faster PEFR (p < 0.001).
Although the trained therapist produced a lower I:E flow rate ratio
(p = 0.004), most therapists (59 of 70 treatments) produced an I:E
flow rate ratio which met the requirements for two-phase gas-liquid
flow. The trained physiotherapist used a longer TI (p < 0.001), but
there was a moderate correlation (r = 0.68, p < 0.001) between TI
for the trained and untrained therapists. There was no significant
difference in wet weight sputum cleared between the trained and
untrained therapists however there was a trend for the trained
therapist to clear more sputum (p = 0.09). CONCLUSIONS: Use of
a set peak inspiratory pressure alone does not standardise pattern
of ventilation during manual hyperinflation in the same patient.
WCPT 2007, Research Reports
Operator performance (use of a three second TI ) is also important.
IMPLICATIONS: The use of a three second TI during manual
hyperinflation is recommended for clinical practice. More complete
documentation of pattern of ventilation in future research is required.
KEYWORDS: Manual hyperinflation, Respiratory therapy. FUNDING
ACKNOWLEDGEMENTS: No funding was received for this work.
ETHICS COMMITTEE: University of Sydney; Concord Repatriation
and General Hospital
Research Report Poster Display
01-21 Monday 4 June 14:00
VCEC Exhibit Hall B & C
THORACOABDOMINAL MOTION AT REST AND DURING
CYCLING EXERCISE IN PATIENTS WITH CHRONIC
OBSTRUCTIVE PULMONARY DISEASE
Britto R1 , Alves G, Campos F, Vilaça A, Moraes K, Parreira V;
1 Federal University of Minas Gerais
PURPOSE: The aim of this study was to compare breathing patterns
and the thoracoabdominal motion of patients with chronic obstructive
pulmonary disease (COPD) during rest and exercise RELEVANCE:
The knowledgement about the breathing patterns and the thora-
coabdominal motion during physical activity is important to plan the
exercises protocols in pulmonary rehabilitation PARTICIPANTS: We
evaluated 25 men with COPD, 68.2±7.4 (SD)years, VEF1 42±12.8%
(SD) predicted and with body mass index of 22.9±3.4 (SD).
METHODS: Changes in respiratory frequency (FR ), tidal volume
(VT ), inspiratory time (TI ), expiratory time (TE ), total respiratory time
(TTOT ), percentage of abdomen and rib cage contribution to tidal
volume (%RC/VT , %AB/VT ) and phase angle (F, synchronism) were
analyzed by inductive respiratory plethysmography at rest and during
three moments of incremental cycling test(30, 70 and 100% of total
time of exercise) ANALYSIS: Repeated measures ANOVA followed
by pre-planned contrasts and Bonferroni corrections were used for
analyses with a significance level of 0.008 RESULTS: As expected,
there were observed progressive increases in VT and FR (p = 0.001).
The progressive decline in TTOT was proportional to the TI and
TE reductions during the two last moments of exercise compared
with rest (p < 0.008). The %AB/VT increased compared to rest
(rest: 50.2±11.4% vs exercise: 63.6±10, 62.8±10.9, 64.69±11.1%;
p = 0.001). Compared with rest F increased (rest: 12±7.6 vs exer-
cise: 23.3±13.9, 20.5±8.6, 21.8±8.4; p = 0.001) without differences
between the moments of exercise CONCLUSIONS: These data
suggest that in patients with COPD there is an increase participation
of abdominal compartment during cycling exercise. IMPLICATIONS:
Aerobic exercises can contribute to improve diaphagmatic movement
in patients with COPD KEYWORDS: plethysmography, abdomen,
exercise, COPD. FUNDING ACKNOWLEDGEMENTS: National
Counsel of Technological and Scientific Development-CNPq/Brazil.
CONTACT: rbrito@ufmg.br
ETHICS COMMITTEE: Ethic Committee of Federal University of
Minas Gerais
Research Report Poster Display
03-01 Monday 4 June 14:00
VCEC Exhibit Hall B & C
INFLUENCE OF THE RETURN-TO-WORK ON MOTOR FUNCTION
AND HEALTH-RELATED QUALITY OF LIFE IN MIDDLE-AGED
PATIENTS UNDERGOING CORONARY ARTERY BYPASS
GRAFTING
Yonezawa R, Matsunaga A, Saitoh M, Ishii A, Kutsuna T,
Matsumoto T, Yamamoto K, Sato T, Sawairi T, Nanri Y, Masuda T;
Graduate School of Medical Sciences, Kitasato University,
Kanagawa, Japan
PURPOSE: The return-to-work is one of the most important goals in
middle-aged patients with acute myocardial infarction (AMI), and has
Poster Displays, Monday 4 June
beneficial effects on their health-related quality of life (HRQOL). It
was reported that the aged patients who underwent coronary artery
bypass grafting (CABG) were showed poor level of activities of daily
living after the hospital discharge, and that middle-aged patients with
AMI returned to work later in CABG than in percutaneous coronary
intervention (PCI). However, there were few studies reporting the
changes of motor function and HRQOL after return-to-work in middle-
aged patients undergoing CABG. The present study investigated
the influence of return-to-work on the motor function and HRQOL
in them. RELEVANCE: This study helps to practice the cardiac
rehabilitation (CR) for middle-aged patients who return to work
after AMI. PARTICIPANTS: Twenty-eight middle-aged outpatients,
54±7 yrs, were divided into following two groups, after completing
a phase I CR because of AMI: 20 patients who received PCI (PCI
group) and 8 who did CABG (CABG group). METHODS: The left
ventricular ejection fraction (LVEF), brain natrium peptide (BNP) and
exercise capacity were evaluated during hospitalization. The motor
function including the lower limb muscular strength, grip strength
and functional reach was evaluated at the hospital discharge and
6 months after AMI. The HRQOL was measured by using the MOS
short-form 36-items health survey (SF-36) that consisted of physical
functioning (PF), role-physical (RP), bodily pain (BP), general health
perceptions (GH), vitality (VT), social functioning (SF), role-emotional
(RE) and mental health (MH) at the hospital discharge and 6 months
after AMI. ANALYSIS: Unpaired t-test and ANOVA were used to
compare clinical variables, motor function and HRQOL between PCI
and CABG groups. RESULTS: All patients returned to work within
3 months after the hospital discharge. The LVEF, BNP and exercise
capacity showed no significant differences between PCI and CABG
groups. The lower limb muscular strength and grip strength were
significantly lower at the hospital discharge in CABG group than those
in PCI group (P < 0.01). Both lower limb muscular strength and grip
strength measured at 6 months after AMI improved significantly as
compared those at the hospital discharge in CABG group (P < 0.01
and P < 0.01, respectively). Although the lower limb muscular strength
at 6 months after AMI showed no significant difference between
PCI and CABG groups, the grip strength was significantly lower
in CBAG group than that in PCI group (P < 0.01). The functional
reach showed no significant difference between the 2 groups. The
PF score was lower at the hospital discharge in CABG group than
that in PCI group (P < 0.05). Although the scores of RP and RE
were significantly ameliorated 6 months after AMI in PCI group
(P < 0.01 and P < 0.01, respectively), the scores of all subscales
showed no significant changes in CABG group. CONCLUSIONS:
The middle-aged patients undergoing CABG showed poor HRQOL
and less improvement of their motor function after return-to-work, as
compared with those who treated with PCI. IMPLICATIONS: The
evaluation of motor function and HRQOL after return-to-work are
very meaningful for middle-aged patients who underwent CABG, to
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:
yonekko7@dc5.so-net.ne.jp
ETHICS COMMITTEE: The study protocol was approved by the
Ethics Committee of Kitasato University on human research.
Research Report Poster Display
03-05 Monday 4 June 14:00
VCEC Exhibit Hall B & C
CARDIOPULMONARY RESPONSES DURING THE 6-MINUTE
WALK TEST IN TRANSPLANT RECIPIENTS: ROLE OF
PHYSICAL FITNESS
Tomczak C1 , Warburton D2 , Bhambhani Y1 , Jendzjowsky N1 ,
Riess K1 , Haennel R1 , Esch B2 , Pechter D1 , Haykowsky M1 ;
1 Faculty of Rehabilitation Medicine, University of Alberta; 2 School
of Human Kinetics, University of British Columbia
PURPOSE: To examine the cardiopulmonary responses during the
6-minute walk test (6MWT) in transplant recipients. RELEVANCE:
S245
Transplant recipients have reduced peak cardiorespiratory fitness,
however, the effect that transplantation has on aerobic endurance
(i.e., 6MWT) has not been well studied. Moreover, the car-
diopulmonary responses during a 6MWT have not been studied
in transplant recipients. PARTICIPANTS: Fifty-four (48±12 years)
individuals who received a heart (n = 12), heart double-lung (n =
2), double-lung (n = 8), kidney (n = 14), kidney-pancreas (n = 2),
liver (n = 14), or bone marrow transplant (n = 2) participated in
this investigation. METHODS: The participants completed a 6MWT
with a portable telemetry gas analyzer and heart rate (HR) monitor
to quantify oxygen consumption (VO2 ), HR, and O2 -pulse (product
of stroke volume and arteriovenous O2 difference). ANALYSIS:
Participants were grouped according to their VO2 during the 6MWT
as: 1) Very low fit (VLF: 25th percentile, n = 17); 2) Low
fit (LF:26-50th percentile, n = 12); 3) Moderately fit (MF:51-75th
percentile, n = 12); 4) High fit (HF:76-90th percentile, n = 7),
and 5) Very high fit (VHF;>90th percentile, n = 6). Comparison
between groups was made using ANOVA and significance set at
p < 0.05. RESULTS: VO2 was significantly different between the VLF
(13±2; mL/kg/min), LF (17±1 mL/kg/min), MF (20±1 mL/kg/min),
HF (24±2 mL/kg/min) and the VHF group (30±3 mL/kg/min). HR
was significantly higher in VHF (147±16 beats/min) compared to
VLF (105±13 beats/min), LF (125±12 beats/min), MF (116±15
beats/min), and HF (128±14 beats/min). HR was also significantly
higher in HF and LF compared to the VLF group. O2 -pulse was
significantly greater (p < 0.05) in VHF (15±3 mL/beat) versus VLF
(10±3 mL/beat) and LF (10±2 mL/beat), but not MF (13±3 mL/beat)
or HF (12±3 mL/beat). 6MWT distance was greatest (p < 0.05) in VHF
(730±37 m) compared with VLF (501±82 m), LF (537±59 m), MF
(601±41 m), and HF (599±40 m). 6MWT distance was also greater
between HF and MF compared with VLF (p < 0.05). CONCLUSIONS:
The increased VO2 in VHF compared to low fit transplant recipients
during the 6MWT is secondary to a greater exercise stroke volume
and/or arteriovenous O2 difference. Further, ~50% of our transplant
recipients have a VO2 during the 6MWT that is below the threshold
level required to function independently in their environment (i.e.,
<18 mL/kg/min). IMPLICATIONS: A substantial number of our
transplant recipients have an impaired cardiopulmonary response
during the 6MWT and would benefit from participating in an
exercise rehabilitation program. KEYWORDS: 6-Minute Walk Test,
VO2 , Transplant Recipients. FUNDING ACKNOWLEDGEMENTS:
Drs. Haykowsky and Warburton are supported by the Canadian
Institute of Health Research (CIHR). C. Tomczak and B. Esch
are supported by the Natural Sciences and Engineering Research
Council of Canada and C. Tomczak is a CIHR Strategic Training
Fellow in TORCH (Tomorrow’s Research Cardiovascular Health
Professionals). CONTACT: mark.haykowsky@ualberta.ca
ETHICS COMMITTEE: University of Alberta Health Research Ethics
Board
Research Report Poster Display
07-13 Monday 4 June 14:00
VCEC Exhibit Hall B & C
A SURVEY OF FACTORS THAT INFLUENCE PHYSICAL
THERAPIST STUDENTS’ INTENTIONS TO WORK WITH THE
ELDERLY POPULATION
Coleman A, Waring P, Bird N, Ladd H, Morris J, Wheeler B;
University of Tennessee, Memphis, TN USA
PURPOSE: The purpose of this study was to investigate the
relationship between various factors and physical therapist students’
intentions to work with the elderly population after graduation.
RELEVANCE: There is concern in the healthcare community that
there will not be sufficient numbers of physical therapists interested
in working with the elderly to meet the expected demand. It is
important to identify factors that might influence a physical therapist
student’s desire to work with this population. PARTICIPANTS: Senior
physical therapist students graduating from four accredited physical
S246
therapy programs in Tennessee in 2005 were invited to participate.
Seventy nine completed questionnaires were returned. Our subject
population consisted of 16 males (20%) and 63 females (80%), with
74 of the respondents being Caucasian, 4 African American and 1
Hispanic. The mean age was 25.4 years old. METHODS: We used
a modified version of a survey developed by Coren et al (1987).
It consisted of demographic questions and 18 yes-no questions
concerning biographical, experiential, socioeconomic and attitudinal
factors. A final yes-no question asked the subjects if they intended
to work primarily with elderly patients after graduation. Subjects
were also asked to list the most positive and negative aspects of
working with elderly persons. Survey packets were distributed to
the students by the Academic Coordinator of Clinical Education
of each institution and were returned in a self-addressed envelop.
ANALYSIS: Survey results were divided into two groups based on
the subjects’ stated intention (I) or no intention (NI) to work primarily
with elderly patients after graduation. Using StatView (1996), a
Fisher’s Exact Test was performed to see if there was a relationship
between the I and NI group and each of the answers to the 18
yes-no questions. A two-tailed t-test compared the mean ages of
the two groups. A chi-square test was performed to determine the
influence of gender and race on the intention to work with the
elderly population. RESULTS: No significant differences were found
between the I and NI groups regarding age (P=0.9), gender (P=.74)
or race (P=.05). Analysis of the responses to the 18 yes-no questions
indicated the answer to one question was statistically significant
(df=1, P=.005). This question asked if the subject believed working
with elderly patients often entailed working in an environment that is
considered depressing. The most commonly cited positive aspects
of working with the elderly were the depth of life experiences in
this population and the perception that the patients were grateful
for their help. The most commonly cited negative aspects were
the concerns about incontinence and other hygiene factors and the
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
in the didactic and clinical portion of the curriculum to address
this concern. Further investigation may identify additional factors
that can be addressed by educational and healthcare institutions
in an effort to encourage more practitioners to consider a career
with the geriatric population. KEYWORDS: elderly, physical therapist
students. FUNDING ACKNOWLEDGEMENTS: None.
ETHICS COMMITTEE: University of Tennessee IRB
Research Report Poster Display
07-17 Monday 4 June 14:00
VCEC Exhibit Hall B & C
THE EFFECT OF HIGH FREQUENCY TRANSCUTANEOUS
ELECTRICAL NERVE STIMULATION (TENS) ON VIABILITY OF
RANDOM SKIN FLAP IN RATS
Liebano R1,2 , Abla L1 , Ferreira L1 ; 1 Plastic Surgery Division,
Surgery Department, Universidade Federal de São Paulo, Escola
Paulista de Medicina, São Paulo, Brazil; 2 Universidade Cidade
de São Paulo, São Paulo, Brazil
PURPOSE: Skin flaps are largely used in all fields of plastic surgery
especially in reconstructives. The main and more feared complication
by plastic surgeons in the use of the flap is the ischemia that
develops to tissue necrosis in a large number of cases taking a
failure in the proposed treatment. The aim of this study was to
determine the effect of high frequency Transcutaneous Electrical
Nerve Stimulation (TENS) on viability of random skin flap in rats.
RELEVANCE: Although there are publications about TENS effects
on skin flaps survival in the literature, there is no consensus about
the optimal parameters for this effect. PARTICIPANTS: Seventy-
five adult male Wistar rats, weighing 230 to 358 g were used
in this study. METHODS: The dorsal skin flap, measuring 10 in
WCPT 2007, Research Reports
length and 4 cm in width was raised in all animals and a plastic
barrier was interposed between the flap and donor site. The flap
was then sutured back in place with 4-0 interrupted nylon sutures.
After the operative procedure, animals of all groups were maintained
anesthetized one more hour with electrodes positioned in the base
of the flap and submitted to treatment according to their respective
group. This procedure was repeated on the two subsequent days.
G1: sham TENS, G2: TENS (f = 80 Hz and I = 5 mA), G3:
TENS (f = 80 Hz and I = 10 mA), G4: TENS (f = 80 Hz and I
= 15 mA), G5: TENS (f = 80 Hz and I = 20 mA). ANALYSIS:
For statistical analyses, one way Analysis of Variance (ANOVA)
was used followed by post hoc Dunnett’s test. RESULTS: The
mean percentage necrotic area was 43.11±9.30 (mean ± standard
deviation) in G1 (sham TENS), 34.65±12.29 in G2 (80 Hz 5 mA),
49.44±15.58 in G3 (80 Hz 10 mA), 23.52±10.83 in G4 (80 Hz 15 mA)
and 45.10±16.14 in G5 (80 Hz 20 mA). Statistical analyses showed
significant differences between G4 (80 Hz 15 mA) and G1 (sham
TENS) (P < 0.001). There were no statistical differences between G2,
G3, G5 and sham TENS (P > 0.05). CONCLUSIONS: The amplitude
of 15 mA presented a lower necrotic area than sham TENS group
and Transcutaneous Electrical Nerve Stimulation was efficient in
improving the random skin flap viability in rats. IMPLICATIONS:
The results of this animal investigation confirm previous reports
about TENS effects on skin flaps viability. The amplitude must be
increased to a high sensorial level or at the beginning of motor
threshold. New studies must be performed in human subjects now.
KEYWORDS: Transcutaneous Electric Nerve Stimulation, surgical
flaps, tissue survival, rats. FUNDING ACKNOWLEDGEMENTS: This
work was financial supported by the Centro de Apoio à Pesquisa e
ao Ensino Superior (CAPES). CONTACT: liebano@gmail.com
ETHICS COMMITTEE: This research was approved by the
Committee of Ethics in Research of UNIFESP/Hospital São Paulo,
CEP Nº. 0380/03.
Research Report Poster Display
07-21 Monday 4 June 14:00
VCEC Exhibit Hall B & C
A POST-MORTEM INVESTIGATION OF THE HEATING PATTERN
OF SHORTWAVE DIATHERMY IN PIG TISSUES USING
THERMOGRAPHY
Aoki M1 , Goh A2 ; 1 Department of Physical Medicine and
Rehabilitation, Shinshu University Hospital, Matsumoto, JAPAN;
2 School of Health Sciences, Shinshu University, Matsumoto, JAPAN
PURPOSE: Short wave diathermy (SWD) is a common modality
that is used for thermotherapy. SWD can be applied either via the
condenser or the induction method. In a previous study, we had
investigated the heating pattern of SWD using the induction method.
The aim of this study is to investigate the heating pattern of SWD
using the condenser method. RELEVANCE: In order to learn how
to apply and control the heat energy from SWD, it is necessary
to understand its heating pattern. This will assist the clinician in
making the right decisions regarding dosimetry. PARTICIPANTS: A
total of three thigh specimens from post-mortem pig tissues were
used for this study. The specimens were left to stabilize at room
temperature prior to commencement of the study. METHODS: The
SWD equipment used was the SW-180 model (Ito Co. Ltd, Tokyo,
JAPAN). Two rigid electrodes were used to apply the SWD energy
to either side of the thigh sections of pig tissues at intensities of
20W, 40W, 60W and 30W (pulsed at 25Hz) for 15 minutes. The
cross sectional tissue temperature at 1, 2, 3, 4 and 5 cm below
the skin were recorded at 1 minute intervals for 15 minutes exposure
followed by another 15 minutes post-exposure using a thermographic
unit, InfraEye 2000 (Nihon Koden, Tokyo, JAPAN). The surface skin
temperature was also recorded at 1 minute intervals using a hand-
held infrared spot thermometer, the HT-11 (Minolta Co. Ltd., Japan).
ANALYSIS: A total of three specimens were used, and the average
increases in temperature were analyzed for the skin surface (0 cm)
Poster Displays, Monday 4 June
and at 1, 2, 3, 4 and 5 cm below the skin. RESULTS: The results
show that increase in temperatures were greatest at the skin surface
(0 cm), and decreased as the tissue depth increased from 1 cm
to 5 cm. CONCLUSIONS: Compared to the previous results for
the induction method, the increase in temperatures were similar
for both induction and condenser methods. IMPLICATIONS: The
results obtained from this study can be used to guide the clinician in
selecting the treatment dosages for SWD. Since both the induction
and condenser methods provided similar heating patterns, it may be
more convenient to use the induction method for SWD treatment
applications. KEYWORDS: Shortwave Diathermy, Electrophysical
Agents, Heating pattern. FUNDING ACKNOWLEDGEMENTS: Nil.
CONTACT: micaoki-sin@umin.ac.jp
ETHICS COMMITTEE: Ethics committee of Shinshu University
Hospital
Research Report Poster Display
09-01 Monday 4 June 14:00
VCEC Exhibit Hall B & C
IMPORTANCE OF INCLUDING MEASUREMENTS OF BOTH
AFFECTED AND CONTROL LIMB VOLUMES IN ASSESSING
OUTCOMES OF LYMPHEDEMA THERAPY
Mayrovitz H1 , Davey S2 ; 1 College of Medical Sciences, Nova
Southeastern University, Ft. Lauderdale Florida, USA; 2 Healing
Hands of Lymphatics Plus, Ft. Lauderdale Florida, USA
PURPOSE: To determine the difference in estimated therapy-related
edema reductions when outcomes are based only on pre-treatment
volumes of non-affected control limbs versus using both pre- and
post treatment control limb values as reference. RELEVANCE:
Progress and outcomes of limb lymphedema therapy are usually
tracked and documented by changes in volumes derived from limb
circumferences. With unilateral limb involvement, paired affected limb
volume (VA) and control limb volume (VC) may be used to assess
pre-treatment edema volume (EV) and to track changes using VC as
a reference. Some clinics measure VC every time that they measure
VA but others only measure VC at the patient’s initial evaluation and
use the pre-treatment volume (VC1 ) as a reference for determining
edema volume changes throughout therapy. Not measuring VC at
each VA assessment is clearly a time saving feature, which in a
busy clinic, is an important consideration. However, since changes
in VC may occur with time and conditions, the effect of using a
single VC value on outcome assessments is unclear. Despite its
clinical relevance, there has been no systematic investigation of
this issue. PARTICIPANTS: Subjects included in this study were
persons who had unilateral arm lymphedema secondary to breast
cancer-related treatment (N=75) and persons with unilateral leg
lymphedema (N=45) all of whom were referred for lymphedema
therapy. To be included in the analyses that form the basis of this
study they had to have an initial edema volume of at least 10%
and have had 10 complete decongestive physiotherapy treatments.
METHODS: Leg and arm circumferences were measured at four
cm intervals starting at the ankle or wrist and ending at the groin
or axilla. From two adjacent limb circumference values, C1 and
C2 separated by a distance of L cm, limb segmental volume
(VSEG) was calculated from the equation for a truncated cone model
as VSEG=L(C12 +C1C2+C22 )/12p. ANALYSIS: Limb volumes were
calculated as the sum of all measured segments. Pre-treatment
edema volume was calculated as EV1 = VA1 − VC1 . End treatment
edema volumes were calculated using the end-therapy control
volume as EV2 = VA2 – VC2 and also using the pre-treatment control
volume as EV’2 = VA2 – VC1 . Thus the only source of potential
difference between EV2 and EV’2 is attributable to a change in VC
from start to end of therapy. EV2 and EV’2 and their percentage
change were compared by paired T-tests. RESULTS: Pre-treatment
edema volumes (mean+/−sd) for arms and legs were 939+/−567 ml
and 2272+/−2302 ml respectively. The main analytical result showed
that EV2 as compared to EV’2 was significantly greater and yielded
S247
a significantly smaller reduction in percentage edema. Thus, EV2
exceeded EV’2 for arms (571+/− 381 vs. 502+/−414 ml, p = 0.002)
and for legs (1388+/−1814 vs. 1206+/−1778 ml, p = 0.002) with
corresponding calculated percentage reductions in edema volume
for arms of 39.2+/−26.4 vs. 49.5+/−30.7%, p = 0.003 and for legs
47.0+/−35.6 vs. 60.0+/−37.3%, p = 0.002. CONCLUSIONS: Using
only pre-treatment control limb volumes as refererence to determine
therapy-related edema and percent edema reductions leads to
significant overestimations. IMPLICATIONS: Avoid this by using
both pre- and post-treatment control limb volumes as reference.
KEYWORDS: lymphedema assesssment, complete decongestive
therapy, limb volumes. FUNDING ACKNOWLEDGEMENTS: None.
CONTACT: mayrovit@nova.edu
ETHICS COMMITTEE: University
Research Report Poster Display
09-05 Monday 4 June 14:00
VCEC Exhibit Hall B & C
THE EFFECTS OF ULTRASOUND IRRADIATION ON THE
INHIBITION OF DISUSE MUSCLE ATROPHY IN THE RAT
Araki K1 , Nakamura M2 , Okita M3 , Nakano J4 , Kataoka H5 ,
Sakamoto J5 , Yoshimura T4 , Ohkida H1 , Tsujihata M6 ; 1 Department
of Rehabilitation, Nagasaki KITA Hospital, Nagasaki, JAPAN;
2 Graduate School of Medicine, Saga University, Saga, JAPAN;
3 Faculty of Care and Rehabilitation, Seijoh University, Nagoya,
JAPAN; 4 Nagasaki University School of Health Sciences, Nagasaki,
JAPAN; 5 Department of Rehabilitation, Nagasaki Memorial Hospital,
Nagasaki, JAPAN; 6 Section of Neurology, Nagasaki KITA Hospital,
Nagasaki, JAPAN
PURPOSE: Ultrasound (US) irradiation has been reported to
stimulate the expression of growth factors such as FGF (Fibroblast
growth factor) and IGF-I (Insulin linked growth factor-I) in various
cells. The expression of these growth factors is known to be
associated with the mechanism of muscle fiber hypertrophy. This
suggests that US irradiation may be effective in the treatment and
prevention of disuse muscle atrophy. We herein investigated the
effect of US irradiation on the inhibition of disuse muscle atrophy.
RELEVANCE: Up to now very little information has been reported
regarding the effect of US irradiation on disuse muscle atrophy. In
this study, we identified a new effect of US irradiation on muscle
fibers. PARTICIPANTS: Twenty male Wistar-derived rats (220±10g)
were divided into four groups: a control group (n=5), a continuous-
US irradiation group (CONTI-US, n=5), a pulsed-US irradiation group
(PULS-US, n=5), and a placebo group (No-US, n=5). METHODS:
Both ankles of rats in the CONTI-US, PULS-US, and No-US groups
were immobilized by the placement of a cast in the maximum
plantar flexion angle for two weeks. The casts were removed
under anesthesia and thereafter US irradiation on the gastrocnemius
muscles through skin for 15 minutes was performed five times a week
for two weeks. Ultrasound irradiation was applied using an ultrasound
machine (ITO, JAPAN), which provided continuous US (1MHz, 1
Watt/cm2) in the CONTI-US group and the pulsed US (1MHz, 1
Watt/cm2, duty cycle=1:4) in the PULS-US group. After the two-week
experimental period, frozen sections of left gastrocnemius muscles
were stained with myofibrillar adenosine triphosphatase (myosin
ATPase, pH 4.2, 4.5) and then the diameters of the muscle fibers for
each muscle fiber type were measured. In addition, the FGF and IGF-
I contents of the left gastrocnemius muscles were determined using
the ELISA method. The experimental protocol was approved by the
Ethics Review Committee for Animal Experimentation of Nagasaki
University (Nagasaki, Japan). ANALYSIS: For multiple comparisons,
one-way ANOVA with Fisher PLSD post hoc tests were performed.
A value of P < 0.05 was accepted as the statistical significance
level. RESULTS: The mean diameter of the muscle fibers for all
fiber types of gastrocnemius muscle significantly increased in the
CONTI-US group in comparison to the PULS-US and the No-US
groups. In addition, the FGF content also significantly increased
S248
in the CONTI-US group in comparison to the other three groups.
The IGF-I content significantly increased in the CONTI-US group in
comparison to the PULS-US and No-US groups. CONCLUSIONS:
The result of this study suggests that the continuous irradiation
of US inhibits the progression of disuse muscle atrophy of the
gastrocnemius muscles due to cast immobilization of the ankle joints.
This mechanism may be associated with the expression of FGF and
IGF-I by US irradiation. IMPLICATIONS: US irradiation may therefore
be a potentially useful method for performing muscle-strengthening
exercise. KEYWORDS: ultrasound, disuse muscle atrophy, growth
factor. FUNDING ACKNOWLEDGEMENTS: The funding source of
this study was the General Research Fund of Nagasaki University
(Nagasaki, Japan). CONTACT: kita_hp_riha1@shunkaikai.jp
ETHICS COMMITTEE: The experimental protocol was approved
by the Ethics Review Committee for Animal Experimentation of
Nagasaki University (Nagasaki, Japan).
Research Report Poster Display
10-13 Monday 4 June 14:00
VCEC Exhibit Hall B & C
EFFECTS OF SUSTAINED CONTRACTION OF LOWER TRUNK
MUSCLES ON THE H-REFLEX OF THE FLEXOR CARPI RADIUS
MUSCLE
Arai M1 , Shimizu H2 , Shimizu M3 , Shiratani T4 , Yanagisawa K5 ,
Tanaka Y1 ; 1 PNF Society of Japan; 2 Division of Occupational
Therapy, Institute of Health Sciences, Faculty of Medicine,
Hiroshima University; 3 Department of Physical Therapy, Faculty
of Health Sciences, Hiroshima Prefectural College of Health
Sciences; 4 Graduate student, Institute of Health Sciences, Faculty
of Medicine, Hiroshima University; 5 Department of Physical
Therapy, Tokyo Metropolitan University of Health Sciences
PURPOSE: Compared with prolonged stretching procedures, the
active and passive range of motion of severely restricted joints
of the upper extremities in patients with orthopedic diseases
was significantly improved with a sustained contraction of the
Proprioceptive Neuromuscular Facilitation pelvic-depression pattern
(SCPD), The purpose of this study was to determine the effect
of an SCPD on the ipsilateral upper extremity without any other
concomitant activation than the direct effect of SCPD resistive
exercise. RELEVANCE: Application of this approach (SCPD) may
be effective in indirectly treating extremities that cannot be exercised
directly. If the remote SCPD exercise actually facilitates the upper
extremities, it will be valid evidence of the indirect facilitative approach
of resistive exercise. PARTICIPANTS: Seven female and five male
subjects, aged 22 to 45 years, with no known neurological diagnoses,
volunteered for this study. METHODS: The study was approved by
the Ethical Committee of the Hiroshima Teishin Hospital, and all
subjects were given written, informed consents. The subjects were
randomly divided into two groups. Group 1 (n=6) served as a control
group. These subjects performed submaximal resistive grasping with
the contralateral upper extremity while the H-wave of the Flexor Carpi
Radialis (FCR) was measured and while no movement of the upper
extremities occurred. Group 2 (n=6) received the pelvic resistive
exercise (SCPD) while the FCR H-wave was measured and while no
movement of the upper extremities occurred. Each subject received
a total of 2 sessions of the SCPD or resistive grasping exercise, with
each resistive exercise lasting 20 seconds. ANALYSIS: 1) Intraclass
correlation coefficients (ICC) were determined by the value of the
force of resistance by a pinch meter at random points for 20 seconds.
2) The data of the M-wave and H-wave at rest were analyzed using
the ICC. 3) An analysis of variance (ANOVA) with repeated measures
over time was calculated for the amplitude of the M-wave and H-
wave respectively. We used the post hoc analysis with Bonferroni
multiple comparison tests to evaluate significant differences between
means. RESULTS: 1) The ICC determined by the pinch meter was
0.93. 2) The ICC of the M-wave and H-wave were both 0.99. 3)
Significant differences were not found for the M-wave during and
WCPT 2007, Research Reports
after each exercise. 4) Significant differences were found between
the groups, time, and interaction between the groups and time for
the H-wave. Post hoc analyses determined that the SCPD caused
a change in the H-reflex of the FCR, while there was no change
in the H-reflex from resistive grasping. The mean H-wave amplitude
during the SCPD was significantly reduced as compared with the
100-120 s post-SCPD potentiation. CONCLUSIONS: The depression
of the H-reflex was most profound during the SCPD, and the post-
exercise potentiation after the SCPD supported the evidence of the
remote ascending effects of SCPD. IMPLICATIONS: The remote
facilitating effects of the upper extremities by the SCPD may be an
effective indirect approach for therapy. KEYWORDS: PNF, SCPD,
resistive exercise. FUNDING ACKNOWLEDGEMENTS: Unfunded.
CONTACT: M060982@hiroshima-u.ac.jp
ETHICS COMMITTEE: The study was approved by the Ethical
Committee of the Hiroshima Teishin Hospital.
Research Report Poster Display
10-17 Monday 4 June 14:00
VCEC Exhibit Hall B & C
SHORT-TERM EFFECTS OF DORSIFLEXION LUNGE
STRETCHING ON GASTROCNEMIUS FLEXIBILITY
O’Connor A1 , Seynnes O2 ; 1 Department of Physiotherapy,
University of Limerick, Limerick, Ireland; 2 Manchester Metropolitan
University, Alsager, UK
PURPOSE: This study investigated whether the validated dorsiflexion
lunge stretch, as prescribed by chartered physiotherapists, has an
acute effect on the flexibility of the gastrocnemius muscle-tendon
unit. RELEVANCE: As well as the importance of the reliability
and validity of this stretching technique, scientific evidence of its
clinical effectiveness is imperative to support its continued use.
Therefore, research is needed to determine the effectiveness of the
dorsiflexion lunge stretch using durations and frequencies commonly
prescribed by chartered physiotherapists in the clinical/ sports
rehabilitation setting. An answer to this question is imperative, in a
time where chartered physiotherapists strive to achieve standards of
excellence by means of evidence based practice. PARTICIPANTS:
Ten healthy males were randomly assigned to two groups. Group
1 (n=5) completed three dorsiflexion lunge stretches of 30 s
duration, once daily, for four days. Group 2 (n=5) completed the
same programme twice daily. Participant’s non-dominant leg acted
as control. METHODS: Elongation of the stretched gastrocnemius
muscle-tendon unit was recorded using real time ultrasound before
stretching, immediately after one set of stretches, and 24 hours after
the last set of stretches. Range of motion (ROM) was recorded and
torque, expressed relative to elongation of the muscle-tendon unit,
was calculated as an index of stiffness. ANALYSIS: Data for length,
ROM and stiffness were not normally distributed, consequently a
Wilcoxon Signed Ranks test was used to determine any significant
differences within groups for each of the variables over the three test
sessions. A Mann-Whitney test was used to detect any significant
differences between groups. RESULTS: There were no significant
changes in length after stretching in any group and no significant
changes in ankle ROM or stiffness, although a trend showing
decreasing ankle stiffness developed after four days. There were
no significant differences between groups. CONCLUSIONS: For this
sample group, dorsiflexion lunge stretching, as prescribed clinically,
has no short-term effect on flexibility. Further research is needed to
ascertain its effectiveness over a longer time, or in individuals with de-
creased ROM. IMPLICATIONS: These results suggest that chartered
physiotherapists may be currently prescribing stretching programmes
for the gastrocnemius muscle using parameters that are not clinically
effective. This study supports other literature which suggests that
the duration of the stretch hold may be more important than the
number of stretches completed. The results of this study are difficult
to extrapolate to a wider population because of the small sample size
used. A follow-up study addressing these limitations would provide
Poster Displays, Monday 4 June
more information about clinically effective parameters for stretching
the gastrocnemius muscle. KEYWORDS: gastrocnemius, stretching,
ultrasound, dorsiflexion. FUNDING ACKNOWLEDGEMENTS: none.
CONTACT: anne.oconnor@ul.ie
ETHICS COMMITTEE: Manchester Metropolitan University Ethics
Committee
Research Report Poster Display
10-21 Monday 4 June 14:00
VCEC Exhibit Hall B & C
EXERCISE THERAPY FOR SEVERELY ISCHEMIC LIMBS
Yamamoto S1 , Shiraishi H1,2 , Sawada N1 , Saito M1 , Mani H3 ,
Tatsumi T2 , Hase H1,4 , Matsubara H2 ; 1 Rehabilitation Unit,
University Hospital, Kyoto Prefectural University of Medicine;
2 Department of Cardiovascular Medicine,Graduate School of
Medical Science Kyoto Prefectural University of Medicine; 3 Faculty
of Laboratory Medicine, University Hospital, Kyoto Prefectural
University of Medicin; 4 Department of Orthopaedics, Graduate
School of Medical Science, Kyoto Prefectural University of Medicine
PURPOSE: Exercise therapy for obstructive arteriosclerosis obliter-
ans and Buerger’s disease is mainly applied to Fontain classification
I and II, and its efficacy for III and IV has not been established
because of aggravation of resting-state pain and skin ulcer.
RELEVANCE: In this study, we investigated exercise therapy in
persons with severely ischemic limbs admitted for regenerative
medical treatment. PARTICIPANTS: The subjects were 11 persons
with Fontain classification III-IV admitted to our hospital between
April 2004 and Februar2005. Group A consisted of 4 people who
received regenerative medical treatment (FontainIV: 4, male/female:
2/2, mean age: 60±2 years, mean number of days with exercise
therapy: 15±17 days), and Group B consisted of 7 people who
received internal medical treatment (not indicated for regenerative
medical treatment) (FontainIII/FontainIV:3/4,male/female: 5/2, mean
age: 63±12 years, number of days with exercise therapy: 12±7
days). METHODS: They underwent the execise therapy such as
lower muscle strengthening, dynamic joint control, and gait trainings
for 40minutes per day. ANALYSIS: the evaluations of Fontain
classification, findings of the ulcerative region, resting-state pain
(Visual analogue scale: VAS) and the maximal gait distance at
the time of initiation and completion of exercise therapy were
compared. RESULTS: In all people, no worsening of Fontain
clasification and ulcer was noted. VAS (initiation/completion) was
5.8±1.0/2.5±2.0 in Group A and 4.1±2.0/3.0±1.0 in Group B.
The maximal gait distance (initiation/completion) was 0/98±92 in
Group A and 215±145/539±377 in Group B. CONCLUSIONS:
In all people, resting-state pain and the maximal gait distance
were improved without aggravation of the severely ischemic limb,
suggesting that combination with regenerative or internal med-
ical treatment allows introduction of exercise therapy even for
severely ischemic limbs. IMPLICATIONS: physical therapy practice
KEYWORDS: Severely Ischemic Limbs,Exercise Therapy. FUNDING
ACKNOWLEDGEMENTS: None.
ETHICS COMMITTEE: yes.
S249
Research Report Poster Display
12-05 Monday 4 June 14:00
VCEC Exhibit Hall B & C
SYSTEM ORIENTED PATHWAYS IN PHYSICAL THERAPY IN THE
ACUTE HOSPITAL BASED ON THE ICF: MUSCULOSKELETAL
SYSTEM
Huber E1,4 , Grill E3 , Gloor-Juzi T1,2 , Stucki G3,5 ; 1 Department of
Rheumatology and Institute of Physical Medicine, University Hospital
Zurich, Switzerland; 2 Physiotherapy Science Studies, Department
of Rheumatology and Institute of Physical Medicine, University
Hospital Zurich, Switzerland and Faculty of Health Sciences,
Maastricht University, the Netherlands; 3 ICF Research Branch of the
WHO FIC Collaborating Centre (DIMDI), IHRS, Ludwig-Maximilian
University, Munich, Germany; 4 Swiss Association of Physiotherapy,
Sursee, Switzerland; 5 Department of Physical Medicine and
Rehabilitation, Ludwig-Maximilians-University, Munich, Germany
PURPOSE: To Improve processes, results and the quality of physical
therapy, and provide information on costs by developing system-
oriented therapeutical pathways based on the ICF. RELEVANCE: In
the acute hospital, physical therapists plan, treat and evaluate based
on assessment of functioning and their identification of the patients’
resources. Hospitals have started to adopt a process-oriented view,
which leads automatically to patient orientation. By introducing
the idea of pathways, we are able to describe how a patient
proceeds from admission to discharge. A patient pathway, also called
clinical pathway, is very often determined by medical and nursing
interventions, but rarely by therapeutical interventions. Nonetheless,
therapeutical pathways (T-pathways) are a documentation of ther-
apeutical activities and output. The International Classification of
Functioning, Disability and Health is a worldwide agreed upon system
for classification of all aspects of human health. Arguably, it can
also be used to classify therapeutical interventions and contribute
to the development of therapeutical pathways. Multidisciplinary work
could be facilitated by use of the ICF as a common framework.
PARTICIPANTS: Patients with musculoskeletal conditions from a
representative sample of 23 acute care hospitals in the three different
language regions of Switzerland. METHODS: Data were collected
prospectively at admission to hospital. ICF categories relevant for
therapeutical interventions had previously been identified by an
international consensus process. Out of this set of ICF intervention
categories, a physical therapist specified the categories which
were treated or modified by therapeutical interventions. ANALYSIS:
We reported absolute and relative frequencies of ICF intervention
categories of the components Body Functions, Body Structures
and Activities and Participation. RESULTS: 234 patients (mean age
56.1 years, 50.0% female) were included. Of a total of 59 ICF
intervention categories, 18 (31%) were treated in at least 30% of the
patients, 9 (39%) of the component Body Functions, one (8%) of the
component Body Structures and 8 (35%) of the component Activities
and Participation. Pain, mobility of joints, muscle power, gait pattern,
walking, and climbing stairs were the categories treated in at least
70% of the patients. CONCLUSIONS: ICF categories can be used to
classify therapeutical interventions and hence to frame therapeutical
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
S250
Research Report Poster Display
12-09 Monday 4 June 14:00
VCEC Exhibit Hall B & C
SEARCHING A MOVEMENT VOCABULARY TO DESCRIBE
HEALTHY ASPECTS OF MOVEMENT QUALITY
Skjærven L1 , Kristoffersen K2 , Gard G3 ; 1 Bergen University
College, Bergen, Norway; 2 University of Bergen, Bergen, Norway;
3 Lund University, Lund, Sweden
PURPOSE: The aim of the study was to search for healthy movement
aspects and to explore the vocabulary used to describe movement
quality by a group of expert physiotherapists. RELEVANCE: In
watching human movement focusing movement quality, we often
observe movement patterns that are bound of flow, unbalanced,
uncoordinated, stiff, staccato, un-rhythmic and in disharmony. Earlier
studies claim that a vocabulary for describing movement quality
for use in a clinical setting is lacking. Physiotherapists requires
awareness and means to describe movement quality from a health
perspective. The relevance of the study is to broaden the movement
vocabulary for use in physiotherapy. PARTICIPANTS: 15 peer-
designated expert physiotherapists, 5 from each field of neurology,
psychiatric physiotherapy and primary health care participated in
the study to ensure information from each professional area.
They were nominated by physiotherapist leaders in the region.
Each physiotherapist was contacted and informed to ensure their
willingness to participate by signing a written informed consent.
METHODS: A qualitative study with phenomenological in-depth
interviews was chosen as source for the research. In addition a
selection of 10 copis of Fine Art of sculptures and paintings were
used to stimulate the description of the phenomenon at the end of
the interview. The interviews were taped, transcribed and sent to
the informants for confirmation. ANALYSIS: Giorgis‘recommendation
concerning analysis of qualitative interviews was followed. The data
of the lived experienced descriptions, told by the physiotherapists,
depicted a movement vocabulary used in their professional context.
In the analysis it was searched for themes around which the
phenomenological synthesis was woven. RESULTS: The results
showed a vocabulary that was categorized in four interacting themes,
describing movement quality from a health perspective: (1) form and
function, relating to a biomechanical aspect, (2) flow, elasticity, vitality
and rhythm, relating to a physiological aspect, (3) attentive, intentional
(cognitive), and emotional expressions in movement, relating to
a psychological aspect and (4) unity, clarity, freedom, ease and
naturalness in movement, including a personal expression, relating
to a purely human aspect. CONCLUSIONS: The results indicates
a vocabulary based on a model of four main themes. However, to
develop a clinical tool, continued analysis and development of the
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.
The results indicate that it is neccessary for physiotherapists not only
to focus pathological and biomechanical movement aspects, but to
include a focus and descriptions of healthy aspects as well. Hopefully,
the study will contribute to strengthen the physioterapists‘ awareness
of movement, views and thinking, to develop the uniqueness of the
profession. KEYWORDS: Movement quality, movement vocabulary,
movement analysis, Basic Body Awareness Therapy. FUNDING
ACKNOWLEDGEMENTS: Thanks to the Faculty of Health and Social
Sciences, Bergen University College, Norway, for supporting the
study. CONTACT: lhs@hib.no
WCPT 2007, Research Reports
Research Report Poster Display
13-13 Monday 4 June 14:00
VCEC Exhibit Hall B & C
THE RELATIONSHIP BETWEEN PERONEUS LONGUS AND
TIBIALIS POSTERIOR MUSCLE ACTIVITIES INVOLVED IN
RAISING THE HEEL DURING CALF-RAISE AND IN GAIT
Tokuoumaru K1 , Inamizu T1 , Sekikawa K1 , Tabusadani M2 , Sota K2 ,
Kawaguchi K2 ; 1 Graduate School of Health Science,Hiroshima
University; 2 Department of Rehabilitation,The Hospital of Hyogo
College of Medcine
PURPOSE: This study aimed to clarify the relationship between
the activities of the peroneus longus and tibialis posterior muscles
in raising the heel from the ground during gait and calf-raise.
RELEVANCE: Movements involved in raising the heel from the
ground during gait and calf-raise are ankle plantar flexion. In
both movements, the trajectory of the maximum point of planter
pressure is especially affected by a balance of the activities of
the peroneus longus and tibialis posterior muscles, which control
inversion and eversion of the calcaneal bone. PARTICIPANTS:
Healthy subjects (5 male, 18 female, aged 22.1±1.4years), were
selected for this study. METHODS: Subjects were examined using
surface electromyography during gait and calf-raise, which showed
peroneus longus, tibialis posterior muscle activities and their ratio
(peroneus longus muscle activity/ tibialis posterior muscle activity).
ANALYSIS: We calculated the root mean square around the time that
the heel was raised from the ground during gait and calf-raise, and
the rate of the root mean square during gait and calf-raise to during
standing. And, Spearmans rho and Pearson correlation coefficient
was used to statistical analysis. RESULTS: The results showed that
peroneus longus muscle activity and the ratio between this and tibialis
posterior muscle activity that take place from the time the calcaneal
bone leaves the ground to when there is maximum planter pressure
at the head of metatarsal bones during gait, correlate with the muscle
activity and the ratio during calf-raise. CONCLUSIONS: The greater
the peroneus longus muscle activity, the greater the ratio between it
and tibialis the posterior in plantar flexion during gait, and the greater
these activities and the ratio in plantar flexion during calf-raising. It
can be considered that the location of the maximum point of planter
pressure during gait is related to that during calf-raising. Further
research is needed to clarify the relationship between the distribution
of planter pressure during the gait, and that during calf-raising.
IMPLICATIONS: As a results, calf-raise can be used as a indicator
of the balance of the peroneus longus muscle activity and tibialis
posrterior muscle activity. KEYWORDS: peroneus longus, tibialis
posterior, calf-raise. FUNDING ACKNOWLEDGEMENTS: This study
was unfunded. CONTACT: k-tokuoumaru@hiroshima-u.ac.jp
Research Report Poster Display
13-17 Monday 4 June 14:00
VCEC Exhibit Hall B & C
RESEARCH OF FREEDOM LEVEL INFLUENCE ON PARTICULAR
JOINT DURING THE SENSORY MOTOR TRAINING
Palma P1 , Strojnik V2 ; 1 University of Ljubljana, University College
for Health Studies, Ljubljana, Slovenia; 2 University of Ljubljana,
Faculty of Sport, Ljubljana, Slovenia
PURPOSE: The purpose of the current study was to determine the
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
Poster Displays, Monday 4 June
randomly divided into two groups of 11 participants. Both groups
performed 6 weeks sensory motor training on two different balance
boards (in sagittal and lateral direction). In the first group subjects
kept balance during the stance on dominant leg without fixation,
while the second group kept balance during the stance on dominant
leg with external knee fixation support. METHODS: Measurements
were undertaken before and after training period. The evaluation of
proprioceptive acuity was performed through position sense using a
bubble inclinometer. H and M waves were recorded with EMG. Twitch
and maximal voluntary isometric contraction were measured with a
special brace that enabled fixation at 90º knee and ankle angles.
Balance during the stand on dominant leg was measured by force
plate. ANALYSIS: Student’s t-test was used to establish differences
before and after training period within single group. Analyses of
covariance were used to compare the group without fixation (WFG)
with the group with fixed knee (FG). RESULTS: Balance and postural
sway with eyes open were improved in both groups. Improvement
on postural sway with lower frequency during measurements with
eyes closed was determined only in the WFG (A-P p = 0.013; M-L
p = 0.034). Furthermore tend to significant decrease of absolute error
on dorsal flexion passive movement was determined only in the WFG
(p = 0.052). Maximum torque of plantar and dorsal flexors of dominant
leg during maximum voluntary isometric contraction was statistically
increased only in the WFG (p = 0.025; p = 0.004). Excitability of a
motoneuron pool was decreased in the WFG, whereas an increasing
trend was determined in the FG. An increased twitch torque was
significant for improved contractile properties of plantar flexors in both
groups (WFG p = 0.004; FG p = 0.007), while at the same time an
improved M wave on soleus muscle after training period was found
only in the FG (p = 0.055). CONCLUSIONS: Sensory motor training
with and without external knee fixation causes different functional
adaptation. Training without knee fixation is more efficient on central
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
with intention to improve function of mechanisms on reflex level in
joint we want to rehabilitate. KEYWORDS: proprioception, sensory
motor training, freedom level of movement control. FUNDING
ACKNOWLEDGEMENTS: The work was supported by the research
grant L5-5330 from the Research Agency of the Republic of Slovenia.
CONTACT: polona.palma@vsz.uni-lj.si
ETHICS COMMITTEE: National Ethics Committee of the Republic of
Slovenia and was carried out in accordance with the Declaration of
Helsinki.
Research Report Poster Display
13-21 Monday 4 June 14:00
VCEC Exhibit Hall B & C
EFFECT OF HIP JOINT FLEXION ON ACTIVITIES OF THE
HIP ABDUCTOR MUSCLES IN STRAIGHT LEG RAISING (HIP
ABDUCTION) EXERCISES
Sugahara Y, Kimoto H, Hakashita H, Furue Y, Nakajima M; Kibi
International University, School of Health Science Department
of Physical Therapy
PURPOSE: A “straight leg raising exercise in side-lying position for
hip joint abductor muscle strengthening” is a hip adductor isometric
muscle-strengthening exercise which can be widely used in early
hip rehabilitation. The objective of this study is to explain how the
hip joint position affects muscular activities of the hip joint abductor
muscles, the gluteus medius and tensor fasciae latae muscles, in
straight leg raising exercises performed while lying on one side.
RELEVANCE: In a clinical setting, we often see patients perform the
straight leg raising exercise in a hip flexed position. PARTICIPANTS:
The subjects were healthy adults with normal physical constitutions
consisting of 6 males and 6 females (average age 21.1±1.1).
METHODS: In this study, we analyzed the effect of this hip joint
S251
bending position by EMG quantification. The subjects held their right
hip joint 10 degrees (abducted position) while lying on their left
side with hip joints 10º extended and 0º, 10º, 20º, 40º, 60º flexed.
Electromyographic activity was recorded using surface electrodes on
the gluteus medius and tensor fasciae latae muscles, and normalized
to values derived from maximal isometric trials. ANALYSIS: The
percent maximal voluntary isometric contraction (%MVIC) of the
gluteus medius and tensor fasciae latae muscles was evaluated
in the each hip position. RESULTS: The %MVIC of the gluteus
medius muscle when the hip joint was flexed 60º was significantly
reduced from 10º extension and 0º flexion. The %MVIC of the
tensor fasciae latae muscle did not vary with hip joint flexion angle
changes. At 60º hip joint flexion, the %MVIC for the gluteus medius
and the tensor fasciae latae muscles showed significant differences.
CONCLUSIONS: Our study reveals two things. First, as the hip
joint flexion angle moves to 60º, muscle activities of the gluteus
medius muscle decrease significantly compared with those of hip
joint flexion angle 0º. Second, muscle activities of the tensor fasciae
latae muscle are not affected by the hip joint flexion angle. It is
determined from these two observations that muscle strength of
the gluteus medius plays an important role because gluteus medius
activities are restricted when using abductor strengths in hip joint
flexion for going up and down stairs. IMPLICATIONS: We tend to
be satisfied that evaluation of the hip joint abductor muscle can
be made by evaluations at 0º hip joint flexion and motion analysis
at the time of walking, but this study suggests the importance of
evaluating the hip joint abductor muscle in hip joint flexion and the
role of the tensor fasciae latae muscle in the hip joint flexion posi-
tion. KEYWORDS: hip abductor muscle, electromyogram, muscle-
strengthening exercise. FUNDING ACKNOWLEDGEMENTS: None.
CONTACT: yqk01270@yahoo.co.jp
ETHICS COMMITTEE: Kibi International University
Research Report Poster Display
15-01 Monday 4 June 14:00
VCEC Exhibit Hall B & C
EFFECT OF PELVIC STABILIZATION AND HIP POSITION ON
TRUNK EXTENSORS ACTIVITY DURING BACK EXTENSION
EXERCISES ON A ROMAN CHAIR
Da Silva R1 , Larivière C2 , Arsenault B1 , Nadeau S1 , Plamondon A2 ;
1 University of Montreal and CRIR – Montreal Rehabilitation
Institute, Montreal (Qc), Canada; 2 Occupational Health and Safety
Research Institute Robert-Sauvé (IRSST), Montreal (Qc), Canada
PURPOSE: To assess the effect of pelvis stabilization and of
hip position on the electromyographic (EMG) activity of back and
hip extensor muscles during a dynamic back extension exercise
on a Roman chair. RELEVANCE: For a more specific training
of back muscles, it is important to maximize the activity of back
muscles while minimizing the activity of hip extensors (specificity
principle). PARTICIPANTS: Twenty-two healthy volunteers (11 males
and 11 females), aged between 20 and 55 years, participated in
this study. METHODS: The subjects performed five trunk flexion-
extension cycles on a Roman chair in the following 3 conditions:
(1) pelvis unrestrained (PUR; control condition), (2) pelvis restrained
(PR), using a strap pressing the pelvis against the support pad
and (3) hip at an angle of 40º relative to the horizontal (H40º)
with the pelvis unrestrained. EMG signals were recorded with 12
pairs of surface electrodes placed bilaterally on four back muscles
(at L4, L3, L1 and T10 levels), as well as on two hip extensor
muscles (Gluteus and Biceps femoris). The EMG amplitude was
computed in the concentric portion (extension) of each cycle and
the Muscular Utilization Ratio (MUR), defined as the percentage
of EMG amplitude relative to the maximal EMG obtained from
maximal contractions, was used to assess the level of muscular
activation of each muscle group across exercises. ANALYSIS: EMG
activity (MUR%) within each muscle group were compared, using
analysis of variance, among Roman chair conditions. RESULTS:
S252
The activity of back muscles ranged between 38 to 54% across
conditions, while hip extensor muscles ranged between 14 to 25%.
The Roman chair conditions did not affect the EMG activity of
back muscles. However, the H40º condition significantly (P < 0.05)
reduced the activity of Biceps femoris, by an average of 10 to
14%, relative to the other two conditions. CONCLUSIONS: This
study demonstrated that pelvic stabilization does not increase the
activation of back muscles nor reduces significantly the activation of
hip extensors during dynamic exercises on a Roman chair. On the
other hand, elongating hip extensors (40º hip flexion) was efficient to
decrease the level of activity of the Biceps femoris. IMPLICATIONS:
Using the H40º exercise would be more likely to avoid task failure
due to possible exhaustion of biceps femoris. This would allow
the exercise to train more specifically the targeted back muscles
by overloading them on a longer duration to induce physiological
changes. This has implications for the training of low back muscle
endurance in low back pain patients. KEYWORDS: Trunk extensor
muscles, Electromyographic Activity, Back extension exercises,
Stabilization effect. FUNDING ACKNOWLEDGEMENTS: Funded by
the Occupational Health and Safety Research Institute Robert-Sauvé
(IRSST). CONTACT: rubens.alexandre.silva@umontreal.ca
ETHICS COMMITTEE: ethics committee of the CRIR-site Montreal
Rehabilitation Institute.
Research Report Poster Display
15-05 Monday 4 June 14:00
VCEC Exhibit Hall B & C
SPINAL MOTION ANALYSIS OF ADOLESCENT IDIOPATHIC
SCOLIOSIS
Minehisa K1 , Shinkoda K2 , Nara I3 , Matsunaga Y4 , Endoh T5 ,
Togashi S1 ; 1 Osaka Kawasaki Rehabilitation University, Osaka,
Japan; 2 Hiroshima University Graduate School of Health
Sciences, Hiroshima, Japan; 3 Faculty of Rehabilitation Kobe
Gakuin University, Kobe, Japan; 4 Anabuki Rehabilitation College,
Takamatsu, Japan; 5 Department of Orthopedic Surgery, Mitoyo
General Hospital, Kagawa. Japan
PURPOSE: Adolescent idiopathic scoliosis (AIS) is a three-
dimensional deformity characterized by lateral vertebral deviation
and axial rotation. The specific spinal movement in each case
of AIS is influenced by the pattern, region, and flexibility of the
spinal curves. It is known that the combined motion of thoracic
rotation occurring with lateral flexion in scoliosis is different from
that of a normal human. However, this mechanism has not yet been
thoroughly examined. Therefore in this study, we examined the spinal
movement of patients with AIS using a three-dimensional motion
analysis system. RELEVANCE: Evaluating the active movement of
the spine in AIS, including structural deformities, by an objective
procedure provides useful information for devising a physiotherapy
program for the management of AIS. PARTICIPANTS: Data were
collected from 6 women (mean age 16±1.9 years). All subjects had
AIS with right major curves. All scoliotic curves (9 curves) including
compensatory curves were analyzed, and the frontal plane Cobb’s
angle in the standing position was 25.6±18.7 degrees. METHODS:
Skin markers were attached using double-sided adhesive tapes on
the spinous processes of C7, T2, T5, T8, T10, L1, L4, and S1. The
subjects were instructed to perform lateral bending to the right and
left, and rotation of the trunk to the right and left. The study employed
a camera motion analysis system and purpose-built software for data
collection and analysis (UM-CAT; Unimec Co. Japan). The angles
between the three points at the top and bottom of each marker
(joints 1-6) and the higher thoracic spine, thoracic spine, and angle of
the lumbar region were calculated in the frontal and sagittal planes.
ANALYSIS: Statistical analysis was performed using Stat View J
5.0 for Macintosh (SAS Institute Inc.). A p-value less than 0.05 was
considered statistically significant. RESULTS: In the region including
the apex for all curves, the lateral flexion angle towards the concave
side was decreased compared to the convex side (p < 0.05). The
WCPT 2007, Research Reports
difference of the lateral flexion angle between the convex and the
concave side was related to the size of the Cobb’s angle (p < 0.05).
In double curve cases, the lateral flexion angle of each convex side
was larger at the top and bottom of the curve. For single curve
cases, the lateral flexion angle of the concave side of the higher
thoracic spine or lumbar vertebrae was increased. There were no
relationships between the laterality of lateral flexion or the rotation
angle in the sagittal plane and the Cobb’s angle. CONCLUSIONS:
Lateral flexion range of the spine in AIS was limited by the structural
curve, and there was laterality through the lateral flexion range of the
whole spine. As for the active lateral flexion of the spine in a natural
standing position, the range of motion toward the concave side rather
than the convex side was decreased in AIS. The rotation range of
motion to the concave side of AIS was limited. IMPLICATIONS: One
must be careful to compensate for the top and bottom regions of the
curve to properly correct scoliosis. KEYWORDS: AIS, spine, motion
analysis. FUNDING ACKNOWLEDGEMENTS: None. CONTACT:
minehisak@kawasakigakuen.ac.jp
ETHICS COMMITTEE: Our experiments were performed based on
the Institutional Guidelines for Experimental Investigations on human
subjects.
Research Report Poster Display
15-09 Monday 4 June 14:00
VCEC Exhibit Hall B & C
RELATIONSHIP BETWEEN UPPER CERVICAL MOTION AND
MASTICATORY MUSCLE IMBALANCE
Oshiro S1 , Miyamoto S2 , Aoki M2 , Iwamoto K1 , Takata Y3 ,
Muraki T1 , Izumi T1 , Takasaki H4 ; 1 Graduate School of
Health Sciences, Sapporo Medical University, Sapporo, Japan;
2 Department of physical therapy, Sapproro Medical University,
Sapporo, Japan; 3 Yamahana Orthopeadic Clinic, Sapporo, Japan;
4 Shinoro Orthopeadic Clinic, Sapporo, Japan
PURPOSE: Previous anatomical, biomechanical, and neurophysio-
logical investigations have indicated that the stomatognathic system
and cranio-cervical motions are functionally linked. Although there
have been reports on the relationship between cranio-cervical
motions and masticatory muscle functions, these relationships have
not been well understood. The purpose of this study is to elucidate
the relationship between upper cervical motion and masticatory
muscle imbalance by using EMG analysis. RELEVANCE: This
study contributes to the physical examination and treatment of the
stomatognathic and cervical dysfunction. PARTICIPANTS: Healthy
subjects (n = 31) with no abnormal history involving the stom-
atognathic system, cervical spine, and shoulder were used as
participants. Bilateral upper cervical rotation of the subjects were
measured, and the ratio of rotational laterality ([range of rotation
towards greater side – range of rotation towards smaller side/range of
rotation towards greater side] × 100), was calculated. Subsequently,
the flexion-rotation test was performed using a device to measure
the cervical range (Performance Attainment Associates, St Paul,
MN), and the subjects were divided into two groups of 12 and 19
members each. Group-1 (8 males and 4 females; mean age, 26±5.8
years) and group-2 (10 males and 9 females; mean age, 24±4.9
years) had rotational lateralities that were equal to or more than
14%, and less than 14%, respectively. METHODS: Surface EMG
activity was recorded using six channels (TeleMyo2400, Noraxon,
USA) that were attached to the bilateral masseter, temporalis,
and sternocleidomastoid muscles. The EMG amplitude (mV) was
assessed by the root mean square (r.m.s.). The sampling frequency
was 1500 Hz and band-pass filtering 10–350 Hz. During the tests,
the subjects sat with their heads unsupported and were instructed
to maintain a natural erect position. EMG recordings were obtained
while the subject performed a 3-s maximum voluntary clench on
cotton rolls that were positioned on his/her posterior teeth (test 1)
and a 3-s maximum voluntary clench without the cotton rolls (test
2). EMG potentials of test 2 were standardized as a percentage
Poster Displays, Monday 4 June
of the maximum potential obtained in test 1. The symmetry rate
of the EMG output of paired muscles was expressed by the
percentage overlapping coefficient (100% = perfect symmetry, by
Ferrario, 2000). ANALYSIS: Student t-tests were used to compare
the paired muscle activity of each muscle between the groups
(P < 0.05). RESULTS: There were significant differences (P < 0.05)
between the mean symmetry rates of masseter muscle contraction in
group-2 (94.49% ±4.44%) and group-1 (87.25% ±11.92%). However,
there were no significant differences in symmetry rates of the
temporal and sternocleidomastoid muscles. CONCLUSIONS: Our
findings showed that the group with greater rotational laterality of
the upper cervical spine demonstrated asymmetric masseter muscle
activity. This suggests a relationship between muscular asymmetry
of the masseter and upper cervical dysfunction. IMPLICATIONS:
Our findings will be useful for the physical examinations and
treatment of masticatory imbalance and upper cervical dysfunction.
KEYWORDS: Upper cervical spine, Masticatory muscles, EMG
activity. FUNDING ACKNOWLEDGEMENTS: No grants or outside
funding were received in support of this research study. CONTACT:
sohshiro@sapmed.ac.jp
ETHICS COMMITTEE: Institutional Review Board of Sapporo
Medical University
Research Report Poster Display
16-13 Monday 4 June 14:00
VCEC Exhibit Hall B & C
EDUCATIONAL NEEDS OF ADULTS UNDERGOING TOTAL HIP
AND TOTAL KNEE ARTHROPLASTY: A QUALITATIVE STUDY
Soever L1−3 , MacKay C1,2,4 , Brien H1 , Davis A1,2,4 , Flannery J1,2,5 ,
Jaglal S1,2,5 , Levy C1 , Mahomed N1,2,4 , Tina S1,2 ; 1 GTA Rehab
Network, Toronto, Canada; 2 University of Toronto, Toronto, Canada;
3 St. Joseph’s Health Centre, Toronto, Canada; 4 University Health
Network, Toronto, Canada; 5 Toronto Rehabilitation Institute, Toronto,
Canada
PURPOSE: To determine the educational needs of adults undergoing
total hip and total knee arthroplasty (TJA) surgery. RELEVANCE:
Total joint arthroplasty of the hip and knee is a widely accepted,
efficacious treatment for patients with advanced arthritis of the hip
and knee, who have unacceptable levels of pain and/or physical
function. There is evidence in the literature that patients with
TJA have better outcomes with timely information and education.
Physiotherapists play an important role in the management of
patients with TJA at all stages of the continuum of care including
pre-admission, acute, and rehabilitative. As part of ther role,
physiotherapists are involved in the education of patients with TJA.
PARTICIPANTS: Participants were eligible if they were scheduled
to undergo TJA or had undergone TJA in the previous three to
six months. Of twenty-two potential participants, fifteen participated.
Five were booked for upcoming TJA and ten had undergone at
least one TJA in the previous three to six months. METHODS:
A qualitative research design using semi-structured interviews was
utilized. Interviews were conducted in a Canadian community at
a location chosen by the participants, and followed an interview
guide. The interviews were taped and transcribed verbatim. Data
collection continued until saturation was reached. The research
protocol was approved by the Research Ethics Boards of the
participating hospitals. ANALYSIS: A comparative contrast method
of analysis was used. Transcripts were analyzed line by line
using a coding process whereby words or groups of words were
identified that addresssed the research question. These words
and groups of words were organized into themes. RESULTS:
Participants reported educational needs that were encompassed
under three main categories: Educational Needs; Factors Affecting
Educational Needs; and Method of Delivery. Common to each
category was the premise that being informed would overall lead to
a better quality of life. CONCLUSIONS: Adults who undergo TJA
identified a broad range of educational needs which validate the
S253
importance of having an all-inclusive information package available
at all stages of the continuum of care. IMPLICATIONS: In an effort
to promote successful outcomes and improved quality of life for
those with TJA, it is recommended that health care professionals,
including physiotherapists, provide an educational package that has
content that is all-encompassing covering a broad range of topics.
KEYWORDS: total joint arthroplasty, educational needs, health care
professional. FUNDING ACKNOWLEDGEMENTS: This research
was generously funded by a grant to the GTA Rehab Network from
The Change Foundation and the Government of Ontario. Views
expressed in this presentation are not the views of The Change
Foundation or the Government of Ontario.
ETHICS COMMITTEE: St. Joseph’s Health Centre Research Ethics
Board; University Health Network Research Ethics Board; Toronto
Rehabilitation Institute Research Ethics Board
Research Report Poster Display
16-17 Monday 4 June 14:00
VCEC Exhibit Hall B & C
SELF-REPORTED SYMPTOMS, FUNCTION AND ANXIETY IN
THE POST-DISCHARGE PERIOD PREDICT SATISFACTION
AND QOL FOLLOWING REHABILITATION AFTER TOTAL KNEE
ARHTROPLASTY
Walton D, Padfield B; The University of Western Ontario
PURPOSE: To examine the ability of a variety of patient demographic
variables and self-report measures captured in the early post-
operative period to predict satisfaction and knee-related quality of life
(KRQOL) at discharge from outpatient physiotherapy following TKA,
and to estimate the feasibility of a larger multi-centre study based
on attrition rates and data collection procedures. RELEVANCE:
In an era of decreased wait times and increased volume of total
joint arthroplasty, outpatient Physiotherapists require a mechanism
of triage for identifying those patients who are likely to do well
with their total knee from those who are at risk of poor self-
reported outcome. A logical extension of this work would be to
identify targetted interventions aimed at preventing poor self-rated
outcomes. PARTICIPANTS: A cohort of 55 patients presenting
for physiotherapy following primary TKA were recruited from one
of two rural hospital-based outpatient physiotherapy clinics in
Ontario, Canada. METHODS: Demographic and self-report data
were captured at initial outpatient physiotherapy visit. Two measures
of outcome were used: A KRQOL scale and an overall satisfaction
score. These outcomes were captured during the final physiotherapy
visit. ANALYSIS: Mean group difference in KRQOL and satisfaction
were investigated for significance between the two levels of any
dichotomous demographic variable. Continuous variables were
evaluated for their association with the dependent variables using
univariate correlational procedures. Stepwise linear regression was
used to generate the final model for predicting each of KRQOL and
satisfaction. RESULTS: We had a 24.7% refusal rate, and a low 3.5%
attrition rate. The baseline ‘other symptoms’ and ADL subscales of
the Knee Injury and Osteoarthritis Outcome Score (KOOS), along
with self-reported anxiety intensity were the strongest predictors of
KRQOL at discharge, explaining 49% of the variance in this measure.
Satisfaction was best predicted by body mass index and the baseline
KOOS ADL subscale. This model explained 28.9% of the variance
in general satisfaction. Anxiety intensity showed a similarly strong
correlation with both measures (r = −0.51). CONCLUSIONS: The
results of this pilot study suggest that a larger multi-centre trial is
feasible. The KOOS subscales of ‘other symptoms’ and ADLs, along
with self-reported intensity of anxiety and BMI show value in their
ability to predict outcome at discharge from outpatient physiotherapy
in patients who receive TKA. IMPLICATIONS: Further research is
needed. The development of a tool based on self-report measures
to be used during triage of patients following discharge from hospital
after TKA appears plausible. Physiotherapists should be aware of
the impact of psychosocial factors on self-report outcome measures.
S254
KEYWORDS: Total knee arthroplasty, prediction, quality of life,
satisfaction, observation. FUNDING ACKNOWLEDGEMENTS: The
authors wish to thank the London region subgroup of the Ontario
Physiotherapy Association for their financial support of this project.
CONTACT: dwalton5@uwo.ca
ETHICS COMMITTEE: Health Sciences Research Ethics Board at
The University of Western Ontario
Research Report Poster Display
16-21 Monday 4 June 14:00
VCEC Exhibit Hall B & C
EFFECTS OF INTERMITTENT STRETCHING AND/OR CLEN-
BUTEROL ON DISUSE ATROPHY OF RAT SOLEUS MUSCLE
Yamazaki T, Yokogawa M, Tachino K; Division of Health Science,
Graduate School of Medical Science, Kanazawa University,
Ishikawa, Japan
PURPOSE: The present study was undertaken to evaluate the effects
of intermittent stretching (IST) or treatment with clenbuterol (Cb,
a drug with anabolic effects) or a combination of IST and Cb on
rat soleus muscle in the presence of progressive disuse atrophy.
RELEVANCE: Prevention or suppression of disuse muscle atrophy
is an important task of physical therapy. For patients lying on bed
for prolonged periods of time, it is difficult to accommodate the
excessive loads borne on their body. Intermittent weight bearing
(IWB) is found to be a safe means of intervention to maintain the
leg muscles of such patients. However, since complete prevention
of atrophy is difficult to achieve with IWB alone, the authors have
previously reported on treatment using a combination of IWB and Cb
(WCPT-AWP&ACPT 2005 Congress, in Seoul). The present study
was aimed at evaluating the effects of a combination of IST (keeping
the soleus muscle stretched for one hour each day) and Cb treatment
in experimental animals, with an assumption that a similar technique
could be used to patients unable to bear weight. PARTICIPANTS:
The subjects were thirty-five male Wistar rats (7 weeks old, mean
body weight 215±6 g). METHODS: The rats were divided into five
groups: control (CON), hindlimb unweighting (HU), Cb treatment
during hindlimb unweighting (Cb), IST during hindlimb unweighting
(IST), and combined Cb+IST during hindlimb unweighting (Cb+IST)
group. This protocol was approved by the committee on animal
experimentation of Kanazawa University (No.050301). ANALYSIS:
The soleus muscle was removed 14 days after the start of treatment
to measure its wet weight, cross-sectional area (CSA) of muscle
fibers, percentage of each fiber type, and contractile properties.
ANOVA was used for statistical analysis. RESULTS: The mean CSA
of type 1 fiber, relative to CON group (= 100%), was 81.0% in Cb
group, 58.3% in IST group and 74.2% in Cb+IST group. Twitch
tension, relative to CON group, was 33.9% in Cb group, 50.3%
in IST group and 45.9% in Cb+IST group. CONCLUSIONS: No
particular benefit was observed after applying IST in combination
with Cb treatment. IMPLICATIONS: IWB involves exercising the
patient by means of stretching the soleus muscle and inducing
the appropriate muscle work needed to bear the body weight. IST
involves only muscular stretching and isometric resistant exercise,
which do not provide adequate stimulus to reinforce the efficacy of
Cb treatment. However, since IST is a technique of physical therapy
useful for inducing muscular tension, it may be possible to elevate
the effectiveness of combined Cb+IST by modifying the method of
applying this combined therapy. KEYWORDS: intermittent stretching,
clenbuterol, soleus muscle. FUNDING ACKNOWLEDGEMENTS:
This study was supported in part by Grant-in-Aid for Scientic
Research (No.17500351), Japan Society for the Promotion of
Science. CONTACT: yamazaki@mhs.mp.kanazawa-u.ac.jp
ETHICS COMMITTEE: This protocol was approved by the committee
on animal experimentation of Kanazawa University (No.050301).
WCPT 2007, Research Reports
Research Report Poster Display
18-01 Monday 4 June 14:00
VCEC Exhibit Hall B & C
PHYSICAL EXAMINATION FOR DIAGNOSING DISC HERNIATION
IN PATIENTS WITH LOW BACK PAIN: COCHRANE PILOT
REVIEW OF DIAGNOSTIC ACCURACY STUDIES
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
medical centre, Netherlands; 3 Department of Experimental
Anatomy, Vrije Universiteit, Brussels, Belgium; 4 Institute for Work
and Health, Toronto, Canada; 5 Department of General Practice,
Erasmus University medical center, Rotterdam, The Netherlands;
6 PhysioSouth, Christchurch, New Zealand; 7 Netherlands Institute
for Health Services Research, Utrecht, The Netherlands; 8 Center
for Evidence Based Medicine, Belgian Branch of the Cochrane
Collaboration, Brussels, Belgium; 9 Division of General Internal
Medicine, University of Washington, Seattle, USA
PURPOSE: In 2003 the Cochrane Collaboration decided to accept
systematic reviews of diagnostic accuracy in their database.
Publication of the first reviews is not expected until 2007 or 2008.
In the meantime, however, review groups in various medical fields
have been working on pilot protocols and reviews. We would like
report on one of these pilot reviews. The objective of this review
was to assess the diagnostic performance of tests carried out
during physical examination in the identification of disc herniation
in patients with low back pain. RELEVANCE: Disc herniation is
the cause of symptoms in a small proportion of patients with low
back pain. Physical therapists and physicians often use physical
examination to decide which patients should be referred for diagnostic
imaging, or to decide if a patient is a suitable candidate for
surgical intervention. An accurate clinical diagnosis of lumbar disc
herniation is desirable to avoid unnecessary surgical intervention.
PARTICIPANTS: Several bibliographic databases including Medline
and Embase were searched to identify eligible studies. We included
diagnostic studies evaluating the accuracy of physical examination
(any test) in the diagnosis of disc herniation among patients with
low back pain. Studies were eligible if they compared the results
of physical examination to those of diagnostic imaging or surgical
findings (reference standard). METHODS: The quality of selected
studies was assessed using the Quality Assessment of Diagnostic
Accuracy Studies checklist (QUADAS). Final selection of papers,
quality assessment, and data extraction was carried out by two
reviewers independently. ANALYSIS: We extracted diagnostic two-
by-two tables (true positive, false positive, true negative, and false
negative rates) from each publication. For each test estimates of
sensitivity and specificity are used to display the results in Receiver
Operating Characteristic (ROC) space, and superimpose a summary
ROC curve (SROC). RESULTS: At the time of preparing this
abstract 18 studies were included in the review. We encountered
several problems during searching and selection of studies, quality
assessment and data extraction. Problems were often associated
with poor quality of reporting. The methods used for patient selection
were poorly described, it was sometimes unclear what reference
standard the participants received, or in what order tests were
executed. Most studies have evaluated the diagnostic performance
of the straight leg raising test. Preliminary results show that this test
has adequate sensitivity, but lower and widely varying specificity.
CONCLUSIONS: Final results on the sensitivity, specificity, predictive
values and likelihood ratios of physical tests used in the diagnosis
of lumbar disc herniation are presented during the conference. We
will address some of the problems encountered when preparing
this review and present our solutions. Methods for summarizing
and presenting diagnostic evidence that are useful and accessible
for physical therapists and other health care professionals will
be explained. IMPLICATIONS: Systematic reviews of diagnostic
research are not easy to perform but provide valuable information on
Poster Displays, Monday 4 June
the diagnostic performance of history taking, physical examination,
and other tests that are commonly used by physical therapists.
These reviews will soon become available through the Cochrane
database, further supporting evidence-based practice in physical
therapy. KEYWORDS: Systematic Review; Diagnostic accuracy,
Lumbar disc herniation. FUNDING ACKNOWLEDGEMENTS: This
project is carried out without additional external funding. CONTACT:
d.van.der.windt@cphc.keele.ac.uk
Research Report Poster Display
18-05 Monday 4 June 14:00
VCEC Exhibit Hall B & C
AN EXPLORATION OF MAITLAND’S CONSTRUCT OF LOW
BACK PAIN IRRITABILITY
Barakatt E1 , Riddle D2 , Romano P3 , Beckett L3 , Retke J3 ,
Bechtold K4 ; 1 California State University, Sacramento; 2 Virginia
Commonwealth University; 3 University of California, Davis Medical
Center; 4 Sutter Davis Hospital
PURPOSE: To examine the inter-rater reliability and construct validity
of Maitland’s construct of low back pain (LBP) irritability, and
to identify LBP characteristics for consideration in an operational
definition of LBP irritability. RELEVANCE: Low back pain irritability is
a clinical characteristic developed by Maitland and used by physical
therapists to influence the vigor of examination and treatment
techniques. Though widely used by physical therapists treating
patients with musculoskeletal disorders, Maitland’s concept of LBP
irritability has not been defined to the extent that its measurement
properties can clearly be tested. PARTICIPANTS: Data for this
investigation were gathered from 183 subjects being treated for
low back pain consecutively recruited from three physical therapy
clinics: two in Sacramento and one in Davis, CA, USA. Thirty
physical therapists with experience in treating patients with low back
pain participated in this investigation. METHODS: Prior to inital
evaluation subjects were surveyed detailing their LBP characteristics
of time to aggravate symptoms with specific activities, time specific
activities were tolerated, and pain persistence following specific
activities. Physical therapists evaluated and treated all 183 subjects
with LBP. Eighty subjects received 2 examinations at their initial
visit. Therapists judged subjects’ LBP as irritable or non-irritable,
and recorded treatments provided at the initial visit. ANALYSIS:
An unweighted kappa statistic evaluated the reliability of therapists’
LBP irritability judgments. A Fisher’s Exact Test evaluated the
association between therapists’ irritability judgments and treatment
decisions. A principal components analysis was performed on
patient-reported LBP characteristics to identify potential components
of an operational definition of LBP irritability. Logistic regression was
used to assess the relationship between LBP characteristics and
therapists’ irritability judgments. RESULTS: The kappa statistic for
inter-rater agreement of physical therapist irritability judgments was
0.39 (95% CI = 0.19 to 0.60). Associations were found between
subject irritability status and various treatment categories. Five
dimensions of LBP irritability were identified related to subjects’ pain
persistence and activity limitations. Four of these five dimensions
were associated with therapists’ LBP irritability judgments. Other
LBP characteristics were found to be as strongly associated with
therapists’ irritability judgments. CONCLUSIONS: Low reliability of
therapists’ LBP irritability judgments suggests the need for the
development of an operational definition of LBP irritability. Multiple
LBP characteristics were identified for consideration in an operational
definition of LBP irritability. IMPLICATIONS: Future research is
needed to develop an irritability construct and test its value for
making treatment decisions. KEYWORDS: Low back pain, Lumbar
spine, Evaluation, Low back pain irritability, Maitland. FUNDING
ACKNOWLEDGEMENTS: Financial support provided by the Sutter
Institute for Medical Research and the California Physical Therapy
Fund, Inc. In-kind support provided by Jamba Juice Corporation,
California State University, Sacramento College of Health and
S255
Human Services, and UC Davis Medical Center Physical Therapy
Department. CONTACT: barakatt@csus.edu
ETHICS COMMITTEE: California State University, Sacramento
Committee for the Protection of Human Subjects
Research Report Poster Display
18-09 Monday 4 June 14:00
VCEC Exhibit Hall B & C
MOTORISED LUMBAR TRACTION IN THE MANAGEMENT
OF LOW BACK PAIN WITH NERVE ROOT INVOLVEMENT: A
FEASIBILITY STUDY OF EFFECTIVENESS
Harte A1 , Baxter G2 , Gracey J1 ; 1 University of Ulster, Northern
Ireland; 2 University of Otago, New Zealand
PURPOSE: Nerve root involvement accompanies between 3-10% of
Low Back Pain (LBP) and despite current guidelines, lumbar traction
is a treatment still used by 40% of physiotherapists treating such
patients. However its benefits remain to be established. The aim of
this study was to establish the feasibility of a pragmatic Randomized
Controlled Trial (RCT) to compare two treatment protocols reflecting
current clinical practice (manual therapy, exercise and advice, with
or without traction) in the management of acute/sub acute low
back pain with ‘nerve root’ involvement. RELEVANCE: Evidence
for the effectiveness of lumbar traction remains inconclusive due
to the poor methodological quality, inadequate treatment doses,
and heterogeneous populations used in past studies. This study
addressed these issues by investigating a homogeneous group
(‘nerve root’) and used treatment parameters for traction established
from a UK wide survey of current practice. This represents the first
high quality trial reflecting current traction use. PARTICIPANTS: 30
patients with nerve root pain, with or without neurological signs,
were recruited between March 2004 and February 2005 within Down
Lisburn Health and Social Care Trust, Northern Ireland. METHODS:
A pragmatic RCT design was employed with patients randomly
assigned to one of two treatment groups: Manual therapy (manual
therapy, exercises and the ‘Back Book’) or Lumbar traction (lumbar
traction, manual therapy, exercises and the ‘Back Book’). Outcome
measures used were the: McGill pain questionnaire, Roland Morris
disability questionnaire, Short form 36, and the Acute LBP Screening
Questionnaire; these were recorded at baseline, discharge, 3
and 6 months post-discharge. In addition, visual analogue scale
(VAS) scores for back and leg pain, the percentage of overall
improvement (patient’s perception), and changes in neurological
and neurodynamic tests were recorded. ANALYSIS: Data recorded
from the primary outcome measures, VAS scores and percentage
overall improvement were considered interval level and analysed
with parametric statistics: repeated measures ANOVA (within group
changes) and the independent t-test (between group changes).
RESULTS: 27 patients completed treatment with a loss of four
patients at the 3 and 6 month follow up: data for 23 patients were
analysed. ANOVA showed a significant improvement in pain and
disability from baseline to all follow up points for both groups; however
there was no significant difference between groups. Feasibility issues
highlighted that recruitment, selection, and outcome measures were
appropriate however a sample size calculation suggested that a large
study would be unfeasible (n=1,975). CONCLUSIONS: The results
demonstrated that both groups improved with treatment but that no
additional benefit was achieved with the addition of lumbar traction
to the package of care. IMPLICATIONS: This study demonstrates
that a study with this subgroup of LBP is feasible; however in light
of the sample size calculation some aspects of the design would
need to be reconsidered prior to a fully powered pragmatic RCT.
KEYWORDS: Lumbar traction, low back pain, nerve root. FUNDING
ACKNOWLEDGEMENTS: None. CONTACT: aa.harte@ulster.ac.uk
ETHICS COMMITTEE: Research Ethical Committee of the University
of Ulster
S256
Research Report Poster Display
19-17 Monday 4 June 14:00
VCEC Exhibit Hall B & C
THE NECK DISABILITY INDEX PREDICTS CHANGES IN PAIN
AND NECK ROM OUTCOMES IN ACUTE WHIPLASH
MacIntyre D1 , Redenbach D1 , Purssell R2 , McKnight D2 ,
Buchanan J3 ; 1 School of Rehabilitation Sciences, University of British
Columbia, Vancouver, Canada; 2 Division of Emergency Medicine,
University of British Columbia, Vancouver, Canada; 3 Emergency
Department, Vancouver General Hospital, Vancouver, Canada
PURPOSE: The purpose of this study was to determine whether
standardized measures of neck pain, range of motion (ROM) and
disability at acute presentation (<24 hours) in patients sustaining a
whiplash injury predicted subsequent outcomes at 48 hours, 3 and
6 weeks post injury, and to determine if there was a correlation
amongst the three outcome measures. RELEVANCE: Knowledge
of which standardized measures for a whiplash injury at initial
presentation are able to guide treatment choices and increase
the accruacy of prognosis is valuable to clinicians. Demonstration
of a relationship between these outcome measures enhances
their usefulness separately or as a group in evaluating progress.
PARTICIPANTS: Patients presenting to the Emergency Department
within 24 hours of sustaining a whiplash injury following a motor
vehicle accident (MVA) were evaluated by an Emergency physician.
Those classified as WAD stage II (whiplash associated disorder
with no neurological involvement) and meeting the defined criteria
of “otherwise healthy” were invited to participate in the study. Ten
subjects, ages ranging from 18-47 years qualified, consented to the
study, and participation in the follow-up sessions (48 hours, 3 and
6 weeks). METHODS: The standardized outcome measures used
were: Neck Pain evaluated with the Visual Analogue Scale (VAS);
Neck Disability as measured by the Neck Disability Index (NDI); and
Neck ROM measured according to Clarkson (2000). The VAS is a
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
questionnaire in which patients select phrases that best represent
their level of ability, expressed as a percentage. Neck ROM is a
series of linear measures (cm) performed by a trained clinician using
a measuring tape. ANALYSIS: Paired t-tests were used to evaluate
changes over time in each outcome measure. Pearson product
moment correlations were used to evaluate the relationships among
the measures. RESULTS: Measures on the VAS, neck ROM, and
NDI deteriorated between 24 and 48 hours post MVA, then showed
improvement by 3 weeks with further improvement at 6 weeks. Strong
correlations were shown between NDI and neck extension ROM at
48 hours (r = −0.80) and NDI and pain at 3 weeks (r = 0.81). The NDI
score at 48 hours predicted changes in subsequent NDI scores at
3 weeks (r = 0.79) and 6 weeks (r = 0.78). CONCLUSIONS: Patients
with WAD stage II experienced worse pain, ROM and disability from
24 to 48 hours post MVA, with improvement at 3 and 6 weeks,
although not full recovery. The NDI predicted disability scores at
3 weeks and 6 weeks and correlated with reduced neck extension
and pain. IMPLICATIONS: These standardized outcome measures
are simple to apply and have potential to predict which patients
will go on to experience limitations in ability following whiplash
injury. KEYWORDS: whiplash, neck disability index, pain. FUNDING
ACKNOWLEDGEMENTS: Canadian Institute for the Relief of Pain
and Disability. CONTACT: macintyr@interchange.ubc.ca
ETHICS COMMITTEE: Clinical Research Ethics Board, University of
British Columbia
WCPT 2007, Research Reports
Research Report Poster Display
19-21 Monday 4 June 14:00
VCEC Exhibit Hall B & C
EFFECT OF RELATIVE AND ABSOLUTE FATIGUE PROTOCOLS
IN THE ASSESSMENT OF NECK MUSCLES FATIGUE IN
WOMEN WITH CHRONIC NECK PAIN
Laliberté M1 , Larochelle J1 , Dumas J2 , Bilodeau M3 , Arsenault B1 ;
1 University of Montreal and CRIR-Montreal Rehabilitation Institute,
Montreal (Qc), Canada; 2 McGill University, School of Physical
and Occupational Therapy, Montreal (Qc), Canada; 3 University
of Ottawa, School of Rehabilitation Sciences, Ottawa (Ont), Canada
PURPOSE: To contrast the discriminating power of two fatigue
protocols, one involving relative and the other absolute force, when
studying neck muscle fatigue in women with non traumatic chronic
neck pain compared to healthy women. RELEVANCE: When evaluat-
ing neck muscle fatigue a relative protocol is often used with subjects
sustaining a proportion of their maximal voluntary contraction (MVC).
However, the real MVC may not be produced because of pain/fear
in individuals with chronic neck pain. Consequently, a an absolute
protocol, imposing the same load to all subjects, for the fatigue test
may be more appropriate. No study has compared such different
protocols. PARTICIPANTS: Thirty women with chronic ( 1 year)
neck pain (CW) aged 31.1±8.3 years and 25 healthy women (HW)
aged 33.0±8.5 years participated in this study. For the CW, mean
score on the Neck Disability Index was 9.57±3.97. METHODS: For
each subject, the MVC was first recorded in isometric neck extension
in a sitting position. They then performed two 10s fatigue tasks,
one using a relative load, the other an absolute load. The relative
task imposed a 75%MVC load in extension, while the absolute
one imposed the same load (16.7Nm) to all subjects. This load
was equivalent to the 75%MVC of a sample of healthy women
(n=15) previously evaluated. EMG signals were recorded with pairs
of surface electrodes placed bilaterally on the splenius. Torque
was measured in reference to C7-T1. The fatigue index used was
the slope (Hz/s) of a series of EMG median frequencies (250 ms
windows) over time during the respective task. ANALYSIS: Three
way ANOVAs with repeated measures were used to compare the
fatigue index between the two groups, the two fatigue tasks and both
2 sides. A t-test compared the strength between the two groups
(alpha = 0.05). RESULTS: The CW (15.91±6.85 Nm) presented
significantly less strength (19.61%) than the HW (19.79±6.26 Nm) in
extension. For the splenius, no differences were found in the fatigue
indices between protocols, sides and groups (e.g. fatigue indices
for the left splenius: CW=-0.21 ±0.81 Hz/s; HW= −0.27±0.64 Hz/s).
CONCLUSIONS: Our hypothesis was that CW would present higher
levels of fatigue than HW in the absolute protocol. However, the
CW did not present increased fatigability. It should be noted that
5 subjects from the CW and one from the HW were not able to
complete the absolute task. The present absolute protocol aimed to
impose 75%MVC. However, the task really corresponded to 94%MVC
in HW and to 129% in CW. It appears that the development of an
absolute protocol that can be generalized to different subjects is
rather complex and would require measurements on larger samples
of subjects in order to obtain the proper level of targeted load.
IMPLICATIONS: A relative protocol appears to be appropriate to
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:
recherche_cou@hotmail.com
ETHICS COMMITTEE: Ethics Committee of Center of Interdisci-
plinary Research in Rehabilitation of Greater Montreal
Poster Displays, Monday 4 June
Research Report Poster Display
21-09 Monday 4 June 14:00
VCEC Exhibit Hall B & C
DOES ACROMIOCLAVICULAR JOINT STIFFNESS CAUSE
DYSFUNCTION OF THE SHOULDER?
Miyamoto H1,4 , Muraki T1 , Oshiro S1 , Takasaki H5 , Fujii M1 ,
Hidaka E1 , Izumi T1 , Uchiyama,MD,PhD E3 , Aoki,MD,PhD M2 ;
1 Graduate school of health science Sapporo medical university,
Sapporo, Japan; 2 Department of Physical Therapy,Sapporo Medical
University of Health Science, Sapporo, Japan; 3 Department of
Anatomy Section II, Sapporo Medical University of the School
of Medicine, Sapporo, Japan; 4 Sapporo Orthopaedic Cardiovascular
Hospital, Sapporo, Japan; 5 Sapporo Shinoro Orthopaedic Clinic,
Sapporo, Japan
PURPOSE: Acromioclavicular joint stiffness can occur in patients
who suffer from shoulder osteoarthritis, frozen shoulder, and
rotator cuff tears. However, it is unclear whether or not it causes
shoulder dysfunctions such as subacromial impingement or other
joint restrictions.The purpose of this study is to examine the
influence of acromioclavicular joint stiffness on scapular mobility
and shoulder motion. RELEVANCE: This study contributes to
application of physical therapy for the treatment of shoulder pain
and contracture. PARTICIPANTS: Five frozen-thawed transthoracic
specimens from fresh cadavers were used. Anatomical structures
of the whole spine, thoracic cage, and bilateral upper extremity
were preserved in the transthoracic specimens. Specimens with
rotator cuff tears, osteoarthritis, and severe shoulder contracture
were excluded. METHODS: In this study, we focused on the range
of shoulder flexion, abduction and upward rotation of the scapula.
The transthoracic specimens were fixed in an upright position on
a wooden pole jig to allow free passive movement of the arm and
scapula. In order to simulate acromioclavicular joint stiffness, we
used two crossing Kirschner wires for fixation of the joint. Then, we
measured the maximum range of passive flexion and abduction of
the shoulder pre- and post- fixation. The angle of upward rotation
of the scapula was measured at 30º, 60º, 90º, 120º, and the
maximum angle of shoulder flexion and abduction pre- and post-
fixation. These angles were measured by an electromagnetic tracking
device (3SPACE FASTRAK, Polhemus, Vermont) with six-degree-
of-freedom. ANALYSIS: A paired t-test was used to examine the
differences in the shoulder and scapular angles between the two
conditions. The a-level of significance was set at 0.05. RESULTS:
There were no significant differences in the maximum angle of
shoulder flexion and abduction between the two conditions. There
were no significant differences in the angle of upward rotation
of the scapula during passive flexion and up to 60 degrees of
shoulder abduction.However,beyond 60 degrees of shoulder abduc-
tion,acromioclavicular joint fixation resulted in a significant reduction
in the scapular rotation angle (p < 0.05). CONCLUSIONS: The results
of the present cadaveric study indicated that beyond 60 degrees
of shoulder abduction,acromioclavicular joint stiffness can influence
the angle of upward rotation of the scapula.Unchanged maximum
shoulder flexion and abduction may imply abnormal compensatory
movements at the glenohumeral joint. Thus, in view of the present
results,it may be inferred that acromioclavicular joint stiffness may
alter the kinematics of the shoulder joint complex during vocational
and sports activities;consequently,it may lead to shoulder dysfunc-
tion. IMPLICATIONS: Our findings suggest that evaluation and
treatment of acromioclavicular joint stiffness should be considered in
patients with shoulder dysfunction. KEYWORDS: Acromioclavicular
joint, kinematics, shoulder. FUNDING ACKNOWLEDGEMENTS: No
grants or outside funding were received in support of this research.
CONTACT: hitosimiyamoto@yahoo.co.jp
ETHICS COMMITTEE: Institutional Review Borad of Sapporo
Medical University
S257
Research Report Poster Display
21-13 Monday 4 June 14:00
VCEC Exhibit Hall B & C
EFFECTIVENESS OF CORE-CONDITIONING EXERCISES USING
A STRETCH-POLE ON THE SPINAL REALINGMNET AND FLEX-
IBILITY: A SINGLE-BLINDED RANDOMIZED CONTROL TRIAL
Sadakiyo M1 , Sugino S1 , Gamada K2 , Yamamoto D3 , Yokoyama S4 ;
1 Department of Rehabilitation, Sadamatsu Hospital, Omura,
Japan; 2 Department of Physical Therapy, Hiroshima International
University, Higashi-Hiroshima Japan; 3 Department of Rehabilitation,
Kijima Hon-In Clinic, Yao, Japan; 4 Department of Physical Therapy,
Seirei Christopher College, Hamamatsu, Japan
PURPOSE: Spinal realignment often plays an important role in
physical therapy (PT) programs for spinal disorders. Little evidence is
available to conclude that an exercise is effective. CoreConditioning™
(CC) program has been introduced to “flatten” the spinal curve and
is widely used among athletes, fitness centers, and orthopaedic
clinics in Japan. The CC program includes upper and lower extremity
and trunk movements on the StretchPole™ (SP) (a modified Foam
Roller), when subjects receive pressure (i.e. direct force) at the
lower sacrum, mid thoracic spine, and posterior head. The objective
of this randomized control trial (RCT) was to determine if the CC
exercise program is more effective than conventional static stretching
programs on spinal realignment and improvement of flexibility of
the spine and proximal joints. RELEVANCE: Evidence regarding a
safe, easy and effective exercise program for spinal realignment is
required in present PT practices. This study will be an important
step in building such evidence. PARTICIPANTS: After obtaining
an IRB approval, 39 young, healthy individuals were recruited and
randomly assigned, either to the CC, static stretching (SS) or
control group. Exclusion criteria were: (1)history of major orthopaedic
injuries, (2)presence of shoulder/hip pain or lumbar back pain (LBP),
(3)scoliosis/spinal deformity, (4)pregnancy, (5)psychiatric problems
and (6)other medical risks. METHODS: The intervention period
was 4 weeks during which the CC group performed basic-seven
exercises (including upper/lower extremity and trunk exercises lying
supine on a SP). The SS group performed 10 static stretching
exercises, and the control group performed no exercises. All groups
refrained from participating in other sports or strenuous activities
during the intervention period. Outcome measures included sagittal
spinal alignment from plain radiography in the upright position, flexed
and extended standing postures, as well as flexibility measurements,
including seated trunk rotation, prone trunk extension, passive
straight leg raises, and passive shoulder flexion. ANALYSIS: Two-
way repeated measure ANOVA with a Tukey/Kramer post-hoc test
were used for comparisons. The level of significance was set at
p < 0.05. RESULTS: None of the 39 consenting participants reported
negative effects by performing the exercise program. Statistical
differences in the spinal curvature were found in the CC group
in the upright (p = 0.042) and trunk extended (p = 0.033) positions
between the pre- and post-intervention measurements. Flexibility
measurements did not show significant differences after Bonfferoni
correction. CONCLUSIONS: CC was effective in spinal realignment
in upright and trunk extension positions in young, healthy individuals.
The post-hoc test revealed that there was a decrease in the
lordosis at L5/S1 and increase at L1/L2 and T12/L1 levels in
upright, while there was an increase in lordosis at L1/L2 in trunk
extension. The SS and control groups showed no adverse effects in
any groups. IMPLICATIONS: CC was safe and effective for spinal
realignment, more specifically reducing lordosis of the lower lumbar
spine and increasing lordosis (hyperextension) of the upper lumbar
spine, in the short term. This information should be taken into
consideration when developing an exercise program intended for
spinal realignment. KEYWORDS: foam roller, spinal realignment,
lumbar lordosis. FUNDING ACKNOWLEDGEMENTS: This study
was supported by the Japanese CoreConditioning Association,
research funding program. None of the authors received salaries or
S258
any other financial benefit by participating in this study. CONTACT:
kazgamada@ortho-pt.com
ETHICS COMMITTEE: Ethics Committee of the Faculty of Health
Sciences, Nagasaki University
Research Report Poster Display
21-17 Monday 4 June 14:00
VCEC Exhibit Hall B & C
DEXTERITY IN PATIENTS WITH HAND OSTEOARTHRITIS
REFFERED FOR MULTIDISCIPLINARY HAND TREATMENT
Van den Ende C, Hoogland A, de Ruiter R, Veerman-Duiveman E,
Van Lankveld W; Rheumatology Centre, St Maartenskliniek
PURPOSE: The purpose of this study is to compare pain, dexterity
and functioning between patients with hand OA and patients with
RA referred to a multidisciplinary treatment because of loss of
hand function. RELEVANCE: Osteoarthritis (OA) is most commonly
associated with monoarticular destruction in the hip or knee. Hand
OA is less common. However, in this subgroup of OA patients the
hands can seriously affected by the condition. Patients report loss
of hand functions in activities of daily life, dexterity, and higher
levels of distress(1). So far it is unclear to what extent hand OA
can affect dexterity and functioning. PARTICIPANTS: Consecutive
patients of the St Maartenskliniek with OA or RA according to ACR
criteria referred in 2005 to multidisciplinary hand treatment were
asked to participate in this study. METHODS: All patients were
assessed in a standardized way. An occupational therapist assessed
the Sequential Occupational Dexterity Assessment (SODA). The
SODA measures observed hand related functions under controlled
conditions. In addition, grip strength was assessed by a physical
therapist. Participants completed the Arthritis Impact Measurement
Scales (AIMS,) questionnaire (higher score reflect worse outcome)
and the Michigan Hand Questionnaire: MHQ) (higher scores reflect
better come). ANALYSIS: Differences between OA and RA patients
in parameters of dexterity were compared using T-tests. RESULTS:
49 patients with OA (12% male, mean (SD) age 59.3 (7.5) years)
and 90 patients with RA (14% male, 57.8 (12.9)) were included
in the study. In both dexterity as assessed by the SODA was
severly limited. No differences in hand strength and functioning
as measured by the AIMS and MHQ were found. OA patients
reported more pain than RA patients during performing activities
of the SODA, whereas observed dexterity as measured by the
SODA were comparable in both groups. CONCLUSIONS: These
findings confirm previously reported findings on the impact of hand
OA on hand function. Dexterity is impaired in OA as well as in
RA. OA-patients suffer from more pain during performing hand
activities. IMPLICATIONS: These findings underline the need to
develop a specific treatment program for this group of patients.
KEYWORDS: Hand function, osteoarthritis, rheumatoid arthritis.
FUNDING ACKNOWLEDGEMENTS: This project was unfunded.
CONTACT: e.vandenende@maartenskliniek.nl
Research Report Poster Display
22-21 Monday 4 June 14:00
VCEC Exhibit Hall B & C
EFFECT OF AN EIGHT-WEEK ADAPTIVE YOGA PROGRAM ON
MOBILITY, FUNCTION, AND OUTLOOK IN INDIVIDUALS WITH
PARKINSON’S DISEASE
Boulgarides L, Coleman-Salgado B, Barakatt E, Choo D, Williams K,
Morales A, El-Zahr M; California State University, Sacramento
PURPOSE: The purpose was to determine the effect on strength,
ROM, balance, gait, depression, and anxiety of 8 weeks of partic-
ipation in an adaptive Yoga class in ten subjects with Parkinson’s
Disease (PD). RELEVANCE: The scope of physical therapy practice
includes wellness and health promotion as well as rehabilitation. The
practice of Yoga has been found to improve physical and mental
WCPT 2007, Research Reports
status in a variety of patient types, including carpal tunnel syndrome,
back pain, and high blood pressure. The practice of Yoga may
provide an option for individuals with PD to improve or maintain
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
a Hoehn and Yahr score of stage 3 or less. METHODS: One-way
repeated measures design was used. After completing the informed
consent form and medical history, subjects were evaluated initially,
passed 8 weeks with no change in usual activity, were evaluated
a second time prior to participation in an 8 week adaptive Yoga
program On completion of the program, subjects were evaluated
a third time. The Yoga program included breathing techniques,
relaxation, meditation, and poses. Poses had potential to improve
alignment, flexibility, balance, strength, and motor control. Subjects
were encouraged to practice at home, and practice calendars were
kept each week. Outcome measures included: Unified Parkinson’s
Disease Rating Scale (UPDRS), the Hospital Anxiety and Depression
Scale (HADS), the anxiety and depression measures of the HADS,
the Berg Balance Scale (BBS), the Modified Dynamic Gait Index
(DGI), the 30 second chair stand, hamstring length tests (Sit and
Reach), and shoulder/upper back flexibility (Apley’s Scratch Test).
ANALYSIS: Difference between initial measures, measures after the
control phase, and measures after the intervention phase were done
using one-way Anova with follow-up T Tests and Friedman’s two-
way ANOVA by ranks with follow up Wilcoxin Signed-Ranks Test.
RESULTS: Analysis revealed the following measures reached or
approached significant improvement after intervention: the Modified
DGI (p = 0.15), BBS (p = 0.24), HADS (p = 0.06), Depression Measure
of HADS (p = 0.002), 30 Second Chair Stand (p = 0.03), and Sit and
Reach (p = 0.02). CONCLUSIONS: Change in measures of strength,
ROM, mobility, gait, balance and psychological health indicate a
positive effect of Yoga for people with Parkinson’s Disease supporting
further study using randomized controlled research design with more
subjects. Further research using larger sample sizes and randomized
subject selection are needed to confirm effectiveness of Yoga for
individuals with PD. IMPLICATIONS: Since flexibility, balance, and
motor control, as well as depression and lack of ability to concentrate
are problems in individuals with PD and are addressed with the
practice of Yoga, Yoga may be an effective intervention to improve
or maintain physical, mental and emotional status in individuals
with PD. The current health care model generally does not provide
ongoing rehabilitation, but clinic or community Yoga programming
would allow individuals to remain actively involved in their health
and wellness at moderate cost. KEYWORDS: Yoga, Parkinson’s
Disease, Alternative Medicine. FUNDING ACKNOWLEDGEMENTS:
The Parkinson’s Disease Association of Northern California provided
financial support. The City of Sacramento Department of Parks and
Recreation provided class space. CONTACT: boulgarides@csus.edu
ETHICS COMMITTEE: f) This project was approved by the California
State University Committee for the Protection of Human Subjects
Research Report Poster Display
23-01 Monday 4 June 14:00
VCEC Exhibit Hall B & C
EVALUATION OF A COMMUNITY-BASED EXERCISE
PROGRAMME FOR PEOPLE WITH PARKINSON DISEASE
Reinikka K1 , MacLeod A; 1 St. Joseph’s Care Group, Thunder Bay,
Canada
PURPOSE: The Northwestern Ontario Parkinson Society Support
Group and rehabilitation staff at St. Joseph’s Care Group (SJCG)
Thunder Bay, Canada, identified the absence of and need for
an ongoing, physical activity programme for people living with
Parkinson Disease (PD). An exercise programme delivered in, and by
community partners was hypothesized to be one solution. An eight-
week exercise programme was developed by physiotherapists and
delivered in the community by a fitness facilitator trained using a
Poster Displays, Monday 4 June
competency based education approach. This study evaluated the
impact of the eight-week exercise programme upon performance
and self-report measures in participants with PD. RELEVANCE:
A number of obstacles to receiving rehabilitation services in
communities across Northwestern Ontario were previously identified,
and included: lack of services, lack of funding for services, services
not available when needed, specific expertise required but not
available, and lack of continuity and follow-up. The need for
alternative forms of health care services and programme delivery
are, therefore, apparent. PARTICIPANTS: 11 participants (6 men,
5 women; mean age: 70.45 ±1.98; mean length of disease: 3.27
years) with Idiopathic PD, Hoehn & Yahr stages 1.0 to 2.5 and
stable medication use, were recruited through the assistance of the
Northwestern Ontario Chapter of the Parkinson Society of Canada,
and the Neurology Day and Movement Disorder Clinics, both held
at SJCG in Thunder Bay. METHODS: A prospective, single group
pre/post test design was used. The Unified Parkinson Disease
Rating Scale motor subsection (UPDRSm), Berg Balance Scale
(BBS), Timed Up and Go (TUG), Parkinson Disease Questionnaire-
39 (PDQ-39), and Activities-specific Balance Confidence Scale
(ABC scale) were assessed at baseline and after eight weeks.
Attendance rates and occurrence of any adverse events were
recorded by the fitness facilitator ANALYSIS: A paired Student’s
t-test was used to assess statistical significance of any changes
in outcome measures as well as any correlations. Effect size was
established using Cohen’s d. RESULTS: Data analysis resulted in
the removal of one participant outlier. Analysis of the remaining
10 participants demonstrated a statistically significant decrease
in the UPDRSm (7.70, p = 0.001), and a statistically significant
increase in TUG scores (2.03, p = 0.005). Significant effect size was
demonstrated for all outcome measures. All participants completed
the study with 90.8% attendance in the exercise programme
and no adverse events. CONCLUSIONS: A community- based
exercise programme, developed by physiotherapists and delivered
by a community fitness facilitator, can be safely provided to a
group of people with Parkinson Disease. The exercise programme
appears to be of sufficient intensity to elicit changes in motor
function and demonstrates potential for change in all outcome
measures. Future studies are needed to assess long-term effects
of participation in the exercise programme in terms of participant
outcomes and utilization of rehabilitation services. These results may
help define the role of community programmes within the health
care system. IMPLICATIONS: It is hoped that this unique process of
identifying and addressing the needs of a specific client population in
Northwestern Ontario will help to facilitate the ongoing development
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,
as well as the Thunder Bay Community Foundation. CONTACT:
reinikkk@tbh.net
ETHICS COMMITTEE: St. Joseph’s Care Group (Board Ethics
Committee); Lakehead University (Research Ethics Board)
Research Report Poster Display
23-05 Monday 4 June 14:00
VCEC Exhibit Hall B & C
MEASUREMENT OF PRESSURE RELIEF POSITIONS IN SEATED
PERSONS WITH SPINAL CORD INJURY
Takeda M, Furusawa K; Kibikogen Rehabilitation Center for
Employment Injuries,Kibityuo,Okayama Pre.Japan
PURPOSE: The purpose of this study was to compare the four
methods of pressure relief in seated patients with spinal cord
injury (SCI). RELEVANCE: It is necessary for patients with SCI to
relief the buttock pressure during sitting on wheelchair. Push-ups
are most effective methods of pressure relief. However, patients
with decreased upper extremity strength and endurance are not
S259
able to perform pressure relief on their own. For these patients,
various methods of pressure relief have been practiced in the clinic.
PARTICIPANTS: Thirty-eight subjects with SCI in clinically stable
state (14 were tetraplegic and 24 were paraplegic) METHODS: We
measured the buttock pressure in five different sitting positions on
wheelchair using the Tekscan pressure measurement system (Big-
Mat 2000, a flexible sensor mat with a 2064 cell (43×48) matrix,
Nitta Co., Osaka, Japan). These positions were 1) neutral position
(control); the subjects sat upright on their prescribed wheelchairs
at rest in a neutral position, 2) forward-leaning; the subjects were
assisted into the forward-leaning position with chest on thighs,
3) lateral bending; the subjects bended their body left side and
relief right buttock pressure, 4) catch grip; the subjects caught
the left grip of wheelchair and relief right buttock pressure, 5)
backward tip; we tipped the wheelchair back to 35 degrees from the
vertical. ANALYSIS: The maximum pressure points in all subjects
were at the ischial tuberosities.The data from both areas were
compared with values recorded in the at control. Calculations were
made with the Scheffe anaiysis of variance (ANOVA). The level of
significance was set to 0.05. RESULTS: In subjects with tetraplegia,
the pressure at ishial tuberosities in control, forward-leaning,
lateral bending, catch grip and backward tip were 123.5±62.6
(mean ± SD) mmHg / 139.6±66.3 mmHg (right/left), 41.5±19.8
mmHg / 44.4±22.1 mmHg, 67.0±36.2 mmHg / 125.7±68.75
mmHg,136.1±74.4 mmHg / 107.6 ±41.2 mmHg, and 97.9±53.5
mmHg / 96.5±42.1 mmHg, respectively. In both side, significant
pressure relief were observed in the forward-leaning (P < 0.01).
In subjects with paraplegia, the pressure at ishial tuberosities in
control, forward leaning, lateral bending, catch grip and backward tip
were 156.3±69.0 mmHg /168.9±64.9 mmHg (right/left), 40.3±33.4
mmHg /37.7±25.6 mmHg, 62.7±48.1 mmHg /95.3±42.4 mmHg,
131.0±56.5 mmHg /136.4 ±42.8 mmHg and 119.6±63.9 mmHg
/131.3±62.4 mmHg, respectively. In both side, significant pressure
relief were observed in the forward-leaning and lateral bending
(P < 0.01). CONCLUSIONS: The results of our study demonstrated
that of the four positions forward-leaning position might be far superior
in decreasing pressure over the ischial tuberosities for patients with
SCI. Moreover, significant pressure relief was shown in the lateral
bending position in only patients with paraplegia. IMPLICATIONS:
This study illustrated the importance of evaluating the efficacy of
rehabilitation procedures routinely used in the clinic. KEYWORDS:
spinal cord injury,pressure relief,Tekscan pressure measurement
system. FUNDING ACKNOWLEDGEMENTS: no funding.
ETHICS COMMITTEE: Kibikogen Rehabilitation Center’s ethics
committee
Research Report Poster Display
24-09 Monday 4 June 14:00
VCEC Exhibit Hall B & C
RELIABILITY AND VALIDITY OF THE KINESTHETIC AND
VISUAL IMAGERY QUESTIONNAIRE FOR ASSESSING MOTOR
IMAGERY IN PERSONS WITH STROKE
Malouin F1,2 , Richards C1,2 , Jackson P2,3 , Lafleur M4 , Durand A5 ,
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
de réadaptation en déficience physique de Québec; 6 Department
of Psychology and Unité de neuroimagerie fonctionnelle, Institut
universitaire de gériatrie, University of Montreal, Qc, Canada
PURPOSE: To benefit from mental practice training after stroke, one
must be able to engage in motor imagery and thus reliable motor
imagery assessment tools tailored to persons with sensorimotor
impairments are needed. The aims of this study were to 1)
examine the test-retest reliability of the Kinesthetic and Visual
Imagery Questionnaire (KVIQ-20) and its short version (the KVIQ-
10) in healthy subjects and subjects with stroke; 2) investigate
S260
the internal consistency of both KVIQ versions and 3) explore the
factorial structure of the two KVIQ versions. RELEVANCE: We have
developed the KVIQ-20 because the self-reporting nature and the
high physical demands of several items of existing motor imagery
questionnaires make them unsuitable for persons with physical
disabilities. PARTICIPANTS: Nineteen persons who had sustained
a stroke (CVA group) and 46 healthy persons (CTL group) took part
to the test-retest reliability study. Construct validity was studied in
a group of 131 persons. METHODS: For the reliability study, the
KVIQ was administered twice by the same examiner 10 to 14 days
apart. The KVIQ assesses on a 5-point ordinal scale the clarity of
the image (visual: V subscale) and the intensity of the sensations
(kinesthetic: K subscale) that the subjects are able to imagine from
the first-person perspective. ANALYSIS: Total KVIQ-20 scores and
subscores from the V and K subscales were averaged for each group.
The test-retest reliability was assessed using intraclass correlation
coefficients (ICC). The internal consistency of the two KVIQ versions
was evaluated with the Cronbach’s alpha and the latent structure was
assessed with the principal factor extraction technique and oblique
rotation. RESULTS: In the CVA group, the ICCs ranged from 0.81 to
0.90 and from 0.72 to 0.81 in the CTL group. Cronbach’s alpha values
were respectively: 0.94 (V) and 0.92 (K) for the KVIQ-20 and 0.89 (V)
and 0.87 (K) for the KVIQ-10. The factorial analyses indicated that 2
factors explained 63.4% and 67.7% of total variance, for the KVIQ-
20 and KVIQ-10 respectively. CONCLUSIONS: Both versions of the
KVIQ present similar psychometric properties that support their use
in healthy individuals and in persons post-stroke. IMPLICATIONS:
Since the KVIQ-10 can be administered in half the time, it is a
good choice for the assessment of persons with physical disabilities.
KEYWORDS: Stroke, mental practice, motor imagery questionnaire.
FUNDING ACKNOWLEDGEMENTS: This work was supported by
the Quebec Provincial Rehabilitation Research Network (FRSQ) and
the CIHR. CONTACT: Francine.Malouin@rea.ulaval.ca
ETHICS COMMITTEE: Ethics committee of the “Institut de
réadaptation en déficience physique de Québec”.
Research Report Poster Display
24-17 Monday 4 June 14:00
VCEC Exhibit Hall B & C
EFFECTS OF LONG-TERM EXERCISE INTERVENTION ON
AEROBIC CAPACITY AND FUNCTIONAL ABILITY IN STROKE
PATIENTS WITH PRIOR CORONARY ARTERY DISEASE
Yang A1 , Su C2 , Lin K3 ; 1 Department of Physical Therapy, College
of Medicine, National Cheng Kung University, Tainan, Taiwan;
2 Department of Occupational Therapy, College of Medicine,
National Cheng Kung University, Tainan, Taiwan; 3 Departments of
Physical Medicine and Rehabilitation, Veterans General Hospital –
Kaohsiung, Kaohsiung, Taiwan
PURPOSE: It is known that regular exercise improves physical
fitness in patients with cardiovascular disorders, as well as stroke
patients. The aim of the present study was to investigate effects of
long-term exercise intervention on aerobic capacity and functional
ability in stroke patients with prior coronary artery disease (CAD).
RELEVANCE: Aerobic exercise training for functional recovery and
physical fitness after either stroke or CAD has been emphasized
clinically. Thus, the effects of exercise intervention on the prognosis
for stroke patients with concurrent CAD should be of concern.
PARTICIPANTS: Twenty-six stroke patients with hemiparetic gait
disturbance and prior CAD were recruited and randomly divided into
exercise and control groups, respectively. The Ethics Committee of
Medicine at National Cheng Kung University approved all procedures,
and informed consent was obtained from all patients for their
participation in this study. METHODS: Thirteen patients (exercise
group) underwent the aerobic exercise training consisting of walking
on a treadmill at 50–60% of their heart-rate reserve for 6 months.
The remaining 13 patients (control group) did not receive any
aerobic exercise intervention. Before and after the intervention,
WCPT 2007, Research Reports
the aerobic capacity and functional ability were assessed by the
symptom-limited exercise testing and Barthel index, respectively. In
addition, the ratio of total cholesterol (TC) to high-density lipoprotein
cholesterol (HDL), the predictor of cardiovascular events, was also
evaluated by the enzyme autoanalyzer. ANALYSIS: A two-tailed,
independent Students t-test was applied to compare the aerobic
capacity and TC/HDL level between exercise and control groups.
Mann-Whitney U test was used to compare the Barthel index
scores between two groups. RESULTS: After aerobic exercise
training, the patients’ absolute peak oxygen consumption (VO2)
was increased (P < 0.01), and absolute VO2 at anaerobic threshold
was also increased (P < 0.01). However, no significant changes in
these variables were noticed in the control group. After the exercise
intervention, the exercise group had better Barthel index scores than
the control group (P < 0.05). Also, the TC/HDL level was significantly
reduced (P < 0.05) in the exercise group, but did not change in the
control group. CONCLUSIONS: Our findings show that long-term
exercise intervention is beneficial to aerobic capacity and functional
ability for stroke patients with prior CAD. It also reduces the risk
factor of cardiovascular events in these patients. IMPLICATIONS:
With a well-designed exercise protocol, aerobic exercise training
could be incorporated into the clinical treatment to improve the
prognosis of stroke patients with prior cardiovascular disorders.
KEYWORDS: ischemic heart disease, cerebrovascular accident,
oxygen consumption. FUNDING ACKNOWLEDGEMENTS: This
study was partly supported by the National Science Council
(Grant No. NSC95-2320-B-006-019 and NSC94-2314-B-075B-003)
in Taiwan.
ETHICS COMMITTEE: The Ethics Committee of Medicine at
National Cheng Kung University
Research Report Poster Display
26-01 Monday 4 June 14:00
VCEC Exhibit Hall B & C
PHYSICAL PERFORMANCE AND SELF-REPORTED HEALTH IN
A GROUP OF DISABILITY PENSIONERS WITH BACK PAIN
Magnussen L1 , Indredavik G1 , Strand L2 ; 1 Department of
Physiotherapy, Faculty of Health and Social Sciences, Bergen
University College, Bergen, Norway; 2 Department of Public Health
and Primary Health Care, Section for Physiotherapy Science,
University of Bergen, Bergen, Norway
PURPOSE: The study is part of a larger project aiming to motivate
disability pensioners with back pain to return to work. Previ-
ously,disability pensioners with back pain have not been examined
systematically. The aim of this study was to examine physical
functioning and self-reported health in this group of pensioners.
RELEVANCE: Functional and mental assessments seem crucial
when deciding who is entitled to receive sickness benefit and
disability pension(DP). Several studies have described work-related
functional ability of individuals on short and long term sick leave
due to LBP. However, little is known about functioning in disability
pensioners. PARTICIPANTS: Eighty-nine 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 to 56 years. Eligible
for the study were all individuals on DP due to back pain in the
county of Hordaland, Norway (n=431), being under 56 years of
age having received full DP for more than one year. The disability
pensioners (n=431) were identified through the National Insurance
Administration. METHODS: Physical performance was assessed
with UKK test battery comprising 1)The UKK walking test, based
on 2 km walking, to measure aerobic capacity. A fitness index
is calculated based on performance time for the walk, heart rate
immediately at the finish, body mass index [BMI], and gender
and 2) The UKK test battery comprised of five tests to assess
musculoskeletal fitness [neck and shoulder flexibility, static balance,
dynamic balance, dynamic sit-ups, and modified push-ups]. The
Back Performance scale (BPS) which is a sumscore of 5 physical
Poster Displays, Monday 4 June
performance tests of daily activities, was used to measure dynamic
mobility of the trunk. Self-reported physical functioning and health
were also registered. ANALYSIS: Descriptive statistics were use
to describe physical performance and self-reported functioning and
health. The tests results were compared to similar data obtained from
the general population in Norway RESULTS: Eighty-five participants
(96%) answered the questionnaire about self-reported physical
functioning and health, and 70 participants (79%) completed the
UKK musculoskeletal tests and 53 participants (60%) completed the
UKK walking test. The mean score of the fitness index were 64.24
(SD 37.98) in men and 69.50 (SD 21.02) in women. The fitness
index scores were considerably below the average scores obtained
in the general population. The mean score of the 5 musculoskeletal
tests varied from 2.21 (SD 1.41) to 1.04 (SD 0.20) in men and
from 2.30 (1.38) to 1.20 (SD 0.54) in women (1 is considerably
below the average in the general population, 2 is somewhat below,
3 is average, 4 is somewhat above, and 5 is considerably above
average). Only 22.2% of the participants reported to have very good
or good health, which is considerably below ratings obtained in
the general population. CONCLUSIONS: Disability pensioners with
back pain have considerably poorer physical functioning and self-
reported health compared to the general population. IMPLICATIONS:
Improvement of physical functioning and health might be important in
future vocational rehabilitation programmes aiming to bring disability
pensioners with back pain to return to work. KEYWORDS: Disability
pensioners, physical functioning, physical performance, perceived
health. FUNDING ACKNOWLEDGEMENTS: The authors thank The
Norwegian Foundation for Health and Rehabilitation for funding.
CONTACT: grethe. indredavik@hib.no
ETHICS COMMITTEE: The study was approved by the Norwegian
Ethics Committee for Medical Research, Health Region west
Research Report Poster Display
26-05 Monday 4 June 14:00
VCEC Exhibit Hall B & C
PREVENTIVE INTERVENTION FOR THE BACK PAIN IN
HOSPITAL NURSERY SHIP WORKERS
Rodriguez Romero B, Riveiro Temprano S, Saleta Canosa J, Patiño
Nuñez S, Raposo Vidal I, Fernandez cervantes R; University of
A Coruña
PURPOSE: Back pain is one of the most important complaints by
pain. Among the nurses and auxiliary nurses evidences of a high
incidence of injuries and back pain exist. Since exercise is widely
recommended in the treatment and prevention of the back pain, we
have designed and applied a protocol of active prevention based on
a programme of exercises for the nursery personnel of Complejo
Hospitalario Universitario Juan Canalejo (CHUJC). RELEVANCE:
The aim of this study was to diminish the incidence of back pain
in the nursery personnel of the CHUJC, and to improve its functional
capacity through the accomplishment of exercises before initiating
the working day. PARTICIPANTS: Nurses and auxiliary nurses of
the CHUJC. METHODS: Prospective Randomized, double-blind,
controlled study. We studied 47 workers, which allows to detect an
improvement in the functional capacity of at least 10 points in the
Functional Ranting Index(FRI), with a statistical power 93% for a
bilateral interpretation. At the beginning of the study the functional
capacity and intensity of the back pain by means of the FRI were
evaluated by 2 physiotherapists. A group of workers was taught a
protocol of heating, stretching and strengthening exercises during
8 sessions of one hour each one. From then this group did the
exercises daily during 15 minutes before beginning each working day.
The other group didn’t receive any intervention. A later evaluation of
the FRI, to both groups, was made 6 months after. ANALYSIS: The
quantitative variables are expressed as the average and ED (standar
deviation). The qualitative variables are expressed in absolute values
and percentage. For the comparison of averages we made a t-test or
S261
test of Mann-Withney, after verifying normality with the Kolmogorov-
Smirnov Test. RESULTS: 47 workers were studied, 26 (55.3%)
received intervention and 21 (44.7%) no. Women 42 (89.4%). There
aren‘t differences in both groups as far as age, sex and years of work-
ing activity length. Forty one workers (87.2%) present a FRI between
0-20%, 5 (10.6%) FRI between 21-40% and 1 (2.1%) with FRI>60%.
Both groups improved. The improvement in the treated group was of
1.16 (ED ±3.8) points, in contrast to the group nontaken part that was
of 0.71 (ED±3). The improvement in both was statistically significant
(p = 0.00). When both groups compare themselves to each other, the
improvement degree did not show statistically significant differences
(p = 0.66). CONCLUSIONS: Although the prevention program gave
rise to an improvement in the functional capacity and level of pain
in the intervention group with respect to the non-treated group, the
differences were not statistically significant. This can be related to
the high number of workers who start off with FRI under (87.2% have
FRI <20%) and therefore with little margin of being able to improve
with the preventive intervention. IMPLICATIONS: The programme
of preventive exercises for back pain has not shown to be effective
short term in workers who leave from low levels of FRI (little initial
pain). One doesn’t discard that in the long term and/or with workers
who present initially moderate-severe back pain, this programme
can be effective. KEYWORDS: Exercise,trial randomized, back pain.
FUNDING ACKNOWLEDGEMENTS: Department of Physiotherapy.
University of Coruña. CONTACT: bear@udc.es
ETHICS COMMITTEE: Ethic Comitte of Clinical Research of Galicia
Research Report Poster Display
27-09 Monday 4 June 14:00
VCEC Exhibit Hall B & C
AN EVALUATION OF THE ADAPTABILITY OF GAIT AMONG
COMMUNITY-DWELLING ELDERLY PEOPLE USING THE
STANDARDIZED WALKING OBSTACLE COURSE (SWOC)
Sakamoto Y, Ohashi Y; Ibaraki Prefectural University of Health
Sciences, 4669-2 Ami Ami-machi, Inashiki-gun Ibaraki, 300-0394
Japan
PURPOSE: The purpose of this study is to evaluate the adaptability
of gait in community-dwelling elderly people to different walking con-
ditions. RELEVANCE: The result of this study might support the po-
tential capability of the SWOC as a clinical tool investigating gait and
balance problem in geriatric field. PARTICIPANTS: Forty elderly peo-
ple (mean age 76.1 ±3.8), living in the community and 18 young peo-
ple (mean age 22.4 ±4.4) were participated in this study. Inclusion cri-
teria for participation were that participants must be able to rise from a
chair and ambulate independently with or without an assistive device.
Methods and procedures used in this study were approved by the
Ethics Committee at Ibaraki Prefectural University of Health Sciences.
All the participants gave informed concent. METHODS: The SWOC,
12 m long and 0.92 m wide walkway with three directional changes
and obstacles, was fabricated based on the original article (Taylor and
Gunther, 1998). Each participant was asked to walk at normal speed
on SWOC with and without obstacles. Young participants were also
asked to walk on SWOC at their maximum speed. Elderly participants
were also asked to walk 11 m straight walkway at their normal and
maximum gait speeds. Ambulation time was measured using a digital
stopwatch and recorded in seconds. ANALYSIS: Correlation analysis
was used to examine the relationship between ambulation times on
the straight walkway and on SWOC. To examine the adaptability of
gait to the obstacles, the two-way repeated ANOVA was used for
ambulation times on SWOC with and without obstacles. RESULTS:
There was no significant correlation between the variation of gait
speed on straight walkway and the ambulation time on SWOC in
two conditions. While the existence of obstacles did not show any
significant effect on normal ambulation times on SWOC in young
people, the elderly people took longer to walk on the SWOC with ob-
stacles than walk on the SWOC without obstacles. CONCLUSIONS:
This study showed the placement of obstacles affected ambulation
S262
time only in elderly people. Interestingly, elderly people who showed
faster gait speed on straight walking were not necessarily walked
faster on SWOC, indicating that SWOC evaluation with and without
obstacles may provide us with information of gait not captured by an
evaluation on straight walkway. The further study about the interaction
between the nature of obstacles and directional changes of walkway
is planed. IMPLICATIONS: Gait problems in elderly people are
complex and require evaluations from multi angles. The evaluation
using SWOC may provide us with a view of underlying mechanisms
of the problems. KEYWORDS: Obstacle course, elderly people, gait.
FUNDING ACKNOWLEDGEMENTS: This study has been supported
by a Grant-In-Aid for Scientific Research by the Ministry of Education,
Culture, Sports, Science and Technology (MEXT) of Japan, grant No.
17700451. CONTACT: sakamotoy@ipu.ac.jp
ETHICS COMMITTEE: Ibaraki Prefectural University of Health
Sciences Ethics Committee
Research Report Poster Display
27-13 Monday 4 June 14:00
VCEC Exhibit Hall B & C
T’AI CHI VERSUS STRENGTH TRAINING: WHICH IS THE BEST
INTERVENTION TO PROMOTE DECREASED FALL RISK IN THE
ELDERLY?
McKenna M1,2 , Lewis R1,2 , Lineberry B1,2 , Lyons A1,2 ,
Thornbury R1,2 ; 1 Elmhurst House of Friendship, Wheeling, WV,
USA; 2 Montani Towers, Wheeling, WV, USA
PURPOSE: This study was to compare the outcomes of two interven-
tions to determine their efficacy in decreasing the risk of falls in the
elderly. RELEVANCE: Falls in the elderly population are a relatively
common occurrence. Interventions to reduce the likelihood of these
are a benefit to those people who are individuals at risk and to those
who care for and support this sector of the population. The two inter-
ventions chosen for this study, T’ai Chi or strength training, can be in-
corporated into any physical therapy setting or offered at an appropri-
ate community facility. PARTICIPANTS: 30 independent community-
dwelling people over the age of 65 volunteered to participate in one
or other of the stated interventions. These volunteers live in two
of the retirement facilities in this local area and were allocated an
intervention program based on their residential location. METHODS:
The study was approved by the University’s IRB and each participant
signed an informed consent. Pre and post testing was conducted at
each end of the study period. The tests included the Berg Balance
Scale, Timed up and Go, ABC scale, and lower extremity strength
using a hand held dynamometer. The interventions were conducted
in a class format at each site for one hour once a week for a period of
ten weeks. Every participant was also encouraged to practice the in-
tervention at least once during the week between classes. The Tai Chi
group was taught the beginning moves of the 24-posture Short Form
and the strength group performed an exercise regime which focused
mostly on the large muscles of the lower extremity. ANALYSIS: One
within subjects factor ANOVA, one between subjects factor ANOVA,
and a covariate analysis, p-value set at <0.05 were used in this
study. RESULTS: Both interventions yielded significant improvement
in balance, balance confidence, and strength in both of the study
groups as evidenced by the results of the tests listed above. No
significance was found in functional mobility. CONCLUSIONS: The
results of the study showed that either T’ai Chi or LE strength training
can improve strength and balance and may decrease the risk of falls
in the elderly. IMPLICATIONS: Both T’ai Chi and strength training
exercise programs or classes can be implemented in many areas,
possibly through senior citizen centers. These can offer the benefits
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
WCPT 2007, Research Reports
Research Report Poster Display
27-17 Monday 4 June 14:00
VCEC Exhibit Hall B & C
EFFECTS OF PERCEPTUAL LEARNING EXERCISES OF FOOT
SOLE ON STANDING POSTURE BALANCE IN ELDERLY
Morioka S1 , Kataoka Y2 , Matsuo A1 , Odagiri M1 , Hiyamizu M1 ;
1 Department of Physical Therapy, Kio University, Nara, Japan;
2 Department of Rehabilitation, Atago Hospital, Kochi, Japan
PURPOSE: The role of somatosensation from human foot sole on
postural sway has been discussed in many studies. Of particular
interest is the degree to which alteration in inputs from cutaneous,
pressure and proprioceptive sensation alters postural sway. The
current study investigated the influence of perceptual learning
exercise for hardness discrimination of sponge rubber by the soles on
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
healthy men aged 61-71 participated in this study. Informed consent
was obtained from all participants prior to participation in the
study. They were divided into two groups of 7 each at random:
perceptual learning exercise group and a control group. METHODS:
For hardness discrimination, sponge rubbers 5, 10, and 15 mm thick
were combined to change the thickness of rubber to 5, 10, 15, 20,
and 25 mm. After blocking the visual sense using an eye mask.
Hardness discrimination task was performed by a pair of participants.
The partner provided sponge rubber with 5 kinds of hardness, and
the trainee guessed their hardness in standing. Knowledge of results
was given immediately after the trainee gave answers. After 30 sec of
resting, 10 times of task were given according to the random table.
During this time of task, knowledge of results was not given. The
number of erroneous answers in these 10 trials was used as the
results of learning. A total of 10 times of hardness discrimination
task were given in 2 weeks. The center of pressure measured using a
stabilometer (Zebris Co. Ltd., PDM system) was used as the indicator
for postural sway. Postural sway was measured for 30 seconds with
eyes open and closed before and after hardness discrimination task.
Also the limit of stability in the forward direction by the Functional
Reach Test (FRT) was examined. ANALYSIS: Statistical analysis
was performed for length, area of ellipse and FRT value. The mean
number of incorrect answers of each of the 10 trials in the hardness
discrimination task performed for 10 days was analyzed by one-
way ANOVA with repeated measures. Student’s t-tests were used
for differences in the selected parameters before and after hardness
discrimination task. All statistical tests were completed at the 0.05
alpha levels. RESULTS: The dispersion of erroneous answers in
hardness discrimination task decreased as the frequency of trials
increased (p < 0.01), and improved learning ability was indicated.
Postural sway after task showed a significant decrease compared
to sway before task in the exercise group (p < 0.05). And FRT
value after task showed a significant increase compared to value
before task in the exercise group (p < 0.05). However, there was
no change on postural sway in the control group. CONCLUSIONS:
These data indicate that the ability of the elderly participants to
regulate their standing posture improved with improvement of the
perceptive ability of the soles. IMPLICATIONS: It is suggested that
the hardness discrimination task by the foot sole is effective as
a simple balance exercise as a clinical approach. KEYWORDS:
elderly, perceptual learning exercise, standing posture balance.
FUNDING ACKNOWLEDGEMENTS: This work was supported by
the Meiji Yasuda Life Foundation of Health and Welfare. CONTACT:
s.morioka@kio.ac.jp
ETHICS COMMITTEE: This presentation obtained the approval of
the ethical committee on Kio university.
Poster Displays, Monday 4 June
Research Report Poster Display
28-21 Monday 4 June 14:00
VCEC Exhibit Hall B & C
TRUNK POSITION SENSE IS ASSOCIATED WITH FALLS AND
BALANCE CONFIDENCE IN COMMUNITY-DWELLING OLDER
ADULTS
Goldberg A, Schepens S, Wallace M; Mobility Research Laboratory,
Department of Health Care Sciences, Wayne State University,
Detroit, Michigan, USA
PURPOSE: The purpose of this study is to determine if there is an
association between trunk flexion position sense, falls, and balance
confidence in community-dwelling older adults. RELEVANCE: Valid
screening tests are needed for clinicians to predict those at risk for
a fall. Controlling the flexing trunk is important in avoiding a fall
after losses of balance. Trunk position sense tests, assessed as
trunk repositioning errors (TREs), incorporate control of the flexing
trunk. Studies have shown TREs to correlate with commonly-used
clinical balance measures. The relationship between TREs, falls,
and balance confidence has not been investigated. Establishing
this relationship may facilitate inclusion of TREs in falls screening
batteries in geriatric physical therapy clinical practice, and lead
to more comprehensive assessments of older adults’ risk for
falls. PARTICIPANTS: Twenty community-dwelling older adults (16
females) with a mean age of 73.5 years (range 61-82 years) were
recruited from urban community senior centers and health fairs.
Nine participants (45%) reported falling at least once in the 12
months prior to testing. METHODS: Participants completed a medical
history, including a report of the number of falls in the previous 12
months and the Activities-specific Balance Confidence (ABC) Scale.
Trunk positioning capabilities were assessed with an inclinometer at
the level of the T4 spinous process. Participants flexed the trunk
to an angle of 30º (position 1). After returning to upright, they
attempted to reproduce the previously attained angle (position 2).
Difference in degrees between positions 1 and 2 was defined as
TREs. Five trials were conducted. The most and least accurate were
discarded, with the mean of the remaining 3 scores representing a
participant’s TREs. ANALYSIS: Differences between fallers and non-
fallers in number of falls, balance confidence scale, and TREs were
calculated with independent samples t-tests. Correlations between
TREs, number of falls, and balance confidence were calculated using
Pearson’s correlation coefficient (r). Sensitivity and specificity values
were calculated to determine the utility of TREs as a test for predicting
fall status. Significance was set at p < 0.05. RESULTS: There was
a significant difference in TREs in fallers (5.48º) versus non-fallers
(2.47º) (p < 0.05). There was a positive correlation between TREs
and number of falls (Pearson’s r=.62; p < 0.05), and a negative
correlation between TREs and balance confidence (Pearson’s r= -
.51; p < 0.05). Using a cut-off score of 3º for a positive TRE test,
TREs exhibit excellent sensitivity (89%) and specificity (91%) in
predicting falls status. CONCLUSIONS: These data suggest that
impairments in trunk position sense are associated with increased
numbers of falls and lower balance confidence in older adults.
TREs may be sensitive and specific indicators of risk for falls.
Future studies should prospectively investigate the role of TREs
as a predictor of falls. IMPLICATIONS: Physical therapy clinicians
should consider adding trunk positioning sense tests to their battery
of falls risk measures in older adults. KEYWORDS: Trunk position
sense, falls, balance. FUNDING ACKNOWLEDGEMENTS: Funded
by a Del Harder award from the Rehabilitation Institute of Michigan.
CONTACT: agoldberg@wayne.edu
ETHICS COMMITTEE: Human Investigation Committee of Wayne
State University.
S263
Research Report Poster Display
29-01 Monday 4 June 14:00
VCEC Exhibit Hall B & C
WALKING VARIABLES DIFFERENTIATING FALLERS FROM
NON-FALLERS
Newstead A1 , Walden J2 , Gitter A2 ; 1 University of Texas
Health Science Center at San Antonio; 2 Audie Murphy Veterans
Administration Hospital Gait Laboratory
PURPOSE: The purpose of this study was to determine the
qualitative and temporal-spatial quantitative differences between two
groups of older adults, fallers (F) and non-fallers (NF), during
over-ground walking compared with a task of obstacle clearance.
RELEVANCE: Falls among adults represent a serious problem with
loss of quality of life and high expenses. Falls frequently occur
during negotiation of obstacles in the home or community. A need
exists for early identification of walking variables that differentiate
people at risk for falls can help rehabilitation professionals perform
interventions that may delay falls and loss of functional mobility.
PARTICIPANTS: Forty-eight community dwelling older adults (F=18;
NF=30) participated. The mean age of the participants was 78.1±7.2
years (F) and 75.8±5.1 years (NF). METHODS: A repeated
measures design was used to examine the effects of differing
walking capacity during one visit for four conditions: 1) baseline
walking; 2) slow walking; 3) fast walking; 4) 5 cm obstacle clearance.
ANALYSIS: Qualitative and quantitative analyses of temporal-spatial
walking measures were analyzed in SPSS version 13 using a Chi-
Square analysis (qualitative) an independent t-test (quantitative) with
a Bonferroni adjustment (p < 0.008). RESULTS: Qualitatively, the
fallers increased knee flexion during both over ground walking and
obstacle clearance (Chi Square = 8.10; p < 0.004) and consistently
took several small steps immediately prior to the obstacle clearance
(Chi Square = 9.30; p < 0.002). During a self-selected walk, the fallers
displayed a slowed, but non significant over-ground walking velocity
compared with the non-fallers (F=0.9±0.2 m/s; NF=1.2±0.2 m/s;
p = 0.018; ES=0.24). Shortened stride length (p < 0.001; ES=0.09)
and reduced single and double support (p < 0.001; ES=0.78-0.81)
were significantly different between groups during the self-selected
walk. During the slow walk, stride length (p = 0.008), single support
(p = 0.001) and second double support (p < 0.001) were significant
between groups, however velocity was not (p = 0.121). No statistically
significant differences existed during the fast walk (F=1.2 m/s ±0.2;
NF=1.5 m/s ±0.3m/s; p = 0.03). During the obstacle clearance, the
fallers walked significantly more slowly than the non-fallers (0.7±0.2
m/s F; 1.0±0.2 m/s NF; p < 0.001; ES=0.23), along with a shortened
stride (p < 0.001; ES=0.22). Compared with self-selected walking,
non-fallers adjusted their stride during obstacle clearance (p < 0.005)
whereas fallers did not. CONCLUSIONS: There are significant
differences in qualitative walking characteristics and quantitative
temporal-spatial variables between fallers and non-fallers during over-
ground walking at various velocities and during obstacle clearance
that differentiates fallers from non-fallers. IMPLICATIONS: Clinicians
are thus encouraged to assess walking at various speeds and under
differing task conditions during baseline examination to determine
the individual’s ability to perform walking tasks when challenged.
KEYWORDS: Walking, fallers, non-fallers, obstacle, stride, velocity,
double support, single support. FUNDING ACKNOWLEDGEMENTS:
This research was funded by the Texas Physical Therapy Education
and Research Foundation. CONTACT: newstead@uthscsa.edu
ETHICS COMMITTEE: University of Texas Health Science Center at
San Antonio, Audie Murphy Veterans Administration Hospital and the
General Clinical Research Center
S264
Research Report Poster Display
29-05 Monday 4 June 14:00
VCEC Exhibit Hall B & C
EARLY DIAGNOSIS AND TREATMENT INTERVENTION FOR
LYMPHEDEMA: A CASE CONTROL SERIES
Gergich N1 , Washington F2 , Pfalzer L3 , McGarvey C4 ; 1 National
Naval Medical Center, Bethesda, Maryland, USA; 2 University
of Maryland School of Medicine College Park, Maryland, USA;
3 University of Michigan – Flint, Flint, Michigan USA; 4 National
Institutes of Health, Bethesda, Maryland, USA
PURPOSE: To investigate the efficacy of a prospective screening
method to diagnose early stage lymphedema and an early interven-
tion for lymphedema management in patients recently diagnosed and
treated for breast cancer. RELEVANCE: The current incidence of
breast cancer related lymphedema is approximately 15% of all breast
cancer patients following axillary lymph node dissection (AXLND)
and 33% of patients treated with AXLND and radiation therapy (RT)
(Petrek 2000). Lymphedema impacts quality of life; range of motion
(ROM), pain, and strength (Armer 2003, Box 2002). Methods used
to measure LE have included circumferential limb girth using a tape
measure (anthropometric), water displacement (volumetric), infrared
optoelectronic, and most recently, bioimpedence. Traditionally these
methods are employed after the condition becomes clinical apparent
(visually detected), resulting in delayed diagnosis and treatment of
an irreversible stage of LE which will require ongoing therapeutic
management. Complete Decongestive Therapy is the current
standard of care for lymphedema in advanced stages (ISL 2001).
There is currently no evidence-based standard treatment outlined
in the literature for early stages of lymphedema. PARTICIPANTS:
A subset of eleven women with lymphedema, ages ranged from
51 to 73 with a mean of 60 years, identified from those enrolled
in a prospective IRB approved study. METHODS: This was a case
control study with the subjects unaffected arm designated as the
control. Lymphedema was defined as a>3% limb volume change
in their affected limb as compared to their pre-operative volume as
measured by the optoelectronic volumeter (Perometer® )at 1, 3, 6,
9, 12 month follow-up. Diagnosis of lymphedema was made by the
PT at their regular follow up visit or when the patient presented with
signs of lymphedema. Upon diagnosis of early stage lymphedema
an intervention was instituted using a ready-made compression
garment of 20 to 30mmHg, worn daily for 2 weeks. ANALYSIS:
The data were analyzed using a 2-way Repeated ANOVA of limb
volume with Arm and Time as repeated factors and mean values.
RESULTS: At baseline no statistically significant difference was
identified in limb volume within the group between the Unaffected
arm (UA) and Affected arm (AA) (p = 0.349). Upon diagnosis of
lymphedema a statistically significant difference in limb volume was
identified between the subjects UA and AA (p = 0.001). From baseline
to intervention the average duration was 8.2 months which was
significant (p = 0.07). From diagnosis to Post-intervention a significant
decrease in AA volume (p = 0.010) was noted. Post-intervention there
was no statistically significant difference in limb volume between
the UA and AA (p = 0.701) within the group. CONCLUSIONS: The
compression garment provided a successful intervention for early
stage lymphedema and, with future investigation, may emerge as
a cost-effective standard of care. IMPLICATIONS: Pre-operative
measurement and assessment of women diagnosed with breast
cancer is imperative for the early detection and management
of impairments including lymphedema. Conservative treatment
interventions, such as ready-made garments, may be efficacious
in managing early stage lymphedema. KEYWORDS: Lymphedema,
case control, compression. FUNDING ACKNOWLEDGEMENTS:
none. CONTACT: nlgergich@bethesda.med.navy.mil
ETHICS COMMITTEE: National Institutes of Health IRB and National
Naval Medical Center IRB. Protocol # B01-52
WCPT 2007, Research Reports
Research Report Poster Display
30-09 Monday 4 June 14:00
VCEC Exhibit Hall B & C
RELATIONSHIPS AMONG GROSS MOTOR FUNCTIONS AND
HEALTH-RELATED QUALITY OF LIFE IN CHILDREN WITH
CEREBRAL PALSY
Hou Y1,2 , Liu W1,3 , Wong A1,3 , Chen C1,4 , Lin P1 , Hong J5 ;
1 Graduate Institute of Rehabilitation Science, Chang Gung
University, Kweishan, Taoyuan, Taiwan, R.O.C.; 2 Department
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
Memorial Hospital – Taoyuan Branch, Kweishan, Taoyuan Hsien,
Taiwan, R.O.C.; 4 Department of Pediatric Physical Medicine and
Rehabilitation, Chang Gung Memorial Hospital – Lin-Kao Children’s
Hospital, Kweishan, Taoyuan Hsien, Taiwan, R.O.C.; 5 Department
of Physical Medicine and Rehabilitation, Kaohsiung Children’s
Hospital, Niausung Shiang, Kaohsiung, Taiwan, R.O.C.
PURPOSE: Gross motor (GM) functions and health-related quality
of life (HRQL) are both considered important outcome indicators in
health care for children with cerebral palsy (CP). The purpose of
this study was to examine the relationships among GM functions
and physical component, as well as psychosocial component, of
HRQL in children with CP. RELEVANCE: This study identified the
lack of correlation between the GM functions and the psychosocial
component of HRQL in children with CP. This finding provides an
evidence to support the importance of addressing psychosocial
aspects of children with CP in the physical therapy management.
PARTICIPANTS: Using a cross-sectional design, a purposive sample
of convenience included 90 children with CP aged 5 to 14 years
of age. METHODS: Gross Motor Function Measure (GMFM) was
used to quantify their GM functions. Their HRQL was determined
by the Child Health Questionnaire-Parent Form 50 (CHQ- PF50),
completed by their caregivers. ANALYSIS: Descriptive statistics was
used to describe their gross motor functions and HRQL. Pearson
product-moment coefficient of correlation calculations were used
to examine the relationships among gross motor functions and
HRQL. RESULTS: There were different correlations among GM
functions and components of HRQL for children with CP. A significant
moderate positive correlation (r = 0.73, p < 0.01) existed for physical
summary scores of CHQ-PF50 and GMFM-66 scores. Psychosocial
summary scores of CHQ-PF50 were weakly related to GMFM-66
scores in CP (r = −0.13, p = 0.23). CONCLUSIONS: GM functions
may be good at predicting the physical component of HRQL, but
appears to be weak at predicting the psychosocial component of
HRQL in children with CP. IMPLICATIONS: In order to promote
the optimal outcomes of children with CP, professionals should
facilitate not only their GM functions, but also need to address the
psychosocial aspects of their HRQL. KEYWORDS: health-related
quality of life (HRQL); gross motor (GM); cerebral palsy (CP).
FUNDING ACKNOWLEDGEMENTS: The authors would like to thank
the National Science Council of the Republic of China, Taiwan, for
financially supporting this research under Contract No. NSC95-2614-
H-182–002. CONTACT: pinging791207@yahoo.com.tw
ETHICS COMMITTEE: Institutional Review Board Chang Gung
Memorial Hospital, Taiwan
Research Report Poster Display
30-13 Monday 4 June 14:00
VCEC Exhibit Hall B & C
INTENSIVE MOTOR TREATMENT OF CHILDREN WITH
CEREBRAL PALSY: A PARTICIPATORY APPROACH
Benz R, Søiland W, Gundersen H, Iversen S, Larsen E; Stavanger
University Hospital, Norway
PURPOSE: In Norway parents of children with cerebral palsy (CP)
have increasingly asked for intensive motor treatment approaches.
Poster Displays, Monday 4 June
In 2004 Stavanger University Hospital initiated a 2-year project
in order to develop an approach, which actively included parents
and local municipal professionals. By focusing on parental and
local inclusion, we aimed at developing a treatment approach
which led to functional improvement for the children involved, but
also increased practical knowledge concerning motor treatment
for important persons in the children’s lives. RELEVANCE: While
intensive motor treatment approaches for children with CP lately have
been recommended based on research findings, evidence is scarce
with regard to long-term effects as well as comparison between
specific types of programs. Health policy and organization differ
between countries, and choice of approaches should be matched
to local structures in order to optimize effects. DESCRIPTION:
Principles from participatory action research were applied as
framework. A project-team consisting of 4 physiotherapists were
responsible for developing and implementing the approach, which
consisted of the following main elements: 1)Visiting the child, family
and local professionals in their daily environment – registration of the
child’s interests and activity-profile. This information was used during
treatment to optimize motivation. 2) Open discussions with parents
regarding choice of treatment goals. Over 90% of the registered
goals were on the functional level of activity. 3)Intensive group-
sessions for either 6 weeks(3x150 minutes pr week) or daily 3
hour sessions for 3 weeks at the hospital. During sessions parents
and local professionals took part and actively assisted the child.
4) Follow-up consultations based on individual and local needs.
During the project three groups consisting of 5-6 children attended
one treatment period, while two groups received two treatment
periods. A total of 30 children and 83 parents and local professional
participated. EVALUATION: All children were assessed with the
Gross Motor Function Measure (GMFM) and Goal Attainment Scaling
(GAS) before and after treatment. Depending on individual needs,
additional standardized measures were applied. After each treatment
period parents and local professionals anonymously answered a
questionnaire. An open participatory evaluation was also undertaken
locally for each child. The results from the questionnaires were in
accordance with the local participatory evaluations. Although a clear
majority of the children showed positive changes at the GMFM, only a
minority of the findings were statistically significant. 81% of the GAS
registrations showed improvement regarding specific skills training.
The participants responded positively towards the children’s enjoy-
ment during sessions, as well as intensity, pedagogically aspects and
cross-over effects. All parents wanted their children to attend another
treatment-period. CONCLUSIONS: Participatory intensive motor
treatment for children with cerebral palsy was evaluated as valuable
in order to obtain specific treatment goals chosen by parents.
Active learning and participation by parents and professionals during
sessions seem to have a positive cross-over effect to the child’s daily
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
motor group treatment are more likely to happen when local
professionals are in included as active participants. KEYWORDS:
Intensive motor treatment, cerebral palsy, participatory approach.
FUNDING ACKNOWLEDGEMENTS: The Norwegian Directorate of
Health and Social Affairs. CONTACT: breg@sus.no
Research Report Poster Display
30-17 Monday 4 June 14:00
VCEC Exhibit Hall B & C
EARLY DETECTION OF CEREBRAL PALSY FROM ANALYSIS
OF FOUR SPONTANEOUS MOVEMENTS
Byrne E, Butler E, Constantinou J; Lucile Packard Children’s
Hospital at Stanford Medical Center Palo Alto, CA USA
PURPOSE: The study purpose was to assess a novel method
of early detection of cerebral palsy (CP) that uses a pediatric
observational motion analysis tool for quantification of desirable and
S265
undesirable spontaneous movements. RELEVANCE: Early detection
of CP is critical to the success of federally-mandated early-start
programs. However, many children are not diagnosed until noticeable
delays in milestones and impairment of mobility occur. This novel
approach to the assessment of the infant born preterm may allow
for earlier identification. PARTICIPANTS: Eighty infants born at
<30 weeks gestational age. METHODS: Archived video recordings
(recorded in the infant’s home) of spontaneously moving supine
infants at 12 weeks corrected-age (CA) were retrospectively analyzed
quantitatively. Using a pediatric motion analysis tool designed for
the study, 5-minute digitized video clips were observed. Frequency
and duration were recorded for two undesirable motor behaviors-
obligatory asymmetric tonic neck reflex and “surrender” position of
the arms and two desirable motor behaviors- midline head and hand
positioning. The primary investigator and second evaluator were both
masked to infant outcome and inter-rater reliability agreement was
89%. Bayley II and neurologic examinations were made at 18 and
30 months. ANALYSIS: The above four spontaneous movement
variables, considered to discriminate between normal and abnormal
early motor patterns, were quantified. A ratio score of total unde-
sirable/desirable spontaneous movements was calculated for each
infant, and a score of >1.0 was considered abnormal. This ratio score
was then assessed for sensitivity, specificity, accuracy, and ability to
positively and negatively predict (PPV and NPV) Bayley II scores
at 18 months CA and a diagnosis of CP by 30 months. RESULTS:
Eighty-four to 94% of infants with more desirable than undesirable
spontaneous movements early in life had age-appropriate behavior
at 18 months CA. By diagnosis and testing, the following was found:
1) CP at 30 months (n = 67) – sensitivity 67%, specificity 78%,
PPV 32%, NPV 94%, accuracy 76%. 2) Testing at 18 months CA (n
= 59): MDI – sensitivity 50%, specificity 80%, PPV 44%, NPV 84%,
accuracy 73%; PDI – sensitivity 67%, specificity 80%, PPV 38%,
NPV 93%, accuracy 78%. CONCLUSIONS: Findings suggest that
this new method of quantifying specific early movement variables
into a movement ratio at 12 weeks CA is a modest predictor of
later developmental outcome. A study weakness is that sample sizes
differed at the two testing times. Continued study of the predictive
power of movement variables appropriate at other developmental
stages may be beneficial. IMPLICATIONS: This inexpensive, non-
invasive method of early assessment of infants born preterm may
be performed by any trained professional in conjunction with other
developmental testing, which may be particularly beneficial for
infants in geographical areas without MRI access. KEYWORDS:
CP, spontaneous movements. FUNDING ACKNOWLEDGEMENTS:
Innovations in Patient Care; Lucile Packard Children’s Hospital at
Stanford Medical Center. CONTACT: ebyrne@lpch.org
ETHICS COMMITTEE: Human Subjects Review Board at Stanford
Medical Center in Palo Alto, California.
Research Report Poster Display
31-21 Monday 4 June 14:00
VCEC Exhibit Hall B & C
AN INVESTIGATION INTO THE FACTOR WHICH MOTIVATES
PATIENTS TO ATTEND FOR OUTPATIENT PHYSIOTHERAPY
O’Sullivan E, Murtagh R, Cooney M; Trinity College Dublin, School
of Physiotherapy, Dublin, Ireland
PURPOSE: The aim of this study was to establish the main
motivating factor that prompts patients to attend outpatient physio-
therapy treatment. RELEVANCE: In Physiotherapy related literature
pain is reported as the symptom that motivates patients to seek
treatment. This claim, while widely accepted does not appear to
be evidence based as there are no published articles available
to substantiate these beliefs. PARTICIPANTS: Patients attending
physiotherapy who were over 18 years, English-speaking and without
cognitive impairments were invited to participate. METHODS: A two-
part questionnaire was administered to all participants Information
regarding patient demographics, motivating factor, area of complaint,
S266
duration of complaint and pain intensity(if present) was gathered.
Subsequently the Short-Form-12 (a Quality of Life Questionnaire)
was completed by all participants. Data was gathered from both
a public and private department ANALYSIS: Descriptive statistics
generated with Microsoft Excel (2003). Short-Form-12 results were
inputted into Quality Metric SF-12 Scoring Software. RESULTS:
A total of 195 patients participated, 60% of whom presented to
physiotherapy with a primary complaint of pain. The majority of
patients were female in both the public and the private setting.
Almost three quarters of all complaints were of chronic duration
(>3 months). CONCLUSIONS: This is the first study to confirm
that pain motivates a majority of Outpatient Physiotherapy patients
to seek treatment, with three out of every five patients attending
because of pain. IMPLICATIONS: This study has confirmed the need
to assess and measure pain in the Outpatient Physiotherapy setting.
KEYWORDS: Pain, Outpatient Physiotherapy, Motivating Factor.
FUNDING ACKNOWLEDGEMENTS: This work was unfunded.
ETHICS COMMITTEE: Ethical approval was awarded by the Ethics
Committee of Trinity College Dublin, Dublin, Ireland.
Research Report Poster Display
32-01 Monday 4 June 14:00
VCEC Exhibit Hall B & C
SELF EFFICACY, DISABILITY AND PHYSICAL OUTCOMES OF
PATIENTS WITH CHRONIC PAIN FOLLOWING A PROGRAM OF
GRADED PHYSICAL EXERCISES AND CBT
Abd Aziz K1 , Mohd Hashim A; 1 Physiotherapy Department, Kuala
Lumpur Hospital, Kuala Lumpur, Malaysia
PURPOSE: The study is to define the characteristics of chronic pain
patients attending a chronic pain clinic and to investigate whether
a program of graded physical exercise and CBT have effect on self
efficacy, functional disabilities and physical outcome. RELEVANCE:
Chronic pain is a complex in nature and results from many factors
not solely a function of pain or pathology.A physiotherapist must take
into account the psychological variables such as self-efficacy when
treating patients with chronic persistance pain. PARTICIPANTS: 77
patients with persisting pain more than 6 months. METHODS: A
prospective study. Data were collected from 77 patients attending
pain management programs from 2002-2006. The management
program consists of cognitive behavioral therapy, relaxation and
physiotherapy in the form of program of exercise to improve flexibility,
strength and endurance. Self efficacy was measured using Pain Self
Efficacy Questionnaires (PSEQ), functional disability was measured
using Roland Morris disability questionnaires. DASS questionnaires
was used to measure the level of anxiety, stress and depression.
Physical function measurement was 20 m timed walk and numbers
of stairs climbed in 2 minutes. Data were collected at the beginning,
and the end of program and at one month after the program.
ANALYSIS: SPSS version 11.0 RESULTS: Data obtained from 32
males (41.6%) and 45 females (58.4%) were analysed. Pain self
efficacy were significantly but negatively correlated with functional
disability (r = 0.27, p < 0.05), stress (r = 0.31, p < 0.05), depression
(r = 0.24, p < 0.05) and showed positive correlation with active coping
(r= 0.55, p < 0.05). Pain self efficacy measurement improved from
26% to 67.5% (PSEQ score>40) one month after the program. There
were also significant changes in physical function in the form of 20
m timed walked and numbers of stairs climbed CONCLUSIONS:
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: zaimah2005@yahoo.com
WCPT 2007, Research Reports
Research Report Poster Display
32-05 Monday 4 June 14:00
VCEC Exhibit Hall B & C
DETERMINANTS OF PHYSICAL ACTIVITY IN COMMUNITY-
DWELLING AMBULATORY INDIVIDUALS WITH CHRONIC
DISEASE
Ashe M1,2,4 , Eng J1,2,4 , Miller W1,2,4 , Soon J3,4 ; 1 Rehab Research
Lab., GF Strong Rehab Centre, Vancouver BC; 2 Rehab Sciences,
University of British Columbia; 3 Faculty of Pharmaceutical Sciences,
University of British Columbia; 4 Physical Activity and Chronic
Conditions Research Group, UBC
PURPOSE: The primary objective of this cross-sectional study
was to determine the predictors of physical capacity and physical
activity participation in older community-dwelling individuals living
with different chronic diseases. The secondary objective was to
evaluate the risk of inactivity associated with chronic disease and
impairments. RELEVANCE: Consistently low rates of physical activity
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
contribution to participation in physical activity and in the development
of function-based interventions. PARTICIPANTS: 200 community
dwelling ambulatory participants living with 2 or more chronic
disease were assessed. METHODS: It was a descriptive cross-
sectional investigation of physical capacity (physiological potential)
and physical activity participation (recorded engagement in physical
activity). This study was approved by the local hospital and university
ethical review boards. ANALYSIS: Multiple regression and odds
ratios were used to investigate determinants of capacity (6 Minute
Walk Test) and participation (Physical Activity Scale for Individuals
with Physical Disabilities Questionnaire; 3 day pedometer record).
RESULTS: Sixty-five percent (65%) were women and the mean age
was 74±6 years (range 65-90 years). Mobility (Timed Up and Go)
was a consistent determinant across all 3 primary outcomes. For
the Six Minute Walk Test, determinants included mobility, BMI, grip
strength, number of medications, leg strength, balance and Chronic
Disease Management Self Efficacy Scale (r2=0.58; P = 0.000). The
determinants for the self-reported participation measure (Physical
Activity Scale for Individuals with Physical Disabilities Questionnaire)
was mobility (r2=0.04; P = 0.007). For the mean daily pedometer
steps, the determinants included mobility, body mass index (BMI),
age and Chronic Disease Management Self-Efficacy Scale (r2=0.27;
P = 0.000). There were higher risks for inactivity associated with
impairments compared with the presence of a chronic disease.
In addition, over one-third of participants had sufficient physical
capacity, but did not meet minimal recommendations of physical
activity. CONCLUSIONS: This study suggests that it is easier to
predict an individual’s physical capacity more than their actual
physical participation. IMPLICATIONS: Physiotherapists are key
providers who can assess individuals and develop programs for those
seniors at risk of inactivity. KEYWORDS: physical activity, capacity,
participation, chronic disease. FUNDING ACKNOWLEDGEMENTS:
We gratefully acknowledge the support of the Canadian Institutes
for Health Research (CIHR) Team Development Grant. We also
thank CIHR (JJE) and Michael Smith Foundation for Health Research
(MCA, JJE, WCM) for Investigator support.
ETHICS COMMITTEE: University of British Columbia Clinical Ethics
Review Board
Poster Displays, Monday 4 June
Research Report Poster Display
33-09 Monday 4 June 14:00
VCEC Exhibit Hall B & C
COMPARISON OF TEACHING AND LEARNING OUTCOMES
BETWEEN VIDEO-LINKED, WEB-BASED, AND CLASSROOM
TUTORIALS
Jones A1 , Dean E2 , Hui-Chan C1 ; 1 Department of Rehabilitation
Sciences, The Hong Kong Polytechnic University, Hong Kong;
2 School of Rehabilitation Sciences, University of British Columbia
PURPOSE: Interactive videoconferencing (IVC) has been reported to
be a powerful tool that has facilitated sharing specialized expertise
across geographic regions within a country and across countries.
We examined the effect of IVC on teaching and learning outcomes
in physical therapy professional education cross culturally, i.e.,
between Canada and Hong Kong (HK). The primary purpose of
this study was to compare across an eastern and a western
culture, teaching and learning outcomes of three formats of
professional education, including video-linked tutorials in combination
with web-based tutorials (VL+WB), web-based tutorials only (WB),
and conventional classroom tutorials (CC). Secondarily, we were
interested in identifying challenges of VL teaching cross culturally
to share experiences with others. RELEVANCE: Although IVC
may be a powerful adjunct to physical therapy education between
universities within and between countries, the related literature is
scant. Further, computer-based teaching and learning strategies
in universities have been largely in the domain of high-income
countries. If we could further elucidate its potential role, IVC
could benefit physical therapy education in middle- and low-income
countries as well. As the demand for physical therapists increases
globally, IVC as a strategy in physical therapy education may help
address the shortage of qualified instructors worldwide. Increasing
clinical competence and standards of practice globally may be
long-term secondary benefits of IVC in entry-level physical therapy
programs. PARTICIPANTS: Physical therapy student volunteers in
Canada and HK who were studying critical care, were assigned
to one of three groups at each site (sample size range 9-
17). METHODS: We compared three instructional formats, i.e.,
international VL tutorials in combination with WB tutorials (VL+WB),
WB tutorials only (WB), and conventional classroom tutorials
(CC).Two critical care topics were selected for this circumscribed
application, and an instructor from each of Canada and HK
contributed equally to the VL sessions. Instruction time was balanced
for the VL+WB groups and CC groups; four hours. There was
no restriction on time on the web for students whose groups
had a WB component. The learning outcomes included grades
and feedback from the students about their learning experience.
In addition, the instructors provided written feedback on their
experience with the instructional formats. ANALYSIS: Descriptive
statistics were used to summarize and tabulate the objective
data. A three-way ANOVA [between-group (2 sites x 3 groups)
and within-subject (2 quiz questions] was used to analyze the
results, and pair-wise comparisons with Bonferroni adjustment
were used for the post hoc tests. The learning experience was
evaluated in writing by the students, and interviews with the
groups by independent education consultants. These comments
were compiled systematically. RESULTS: Overall, the students’
grades were superior for the VL+WB groups compared with the
other two groups (p > 0.05). No difference was observed between
the WB and the CC groups. The VL+WB groups valued learning
about cultural differences in physical therapy education. Also, the
instructors acknowledged that preparation for VL tutorials was
unique and challenging. CONCLUSIONS: IVC may enhance the
professional education of undergraduate physical therapy students
cross culturally. IMPLICATIONS: Cross cultural interaction may
further enhance student learning. KEYWORDS: interactive video
conferencing, learning, physical therapy education, teaching, web-
based instruction. FUNDING ACKNOWLEDGEMENTS: Teaching
and Learning Enhancement Fund Award of the University of British
S267
Columbia, and Teaching grant for Strategic Objective 1.1, The Hong
Kong Polytechnic University. CONTACT: rsajones@polyu.edu.hk
ETHICS COMMITTEE: Ethics committee in both University of British
Columbia and The Hong Kong Polytechnic University
Research Report Poster Display
33-13 Monday 4 June 14:00
VCEC Exhibit Hall B & C
PATIENT-SATISFACTION WITH PHYSIOTHERAPY
Eriksdotter A1 , Graver V2 , Andreassen G2 ; 1 Department of Physical
Medicine and Rehabilitation and Department of Physiotherapy,
Ullevaal University Hospital, Oslo, Norway; 2 Department of
Physiotherapy, Ullevaal University Hospital, Oslo, Norway
PURPOSE: The purpose of this study, carried out in an outpatient
physiotherapy clinic at Ullevaal University Hospital, Norway, was to
assess patients’satisfaction, predictors of satisfaction and to see if
proffesionals in the department were able to predict areas referred
to as problematic by the patients. RELEVANCE: Patient satisfaction
is increasingly applied to monitor patient perception concerning
quality of health care services. Patient satisfaction can be one
indicator of the quality of care. PARTICIPANTS: One hundred sixty
six patients with muscular skeletal disorders who had completed
outpatient physiotherapy treatment (mean age 46.6 (SD13.2), 97
women, 66 men and three patients with unknown gender) were
included. Twenty two per cent of the patients did not have the
Scandinavian languages as their mother tongue. In addition, 20
proffesionals in the department (doctors and physiotherapists) were
included in the survey. METHODS: A questionnaire developed
by the authors was sent to 277 patients and 30 proffesionals.
All participants answered anonymously. The proffesionals were
asked to answer in accordance with what they thought patients
would answer. The questionnaire consisted of three global effect
variables and twenty one questions measuring various aspects of
satisfaction with physiotherapy. Age, gender and language were
registered. ANALYSIS: The significance of associations between
the global questions and the different other items were investigated
by means of univarieted and multivariated regression analyses,
Chi-square test and Kruskall-Wallis test. Kruskall-Wallis and Chi-
square tests were performed to determine the differences between
the answers of the patients and the proffesionals. RESULTS: A
total of 166 (60.4%) questionnaries were returned from the 277
patients and 20 (66.7%) from the 30 professionals. The majority
of the patients where satisfied with the treatment and services
and wanted to recommend the physiotherapy outpatient clinic
(p < 0.0001), although a large number of patients reported that
their condition had not improved (p < 0.0001). Environmental factors
(premises, accessibility and cleaning) were identified as areas with
great potential for improvement but they were not strongly correlated
to overall satisfaction. Age and gender had little influence on the
results. Patients not having a Scandinavian language as their mother
tongue were less satisfied with the treatment on an overall basis
(p = 0.01). There were significant diffrences between the anserwers
of the proffesionals and the patients in two-third of the questions.
CONCLUSIONS: Patient satisfaction was highly associeted with
proffesional skills, information and communication. Environmental
factors had less impact on the results. The proffesionals had
great difficulty predicting the patients opinions. Non-Scandinavian
language was a strong predictor of dissatisfaction. In order to
give minority groups of patients’relevant treatment and service,
we are doing another follow up study. IMPLICATIONS: Earlier
studies have shown that qualitative studies are needed to study
patients’ perspective. Patient’s perspective and expectaions are
of importance for how they perceive satisfaction. In our survey
we have shown that to know what is of importance to the
patients you have to ask them. It is also important to focus on
measurements of dissatisfaction, this can be a step forward in
improving patient satisfaction and thereby the quality of treatment
S268
and services. KEYWORDS: physiotherapy, patient-satisfaction and
questionnarie. FUNDING ACKNOWLEDGEMENTS: No external
founding. CONTACT: ansd@uus.no
Research Report Poster Display
34-21 Monday 4 June 14:00
VCEC Exhibit Hall B & C
PSYCHOSOCIAL IMPACT OF CHILDHOOD DISABILITY ON
FAMILIES OF CHILDREN 0−6 YEARS
Ajagbe O; Brothers of Charity Disability Services, Cork City,
Republic of Ireland
PURPOSE: This study seek to examine the Psychosocial Impact of
childhood disability on families with children 0-6years. RELEVANCE:
The result of this study would assist service providers and policy
makers to help families to overcome the difficulty encountered in
relation to the birth and care of a child with disability. PARTICIPANTS:
Participants involve families (n=68) who have at least a child
with intellectual disability whose age range is between 0-6 years.
METHODS: A standardised questionnaire ‘Impact of illness on
families (Adapted version) developed by Stein and Jessop,(2003)’
was used to determine the Psychosocial Impacts of child’s disability
on families. The quality of life of family was measured by ‘The Beach
Family Quality of life Scale’. ANALYSIS: The data were subjected to
both quantitative and qualitative statistical analysis. The quantitative
analysis involves the use of simple descriptive and inferential analysis
using Microsoft Excell, 2000 and Statistical Package for Social
Sciences (SPSS) to calculate the means, Standard deviation with
ANOVA to calculate the level of significance and non significance. The
qualitative component was analysed by identifying commom themes
in relation to Resources and competencies available for family, the
other impact the child’s disability has on family and the form of
help needed by family. RESULTS: The result shows no significant
difference in the mean scores of the Psychosocial Impact of child’s
disability on families in relation to Severity of disability across group
for Total Impact, Social Relation, Coping and Finance,(p > 0.05, df 2,
65), however there is a significant difference in the means score for
General Impact domain (p < 0.05).In relation to the quality of life of
family, the result show no significant difference between the quality of
life of Parents in relation to Severity of disability (p > 0.05).Concerning
the resources and competencies available for family, the master
theme that emerged is Multidisciplinary intervention, Respite care
and intervention of social worker. The other theme is that they got
help in local pre-school and help with entitlements. In relation to
the other Impact the child’s disability has on family, the theme that
emerged is that the care of child with disability creates emotional,
social, financial and psychological problems.Another theme is that
the care of child with disability is stressful,and affects the overall day
to day planning of families.Regarding the expected help by families
the main theme identified is that family needed home support,
involvement of social worker and support group. The other theme
is that family needed an improved service and better intervention.
CONCLUSIONS: There is no significant difference in both the
Psychosocial impact of childhood disabity and quality of life of families
in relation to severity of disability. IMPLICATIONS: Service providers
and Policy makers are now called to assist family in alleviating
the difficulty encountered by family in relation to the care of their
child with disability. KEYWORDS: Psychosocial, Disability, Child
and Family. FUNDING ACKNOWLEDGEMENTS: Nil. CONTACT:
rotimi04@yahoo.co.uk
ETHICS COMMITTEE: Management of Brothers of Charity services
(St. Gabriel’s School)
WCPT 2007, Research Reports
Research Report Poster Display
35-01 Monday 4 June 14:00
VCEC Exhibit Hall B & C
PSYCHOSOCIAL VARIABLES IN PATIENTS WITH SUBACUTE
LOW BACK PAIN. AN INCEPTION COHORT IN PRIMARY CARE
PHYSICAL THERAPY IN THE NETHERLANDS
Heneweer H1 , Aufdemkampe G1 , van Tulder M2 , Kiers H1 ,
Vanhees L3 ; 1 Research department Lifestyle and Health and
Department of Physical Therapy, University of Professional
Education, Utrecht, The Netherlands; 2 Institute for Research in
Extramural Medicine, VU University Medical Center, Amsterdam,
The Netherlands and Institute for Health Sciences, Faculty of Earth &
Life Sciences, Vrije Universiteit, Amsterdam, The Netherlands;
3 Department of Rehabilitation Sciences, Faculty of Kinesiology and
Rehabilitation Sciences, Katholieke Universiteit Leuven, Belgium
and Faculty Chair research department Lifestyle and Health,
University of Professional Education, Utrecht, The Netherlands
PURPOSE: To study the association between psychosocial factors
and the transition from acute or sub acute low back pain to chronic
low back pain in primary care physical therapy. RELEVANCE: Given
the serious consequences of chronic LBP, it is important to study
interventions that may prevent acute complaints becoming chronic.
Psychosocial factors have long been believed to be associated with
chronic pain only. More recent research1-8 focuses on psychosocial
factors associated with acute or sub acute pain. Physical therapy
in primary care may play an effective role in identifying patients at
risk of developing chronic LBP. PARTICIPANTS: The participants
(n=56) in the study were consecutive new referrals consulting their
physical therapist for the first time with a first or new episode of
LBP. Subjects were recruited from 20 primary care physical therapy
centers in the Netherlands between September 2002 and September
2004. All subjects were referred by their general practitioner or
medical specialist. The main inclusion criterion was non-specific low
back pain preceded by a pain-free period of at least 3 months in
which no physical therapist was seen for treatment. METHODS:
At baseline subjects were asked to complete a comprehensive
set of questionnaires including sociodemographic characteristics,
cause and further development of LBP, fear-avoidance, anxiety,
depression, kinesiophobia and pain-coping behavior. Follow-up
questionnaires, administered by post at week 2, 4, 8 and 12,
measured pain intensity, disability and overall improvement. Except
for the sociodemographic characteristics, all baseline measurements
were repeated in week 12. ANALYSIS: The effect of the predictor
variables on the risk of non recovery was assessed in logistic
regression models. All the variables were studied one at a time
in a base model, followed by stepwise approaches (pin <0.05,
pout>0.10). A receiver operating characteristic curve was used
to compare the accuracy of the models without the use of a
specific cutoff point. RESULTS: At week twelve, 35 patients (51%)
judged their status as ‘not recovered’ of whom six (17%) reported
work absenteeism. A multivariate logistic regression including the
Acute Low Back Pain Scale (ALBPSQ), Fear Avoidance Beliefs
Questionnaire, Tampa Scale for Kinesiophobia and Pain Coping
Inventory resulted in a model in which the ALBPSQ appeared
to be the only significant variable. Scores on the subscale ‘pain’
of the ALBPSQ proved to be the strongest risk factor (p .001)
with an overall accuracy of 75.4%. Predicted scores resulted in a
relative risk of 3.09 (95% CI 1.64%-5.82%) for not being recovered
after 12 weeks. CONCLUSIONS: The study revealed pain-related
items to be essential factors in the development of chronic low
back pain and long-term disability in primary care physical therapy.
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
Poster Displays, Monday 4 June
pain, prediction, psychosocial. FUNDING ACKNOWLEDGEMENTS:
The work was funded by the Hogeschool Utrecht, University of
Professional Education. CONTACT: hans.heneweer@hu.nl
Research Report Poster Display
35-05 Monday 4 June 14:00
VCEC Exhibit Hall B & C
PAIN AND COGNITIVE-BEHAVIOURAL FACTORS AS BARRIERS
TO COMPLIANCE WITH WALKING EXERCISE IN PATIENTS WITH
PERIPHERAL ARTERIAL DISEASE – PRELIMINARY EVIDENCE
Roche P1 , Belch J2 , Ellis B3 , Raza Z4 ; 1 School of Health Sciences,
Queen Margaret University College, Edinburgh, UK; 2 University
Department of Medicine, Ninewells Hospital, Dundee, UK; 3 School
of Health and Social Care, Glasgow Caledonian University, Glasgow,
UK; 4 Vascular Surgery Department, Royal Infirmary, Edinburgh, UK
PURPOSE: A pilot study to assess pain and psychosocial factors
in Peripheral Arterial Disease (PAD) and to test these as baseline
measures for patient’s compliance with prescribed daily exercise for
PAD. RELEVANCE: Peripheral Arterial Disease (PAD) is a significant
cause of morbidity in the middle aged & elderly. Physical therapists
play a major role in the exercise management of patients with PAD yet
patient’s compliance with prescribed exercise in PAD is between 10%
and 50% and is therefore poor. This study examined IC (pain in the
calf while exercising), in detail, and investigated the potential need
for psychosocial screening, as a means of improving compliance
with exercise instructions in PAD. PARTICIPANTS: were thirty-one
out-patients with PAD. The average age was 70.5 years. Patients
were attending a vascular out-patient unit, or podiatry clinic. Each
had been prescribed daily walking for their condition. They were
included in the study if Ankle Brachial Pressure Index (ABPI) and
Edinburgh Claudication Questionnaire (ECQ) scores indicated stable
IC. METHODS: Participants consenting to a 40 minute interview
reported whether he / she continued walking after the onset of
calf pain. Self-rated measures were a 10 cm VAS scale of pain
intensity, the McGill Pain Questionnaire (MPQ), the Roland & Morris
Disability Questionnaire (RDQ), the Tampa Scale of Kinesiophobia
(TSK) and the Pain Self-Efficacy Questionnaire (PSEQ). Wording
on questionnaires was adapted to refer to leg pain. Three 10 cm
VAS scales measured frustration, anger and helplessness due to
calf pain. ANALYSIS: Measures of central tendency and correlation
analysis described average scores and relations between clinical
and psychosocial measures. The percent use of the MPQ word
list and average scores of the rank of words chosen gave a 20-
dimensional illustration of IC. T-test for independent samples tested
for significant (p < 0.05) differences between participants who did,
or did not, continue to walk with IC. RESULTS: Fifty-two percent
of participants stopped walking at the onset of IC. Average pain
severity in the calf (VAS = 5.31 +/− 1.64; MPQ-PRI = 25.29 +/− 10.4)
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
were negatively and significantly associated with high scores of
perceived disability (−0.737, p < 0.0001). A sub-group (N=13) was
revealed however, who had high scores of self-efficacy and who
continued to walk, despite similarly high levels of ABPI, pain and
fear of movement as ‘non-walkers’. CONCLUSIONS: Preliminary
results suggest that IC pain is severe and that cognitive-behavioural
factors linked with pain-related disability play a significant role in self-
reported walking behaviour with PAD. IMPLICATIONS: The results
have informed the development of a larger proposal to study the
psychological determinants of structured exercise behaviour in PAD.
They also support the inclusion of a wider range of psychosocial
measures of self-efficacy and related constructs such as acceptance
of pain. KEYWORDS: Compliance; Psychosocial; Peripheral Artery
Disease. FUNDING ACKNOWLEDGEMENTS: Supported by a
S269
grant from Queen Margaret University College Small Project Fund
(RDSSC/06/7).
ETHICS COMMITTEE: Lothian Research Ethics Committee
Research Report Poster Display
36-09 Monday 4 June 14:00
VCEC Exhibit Hall B & C
MODIFIED TIMED UP AND GO TEST FOR JAPANESE LIFE
STYLE
Fujita H, Shiomi T, Kaneko J, Maruyama H; International University
of Health and Welfare
PURPOSE: The ability to maintain dynamic balance control is critical
for the successful performance of most daily living. Timed up and
Go Test (TUG) is one of the widely used performance test for
dynamic balance ability. Standing-up from a floor is indispensable
activity for the Japanese lifestyle. TUG dose not reflect the Japanese
lifestyle. In this study, we designed a new performance test including
standing-up from floor modified from TUG. The purpose of the
present study was to determine the reliability and usefulness of
this newly developed performance test (Modified Timed up and
go test: MTUG). RELEVANCE: Dynamic balance ability is one
of the essential components of moter functuion and its evalution
prerequisite for the physical therapy intervention. PARTICIPANTS:
Ten elderly community-dwellers (Three males and seven females,
averaged age was 81.4 y.o.) participated in this study. METHODS:
Measurement items were TUG, MTUG, and walking time. We also
surveyed their style of the bedding and their usual life style (sitting
on floor or sitting on chair) at mealtime by using the questionnaire.
We divided them into two groups, Japanese style dwellers (JSD)
and Western style dwellers (WSD) as the results of questionnaire.
We conducted TUG according the original Podsiadlo’s method. We
measured MTUG as follows: subjects postured long sitting stand
up from floor, they walk toward a 3m ahead target and turn it, go
back to original position and sitting down on the floor. We measured
the required time for this series of motion by using the stopwatch.
Walking speed was calculated by the required time measured on
a 10m flat walkway at their comfortable speed. ANALYSIS: We
calculated the intra-rater coefficients and inter-rater coefficients as
a reliability of measurements. The significant differences of means
and deviations were determined by using the Mann-Whitney’s U test.
RESULTS: High reliability of measurements was obtained in MTUG
both ICC(3,1) = 0.83 and ICC(1,2) = 0.99. MTUG of WSD significantly
took much time compared with JSD at mealtime (p < 0.01). There
were no significant differences between JSD and WSD both in
10m walk speed and in TUG. CONCLUSIONS: MTUG has a high
reliability, and is a suitable performance test to evaluate mobility for
Japanese life style dwellers. IMPLICATIONS: This new performance
test is applicable for physical thrapy intervntion. KEYWORDS:
Timed up and Go Test,Modified Timed up and go test,performance
test. FUNDING ACKNOWLEDGEMENTS: This work was Unfunded.
CONTACT: hiroaki-f@iuhw.ac.jp
Research Report Poster Display
36-13 Monday 4 June 14:00
VCEC Exhibit Hall B & C
RELIABILITY AND VALIDITY OF A TIMED TWO-MINUTE
WHEELCHAIR TEST IN OLDER ADULT RESIDENTS OF
LONG-TERM CARE CENTRES
Connelly D, Pellegrino E, Hutchinson A, Lueck D, Richard J; School
of Physical Therapy, The University of Western Ontario, London,
ON, Canada
PURPOSE: To determine reliability and construct validity of a
timed two-minute wheelchair test (2MWCT) by long-term care (LTC)
residents who use a manual wheelchair for mobility. RELEVANCE:
Functional mobility measures usually have an ambulation component
making them inappropriate to assess mobility of those who are
S270
wheelchair dependent. In addition, existing wheelchair mobility
measures include tasks that do not reflect the daily activities or
the environments of older adult wheelchair-users. PARTICIPANTS:
Forty residents recruited from three LTC centres, who were 70 years
or older and able to self-propel their wheelchairs, were studied
(mean age = 86 ±7 years, 32 women). Eight subjects withdrew
for reasons unrelated to the study. METHODS: Subjects wore a
heart rate monitor and completed one practice and two measured
trials of the 2MWCT with each rater (intra-rater and inter-rater)
on two separate occasions one week apart (test-retest). Distance
travelled in two minutes, Borg Rating of Perceived Exertion, and
resting and maximum heart rates were collected for each trial. Energy
cost was calculated from the heart rate data. On a third occasion,
subjects completed two questionnaires, the Nursing Home Life Space
Diameter (NHLSD) and the Physiotherapy Functional Mobility Profile
(PFMP), and the Nursing Home Physical Performance Test (NHPPT)
in order to address validity of the 2MWCT. ANALYSIS: Descriptive
statistics for the group (mean + one standard deviation) were
calculated for each outcome. Intra-rater reliability was calculated from
a one-way repeated measures analysis of variance (RM ANOVA) and
reported as an intraclass correlation coefficient model 1,1 (ICC1,1).
Separate two-way RM ANOVAs were completed for inter-rater
reliability and test-retest reliability and reported as ICC2,1. Pearson r
correlations were used to describe the relationship between distance
wheeled and NHLSD, NHPPT, and PFMP, as well as the relationship
between the NHPPT quantitative and prompting scores. RESULTS:
Trial one of the 2MWCT showed excellent test-retest (ICC2,1 = 0.92,
0.83–0.96), intra-rater (ICC1,1 = 0.97-0.99, 0.92–1.0) and inter-rater
(ICC2,1 = 0.97, 0.94–0.99) reliability. For trial one, standard error
of measure was 4.16 m and the minimal detectable change was
11.50 m. The NHLSD and NHPPT fairly correlated with the 2MWCT,
r = 0.51 (p < 0.01) and r = 0.44 (p < 0.05), respectively. The NHPPT
quantitative score showed an excellent correlation with the NHPPT
prompting score (r = 0.85, p < 0.01). CONCLUSIONS: The 2MWCT is
a reliable outcome measure for functional mobility of older residents
of LTC centres who primarily use a wheelchair. Further investigation
of construct validity is warranted, in particular known groups,
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,
independent mobility, the effects of an intervention, and provide a
functional addition to qualitative measures. KEYWORDS: reliability,
validity, seated mobility. FUNDING ACKNOWLEDGEMENTS: This
work was unfunded. CONTACT: dconnell@uwo.ca
ETHICS COMMITTEE: Health Sciences Review Ethics Board, The
University of Western Ontario
Research Report Poster Display
36-17 Monday 4 June 14:00
VCEC Exhibit Hall B & C
CAN THE 8-FOOT WALK TEST REPLACE THE 20-FOOT WALK
TEST?
Newton R1 , Cromwell R2 , Klima D3 , Lidicker J4 ; 1 Department
of Physical Therapy, Temple University, Philadelphia PA, USA; 2
Physical Therapy Department, University of Texas Medical Branch,
Galveston TX, USA; 3 Department of Physical Therapy, University
of Maryland-Eastern Shore, MD, USA; 4 Center for Statistical
and Information Science, College of Health Professions, Temple
University, Philadelphia PA, USA
PURPOSE: To validate the 8-Foot Walk Test to assess velocity,
cadence and the Gait Stability Ratio. RELEVANCE: Impaired balance
and gait are two of the most significant risk factors for limited
mobility and increase risk of falls in older adults. Because the
practice of physiotherapy occurs in multiple settings and often times
where space is restricted, assessment of gait may not be practical.
There is a need to develop and validate a short walk test that
WCPT 2007, Research Reports
can be used in a variety of practice settings. A short walk test
documenting gait velocity and the Gait Stability Ratio can provide
insight balance instability during walking PARTICIPANTS: University
faculty, senior housing and assisted living facilities (n=107 mean age
= 80 +10 yrs) who were independent walkers, including those using
a cane or walker (AD), and received a score >3 on the Six Item
Mental Status. METHODS: Subjects received a brief demographic
questionnaire to self-report chronic conditions, health status and fear
of falling. Subjects then walked at their normal walking speed for a
minimum of 50 feet on a level surface. Start and stop lines were
marked on the floor and included 10 feet for the initial acceleration
phase and the deceleration phase. Expert recorders recorded the
time and steps to complete the 8-foot and the 20-foot distance.
The study was approved by the University’s Institutional Review
Board. ANALYSIS: Data were entered into SPSS 14.0 Statistical
Package. Descriptive statistics were used to characterize the sample.
Regression analysis was used to analyze the parameters of the walk
tests; cadence, velocity and Gait Stability Ratio (GSR). RESULTS:
The majority of subjects self-reported no problems with balance,
walking or strength, and 56% used an AD. The most common co-
morbidities were poor vision (93%) and arthritis (66%). The following
were significant (all p < 0.0001): Cadence 8-foot predicted 97% of
Cadence 20-foot = 0.969(Cadence 8-foot); Velocity 8-foot predicted
96% of PF Velocity 20-foot = 1.043(PF Velocity 8-foot); GSR 8-foot
predicted 98% GSR 20-foot = 0.95(GSR 8-foot). CONCLUSIONS:
When space limitations occur, the 8-Foot Walk Test can be used
in place of a longer walk test and values converted to the 20-
Foot Walk Test. IMPLICATIONS: Additional testing incorporating
clinical outcomes will occur in other practice settings to ensure the
validity of the 8-Foot Walk Test. Physiotherapists can use the 8-Foot
Walk Test when a longer walk test is compromised due to space
limitations as evidenced in the home setting, Emergency Department,
hospital room or other practice settings. KEYWORDS: older adults,
gait, assessment. FUNDING ACKNOWLEDGEMENTS: College of
Health Professions, Temple University, Philadelphia PA. CONTACT:
roberta.newton@temple.edu
ETHICS COMMITTEE: Temple University Institutional Review Board
Research Report Poster Display
37-21 Monday 4 June 14:00
VCEC Exhibit Hall B & C
AQUATIC RESPIRATORY EXERCISES IN THE RESPIRATORY
MUSCLE STRENGTH AND DYSPNEA OF SUBJECTS WITH
FIBROMYALGIA
Ritomy Ide M1 , Tanaka C2 , Borges Ferreira C3 , Chueire de Andrade
J M3 , Imai M3 ; 1 Division of Physical Therapy, University of the West
of Paraná, Brazil; 2 PhD, Division of Physical Therapy, School of
Medicine, University of Sao Paulo, Brazil; 3 Physical therapy student
PURPOSE: This study aims to identify changes in the respiratory
muscle strength and incidence of dyspnea in subjects with FM. It still
aims to verify the effects of an aquatic respiratory exercises program
in the respiratory muscle strength and dyspnea of these subjects.
RELEVANCE: There is no studies about respiratory exercises in sub-
jects with fibromyalgia. PARTICIPANTS: 35 women with fibromyalgia,
selected through interview. METHODS: 40 women with FM initiated
the study. The dyspnea was assessed through Visual Analogue Scale
(VAS) and the respiratory muscle strength through the measure
of the inspiratory and expiratory maximum pressures (IPmax and
EPmax), using a manovacuometer. The 40 women were randomized
into 2 groups (GA and GB). Thirty-five subjects concluded the
study (GA = 18, GB = 17). GA performed aquatic respiratory
exercises (4 times a week, 4 weeks, 1-hour each session) and GB
was the control group (subjects performed sedentary activities, as
lectures, once a week). ANALYSIS: Quantitative analysis: IPmax
and EPmax were compared with the expected to age, through
paired t-test. Baseline and post-test scores differences were also
analyzed through paired t-test. RESULTS: The average age of the
Poster Displays, Monday 4 June
subjects who concluded the study was 46.33±9.11years. Of these,
71.42% described some degree of dyspnea (mean = 3.97±3.07).
The IPmax and EPmax baseline scores were significantly lower
from the expected to the age in normal subjects (IPmax – mean
of 29.4±12.68 and 80.2±4.46, for found and expected, respectively;
EPmax – 41.4±23.51 and 77.7±5.56), with p = .001 for both IPmax
and EPmax. The maximum respiratory pressures did not improve
after exercise program (p = .0254 and 0.092 for IPmax and EPmax,
respectively). However, the dyspnea improved significantly post-test
(p = .040). It was not observed correlation between the changes in
the dyspnea with changes in IPmax (p = -.188) and EPmax (p = -
.196). CONCLUSIONS: The respiratory muscle strength is reduced
in subjects with FM. A high incidence of dyspnea is observed in these
subjects. The aquatic respiratory exercises reduces the dyspnea of
women with FM, although do not improve the respiratory muscle
strength in these subjects. IMPLICATIONS: The results of this study
justify aquatic respiratory exercises to subjects with fibromyalgia to
help in dyspnea control. It also proves that this kind of exercises are
not indicated to improve respiratory muscle strength in this subjects.
KEYWORDS: Aquatic exercise; Respiratory exercise; Fibromyalgia.
FUNDING ACKNOWLEDGEMENTS: This study did not receive
financial support. CONTACT: maizaide@hotmail.com
ETHICS COMMITTEE: This work was approved by the Ethic Comitee
of the University of the West of Paraná.
Research Report Poster Display
38-01 Monday 4 June 14:00
VCEC Exhibit Hall B & C
PHYSICAL ACTIVITY LEVEL NECESSARY TO PREVENT
DETERIORATION OF WALKING ABILITY IN PATIENTS OF
CHRONIC RENAL FAILURE ON MAINTENANCE HEMODIALYSIS
Kutsuna T, Matsunaga A, Nanri Y, Saitoh M, Yonezawa R,
Matsumoto T, Ishii A, Yamamoto K, Sato T, Sawairi T, Masuda T;
Graduate School of Medical Sciences, Kitasato University
PURPOSE: To prevent the deterioration of walking ability in the pa-
tients of chronic renal failure undergoing maintenance hemodialysis
(HD), it is essential to establish an appropriate exercise guidance
as well as medical management. The patients on HD are known
to have poorer physical activity (PA) as compared with healthy
sedentary adults, because HD imposed the restriction on the free
time available to them and induced dialytic symptoms. As the
evaluation of PA is meaningful for maintenance and improvement
in the motor function including walking ability, the present study
investigated PA level that prevented HD patients from reducing the
walking ability. RELEVANCE: The physical therapy was related to
a part of the preventive education in daily life for HD patients.
PARTICIPANTS: Thirty-seven male and 64 female HD patients,
63±11 years of mean age and 8.4±6.4 years of the duration on
HD, were divided into the following 2 groups according to PA time
(a total time during walking and running per day): group A (PA
time<60 minutes) and group B (PA time60 minutes). Moreover, each
group consisted of another subgroups: the patients performing the
home-based exercise training (exercise patients), and those who did
not any exercise (non-exercise patients). METHODS: The patients’
clinical characteristics including age, duration on HD, body mass
index, hematocrit and serum albmin were before the 6-month study
period. PA time and maximum walking speed (MWS) were measured
before and after the study period. PA time was recorded over a
week using an accelerometer (LifeCorder, Suzuken), and MWS was
measured as walking ability while the patient walked a distance of
10 meters at maximum walking speed. The home-based exercise
training program consisted of training with an elastic tubing and own-
weighted training, and was performed for 2 months. Physical therapist
adjusted the exercise intensity appropriately to suit the patients’ motor
function and condition. ANALYSIS: The clinical characteristics and
MWS were compared between the two groups using unpaired t-
tests. The correlation between PA time and MWS was evaluated
S271
statistically through Pearson’s correlation coefficient. The change in
MWS measured before and after the study period was analyzed using
two-way ANOVA. RESULTS: There were no significant differences in
the clinical characteristics between the 2 groups. MWS measured
was significantly lower in group A than that in group B (P < 0.01).
There was a significant and positive correlation between PA time
and MWS in group A before the study (r = 0.44, P < 0.01). MWS
decreased significantly after the study in non-exercise patients of
group A as compared with that before the study (P < 0.01), although
MWS showed no significant change in exercise patients. On the
other hand, there were no significant correlation between PA time
and MWS in group B before the study and no significant changes in
MWS before and after the study in both exercise and non-exercise
patients of group B. CONCLUSIONS: HD patients should maintain
the PA for 60 minutes and more a day as PA time, to prevent the
deterioration of walking ability. IMPLICATIONS: This study suggests
that physical therapists should evaluate PA level when educate HD
patients in daily life. KEYWORDS: physical activity, walking ability,
chronic renal failure. FUNDING ACKNOWLEDGEMENTS: None.
CONTACT: toshi_k_1981@yahoo.co.jp
ETHICS COMMITTEE: Ethics Committee of Kitasato University
Research Report Poster Display
39-09 Monday 4 June 14:00
VCEC Exhibit Hall B & C
EFFECTS OF PELVIC FLOOR EXERCISES WITH OR WITHOUT
ELECTRICAL STIMULATION AMONG FEMALE OLDER ADULTS
WITH URINARY STRESS INCONTINENCE
Meir J1 , Smudey J1 , Luyckx-Baestaens G2 , Village D1 ; 1 Andrews
University, Berrien Springs, MI, United States; 2 LB Physical
Therapy, St. Joseph, MI, United States
PURPOSE: The purpose of this study was to compare the effects
of pelvic floor exercises alone or in combination with electrical
stimulation in older adult females with urinary stress incontinence.
RELEVANCE: Urinary incontinence is becoming more prevalent in
a burgeoning older adult population. Physical therapists provide
conservative treatment, including exercise and electrophysical modal-
itites, to alleviate this problem. Very few studies have examined
the combined effects of using exercise and electrical stimulation
for the treatment of urinary incontinence. PARTICIPANTS: The
sample population was obtained from a outpatient clinic and included
35 females 55 years of age. All participants had a medical
diagnosis of urinary stress incontinence. Patients with other types
of urinary incontinence were excluded. Subjects were assigned to
either the exercise group or the exercise and electrical stimulation
group using a consecutive assignment strategy. METHODS: For
both groups, a completed bladder health questionnaire, protective
pads used (self-report), and EMG reading were collected during
the subject’s first and last sessions. The questionnaire consisted of
5 items, each with 5 force-choiced answers. For the biofeedback
EMG reading, a vaginal tube-like probe was used to assess
changes in pelvic floor musculature. Each group received education
regarding bladder irritants and home exercise along with 6 weeks
of treatment by a physical therapist. The home exercise program
consisted of completing quick and slow contractions of the pelvic floor
musculature. Subjects were instructed to perform quick contractions,
consisting of a 2-second hold followed by 4 seconds of relaxation,
and slow contractions consisting of a 5-second hold followed by 10
seconds of relaxation. During the first week, 5 repetitions of quick
and slow exercises were to be performed 4-6 times per day, and for
the remaining 5 weeks, 10-12 contractions of each were expected
to be performed 2-3 times daily. Proper technique of performance
of the exercise was ensured by a weekly session with the therapist;
compliance was encouraged by completing a daily exercise log. For
the exercise in combination with electrical stimulation group, electrical
stimulation was administered once per week for 15 minutes. An
intermittent 5 seconds on 15 seconds off cycle was used at 50 Hz
S272
and the amplitude was based upon patient tolerance. Prior to any
treatment, subjects read and signed an informed consent form after
opportunity was given for questions. Ethics approval was provided
by the Andrews University Institutional Review Board. ANALYSIS:
Descriptive, Independent t-tests, Repeated Measures ANOVAs,
Mann-Whitney U test, and Wilcoxin statistics were calculated.
RESULTS: The results of this study indicate that both treatment
groups showed improvement over time for each category, but
neither treatment group improved significantly more than the other
over time. CONCLUSIONS: Electrical stimulation provided as an
adjunct to pelvic floor exercises for the treatment of urinary stress
incontinence does not appear to enhance outcomes. The results
of this pilot study should be interpreted cautiously until a follow-up
studies with a larger participant pool is conducted. IMPLICATIONS:
Though electrical stimulation for stress incontinence may not be
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
funded. CONTACT: village@andrews.edu
ETHICS COMMITTEE: Andrews University Institutional Review
Board
Research Report Poster Display
39-13 Monday 4 June 14:00
VCEC Exhibit Hall B & C
DIASTASIS OF THE RECTI ABDOMINIS IN PREGNANCY: RISK
FACTORS AND TREATMENT
Lo T, Candido G, Janssen P; B.C. Women’s Hospital & Health
Centre, Vancouver, B.C., Canada
PURPOSE: The purpose of this study was to a) determine risk
factors for diastasis of the recti abdominis in pregnancy, b) to
describe an in-hospital and follow-up postpartum treatment program
and c) to ascertain factors modifying rate of recovery from diastasis.
RELEVANCE: Diastasis recti abdominis (DRA) is a condition in
which the rectus abdominis muscle bellies separate (widen) at
the midline along the linea alba. In pregnancy, a combination of
histochemical changes mediated by alterations in maternal hormones
and increased tension imposed by the expanding uterus predisposes
to separation. Diastasis can occur in varying degrees during
pregnancy and may not resolve spontaneously in the postpartum
period. Consequent lack of muscle integrity may lead to back
injury and cosmetic defects. Thus, it is important for this condition
to be recognized by physiotherapists and treated accordingly.
PARTICIPANTS: 55 cases were identified by physiotherapists from
routine testing of early postpartum women attending physiotherapy
classes and by referral from physicians and nurses and were defined
as women with a paplable midline gap of more than 2.5 cm. or
any visible bulging along the linea alba on exertion. METHODS:
This was a case-control study, done between 1992 and 1995,
comparing women with diastasis in a tertiary maternity centre with
the general hospital population. Data collection was retrospective
and utilized hospital records and physiotherapy records. ANALYSIS:
Cases and controls were compared on demographic and pregnancy
related factors using t-tests for continuous variables and chi-square
for dichotomous discrete variables. The type 1 error was set at
0.05. Contribution of factors influencing recovery time were analyzed
using linear regression analysis. This analysis addressed only
those patients who participated in the exercise program. RESULTS:
Women with diastasis were more likely to be older, of higher parity
(p < 0.001), have had twins, bigger babies, and birth by cesarean
section (p < 0.01). There was no difference in gravidity or weight
gain. Although differences did not reach statistical significance in this
small data set, our data suggest that earlier recovery may also be
associated with lower parity, singleton birth, weight gain under 35
pounds, birth of baby less than 3600 grams, increased activity levels
before, during, and after pregnancy, compliance with the treatment
WCPT 2007, Research Reports
program, time at initiation of treatment program, and severity of
diastasis. CONCLUSIONS: The identification of risk factors for
diastasis of the recti abdominis suggest the need for selected
screening in obstetrical populations. The condition is amenable
to treatment. Further study in a larger sample may delineate
factors which hasten recovery. IMPLICATIONS: Recognition, specific
management education, and appropriately modified exercise in
early postpartum period can hasten recovery and may reduce
the probability of recurrence. Recovery can be enhanced through
a regime of appropriate exercise prior to and during pregnancy.
KEYWORDS: diastasis recti abdominis, pregnancy, physiotherapy.
FUNDING ACKNOWLEDGEMENTS: Provided by B.C. Women’s
Hospital & Health Centre.
ETHICS COMMITTEE: B.C. Women’s Research Co-ordinating
Committee and University of British Columbia Ethics Committee
Research Report Poster Display
39-17 Monday 4 June 14:00
VCEC Exhibit Hall B & C
LOW-BACK PAIN ON PREGNANT WOMEN: INFLUENCE IN
CENTER OF PRESSURE DISPLACEMENT, PLANTAR PRESSURE
DISTRIBUTION, HEALTH AND FUNCTIONAL STATUS PROFILES
Rosado J1 , Cabri J2 ; 1 Caritas Diocesan of Coimbra, Portugal;
2 Faculty of Human Movement Studies, Technical University of
Lisbon, Portugal
PURPOSE: Low-back pain (LBP) occurs on the majority of pregnant
women. During pregnancy, women suffer physical, psychological
and social changes. These changes can interfere in balance and
plantar distribution and in health and functional status, which can
be influenced by LBP. The aims of this study were: to compare
pregnant women with (WLBP) and without low-back pain (wLBP)
for center of pressure (COP) displacement, plantar pressure (PP)
distribution and health status profile; to characterize pregnant women
WLBP for functional status profile. RELEVANCE: This study can
be relevant for physical therapy because none of the previous
studies about LBP on pregnant women examine COP displacement
and PP distribution. Additional information on health and functional
status can help to understand the influence of LBP on pregnant
women. PARTICIPANTS: Forty four volunteer women on the third
trimester of pregnancy took part (gestation: 34.55±3.57 weeks; age:
27.38±5.04 years; wLBP: 27, WLBP: 17). METHODS: Pregnant
women completed Medical Outcomes Study – 36 item Short Form
(MOS SF-36) and Roland-Morris Questionnaire (RMQ) to collect
data on health and functional status (RQM was complete only
by women WLBP). A pressure platform (FootScan) was used to
collect data on COP displacement (bi/unipodal) and PP distribution
(static/dynamic). ANALYSIS: Mann-Whitney test was performed to
compare pregnant women WLBP and wLBP for kinetic variables of
COP displacement and PP distribution and for profile of health status.
Significance level was set at p < 0.05. Profile of functional status
was analyzed with descriptive statistics. RESULTS: The presence
of LBP doesn’t interfere with COP displacement (uni/bipodal) neither
with PP distribution on static bipodal support. The PP distribution on
dynamic bipodal support was significantly different between groups:
the WLBP group present larger time of contact under hallux of left
foot (p = 0.007); higher load rate under first metatarsal head of left
foot (p = 0.015); lower peak pressure under fifth metatarsal head of
right foot (p = 0.017) and higher peak pressure under hallux of left
foot (p = 0.005). Women WLBP had lower levels of health status only
on vitality (p = 0.002) and mental health (p = 0.003) dimensions of
MOS SF-36. Pregnant women WLBP presented a lower limitation
level of functional status (RMQ = 7.19±3.97). CONCLUSIONS:
On the third trimester of pregnancy, the presence of LBP doesn’t
appear to interfere with COP displacement and PP distribution on
static bipodal support. By the contrary, LBP seems to influence
the PP distribution on dynamic bipodal support. LBP seems to
negatively influence only vitality and mental health dimensions of
Poster Displays, Monday 4 June
health status. Women WLBP doesn’t appear to have significant
restrictions on functional status. IMPLICATIONS: The generated
knowledge can be useful for physical therapists to improve prevention
and intervention strategies in pregnant women. KEYWORDS: Low-
back pain, pregnancy. FUNDING ACKNOWLEDGEMENTS: The
work was unfunded. CONTACT: jcorosado@yahoo.com
ETHICS COMMITTEE: Scientific Board of the Faculty of Human
Movement Studies, Technical University of Lisbon
Research Report Poster Display
01-15 Monday 4 June 15:30
VCEC Exhibit Hall B & C
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
Health Network, Toronto Canada; 2 University Health Network,
Toronto Canada; 3 University Health Network, Toronto Canada;
4 University Health Network, Toronto Canada; 5 University Health
Network, Toronto Canada
PURPOSE: To determine current mobilization practices of physical
therapists (PTs)working with patients with indwelling femoral lines,
and to make recommendations regarding promoting safe practices for
healthcare professionals working with this population. RELEVANCE:
In clinical practice, early mobilization in patients with indwelling
femoral lines may be delayed due to the belief that mobilization
may result in perforation of the vessel, movement of the line,
and/or dislodgement of the line. While there is little reported in
the literature to support or restrict mobilization in this population.
PARTICIPANTS: A sample of convenience consisting of PTs from
33 healthcare facilities in Ontario (response rate = 87.8%) and
17 PTs from our facility completed a questionnaire regarding their
mobilization practices in patients with indwelling femoral lines.
METHODS: An electronic questionnaire, and follow-up email three
weeks later to non-responders, was sent in January 2006. The
questionnaire solicited information on demographics, characteristics
of current working environments, current mobilization practices with
four femoral lines (arterial, central venous, rigid and semi-rigid
vascular catheters) issues, concerns and rationale supporting current
practice. ANALYSIS: Descriptive statistics were used to characterize
the demographic profile and mobilization practices of the subjects.
Differences in mobilization practices between PTS at our facility and
facilities external to UHN were compared using analysis of variance.
RESULTS: The majority of respondents were female (76.5%), had
received Baccalaureate degrees (82.4%), worked full-time (97.5%),
had over ten years of work experience (53.2.1%) and worked in
large (>300 beds) community hospitals (76.7%) or teaching hospitals
(23.3%). Approximately half of respondents practiced in the MSICU.
Almost all of the PTs reported working with patients with arterial lines
(88%) and central venous lines (96%) but less so with rigid (53%)
and semi-rigid (69%) vascular catheters. Although over 50% reported
mobilizing patients by dangling, transfering, and hip range of motion
(ROM) up to 90º with all lines except the rigid vascular catheter
there was a significantly higher percentage of PTs from teaching than
community hospitals that engaged in these types of mobilizations. Of
the factors guiding clinical practice, the majority cited safety concerns
and clinical experience. For those respondents in teaching hospitals
evidence from the literature (11.5%) and a previous critical incident
(23.8%) were cited as factors influencing practice. Physiotherapists
believed that line occlusion, breaking and shifting, as well as
internal/external bleeding, present safety concerns when mobilizing
patients with indwelling femoral lines. There were no between
group (hospital type or line type) differences. CONCLUSIONS:
There appears to be some differences in practice of mobilizing
patients with indwelling femoral lines in teaching and community
facilities. In general PTs in teaching hospitals may implement more
aggressive practices (i.e. a higher percentage do more mobilization)
and have few safety concerns than those in community hospitals.
S273
IMPLICATIONS: To maximize the safety of these mobilization
practices, patients should be screened by the healthcare team for
cognitive status and overall medical condition. Furthermore, proper
orientation and education about the structure, purpose, and inherent
risks of each type of femoral line should be encouraged for all
healthcare professionals to increase the practice of mobilization.
KEYWORDS: mobilization practices; physical therapists; intensive
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: nathalie.cote@uhn.on.ca
ETHICS COMMITTEE: Research Ethics Board, University Health
Network; Research Ethics Board, University of Toronto
Research Report Poster Display
01-19 Monday 4 June 15:30
VCEC Exhibit Hall B & C
RESPIRATORY MUSCULAR ELECTROMYOGRAPHIC ACTIVITY
DURING THE ERGOMETRIC TEST AND RESPIRATORY
ENDURANCE
Costa D, Riedi C, Bueno Tesch C, de Jesus Guirro R; Methodist
University of Piracicaba, Piracicaba, Brazil
PURPOSE: The purpose of this study was to compare the
electromyography respiratory muscular action during the respiratory
muscular endurance test (RMET) and during an ergometric test (ET).
RELEVANCE: The electromyography exploration of the respiratory
muscles during physical effort has been an important object of study
to elucidate the respiratory functional evaluation of these muscles
and for its application on the clinical practice area. PARTICIPANTS:
A total of 28 volunteers participated of the study (12 men and
16 women), sedentary, no smoking, and without a history of
cardiopulmonary diseases. METHODS: The electric activity of the
respiratory muscles was analyzed by an EMG 100 module for
capturing signal (Lynx, Brasil). Three bipolar active surface electrodes
coming out of two Ag/AgCl bars were used with a 2000Hz frequency
range. The electrodes were positioned: between the mandible angle
and the earlobe, at the muscular womb of the sternocleidomastoid
muscle, 4cm bellow the mastoid process at the third intercostals
space, 3 cm paraesternal, to the external intercostals muscle and at
the seventh intercostals space of the mammilar line to the diaphragm
muscle. The RMET were prepared with an IMT® threshold and the
volunteers initiated the test with a load of 30% of the maximum
inhalation pressure, with increments of 5 cmH2O on every 2 minutes.
The ET was prepared in a Monark® ciclergometer, with a degree
protocol and increments of 25 watts. The electromyography data
analysis was applied during the initial rest, at the beginning of
the test, at 50% and 100% of the test and on the final rest.
The RMS (mV) value of the signals were normalized by the peak.
ANALYSIS: After the normality analysis of the data, it was applied
the Wilcoxon procedure to compare the different results of the tests.
RESULTS: Despite observing an increase on the RMS value with
the load increasing, on both of the tests, it was noticed that on
the RMET this increase was higher than the one on the ET, for all
the muscles, highlighting the sternocleidomastoid muscle that, on
the maximum off the exercise, showed an RMS of 0.10±0.05 mV
on the ET, while 0.15±0.03 mV on the RMET. CONCLUSIONS:
Facing these results, it was concluded that the respiratory muscles
are more demanded during specific exercises, such as the RMET,
than during general exercises, like the ET. IMPLICATIONS: It was
also noticed that the accessories muscles are more requested than
the rest, on the physical effort. KEYWORDS: electromyography,
respiratory muscles, ergometric test, respiratory endurance test.
FUNDING ACKNOWLEDGEMENTS: CAPES/Prosup. CONTACT:
dcosta@unimep.br
ETHICS COMMITTEE: aproved by the Ethical Comitte of the
Institution, protocol 98/04
S274
Research Report Poster Display
01-23 Monday 4 June 15:30
VCEC Exhibit Hall B & C
CAN THE PAO2/FIO2 RATIO INFORM CLINICAL REASONING
FOR REHABILITATION IN THE GENERAL INTENSIVE CARE
UNIT?
Thomas A1 , Tose D3 , Mill L2 , Sirivol S1 , Reffold O1 ; 1 King George
Hospital, Ilford, United Kingdom; 2 The Wellington Hospital, St Johns
Wood, United Kingdom; 3 Kings College, London, United Kingdom
PURPOSE: An evidence base for the initiation of rehabilitation
in critically ill patients does not exist, although several guidelines
for “safe” mobilisation have been published. In one guideline, a
PaO2/FiO2 ratio greater than 300 is suggested when determining
respiratory reserve for exercise in the critically ill patient. The purpose
of this analysis was to determine the incidental PaO2/FiO2 ratio
associated with rehabilitation tasks performed by patients in a general
Intensive Care Unit. RELEVANCE: There are no published reports
interpreting the PaO2/FiO2 ratio prior to rehabilitation of the critical
ill patient. This quantitative analysis will identify the ability of the
PaO2/FiO2 ratio to inform clinical practice and benchmark PaO2/FiO2
values for a variety of rehabilitation tasks commonly performed with
the critically ill. PARTICIPANTS: 45 patients (mean age 63±17.5yrs)
admitted consecutively to the general Intensive Care Unit over a
4-month period were included in the analysis. METHODS: Data
was collected regarding all physiotherapy sessions during a 4-month
period, consisting of the mode of ventilation, PaO2 and FiO2 prior
to treatment and rehabilitation task performed (positioning, passive
movement, active limb exercises, sitting on bed edge, standing
transfers, hoist transfers and walking). ANALYSIS: Descriptive statis-
tics were calculated describing the incidence of each rehabilitation
activity as a percentage of the total sessions. The mean, standard
deviation and range (min & max) of pre treatment PaO2/FiO2 ratios
(mmHg) were calculated for each rehabilitation task. RESULTS: 287
individual treatment sessions were analysed. No adverse events were
recorded during any rehabilitation activity. 70% of the treatments
included body positioning yielding a mean (±SD) PaO2/FiO2 ratio
of 253±125 (range 74–821). Passive movements (50%) recorded
the lowest mean PaO2/FiO2 ratio (237±146, range 74-689), and
active movements (35%) a mean ratio of 301±133 (range 106–821).
Sitting on the bed edge (10%) was performed with a mean ratio
of 276±148 (range 136–821), while participation in a hoist transfer
(9.5%) was 279±98 (range 155–489). Standing transfers revealed
the highest mean ratio (317±146, range 136-689) and walking was
performed with a mean PaO2/FiO2 ratio of 282±86 (range 158–476).
The minimum PaO2/FiO2 ratio data showed a tendency to be lowest
for positioning and passive movement (74), greater than 130 in all
activities requiring weight bearing and highest (158) in patients who
could mobilise. CONCLUSIONS: While the mean PaO2/FiO2 ratio
associated with rehabilitation tasks reflected little overall differences
and a wide range of scores, the clinically relevant values were
the minimum PaO2/FiO2 ratios observed. Active rehabilitation tasks
were successfully initiated when PaO2/FiO2 ratio’s were greater
than 130 while walking was initiated when the ratio exceeded 150.
IMPLICATIONS: Rehabilitation activities were successfully initiated
in the patient with critical illness when the PaO2/FiO2 ratio was
less than 300. The minimum PaO2/FiO2 ratio data reported may be
used for the preparation of evidence-based guidelines that inform the
clinician when reasoning the safety of rehabilitation in the critically
ill patient. KEYWORDS: PaO2/FiO2 ratio,Rehabilitation,Intensive
Care. FUNDING ACKNOWLEDGEMENTS: Nil. CONTACT: midaz_
europe@hotmail.com
WCPT 2007, Research Reports
Research Report Poster Display
03-03 Monday 4 June 15:30
VCEC Exhibit Hall B & C
BREATHING EXERCISES FOLLOWING GASTROPLASTY:
ANALYSIS OF BREATHING PATTERN AND
THORACOABDOMINAL MOTION
Tomich G1 , França D2 , Britto R3 , Sampaio R3 , Diniz M4 , Franco
Parreira V3 ; 1 Master Program at the Federal University of Minas
Gerais, Belo Horizonte, MG, Brazil; 2 Physiotherapist; 3 Physical
Therapy Department at the Federal Univsersity of Minas Gerais,
Belo Horizonte, MG, Brazil; 4 Surgery Department at the Federal
Univsersity of Minas Gerais, Belo Horizonte, MG, Brazil
PURPOSE: To evaluate breathing pattern and thoracoabdominal mo-
tion in subjects with obesity after gastroplasty during three breathing
exercises: diaphragmatic breathing (DB), incentive spirometry (IS)
with a flow-oriented device (Triflo II) and IS with a volume-oriented
device (Voldyne). RELEVANCE: Breathing exercises based on deep
and slow inspirations are frequently used in chest physiotherapy for
treatment of patients during post-operative period. Besides many dif-
ferents regimes of treatment have been used, there is still no specific
and universally acceptable therapeutic concept. PARTICIPANTS:
Twenty-four subjects (18 women, 6 men), aging 37 ±11 years (mean
±standard deviation), with obesity levels II and III, and body mass
index of 44 ±3 Kg/m2 were studied on second post-operative day.
METHODS: Sample size of 23 participants was calculated based
on pilot study performed with the first ten subjects; taken into
consideration the level of significance of 0.05 and the power of 0.80.
Respiratory inductive plethysmography was used to measure volume
and time components of breathing pattern and thoracoabdominal
motion. The following variables were analyzed: tidal volume (Vt),
respiratory frequency (f), minute ventilation (VE), inspiratory time
(Ti), expiratory time (Te), respiratory total time (Ttot), inspiratory duty
cycle (Ti/Ttot), mean inspiratory flow (Vc/Ti), rib cage contribution
to Vt (RC/Vc), inspiratory phase relation (PhRIB), phase angle
(PhAng) and labor breathing index. ANALYSIS: For comparisons
between rest breathing (baseline) and breathing exercises periods,
ANOVA for repeated measures followed by pairwise comparisons
was used, when data distribution was normal, or Friedman test
followed by Wilcoxon, when distribution was not normal. Level of
significance was set at 0.05, with Bonferroni corrections to adjust
this level according to number of comparisons performed. RESULTS:
Comparisons between baseline and breathing exercises periods
showed an increase in Vt and a decrease in f during all exercises,
with an increase in VE only during exercise with Triflo II (p < 0.008).
There was increase in Ti during DB and Voldyne, in Te and Ttot during
all exercises, and in Ti/Ttot during exercise with Voldyne(p < 0.008);
in the comparisons between exercises, there were a higher Vt during
IS compared to DB, a lower f during Voldyne compared to Triflo II
and a higher VE during IS compared to DB (p < 0.008). There were
a higher Ttot during Voldyne compared to Triflo II and a higher Vt/Ti
during Triflo II compared to DB (p < 0.008). Comparisons between
baseline and exercises did not showed significant changes in RC/Vt
and labor breathing index. Considering PhRIB and PhAng, variables
of thoracoabdominal asynchrony, there were an increase in PhRIB
during DB and Triflo II and an increase in PhAng during IS compared
to baseline (p < 0.008). Comparisons between exercises with respect
to thoracoabdominal motion showed no significant differences.
CONCLUSIONS: Considering variables analyzed during breathing
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
Poster Displays, Monday 4 June
Spirometry. FUNDING ACKNOWLEDGEMENTS: Partly supported
by CNPq and CAPES, Brazil. CONTACT: parreira@ufmg.br
ETHICS COMMITTEE: University Federal of Minas Gerais Ethics
Research Committee approved the study and all subjects gave
written informed consent.
Research Report Poster Display
06-07 Monday 4 June 15:30
VCEC Exhibit Hall B & C
THE REINFORCEMENT OF DELIVERING CLINICAL SKILLS
ONLINE WITH BLENDED LEARNING ACROSS DIFFERENT
HEALTH DISCIPLINES
Younis A1,2 ; 1 St. George’s, University of London; 2 Faculty of Health
and Social Care Sciences, Kingston University
PURPOSE: Demand for educating health professionals for teamwork
is increasing. In order to achieve effective, efficient education,
emphasis should be placed on initiatives to reach large groups of
students, across disciplines. Clinical skills are a major part of the
curriculum in all health care sciences. Time needed for preparation
and teaching is vast, especially when sessions need to be repeated
to reach increasing large cohorts of students. Extensive resources,
including personnel, are also required. An added difficulty is the acute
lack of clinical placements and limitations on the choice of suitable
patients. The purpose of this study is to evaluate the suitability of
online and blended learning delivery methods for teaching clinical
skills across different disciplines. RELEVANCE: Blended learning
is a combination of clinical skills teaching online and face to
face clinical skills sessions. Online learning reduces repetition of
classes and enables students access to materials for revision.
PARTICIPANTS: 54 students from the 2 different disciplines at St
Georges University London and the Faculty of Health and Social Care
Sciences at Kingston University participated in the study. METHODS:
Clinical skills designed to be used initially by physiotherapy and
paramedic students were delivered online and by traditional face-
to-face techniques. A questionnaire in a Likert Scale format was
distributed to all year 1 physiotherapy and paramedics students to
obtain their views. ANALYSIS: Non-parametric statistics included
Mann-Whitney U test and cross tabulation to establish the difference
and/or agreement between Physiotherapy and Paramedics students,
as well as frequency distribution, minimum and maximum, range,
mean and standard deviation (SD). The data was analysed using the
Statistical Package for Social Sciences (SPSS) version 13. The level
of significance was calculated at 5% (0.05), where if the P value is
more than (P > 0.05) the results will not be significant. RESULTS: In
general the majority (n=36, 66.7%) of the participants agreed that
online Clinical Skills were “very beneficial for my clinical education”,
and a minority (n=12, 22.2%) held a neutral opinion. Overall, it was
clear that there was no statistically significant difference between
the disciplines (P > 0.05) except for the variable “Online skills helped
me to answer the relevant questions in my practical exam”, where
P=0.001 (<0.05). CONCLUSIONS: Online Teaching can be used as
a means to enhance the acquisition of Clinical Skills. The results
reported here show agreement between both groups of students
that online skills should be delivered in a blended learning format.
They did not want the number of face-to-face classes decreased
and wanted to keep the online information for revision and future
reference. They were very satisfied with the design and delivery
of the shared modules. IMPLICATIONS: The implication of this
study concerns the provision of support study materials which are
available to students at any time, via the intranet. These materials
are accessible to students wherever they are and enable them to
revise clinical skills, supported by photographs. They may also be
used by students from a range of disciplines, which will decrease
the number of lecturers who are involved of the delivery of clinical
skills. KEYWORDS: Blended learning, clinical skills, e-learning,
S275
interdisciplinary education. FUNDING ACKNOWLEDGEMENTS:
none. CONTACT: ayounis@hscs.sgul.ac.uk
ETHICS COMMITTEE: Full ethical approval was given by the Faculty
of Health and Social Care Sciences ethics committee.
Research Report Poster Display
07-19 Monday 4 June 15:30
VCEC Exhibit Hall B & C
EFFECTS OF RANDOM APPLICATION OF CIRCUMFERENTIAL
PRESSURE AND TENS ON MOTONEURONE EXCITABILITY IN
NORMAL HUMAN SUBJECTS
Kennedy E1 , Wood L2 , Nicol J2 ; 1 Division of Physiotherapy,
School of Health and Social Care, Glasgow Caledonian University,
Glasgow, Scotland, UK; 2 Department of Biological and Biomedical
Sciences, School of Life Sciences, Glasgow Caledonian University,
Glasgow, Scotland, UK
PURPOSE: To investigate the effects of non-noxious cutaneous
stimulation on the excitability of the motoneurone pool of triceps
surae. RELEVANCE: Following an Upper Motor Neurone Lesion
(UMNL), the excitability of the motoneurone pool is increased,
resulting in increased muscle tone. We have previously demonstrated
that pressure, applied circumferentially around the lower limb can
alter reflex excitability in neurologically intact subjects. In the current
study we investigated whether similar effects are produced when
pressure is applied in a non-incremental fashion and also compared
the effects of pressure application with transcutaneous electrical
nerve stimulation (TENS). This may be of relevance in treating
increased muscle tone in subjects with spasticity. PARTICIPANTS: A
convenience sample of 22 neurologically intact individuals between
the ages of 20 and 60 years were recruited. Local ethical approval
was obtained and all provided informed consent. METHODS:
The tibial nerve was stimulated in the popliteal fossa with a
1ms pulse duration at 1.1 times the H-reflex threshold. Surface
electromyographic recordings were recorded from the skin overlying
the lateral head of gastrocnemius. H-reflexes were elicited every 10s
and their amplitude recorded. Circumferential pressure was applied
for 90s around the lower right leg, using a blood pressure cuff, to
magnitudes of 20, 40, 60 and 80mmHg in a pseudo-randomised
order. Control measures of H-reflex amplitude were obtained prior to
application of pressure. H-reflex amplitude was also measured upon
pressure release. In addition, high frequency, low intensity TENS
was applied for 20 minutes to the skin overlying the triceps surae,
distal to the stimulating and recording electrodes. During this time, at
5 minute intervals, H-reflexes were elicited and amplitude recorded
10 times at a frequency of 0.1Hz. Control H-reflex amplitudes were
recorded prior to and 5 minutes after the TENS. ANALYSIS: The
mean amplitude of the H-reflex was calculated for each test period
for each subject and expressed as a percentage of the control.
An ANOVA was performed on the mean H-reflex for each pressure
condition / TENS time frame. RESULTS: When pressure was applied,
there was a progressive decrease in mean H-reflex to 52% of the
control values. This occurred under the highest pressure magnitude,
regardless of the order in which the pressure was applied and
was significantly different to the H-reflex amplitude obtained under
20mmHg (p = 0.002). When TENS was applied, a decrease in mean
H-reflex amplitudes was also observed, to 86% of control values at 20
minutes. However this was not related to the length of time of TENS
stimulation (p = 0.458). CONCLUSIONS: Circumferential pressure
applied to the lower limb had an inhibitory effect on motoneurone
pool excitability: the greater the pressure magnitude, the greater the
effect. However, the effect of TENS on motoneurone excitability was
not conclusive as a method of inhibiting motoneurone excitability.
IMPLICATIONS: These results support and expand on our previous
research proposing the use of circumferential pressure as a method
of reducing motoneurone excitability and therefore muscle tone in
S276
patients with spasticity. KEYWORDS: motoneurone; pressure; TENS.
FUNDING ACKNOWLEDGEMENTS: None.
ETHICS COMMITTEE: Glasgow Caledonian University Ethics
Committee. Glasgow Caledonian University, Glasgow, G4 0BA.
Scotland
Research Report Poster Display
07-23 Monday 4 June 15:30
VCEC Exhibit Hall B & C
PAIN RELIEF IN LABOUR BY TRANSCUTANEOUS ELECTRICAL
NERVE STIMULATION: A RANDOMIZED CONTROLLED TRIAL
Racunica K1 , Scepanovic D1 , Premru Srsen T2 , Zgur L2 ; 1 University
of Ljubljana, College of Health Studies, Department of Physiotherapy,
Ljubljana, Slovenia; 2 University Medical Centre Ljubljana,
Department of Obstetrics and Gynaecology, Ljubljana, Slovenia
PURPOSE: For several years Transcutaneous Electrical Nerve
Stimulation (TENS) has been used in the management of chronic
and acute pain. The aim of this randomized controlled trial was to
determine its effectiveness in providing pain relief during labour.
RELEVANCE: To date, there is no ideal analgesic that can give
complete relief of pain during labour without risking complication.
PARTICIPANTS: The study population included 145 pregnant women
(mean age of 29.8±4.2 years) in the hospital antenatal classes of
Dept of Obst & Gynecol at University Medical Centre in Ljubljana
during the period of two months. PARTICIPANTS: The study
population included 145 pregnant women (mean age of 29.8±4.2
years) in the hospital antenatal classes of Dept of Obst & Gynecol
at University Medical Centre in Ljubljana during the period of two
months. METHODS: Women were randomly allocated by use of
sealed envelopes into 2 groups. The experimental group (receiving
TENS by burst – conventional obstetric TENS device) and the
control group (not receiving TENS) consisted of 77 and 68 women
respectively. Pain medication was allowed in both groups on request.
All women were asked to rate the pain half-hourly according to
the visual analogue scale. The marking took place between the
contractions. The questionnaire was completed by women two
day postpartum. This study was approved by the National Ethics
Committee of Slovenia. ANALYSIS: Statistical analysis included Chi-
square tests, Student’s t-test, Mann-Whitney test, Wilcoxon test and
Spearman’s correlation. The level of significance was set at 0.05.
RESULTS: Women in each group were comparable in age, length
of gestation, birth-weight, parity, the amount of cervical dilatation
on admission to labour word, and surgical induction rate. Other
data collected showed no significant differences in length of labour,
number of obstetrics interventions, and Apgar scores between the
two groups. There was no difference in the intensity of pain recorded
by each group and incidence of epidural analgesia. There was
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
amount of analgesics administered to individual women (p = 0.002).
In the experimental group all women would ask for TENS again
during their next labour. CONCLUSIONS: TENS could statistically
significant reduce the amount of medication necessary and hence
the side effects to mother and child. Nevertheless, there is a
clear necessity for more precisely designed randomized controlled
trials to determine effectiveness of TENS in labour pain. The
results of this study showed that TENS analgesia is compatible
with nursing practice in a public hospital. The study failed to
demonstrate lower pain scores in the experimental group when
compared with the control group. IMPLICATIONS: TENS is going
to take its place in a public hospital labour ward beside other
forms of pain relief available to women in labour. KEYWORDS:
Transcutaneous electrical nerve stimulation; Labour; Pain. FUNDING
ACKNOWLEDGEMENTS: None. CONTACT: karolina.r@email.si
ETHICS COMMITTEE: National Ethics Committee of Slovenia
WCPT 2007, Research Reports
Research Report Poster Display
09-03 Monday 4 June 15:30
VCEC Exhibit Hall B & C
LYMPHEDEMA EDUCATION IN PHYSICAL THERAPY
PROGRAMS
Rinehart-Ayres M, Dinkel E, Donohoe K, Goodman J, Hartman J;
Thomas Jefferson University, Jefferson College of Health
Professions, Philadelphia, PA USA
PURPOSE: The purpose of this study was to determine what
principles of lymphedema and lymphedema management are taught
in accredited entry-level physical therapy education programs and
to determine if there is a difference between programs awarding
an entry-level masters degree and those awarding an entry-
level doctorate in physical therapy. RELEVANCE: Graduates of
physical therapist educational programs are expected to have basic
knowledge and skills to enable them to provide care for individuals
with lymphedema. At this time it is unclear what is being taught
about this condition in Masters and DPT educational programs.
PARTICIPANTS: One hundred ninety eight accredited Physical
Therapy programs in the United States were asked to participate
in the study. METHODS: The Directors of the Programs were sent
survey questionnaires, via email. Completion of the demographic
questionnaire and a lymphedema questionnaire provided consent
to participate in the study. The questions were divided into the
following five categories: anatomy and physiology, pathophysiology,
exam/assessment, interventions, and training. Respondents were
not made aware of the categories ANALYSIS: Frequency of yes
responses were counted and converted into percentages. RESULTS:
Thirty-four percent of physical therapy programs participated in the
study, 58% Masters and 42% DPT. There was only a significant
difference between the Masters and DPT programs in the category
of Anatomy and Physiology, with Masters Programs addressing this
more often. There were no significant differences between the two
types ofeducational programs in the 4 subcategories of functional
outcomes, skills, innovative techniques or traditional techniques.
CONCLUSIONS: Although there was little difference between
Masters and DPT Programs in the educational content related to
lymphedema, our findings suggest that the majority of programs
are providing graduates with a sound knowledge base about
lymphedema in all five categories. Less than 60% of the programs are
teaching students the manual skills necessary to treat patients with
lymphedema. However, this is a positive trend and demonstrates an
overall improvement in the training of physical therapy students when
compared to a study of educational programs done by Augustine,
et al seven years ago. IMPLICATIONS: All graduates from physical
therapy programs have not been taught the manual skills necessary
to treat patients with lymphedema. KEYWORDS: Lymphedema,
education. FUNDING ACKNOWLEDGEMENTS: N/A. CONTACT:
margaret.ayres@jefferson.edu
Research Report Poster Display
09-07 Monday 4 June 15:30
VCEC Exhibit Hall B & C
LOW INTENSITY PULSED ULTRASOUND CAN ACCELERATE
OSTEOGENIC POTNTIAL OF HUMAN BONE-MARROW-DERIVED
MESENCHYMAL STEM CELLS
Okubo A, Ishikawa M, Yasunaga Y, Mochizuki Y, Ochi M;
Department of Orthopaedic Surgery, Graduate Scool of Biomedical
Sciences, Hiroshima University, Hiroshima, Japan
PURPOSE: Low intensity pulsed ultrasound (LIPUS) is an es-
tablished therapy for fracture repair and distraction osteogenesis.
Despite its pronounced osteogenetic effects on osteoblastic cells,
the underlying mechanisms of action of LIPUS remain unclear. The
purpose of this study was to determine the effect of LIPUS on
differentiation of human bone-marrow-derived mesenchymal stem
cells (hMSCs) defined as osteogenic precursor cell. To verify this
Poster Displays, Monday 4 June
osteogenetic effect, mRNA expression of cellular phenotype-specific
markers characterizing osteoblasts was studied using real-time PCR
analysis. RELEVANCE: LIPUS has been used as an available
physical therapy procedure targeting bone formation. This study
can provide an important evidence to support the therapeutic
effect of LIPUS by understanding the action mechanism in vitro.
PARTICIPANTS: After informed consent, human mesenchymal stem
cells (hMSCs) were derived from adult donor bone marrow as
osteogenic precursor cell. METHODS: Mononuclear cells were
isolated and expanded in vitro. The cells were followed by passages
3 times. The purity and characteristics hMSCs were confirmed
by flow cytometry. Before treatment, the hMSCs were seeded at
6 well plates and cultured in Dulbecco’s Modified Eagle Medium
with 10% fetal bovine serum and 0.5% antibiotic for one day
to facilitate their attachment. The cell density was unified to
3.0×104 cells per well. Then, we exchanged the medium with
the osteogenesis-induced medium and started LIPUS exposure or
sham exposure for 20 minutes per day for a period of 7 or 14
days. The expression of following genes associated with osteoblast
differentiation by real-time PCR analysis: osteocalcin, ALP, Runx2,
Dlx3 and Dlx5. ANALYSIS: Statistical significance was determined
using Bonferroni’s modification of Student’s t-test. The level of
significance was set at 0.05. RESULTS: We confirmed that the
major populations of adherent cells used in this study were MSCs.
Flow cytometric analysis demonstrated that the bone marrow-MSCs
were CD44 and CD105 positive, but were negative for AC133,
CD34, CD45, CD14 and CD271. These results were consistent
with the properties of the documented bone marrow-derived MSCs.
The expression of Dlx3 mRNA was up-regulated to about fivefold
at 7 days and about threefold at 14 days by LIPUS treatment
(P < 0.05). In addition, ALP and Runx2 gene was also significantly
upregulated by the treatment at 14 days. CONCLUSIONS: Dlx
genes are key-players of development and have also been pos-
tulated to regulate cell differentiation in skeleton including bone.
In vertebrates, Dlx3 is expressed in skeletal progenitor cells to
promote osteoblast differentiation among the Dlx family. Our findings
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-
fos and COX-2, expressed by transduction of mechanical stress.
Although this process is referred the primitive response arisen by
extracellular stimuli, our findings suggest that another cascade or
mechanisms can exist in pathway of this appreciation. This is the
first and meaningful study to identify the expression of Dlx genes
following LIPUS exposure during human osteoblast differentiation.
IMPLICATIONS: For physical therapy practice. KEYWORDS: LIPUS
/ osteogenesis / Dlx3. FUNDING ACKNOWLEDGEMENTS: national
research grant. CONTACT: atsu323@hiroshima-u.ac.jp
ETHICS COMMITTEE: Hiroshima University.
Research Report Poster Display
09-11 Monday 4 June 15:30
VCEC Exhibit Hall B & C
EFFECTS OF THE SELECTION OF FOOD INTAKE BEFORE
CARDIOPULMONARY EXERCISE TEST
Yokogawa M1 , Ueda K1 , Murase J2 , Miaki H1 , Sasaki M3 , Inoue K1 ,
Susaki T1 , Tachino K1 ; 1 Kanazawa University, Kanazawa, Japan;
2 Kariya Toyota General Hospital, Kariya, Japan; 3 Akita University,
Akita, Japan
PURPOSE: We examined the effects of water and a jelly supplement
taken before the cardiopulmonary exercise test (CPX) on respiration,
heart rate, and blood pressure. RELEVANCE: Evaluation of exercise
prescription or exercise tolerance is performed based on results of
the CPX. Generally, prior to the CPX, food intake within 2-3 hours
before its commencement is forbidden. Although a small amount of
water or food should be taken depending on the condition of meal
S277
intake before measurement, the effects of food or water intake on
the CPX have not been clarified. PARTICIPANTS: The subjects were
12 healthy males who gave consent to this study. METHODS: The
subjects, who had fasted, took 420 ml of water (water), or 420 g of
jelly containing 400 kcal (jelly) after fasting for more than 12 hours
from the previous night, and performed the CPX 30 min after intake.
Expired gas analysis, heart rate, blood pressure, exercise loading
at rest, anaerobic threshold (AT), and maximal exercise level were
evaluated in each intake condition group. ANALYSIS: Measurements
were expressed as the means ± standard deviation. The parameters
were analyzed in the 3 intake groups by one-way analysis of
variance (ANOVA). If there was a significant difference, analysis was
further performed by the Bonferroni method. A value of p < 0.05 was
regarded as significant in all analyses. RESULTS: The respiratory
gas exchange ratio (R) was significantly lower in the water group
(0.76±0.06) than in the fasting (0.83±0.01) and jelly (0.83±0.05)
groups at rest. There was no significant difference in R between the
fasting and jelly groups. Food intake is considered to increase the
heart rate, stroke volume, and cardiac output because of a reduction
in total vascular resistance, but there were no significant differences
in the resting heart rate, blood pressure, and oxygen pulse among the
intake groups. There were no significant differences in the parameters
measured at the AT and maximal exercise level among the intake
groups. CONCLUSIONS: Under our intake conditions, enhancement
of energy metabolism by food intake was suggested in the water
and jelly groups at rest, but there were no significant differences in
the CPX measurement among the groups. IMPLICATIONS: These
results suggested that blood allocation to skeletal muscles was
prioritized at the maximal exercise level even during the digestion
and absorption of food. When fluid replacement or food is taken
before exercise, it is necessary to determine their amounts and
kinds, taking the load on the digestive system during exercise into
consideration. KEYWORDS: cardiopulmonary exercise test, food
intake, physiological response. FUNDING ACKNOWLEDGEMENTS:
Unfunded. CONTACT: yokogawa@mhs.mp.kanazawa-u.ac.jp
ETHICS COMMITTEE: Kanazawa University
Research Report Poster Display
10-15 Monday 4 June 15:30
VCEC Exhibit Hall B & C
A NOVEL DEVICE FOR TRAINING: A FLOAT WALKING ASSIST
SYSTEM USING POSITIVE AIR PRESSURE
Kuroki H1 , Sakakima H1 , Ikezoe T1 , Oka T2 , Morinaga T3 , Hama H4 ;
1 Department of Physical Therapy, School of Health Sciences, Faculty
of Medicine, Kyoto University; 2 Department of Physical Therapy,
Kyoto Police Hospital; 3 Department of Physical Therapy, Faculty
of Rehabilitation, Shijo-Nawate Gakuen University; 4 Department of
Occupational Therapy, School of Health Sciences, Bukkyo University
PURPOSE: Partial weight-bearing walking is one of the most
frequently used methods in physical therapy after surgical treatment
or muscloskeletal disorder of lower extremities. In clinical practice,
partial weight-bearing was performed as under-water walking,
walking with crutches and walking using suspension devices. We
have developed a novel device for partial weight-bearing and training
using positive air pressure. The purpose of study was to examine
whether this positive air pressure has adverse effect on fatigue
or muscle metabolism during walking or not. RELEVANCE: For
evidence-based practice, we should have knowledge not only about
accurate weight-bearing status but also about physiological effects
of the walking on fatigue and muscle metabolism. PARTICIPANTS:
Ten volunteers (3 women and 7 men, mean age of 25.5 years,
mean height of 166 cm and mean body weight of 60 kg) who
gave informed consent were participated in the study. METHODS:
Lactic acid level, muscle blood flow, skin temperature and core
temperature of gastrocnemius muscle were measured during normal
treadmill walking at a speed of 4 km/hr (FWB) and during two
conditions of 2/3 and 1/2 partial body weight-bearing treadmill walking
S278
using the system (2/3 PWB and 1/2 PWB, respectively). ANALYSIS:
Repeated-measure ANOVAs and Scheffe’s post hoc test were used
to compare lactic acid level, muscle blood flow, skin temperature and
core temperature during FWB, 2/3 PWB and 1/2 PWB. RESULTS:
Lactic acid level was 1.4±0.39 mol/ml in FWB, 1.5±0.80 mol/ml
in 2/3 PWB and 1.5±0.93 mol/ml in 1/2 PWB, respectively, and
no difference of lactic acid level was observed among FWB, 2/3
PWB and 1/2 PWB settings. Muscle blood flow of FWB, 2/3 PWB
and 1/2 PWB was 16.1±4.70 ml/min, 13.6±4.17 ml/min, 12.4±3.96
ml/min, respectively. Percent muscle blood flow at 2/3 PWB and
1/2 PWB settings was 84.5% and 76.8% of FWB, respectively, and
significantly differed with FWB (P = 0.00172 and P = 0.00002,
respectively). No difference of skin temperature and core temperature
of gastrocnemius muscle was observed among FWB, 2/3 PWB and
1/2 PWB settings. CONCLUSIONS: Although positive air pressure
at 2/3 PWB and 1/2 PWB settings has slightly decreased muscle
blood flow, there is no adversely effect on fatigue measured by lactic
acid level and on muscle metabolism measured by skin temperature
and core temperature of gastrocnemius. IMPLICATIONS: The float
walking assist system using positive air pressure may be able to
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’.
CONTACT: kuro@hs.med.kyoto-u.ac.jp
ETHICS COMMITTEE: The Committee of Department of Physical
Therapy, School of Health Sciences.
Research Report Poster Display
10-19 Monday 4 June 15:30
VCEC Exhibit Hall B & C
INFLUENCE OF TRAINING WITH AN UNSTABLE PLATE ON
ACTIVITY OF THE TRANSVERSUS ABDOMINIS
Nitta O1 , Tawara N2 , Kuruma H1 , Yorimitu Y1 , Yanagisawa K1 ,
Seno A1 , Surya J1 , Uchi M3 ; 1 Tokyo Metropolitan University; 2 Japan
Institute of Sports Sciences; 3 Toho University Oomori Hospital
PURPOSE: The study was designed to investigate the influence
of training on muscles in the deep part by using changes in
magnetic resonance (MR) signal before and after training as indicator.
RELEVANCE: Improvements in postures are considered important
for prevention of low back pain. In recent years there have been
many reports on the results of studies, which show that the deep
muscles of the trunk play an important role in the maintenance of
postures. However, efficient training has not ever been demonstrated,
because it is difficult to evaluate deep abdominal muscle activity from
the body surface. PARTICIPANTS: The subjects were 8 men with a
mean age 21.01 years (20-22), which had no past history of low back
pain. The study was approved by the Ethics Screening Committee of
Tokyo Metropolitan University. METHODS: The muscles in the deep
part analyzed were the transversus abdominis and the musculus
psoas major. The musculus rectus abdominis, a superficial muscle,
was used as controls. In the training an unstable plate of 320 mm
in diameter was placed under the pelvis of subjects in a supine
position. While the pelvis was sustained in the proper position, the
lower extremities were alternately raised by approximately 20 mm for
20 seconds each, for a duration of 20 minutes. The system used
was 1.5-T Magnetom Symphony (SIEMENS, LTD.). The imaging
technique was True FISP (TR = 4.30 ms, TE = 2.15 ms, NEX =
1, FA = 50degree, scan time = 10 sec, FOV = 400 mm). The site
of analysis was the 4th lumbar vertebra, each slice was 10 mm in
thickness, and gap was 2 mm. All the parts of the device for exclusive
use were non-magnetic substance. Since the patterns of muscle
activity were evaluated only from changes in signal, the experiment
was conducted with the subjects, and the device placed in the MR
system. Ranges of interest (ROI) were established in the bilateral
transversus abdominis, the musculus psoas major and the musculus
rectus abdominis for the analysis, and the mean values in ROI were
WCPT 2007, Research Reports
regarded as MR signals. ANALYSIS: The bilateral MR signals were
averaged, and the mean MR signals before and after training were
compared by paired t-test. The significance level was designated
5%. RESULTS: The mean MR signal for the transversus abdominis
before training was 179.3 (SD 27.3) and the corresponding value
after training was 259.6 (SD 57.7), showing a significant difference.
The mean MR signal for the musculus psoas major before training
was 110.7 (SD 11.2) and the corresponding value after training was
111.4(SD 14.1), showing no difference. The mean MR signal for the
musculus rectus abdominis before training was 300.6 (SD 50.8) and
the corresponding value after training was 301.8 (SD 52.6), showing
no difference. CONCLUSIONS: All of the above-described research
observations indicated selective activity of the transversus abdominis
by training. IMPLICATIONS: This result showed the effectiveness
of this training method in conditioning the transversus abdominis.
KEYWORDS: transversus abdominis, MR signal, an unstable plate.
FUNDING ACKNOWLEDGEMENTS: Tokyo Metropolitan University.
CONTACT: nittaosm@post.metro-hs.ac.jp
ETHICS COMMITTEE: Ethics Screening Committee of Tokyo
Metropolitan University
Research Report Poster Display
10-23 Monday 4 June 15:30
VCEC Exhibit Hall B & C
EFFECT OF EXERCISE INTENSITY ON STATIC BALANCE
Song J
PURPOSE: The purpose of this study was to evaluate the effect
of exercise intensity on static standing balance. RELEVANCE:
Balance is essential elements for the performance of activities of
daily living. To understanding possible contributions of exercise
intensity to perturbations on static balance, are useful to plan
exercises in rehabilitation process and to decease secondary injuries
after exercise. PARTICIPANTS: Twenty-five college students without
musculoskeletal diseases such as lower back pain and ankle sprain,
neuronal problems, and balance disturbance recently within 3 months
participated. METHODS: Exercise intensity was calculated using the
maximum heart rate of each subjects. Static balance was assessed
before and after running exercise on the treadmill for 20minutes
(50% and 70% intensity) using the KAT3000 (Kinesthetic Ability
Trainner). ANALYSIS: Paired t-test were used to compare balance
index (BI), forward backward ratio (FB ratio), and right left ratio (RL
ratio) according to exercise intensity. RESULTS: BI in 70% intensity
exercise (687.84±634.36mm) was greater than 50% intensity
(414.08±137.41mm) and pre-exercise (376.20±125.84mm). There
was significant difference between pre-exercise and after 70%
intensity exercise (p < 0.05). FB ratio in pre-exercise and 50%
intensity exercise was not statistically significant difference. However,
there were significant difference between 50% and 70% intensity
exercise and between pre-exercise and 70% intensity exercise
(p < 0.05). After 70% intensity exercise, weight was shifted from
backward to forward. RL ratio in pre-exercise and 50% intensity
exercise were 0.80108±2.9706 and 0.90320±.18649 respectively,
therefore body weight was loaded to right side. RL ratio after 70%
intensity exercise was 0.22492±0.75897. There were significant
difference between 50% and 70% intensity exercise and between
pre-exercise and 70% intensity exercise (p < 0.05). CONCLUSIONS:
Higher intensity exercise contributed to perturbation on static
balance. There were no significant difference between pre-exercise
and 50% intensity exercise on BI, FB ratio, and RL ratio. After 70%
intensity exercise, ability to maintain static balance was decreased.
IMPLICATIONS: This study provides information on the disturbing
effect after higher intensity exercise. KEYWORDS: exercise intensity,
static balance, balance index. FUNDING ACKNOWLEDGEMENTS:
None. CONTACT: jysong@mail.uc.ac.kr
Poster Displays, Monday 4 June
Research Report Poster Display
12-03 Monday 4 June 15:30
VCEC Exhibit Hall B & C
CHANGE IN PATIENT CONCERNS DESCRIBED USING
COMPONENTS OF THE ICF DURING THE FIRST SIX WEEKS
FOLLOWING PRIMARY TOTAL KNEE ARTHROPLASTY
Rastogi R1 , Chesworth B1 , Davis A2 ; 1 University Of Western
Ontario, London, Canada; 2 Toronto Western Research Institute,
Toronto, Canada
PURPOSE: The objectives of this study were: 1) to quantify how the
level of importance of items identified by patients changes during
the first six weeks following primary total knee arthroplasty (TKA)
and, 2) to determine if this change in importance reflects a shift
in components of the International Classification of Functioning,
Disability and Health (ICF) over time. RELEVANCE: There is no
published evidence of how patient concerns change during the first
six weeks following primary TKA. An understanding of the recovery
process from the patient perspective will aid clinicians/researchers
in selecting appropriate outcome measures when evaluating patients
following primary TKA. PARTICIPANTS: Convenience sampling was
done to recruit 54 consecutive patients (28 females) undergoing
primary TKA at a tertiary care hospital in Southwestern Ontario,
Canada. METHODS: Subjects completed a questionnaire pre-
operatively and at two, four and six weeks post-operatively to rate
the level of importance (1=not important at all 7=important to a very
great extent) of 32 items previously identified as important in the
six weeks following primary TKA. ANALYSIS: Measures of central
tendency and dispersion were calculated to determine the level of
importance of each item on the questionnaire for each evaluation
session. The median importance rating of the items within each
ICF component at each time point of data collection were used to
assign a level of importance to that ICF component. RESULTS:
Patient concerns about recovery that are related to body function and
environmental factors are of great importance throughout the first six
weeks following surgery. Activity limitations are also important during
this time period but are less important to patients during the first two
post-operative weeks. Conversely, participation restrictions are not
important to patients early in their postoperative recovery but rise
to small importance by post-operative week six. CONCLUSIONS:
Concerns of patients change as a function of time even during
this early post-operative phase of recovery. Clinicians should keep
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
weeks of recovery. IMPLICATIONS: When evaluating outcome during
the first six weeks of recovery following primary TKA, clinicians
should use measures that evaluate impairments (loss of body
function), activity limitations and the role that their environmental
plays in improving or hindering the patients’ function. KEYWORDS:
Arthroplasty, knee, concerns. FUNDING ACKNOWLEDGEMENTS:
This work was supported by a Premier’s Research Excellence Award
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
the Ontario Physiotherapy Association to Ravi Rastogi. CONTACT:
rrastogi100@hotmail.com
ETHICS COMMITTEE: University of Western Ontario Research
Ethics Board for Health Sciences Research Involving Human
Subjects
S279
Research Report Poster Display
12-07 Monday 4 June 15:30
VCEC Exhibit Hall B & C
CRITERION OF ALTERED KINEMATICS AND EMG ACTIVITIES
IN PATIENTS WITH CHRONIC NON-SPECIFIC NECK PAIN
Wang S, Lin J, Tang P, Lin K; School and Graduate Institute of
Physical Therapy, College of Medicine, National Taiwan University
PURPOSE: This study compared the neck kinematics and elec-
tromyographic (EMG) activities of neck between patients with chronic
neck pain and asymptomatic subjects during cyclic cervical flexion
and extension movement. RELEVANCE: To define the criterion
that could determine whether the patients with chronic neck
pain demonstrate motor control abnormality. PARTICIPANTS: Nine
asymptomatic adults (aged 50.2±12.8), and 10 patients with chronic
neck pain (aged 56.9±6.5) were recruited. METHODS: Active neck
extension (EXT) and flexion (FLEX) movement was divided into 4
phases by the terminal range (t) of neutral position (n): FLEXtn,
FLEXnt, EXTtn, and EXTnt phases. Range of motion (ROM), speed,
and surface EMG of left and right paraspinal muscles (DOR) and
sternocleidomastoid (SCM) was recorded. ANALYSIS: Repeated
ANOVA was used to test the ROM, speed, normalized integrated
electromyography (NIEMG) of DOR and SCM. Receiver operating
characteristic (ROC) curve was used to determine discrimination
level of kinematic and EMG measurement. RESULTS: The patients
moved significantly slower in all phases (p = 0.019). The NIEMG of
SCM of patients with chronic pain is significantly increased in all
phases compared to that of the asymptomatic group (p = 0.043).
The movement speed during EXTtn phase and NIEMG of SCM
during EXTnt and EXTtn phase can be used to correctly estimate
at least 70% and 88.9% possibility that an individual with chronic
neck pain. CONCLUSIONS: Reduced movement speed and over-
activated SCM during neck motion appeared to be a control
strategy during pain-related adaptation in patients with chronic
neck pain. IMPLICATIONS: The speed and NIEMG SCM in the
extension phase could serve to differentiate the movement pattern
of patients with chronic non-specific neck pain and asymptomatic
subjects. KEYWORDS: EMG, chronic neck pain, head movement,
neck muscles. FUNDING ACKNOWLEDGEMENTS: NHRI-GT-EX
89E823C. CONTACT: sfwang@ntu.edu.tw
ETHICS COMMITTEE: Ethic committee of National Taiwan University
Hospital
Research Report Poster Display
12-11 Monday 4 June 15:30
VCEC Exhibit Hall B & C
SEEING MOVEMENT QUALITY THROUGH THE LENS OF NEW
TRAINING ASPECTS
Skjærven L1 , Kristoffersen K2 , Gard G3 ; 1 Bergen University
College, Bergen, Norway; 2 University of Bergen, Bergen, Norway;
3 Lund University, Lund, Sweden
PURPOSE: The aim was to study a group for expert physiotherapists‘
experiences of training movement quality based on their clinical work.
The phenomenon of movement quality is in earlier studies described
as a set of movement processes or a series of events proceeding
through time; each of them with certain goals, becoming mini-
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.
S280
METHODS: A qualitative study with phenomenological in-depth
interviews was chosen as source for the research. The interviews
were taped, transcribed and sent to the informants for confirmation.
ANALYSIS: Giorgis‘ recommendation concerning analysis of the
qualitative interview was followed. The data of the lived experienced
descriptions, told by the physiotherapists, depicted what training
movement quality meant in their professional context searching
for themes around which the phenomenological synthesis is to be
woven. RESULTS: The most outstanding features found so far in
the analysis are 1) creating the physical environment, 2) creating an
atmosphere of safety and acceptance, 3) creating an interrelation and
true meeting between patient and therapist, 4) guiding movement
rather than to correct, 5) focus the being in movement, 6) focus
healthy movement resources, 7) inviting the patient to explore
movement from within rather than to repeat mechanically, 8) use of
metaphors in guiding movement, 9) awareness as the gate to learning
new movementpatterns, 10) to structure situations for movement
experiences and reflections, 11) the role of being a “father” and
a “mother” as physiotherapist and 12) the movement awareness
to the physiotherapist. CONCLUSIONS: The result suggests a
development in the nature of movement training that leads toward
a “know how” concerning the patients resources to move and
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
study provide a clinical reasoning framework for the adoption of an
emerging model for use in physiotherapy. KEYWORDS: Movement
training, movement quality, rehabilitation, Basic Body Awareness
Therapy. FUNDING ACKNOWLEDGEMENTS: Thanks to Faculty of
Health and Social Sciences, Bergen University College, Norway for
supproting the study. CONTACT: lhs@hib.no
Research Report Poster Display
13-15 Monday 4 June 15:30
VCEC Exhibit Hall B & C
EVALUATION OF GAIT INSTABILITY BASED ON THE
EXTRAPOLATED CENTER OF MASS POSITION
Shimoda H, Sato H, Suzuki Y; Kitasato University, Sagamihara,
JAPAN
PURPOSE: The extrapolated center of mass position (XCOM) was
defined on the basis of the velocity of the center of mass (COM),
which suggests that it is a measure of dynamic stability. This
study was conducted to examine whether the XCOM expresses gait
instability more efficiently than does the COM position. RELEVANCE:
Physiotherapists have to decide whether a patient can walk
independently or not. Because the decision usually depends on the
therapist’s experience, it tends to be made subjectively. Sometimes a
therapist hesitates to determine that the patient can be “independent”
because nobody would help the gait-impaired patient to prevent a
fall when walking alone. Objectively assessing gait instability will
help to determine whether patients can walk independently or not.
PARTICIPANTS: Eleven participants (11 males; age 21.5±2.1 years,
body mass 61.0 ±5.0 kg, height 170.3±5.0 cm) volunteered for this
study. None of the participants had muscular neurological disorders.
Although there is no ethics committee in our organization, the
experimental procedures were explained to all participants prior to
testing and verbal and written consent were obtained. METHODS:
To generate an unstable gait condition, we used a separated-belt
treadmill. The treadmill belt could be driven at the same speed
(stable condition) and at different speeds (unstable condition). In
the stable condition, the subjects walked at slow (1.0 km/h), normal
(2.5 km/h), and fast (5.0 km/h) rates. In the unstable condition, the
subjects were perturbed by randomly decelerating and accelerating
one side of the walking-belt (0 km/h – 5.0 km/h). The COM position
was calculated from kinematic and anthropometric data with the
use of an 8-segment rigid body model. The XCOM position was
WCPT 2007, Research Reports
obtained from the COM position plus its velocity times the square
root of (l/g), where “l” represents leg length and “g” represents
the acceleration of gravity. Three ten-second trials were performed
and averaged for each gait condition. ANALYSIS: In the statistical
analysis, we performed one-way layout analysis of variance and
Scheffe’s multiple comparison tests. The independent variable was
assumed to be each gait condition and the dependent variables were
assumed to be the coefficient of variation of the amplitude of XCOM
and COM. RESULTS: The coefficient of variation of the amplitude
of the XCOM increased significantly only with an unstable gait
(p < 0.05). The value was not reflected by the influence of gait speed
changes between the three stable gait conditions (p > 0.05). Though
the coefficient of variation of the amplitude of the COM increased
significantly with an unstable gait (p < 0.05), significant between-
condition differences were found between the slow condition and the
fast condition and between the normal condition and the fast condition
(p < 0.05). CONCLUSIONS: The change in XCOM suggested the
instability of the gait better than change in COM in this study.
IMPLICATIONS: The change in XCOM make it possible to evaluate
gait objectively. KEYWORDS: Dynamic stability, unsteadiness of
gait, center of mass. FUNDING ACKNOWLEDGEMENTS: None.
CONTACT: goodspeed73742197@yahoo.co.jp
Research Report Poster Display
13-19 Monday 4 June 15:30
VCEC Exhibit Hall B & C
ANALYSIS OF TIBIAL ROTATION THROUGHOUT KNEE MOTION
USING MAGNETIC RESONANCE IMAGING
Samukawa M1 , Yamaguchi A2 , Yamamoto T3 , Miyamoto S4 ,
Yamanaka M1 ; 1 Department of Physical Therapy, Faculty of Health
Sciences, Hokkaido University School of Medicine, Sapporo, Japan;
2 Department of Radiology, Hokkaido University Hospital, Sapporo,
Japan; 3 Department of Radiological Technology, Faculty of Health
Sciences, Hokkaido University School of Medicine, Sapporo, Japan;
4 Department of Physical Therapy, Graduate School of Health
Sciences, Sapporo Medical University, Sapporo, Japan
PURPOSE: “Screw-home motion,” a well-known component of tibial
rotation, occurs throughout the knee flexion-extension movement.
However, precisely just how much tibial rotation occurs during the
movement is unclear. Magnetic Resonance Imaging (MRI) is a non-
invasive procedure and often used for kinematic studies. The purpose
of this study was to determine the angle of tibial rotation at different
angles of knee flexion using MRI. RELEVANCE: Tibial rotation with
flexion and extension is an important physiological element of knee
motion. To measure and see the angle of tibial rotation is relevant in
the comparison of normal and pathological knees. PARTICIPANTS:
Ten normal subjects (5 male and 5 female) were chosen for the
study. The mean age was 19.9±1.6 years old; mean weight was
55.9±10.7 kg; and mean height was 162.3±8.4 cm. The subjects
had no previous history of knee injuries, and no signs or symptoms
of neurological diseases or disorders. METHODS: The Sapporo
Medical University Ethical Committee approved this study. A clinical
1.5-T whole-body MR scanner (Magnetom Symphony, Siemens
Medical Solutions, Erlangen, Germany) was used throughout the
study. Each subject was measured in the supine position and a
custom-built wooden apparatus was utilized to fix the knee and hip
angles. The subjects lay on the apparatus, which was set on the bed
of the MRI machine. The angle of tibial rotation was measured at
30, 60, and 90 degrees of knee flexion. ANALYSIS: The repeated-
measures analysis of variance (ANOVA) test was used to compare
the angles of tibial rotation among 30, 60, and 90 degrees of flexion.
Tukey’s post-hoc test was used to examine any significant findings.
The interpretation of correlation coefficients was used to see the
relationship between the right and left sides. RESULTS: Internal
rotational angles occurred throughout the angles of knee flexion
(4.3±10.9 degrees on the right side and 7.1±4.5 degrees at 30
degrees of flexion; 7.2±6.6 degrees on the right side and 7.2±4.2
Poster Displays, Monday 4 June
degrees on the left side at 60 degrees of flexion; 5.4±4.6 degrees
on the right side and 5.6±5.6 degrees on the left side at 90 degrees
of flexion). There were no significant differences in the angles of
tibial rotation among 30, 60, and 90 degrees (p > 0.05), but there
was a significant correlation in tibial rotation angles between the
right and the left legs (r = 0.400, p = 0.028). CONCLUSIONS: At 30,
60, and 90 degrees of flexion, the tibial rotation angles were all
internally rotated. The angle of tibial rotation between the left and
right legs was significantly correlated. IMPLICATIONS: The primary
result of this study is that the angle of tibial rotation can be used
to treat knee joint pathology with range of motion exercises or joint
mobilization. The muscles, tendons, ligaments, menisci, and capsule
provide joint stability, and as such, tissue injuries around the knee
are considered to change joint kinematics. Therefore, this result
would be relevant in the comparison of normal and pathological
knees. KEYWORDS: tibia, rotation, knee kinematics. FUNDING
ACKNOWLEDGEMENTS: The work is supported by the grant-in-
aid of Faculty of Health Sciences, Hokkaido University School of
Medicine. CONTACT: mina@cme.hokudai.ac.jp
ETHICS COMMITTEE: The Sapporo Medical University Ethical
Committee approved this study.
Research Report Poster Display
13-23 Monday 4 June 15:30
VCEC Exhibit Hall B & C
PARALLEL RELIABILITY OF PHOTOGRAMMETRY VERSUS GO-
NIOMETRY IN POSTURAL ASSESMENT OF LOWER EXTREMITY
Aliberti S, Queiroz B, Teixeira P, Sacco I; Lab. Biomechanics of
Human Movement and Posture, Physical Therapy, Speech and
Occupational Therapy Department, School of Medicine, University
of São Paulo – São Paulo – Brazil
PURPOSE: To verify a parallel reliability of computerized pho-
togrammetry in relation to goniometry. It was compared four angles
measurements in the lower extremity measured by goniometry and
by two different softwares used in photogrammetry: Corel Draw
and SAPo. RELEVANCE: This research is relevant for Physical
Therapy because studying measurements characteristics can be
useful to improve clinical evaluation process which is essential
for evidence based practice. PARTICIPANTS: Twenty- six young
healthy volunteers (17 woman, 9 man/ 52 legs), recruited among
university students, aged 21±5 yr, 62.7±13.5 kg, signed an informed
consent before their participation in the study. METHODS: The
subjects were positioned in standardized orthostatic position. It was
evaluated the Tibiotarsal angle (TT), the Knee Extension/Flexion
angle(Fl/Ex), the Quadriceps angle (Q), and the Subtalar angle(S)
with the aid of the universal goniometer (Carci) (Marques, 2003).
After that, the subjects in the same position had front-, sagittal-
, and back-side-view digital photo taken, with specifics anatomic
landmarks highlighted using 10mm spheres. Lastly, photogrammetry
measurements (Watson, 1998) were calculated with the aid of the
softwares Corel Draw v. 12 and SAPo v.0.63 (Brazil). ANALYSIS:
Statistics was done by using repeated-measures ANOVA among
three groups and Pearson correlation (a=5%). The reliability of
goniometry and photogrammetry alone has already been discussed
in previous studies (Iunes, et al. 2005). RESULTS: The Means,
Standard Deviations and p values were evaluated by the three
methods.Goniometry (TT: 112.3 ±4.0; S: 7.5 ±3.05; Q: 15.01 ±5.58;
Fl/Ex: 184.0 ±4.7) presented similar values (p < 0.05) compared to
photogrammetry (Corel Draw: TT 112.4 ±3.6; S: 8.07 ±4.52; Q:
13.05 ±7.75; Fl/Ex: 181.7 ±4.1; SAPo: TT: 112.4 ±3.4; S: 8.26
±4.39; Q: 13.18 ±7.76; Fl/Ex: 181.6 ±4.3). There was no significant
difference in the results among the three methods in all measured
angles with the exception of Q-angle. The anatomic landmarks of Q
come from two different and distant joints (hip. knee). It probably may
decrease the reliability of this measure in goniometry assessment.
There was a high and positive correlation between the two software’s
data (Corel Draw and SAPo). suggesting that they provide very
S281
close results. The correlation found between manual goniometry and
photogrammetry ranged from 0.06 to 0.97. The highest correlation
values between angles measurements were Gonio/SAPo for TT
(p = 0.001, r = 0.47), Gonio/Corel for Fl/Ex (p = 0.000, r = 0.48). This
results sound reasonable as the data came from two instruments
with different resolutions. CONCLUSIONS: Photogrammetry data
showed a good parallel reliability when compared to goniometry in
all lower extremity angular measures but Q-angle. Future studies
envolving other angular measurements are necessary to improve
evidence-based assessment in Physical Therapy. IMPLICATIONS:
Physioterapists should be aware of measures obtained by different
postural assessments methods since we didn’t find a good parallel
reliability for the Q-angle. KEYWORDS: photogrammetry, goniom-
etry, reliability. FUNDING ACKNOWLEDGEMENTS: This work was
unfunded. CONTACT: bggca@uol.com.br
ETHICS COMMITTEE: The local ethics committee
Research Report Poster Display
15-03 Monday 4 June 15:30
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,
Nakano-ku, Tokyo, Japan; 3 Faculty of Physical Therapy, Saitama
Social Insurance, Saitama-shi, Saitama, Japan; 4 Department of
Physical Therapy, Faculty of Health Sciences, Mejiro University,
Iwatsuki-ku, Saitama-shi, Japan
PURPOSE: It is a common knowledge that the reach movement
needs not only the upper extremity function but also the trunk
function. Nevertheless, the activity of the trunk muscle at reach is not
clear. The purpose of this study is to clarify the activity of the trunk
muscle in bilateral reaching. RELEVANCE: The approach obtaining
to find the trunk muscle activity in reach with a healthy person
will be good treatment and the evaluation of physical therapy for
person with the dysfunction of the trunk. PARTICIPANTS: Subjects
were healthy 11 volunteer students (6 males and 5 females). Their
age was from 18 to 19 years. They had no dysfunction of trunk,
upper and lower limbs. METHODS: The surface electrodes were
attached to rt. rectus abdominis, bilateral external oblique, internal
oblique and erector spinae muscles. The norswitch was placed to
a palm of researcher. The electromyogram and pressure signals
were synchronous recorded by TeleMyo2400T V2® (Noraxon).
A sampling frequency was 1500 Hz. After these signals were
taken into MyoVideo™ (Noraxon), they were analyzed by using
MyoResearch (Noraxon). Each subject was measured maximum
voluntary contraction (MVC) by manual muscle testing of the grade
5 (normal). The measured posture was both sitting and standing.
Each subject reached forward (task 1), reached to a side (task 2),
and reached to the other side (task 3). The beginning point was
the direction of “start” in voice sending a signal to the norswitch
in the same time, and the terminal point was when the signal was
received again. The instruction and the judgment were both done
by same researcher. ANALYSIS: After each data was rectified, it
was normalized amplitude of the MVC. Data was analyzed using
a repeated-measure analysis of valiance (ANOVA). Next, it was
analyzed using one-way ANOVA. Both of data were compared by
Tukey-Kramer method with the significant level set at P is less than
0.05. RESULTS: All muscles did not have a significant difference
in comparing with reaching pattern of a standing posture and a
sitting posture. In external oblique, both task 2 and task 3 of the
other side muscle increased significantly (p < 0.01). In addition task
3 of the other side muscle was significant (p < 0.05) increased
in comparison with task 2 of the other side muscle. The erector
muscle increased significantly (p < 0.01) in task 1. CONCLUSIONS:
In reaching task, we found that activities of the trunk muscle by a
S282
posture were changeless. It is important that the action of external
oblique acts on the trunk fixation and the rotation, and erector
muscle acts on the trunk fixation in any posture. It is necessary
to research the association of trunk movement and joint movement
of legs at reaching in the future. IMPLICATIONS: The activity of
external oblique and erector spinae muscles are the most necessary
among the trunk muscles for the acquisition of reaching performance.
KEYWORDS: trunk muscle, reach, electromyogram. FUNDING
ACKNOWLEDGEMENTS: We are grateful to the volunteer students
of the Faculity of Health Sciences in Mejiro University, RPT Miss
Jinbo, and physical therapists of Yoshikawa Hospital. CONTACT:
happysmiletsukasa@yahoo.co.jp
Research Report Poster Display
15-07 Monday 4 June 15:30
VCEC Exhibit Hall B & C
EFFECT OF TRUNK RANGE OF MOTION AND ANGULAR
VELOCITY ON ISOKINETIC PEAK TORQUE OF TRUNK FLEXOR
AND EXTENSOR MUSCLES
Elhafez S1 , Nassif N1 , Elhafez G1 , Fawaz H1 , Balbaa A2 ;
1 Department of Biomechanics, Faculty of Physical Therapy,
Cairo University, Egypt; 2 Department of Physical Therapy for
Musculoskeletal Disorders, Faculty of Physical Therapy, Cairo
University, Egypt
PURPOSE: This study was conducted to explore the effect of
different trunk ROM (30º, 50º and 70º) and different angular velocities
(30º/sec and 60º/sec) on the trunk flexor and extensor isokinetic
peak torque ratio. RELEVANCE: There is a lack of data concerning
the interpretation of spinal isokinetic parameters with different spinal
ROM. Thus, the ability to specify the optimal range of motion and
angular velocity that can develop maximal trunk muscle strength
is not clear. Therefore, the current study was designed to test
the trunk flexors/extensors strength ratio through a different spinal
range of movement and angular velocities. PARTICIPANTS: Thirty
healthy male subjects with a mean age of 19.95 years volunteered to
participate in this study. They were all free from any musculoskeletal
impairment. METHODS: The study was carried out using the Biodex
system 3 Isokinetic dynamometer. Each subject was instructed to
perform four trials of consecutive trunk flexion and extension at
the three trunk ROM in the concentric trunk flexors and extensors
contraction mode. During each ROM, the subject performed the
trial with 30º/sec velocity and another time with 60º/sec velocity.
ANALYSIS: Two way ANOVA with repeated measures and LSD
multiple comparison post-hoc test were performed to compare
between the different ROM with the two velocities on the trunk flexors
and extensors. RESULTS: The results indicated that the trunk flexors
PT and the trunk flexors/extensors PT ratio decreases significantly
(p < 0.05) with increasing trunk ROM at the two tested velocities. In
contrast, the PT values of the trunk extensors at the two angular
velocities increased significantly (p < 0.05) by increasing the trunk
ROM. Furthermore, the trunk flexors and extensors PT value at
60º/sec angular was lower than that at 30º/sec angular velocity.
CONCLUSIONS: This study revealed that the spinal isokinetic
data is dependent on the spinal ROM. Moreover, the optimal
trunk ROM and angular velocity that produce the highest torque
of trunk flexor were at the first ROM (30º flexion) using 30º/sec
angular velocity. Regarding the trunk extensors peak torque, the
highest PT value can be obtained at the third ROM (70º flexion)
using 30º/sec angular velocity. IMPLICATIONS: The current study
can help physical therapists to accurately specify the optimal
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:
drhfawaz@yahoo.com, Nagui3@gega.net
ETHICS COMMITTEE: Egyptian Physical Therapy Syndicate
WCPT 2007, Research Reports
Research Report Poster Display
15-11 Monday 4 June 15:30
VCEC Exhibit Hall B & C
QUANTITATIVE ANALYSIS OF HEAD, TRUNK AND PELVIS
MOVEMENTS DURING TILTING REACTION IN SITTING
POSITION
Takahashi T, Ihashi K, Knazaki H, Minamizawa T; Yamagata
Prefectural University of Health Sciences
PURPOSE: Tilting reaction is induced when supporting surface is
tilted to maintain body balance. However, there are few studies
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,
and pelvis movements were examined simultaneously and direction
and the timing of the movement were analyzed. RELEVANCE: This
work offers direction, timing and magnitude of key movements of
tilting reaction in sitting position and the findings can be utilized
to assist and instruct the movement to clients in clinical practice.
PARTICIPANTS: Participants were 21 young healthy subjects (11
male, 10 female). All participants provided their written informed
consent. Mean age was 21.3±1.5 (mean ± SD) years, height was
164.3±9.7 cm and body weight was 57.0±8.8 kg. METHODS: A
three dimensional motion analyzer (Vicon 370) with 7 cameras was
used to measure exact angle displacement of all direction of the
head, trunk and pelvis movements. A tilting platform tilted to 20
degrees with the tilting velocity of 5 and 10 degrees per seconds
to induce the tilting reaction. The movements of flexion- extension,
lateral flexion, and rotation of the head and trunk, also anterior-
posterior tilt, lateral tilt and rotation of the pelvis were measured.
The order and tilting angle of the platform at beginning of induced
movements, also the directions and angle of the movements of each
segments at maximum tilt (20 degrees) were analyzed. ANALYSIS:
Statistical analyses were carried out using StatView (ver.5.0). Chi-
square test, ANOVA and t-test were used to assess statistical
difference for order of beginning and direction of movements, tilting
angle at beginning of movements of each direction, and movements
between two velocities respectively. RESULTS: All the movements
were induced before tilting angle was reached 10 degrees. The
movements that happened in the early stage of the reaction were
trunk rotation and lateral flexion to opposite side (TRO and TLFO),
head lateral flexion to opposite side (HLFO). The pelvis movements
began in the late stage of the reaction. These findings regarding
timing of the induced movements were clear in tilting velocity at
10 º/s. The main directions of the movement at maximum tilt were
HLFO, trunk flexion (TF), TLFO, TRO and opposite side lateral
tilt of the pelvis (PLTO). Also the ratio of ROM (induced / active
maximum ROM) of HLFO, TF, TLFO and TRO were 16%, 10%,
36% and 16% respectively and other movements were less than
10%. CONCLUSIONS: The results indicated that HLFO, TF, TLFO,
TRO and PLTO are key movements of tilting reaction in sitting
position in healthy young subjects. Further study is required to
clarify other age group and people with neurological dysfunction.
IMPLICATIONS: From this work, HLFO, TF, TLFO, TRO and PLTO,
especially TLFO and TRO in the early stage of the reaction are
important to balance exercise. KEYWORDS: tilting reaction in sitting
position, 3-dimensional analysis, quantitative analysis. FUNDING
ACKNOWLEDGEMENTS: This study was unfunded. CONTACT:
ihashi@yachts.ac.jp
ETHICS COMMITTEE: Ethics approval for this study was given from
the ethics committee of Yamagata Prefectural University of Health
Sciences.
Poster Displays, Monday 4 June
Research Report Poster Display
16-15 Monday 4 June 15:30
VCEC Exhibit Hall B & C
IS THERE ANY DIFFERENCE BETWEEN UNILATERAL AND
SIMULTANEOUS BILATERAL KNEE ARTHROPLASTY ON PAIN
RELIEF AND KNEE FUNCTION?
Can F, Erden Z, Bozkurt M, Aygul V
PURPOSE: Degenerative arthritis may be seen in both knees
concurrently and may required bilateral Total Knee Arthro-
plasty(TKA).Surgical treatment of bilateral symptomatic arthritis of
the knee is controversial.Simultaneous bilateral TKA than staged
bilateral TKA is known to be cost effective for patients requiring
bilateral TKA.The literature has not yet to answer the questions
about improvements in pain and knee functions as well as patient’s
satisfaction.The aim of this study was to compare the results of
pain level, knee functions and patient’s satisfaction in patients
with unilateral TKA and simultaneous bilateral TKA. RELEVANCE:
The determining pain levels, restoration of knee mechanism and
knee functions in patients with simultaneous bilateral TKA are
the other important predictors of outcome of TKA in addition to
analyzing of total cost and complications.To replying those questions
about efficacy on pain and functions and patient’s satisfaction
which are still unclear in simultaneous bilateral TKA could be a
guide related to the treatment regime of patients with bilateral
symptoms. PARTICIPANTS: 12 patients (10 females,2 males)
undergone unilateral TKA with a mean age of 60.75±7.5 years
and 9 patients (9 females) undergone simultaneous bilateral TKA
with a mean age of 66.22±10.58 included in the study.Patients
who had undergone a revision or corrective surgery and those
who had an infection, diabetes, peripheral vascular or motor neuron
disease were excluded. METHODS: All the patients were measured
for pain intensity level in rest and in activity according to the
Visual Analogue Scale. Knee score and functional score was
recorded using Knee Society Scoring Scale. Patient’s satisfaction
was assessed using a subjective measurement system ranged 0-
10 points. To measure overall satisfaction a score graded 0-4 was
used. ANALYSIS: The datas were analized using SPSS for Windows
Release 11.5 packed program.Unrelated t-Test was used to compare
the parameters in the groups.The significance level was set at
p < 0.05. RESULTS: The mean pain level in rest was 1.5±0.84
cm for bilateral TKA and 2±0.85 cm for unilateral TKA.Their pain
level in activity was 3.44±1.27 cm in bilateral TKA and 3.46±0.75
cm in unilateral TKA.Knee score was found 64.22±4.53 points
and functional score was 57.22±7.22 points in the bilateral TKA
group while knee score was 64.25±2.35 points and functional score
was 71.25±3.32 points.There was no significant difference in pain
level in rest and in activity between the patients with bilateral TKA
and unilateral TKA (t1=0.602p > 0.05,t2=0.862p > 0.05).Knee score
and functional level were similar in unilateral and bilateral TKA
groups (t1=0.808p > 0.05,t2=0.111p > 0.05).Patient’s satisfaction in
rest was higher in bilateral TKA group than the unilateral TKA group
(t=0.04p < 0.05) whereas there was no difference between the groups
in patient’s satisfaction in activity (t=0.11p > 0.05). Overall satisfaction
was also higher in bilateral TKA group than the unilateral TKA group
(t=0.04p < 0.05). CONCLUSIONS: It has revealed that there is no
difference in pain and in functions between unilateral and bilateral
TKA.However patient’s satisfaction was higher in simultaneous
bilateral TKA.In following those results, simultaneous bilateral TKA
could be recommended for patients with bilateral degenerative
arthritis of the knee. IMPLICATIONS: Simultaneous bilateral knee
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
S283
Research Report Poster Display
16-19 Monday 4 June 15:30
VCEC Exhibit Hall B & C
WICH CLINICAL METHODS SHOULD WE USE TO ASSES LEG
LENGTH DISCREPANCY?
Sonsino Pereira C, Silva de Andrade M, de Camargo Neves
Sac I; Departament of Speech, Physical Therapy and Occupational
Therapy, School of Medicine, University of São Paulo
PURPOSE: The aim of this study was to find out which clinical
method should be used in clinical practice by examiners to
determine precisely leg length discrepancy. RELEVANCE: Many
anthropometric methods have been used in physical therapy practice
to evaluate leg length discrepancy (LLD), including clinical and
radiological methods. Several studies have described how clinical
methods can be inaccurate which is unacceptable when you wish
to correct an asymmetry. It would be usefull to have at least one
efficient clinical method considered as the main tool to evaluate LLD
when the radiographic method can not be done. PARTICIPANTS:
230 physically active subjects were studied with mean age 28.7±7.2
years. 47 subjects were randomly chosen to perform the scanogram.
METHODS: Subjects were positioned supine with lower limbs in
anatomic position in order to perform the measurements, which
were acquired twice on each lower limb for each method. Four
clinical methods were analyzed: from anterior superior iliac spine
(ASIS) to superior border of medial malleolus (MM); from ASIS to
superior border of lateral malleolus (LM); from iliac crest to inferior
border of MM; and from umbilicus to inferior border of MM. The
scanogram was the radiologic method chosen as gold standard. LLD
was calculated by subtracting the shorter leg length measurement
from the longer leg length measurement. ANALYSIS: LLD data
were compared among five methods using Friedman ANOVA.
Pearson’s correlation between each clinical method to radiologic
method was done. An a of 0.05 was adopted. RESULTS: The
mean values of LLD obtained by the methods ASIS/MM, ASIS/ML
and iliac crest/MM (1.0±0.8cm, p ≡ 0.010; 1.0±0.7cm, p ≡ 0.002;
0.8±0.6cm, p ≡ 0.013; respectively) were statistically different from
the scanogram (0.6±0.5cm). However, LLD values obtained by
the method Umbilicus/MM presented no significant difference
(0.6±0.5cm, p ≡ 0.577) in comparison with scanogram. Results
showed also that leg length data obtained by the four clinical methods
presented a higher correlation to data obtained by scanogram (r from
0.93 to 0.96; p  0.001). CONCLUSIONS: Although the four clinical
methods presented a higher correlation to the radiologic method in
relation to leg length, only the method umbilicus/MM presented the
same value of LLD as presented by the radiologic method, indicating
be the most precise clinical method. IMPLICATIONS: We suggest
that therapists should use the distance from umbillicus to inferior
border of medial malleolus as the main tool during clinical practice
in order to obtain precise values of LLD. KEYWORDS: Leg Length
Inequality; Anthropometry. FUNDING ACKNOWLEDGEMENTS: this
work was funded by FAPESP. Process number 1: 03/08165-7 (Carla
Sonsino Pereira under orientation of Isabel de Camargo Neves
Sacco, PhD, Professor of the Departament of Speech, Physical
Therapy and Occupational Therapy, School of Medicine, University
of São Paulo). Process number 2: 04/10604-1 (Mariane Silva de
Andrade under orientation of Isabel de Camargo Neves Sacco, PhD,
Professor of the Departament of Speech, Physical Therapy and
Occupational Therapy, School of Medicine, University of São Paulo).
CONTACT: marianeandrade@hotmail.com
ETHICS COMMITTEE: Approved by the Education and Research
Committee of the Hospital das Clinicas of the University of São Paulo,
Brazil
S284
Research Report Poster Display
16-23 Monday 4 June 15:30
VCEC Exhibit Hall B & C
EFFECTS OF DIFFERENT EXERCISE CONDITION IN
IMMOBILIZATION-INDUCED MUSCLE ATROPHY IN THE RAT
Sakakima H1 , Yoshida Y2 , Matsuda F2 , Hiroshi K1 ; 1 Department
of Physical Therapy, School of Health Sciences Faculty of Medicine,
Kyoto University; 2 Department of Physical Therapy, School of
Health Sciences Faculty of Medicine, Kagoshima University
PURPOSE: The purpose of this study was to investigate the effects
of different condition of treadmill running on immobilization-induced
soleus and gastrocnemius muscle atrophy of rats by morphology
and histochemistry. RELEVANCE: This study might provide a basic
evidence of rehabilitation medicine. PARTICIPANTS: Thirty-nine 8-
week old female Wistar rats weighing 188.2±10.6 g (mean ±
standard deviation) were used in this study. METHODS: The right
ankle joint of rat was immobilized for two weeks. Thereafter, rats
were randomly assigned to 4 groups for 6 weeks of exercise under
different conditions: free cage activity and free remobilization (FR),
once-a-week treadmill running (low frequency running: LFR), three
time-a-week running (middle frequency running: MFR), and six
time-a-week running (high frequency running: HFR) groups. The
program was progressive so that the running time increased from 10
min/session in the first week to 40 min/session in the sixth week,
and running speed was increased from 12 m/min to 24 m/min,
with an inclination of 10º. ANALYSIS: One-way analysis of variance
(ANOVA) was used and when a significant F ratio was found, post-
hoc Fisher’s protected least significant differences (PLSD) test was
performed on each variable. RESULTS: Two weeks of immobilization
significantly reduced the muscle fiber cross-sectional area of soleus
type I and type II fiber, gastrocnemius type I and type II fibers.
It increased the ratio of type II to total fiber numbers in the
soleus, and gastrocnemius, and induced pathological changes in
muscle fibers. Some of these changes could not be corrected
by free remobilization; however, the LFR, MFR, and HFR groups
clearly recovered toward normal levels with exercise frequency, the
effect on muscle recovery being more beneficial in the MFR and
HFR-groups. CONCLUSIONS: Our study provided evidence that
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
treadmill running three and six times a week was more beneficial
in recovery of muscle atrophy compared to no running or once-a-
week running. Thus, middle frequency exercise is as beneficial as
high frequency exercise for recovery of atrophied muscle tissues,
although low frequency exercise showed little effect. IMPLICATIONS:
This study may be helpful to determine the appropriative frequency
of a rehabilitation program. KEYWORDS: muscle atrophy, exercise,
recovery. FUNDING ACKNOWLEDGEMENTS: Supported by the
Ministry of Japan Culuture, Education and Science.
ETHICS COMMITTEE: The following experimental protocol was
approved by the ethical board of the Institute of Laboratory Animal
Sciences of Kagoshima University.
Research Report Poster Display
18-07 Monday 4 June 15:30
VCEC Exhibit Hall B & C
IS NON-SPECIFIC LOW BACK PAIN ASSOCIATED WITH
NEURAL COMPRESSION?
Sabbahi M; Texas Woman’s University, Houston, Texas, USA
PURPOSE: Non specific low back pain (LBP) without radicular
symptoms (pain, numbness or weakness) has always been evaluated
and treated as musculo-ligamentous disorders. The lack of sensitivity
in clinical evaluation and lack of studies of standing MRI for those
patients resulted in missing the neural involvement in non-specific
LBP. Purpose: The objective of this study was to evaluate the
WCPT 2007, Research Reports
neural compression and its degree in patients with non-specific
LBP. The neural compression was evaluated by Soleus (sol) and
Vastus Medialis (VM) H-reflexes from affected and unaffected lower
extremities during loading and unloading postures RELEVANCE:
Treatment would therefore be directed to the compromised structure
e.g. neural or musculo-ligamentous PARTICIPANTS: Patients (n=30)
with non-specific LBP with no leg pain, numbness or weakness
were selected by convenient sampling and consented to the stud
METHODS: Patients were tested with electrophysiologic studies of
the Sol and VM H-reflexes during lying (unloading) and standing
(loading). The reflex amplitude was the dependent parameter. Both
legs were tested and the peak-to-peak amplitude of the right to
left lower limb’s sol. and VM reflexes were compared to measure
reflex symmetry/asymmetry. The difference in the reflex amplitude
between the right and left side was compared for the lying and
standing postures (R/L lying, R/L standing, R lying/R standing, L
lying/L standing). The compromised spinal side (right Vs left) and
the spinal levels (soleus for S1/L5 & VM for L4) were identified.
Sol. & VM H-reflexes were recorded using Sabbahi & Khalil (1990)
after electrical stimulation of the tibial nerve at the popliteal fossa
or the femoral nerve at the inguinal canal and recording the sol. or
VM reflex action potential with surface electrodes. Electromyography
(EMG) unit was used for H-reflex testing. ANALYSIS: ANOVA was
used for statistical analysis with a value set at 0.05. RESULTS:
showed reflex asymmetry with a smaller amplitude of sol. or
VM H-reflexes on one side (of more than 20%) that was more
pronounced during standing postures. Such 20% reduced amplitude
was significant (p < 0.05) when compared to our previous data on
normal subjects. Patients with compromised sol. H-reflex suffer LBP
at the lower segment of lumbosacral region indicating S1 root
involvement. Patients with smaller VM H-reflexes suffer higher spinal
segmental level (L4) of pain/tenderness CONCLUSIONS: These
results indicate possible neural compromise to the spinal nerve
roots in patients IMPLICATIONS: Treatment of non-specific LBP
must be directed toward the nerve root compromise/impingement
and not the musculo-ligamentous dysfunction for speedy recovery.
KEYWORDS: low back pain, H-reflex, electrophysiologic testing,
nerve roots. FUNDING ACKNOWLEDGEMENTS: unfunded study.
CONTACT: MSabbahi@mail.twu.edu
Research Report Poster Display
19-19 Monday 4 June 15:30
VCEC Exhibit Hall B & C
NECK MUSCLE STIFFNESS MEASUREMENT BY AN
ULTRASOUND PALPATION SYSTEM
Lee E1 , Moore A2 , Jones M3 , Leung S4 ; 1 Physiotherapy
Department, Prince of Wales Hospital, Shatin, Hong Kong SAR;
2 Clinical Research Centre for Health Professions, University
of Brighton, United Kingdom; 3 School of Engineering, University
of Brighton, United Kingdom; 4 Department of Clinical Oncology,
Chinese University of Hong Kong, Hong Kong SAR
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
Modulus (YM) which is a biomechanical property that characterises
the deformability of the soft tissue. RELEVANCE: Manual palpation
is a common clinical assessment method to reflect the soft tissue
stiffness. The information obtained is subjective and can only be
categorized in ordinal form. Soft tissue stiffness can be measured
by the YM. The development of an ultrasound palpation device
to measure YM has been addressed by one of the authors in
previous studies. The concept was applied to quantify post-irradiation
fibrosis which is a very common late complication in patients
with nasopharyngeal carcinoma (NPC). PARTICIPANTS: Patients
suffering from NPC with their cancer in remission and were attending
treatment in the physiotherapy department in a regional teaching
Poster Displays, Monday 4 June
hospital were invited. Those reluctant to participate or had signs
of active metastases were excluded. All invited patients agreed and
they were recruited for the one-off assessment (n=20). 15 healthy
health-care workers volunteered for this neck muscle stiffness profile
assessment. METHODS: Intra- and inter-rater reliability studies were
first performed on a 50mm diameter x 9.5mm thick circular phantom
silicone gel pad. Two raters were included for the inter-rater reliability
calculation. Afterwards neck muscle stiffness was measured, the
subjects were seated and their necks were put in a neutral position.
An ultrasound probe was applied on a reference point 3cm inferior
to the lowermost point of the mastoid on each side of the neck
and YM was calculated from the load-indentation response curve.
ANALYSIS: Intra- and inter-rater reliabilities were calculated by
Bland and Altman plot using MedCalc for Windows, version 8.2.0.3.
Independent t test using SPSS 13.0 were performed to compare
YM values between normal subjects and patients. RESULTS: Very
good intra- and inter-rater reliabilities were shown by the ultrasound
palpation device in YM measurements of the phantom silicone pad.
Regarding the patient profiles, their average age was 46.5 (13 males,
7 females) versus 48.6 in the healthy normal subjects (9 males,
6 females). Average post radiotherapy completion time was 13.2
months (range: 4-62). The YM values of patients were significantly
higher. The respective YM of the left neck muscle of patients and
normal subjects were 28.8+/−21.9 kPa and 17+/−4.6 kPa (mean +/−
SD) with p = 0.049 while that of the right side were 26.6+/−19.3 kPa
and 16.8+/−4.7 kPa (mean +/− SD) with p = 0.044. CONCLUSIONS:
YM values were obtained by the ultrasound palpation method which
produced a quantified outcome parameter. The method also proved
to differentiate between normal subjects and patients with irradiation
given to the neck, and post-radiotherapy gave rise to a stiffer neck.
IMPLICATIONS: A wide range of YM values were documented for
the patient group which needs to be further divided into groups
with and without fibrotic changes. Correlational studies with neck
symptoms and neck ranges can be explored. KEYWORDS: neck,
stiffness, palpation. FUNDING ACKNOWLEDGEMENTS: The study
was funded by Sir Robert Black Trust Fund Postgraduate Scholarship.
CONTACT: edwinlee@cuhk.edu.hk
ETHICS COMMITTEE: Joint the Chinese University of Hong Kong_
New Territories East Cluster Clinical Research Ethics Committee
Research Report Poster Display
21-11 Monday 4 June 15:30
VCEC Exhibit Hall B & C
SONOGRAPHIC EVALUATION OF THE SUBCLAVIAN ARTERY
DURING THORACIC OUTLET SYNDROME SHOULDER
MANOEUVRES
Stapleton C1 , Herrington L2 , George K1 ; 1 Research Institute for
Sport and Exercise Sciences, Liverpool John Moores University,
Liverpool, UK; 2 Centre for Rehabilitation and Human Performance
Research, University of Salford, Manchester, UK
PURPOSE: Clinical tests for vascular thoracic outlet syndrome
generally incorporate shoulder horizontal flexion/extension, gleno-
humeral abduction and external rotation. It is assumed that these
manoeuvres stress the vasculature to accurately reproduce the signs
(e.g. radial pulse disappearance) and symptoms (e.g. heaviness,
paraesthesia) of vascular insufficiency. The effect of these clinical
tests on blood flow characteristics and the most effective arm
positions for detecting arterial compromise are, however, unknown.
The aims of this study are to; establish normative vascular responses
(i.e. arterial diameter [D] and peak systolic blood flow velocity [PSV])
to various arm positions, and to identify the most effective
arm position(s) for differential diagnosis. RELEVANCE: Vascular
compromise has been reported in individuals performing repetitive
athletic and occupational overhead actions. Physiotherapists require
accurate clinical tests to differentiate vascular insufficiency from
neuro-musculoskeletal injury. PARTICIPANTS: 10 male and 21
female (mean age: 25 yr) healthy volunteers underwent subjective
S285
and objective screening for past or present injury to the neck,
shoulder girdle or upper limb, inflammatory joint conditions, and
vascular or neurological disorders. METHODS: Whilst seated the
subjects’ arm was passively supported in a randomised series
of 12 standardised arm positions incorporating varying degrees
of horizontal flexion/extension, abduction and external rotation.
Doppler ultrasound insonated subclavian artery D (mm) and PSV
(cm/s) in each position. ANALYSIS: Data comparisons were made
using ANOVAs with bonferroni adjustment for multiple comparisons.
Alpha level was set at P = 0.01. RESULTS: The normative re-
sponse for most arm positions was consistent with no change in
subclavian artery D and PSV. However, at 180º abduction, and
120º abduction with 30º horizontal extension and 90º external
rotation, a heterogeneous PSV response was evident. Specifically,
complete occlusion was demonstrated by 6 subjects’ and 2 subjects’
respectively. Further, significant decreases (P = 0.008) in PSV were
recorded from 120º, 90º and 45º abduction (92±10, 89±11, 88±14
cm/s, respectively) to 180º abduction (mean±95% CI: 52±16 cm/s).
Similarly, post hoc comparisons revealed a significant decrease
(P = 0.008) in PSV from 120º abduction (94±14 cm/s) to 120º
abduction with 30º horizontal extension and 90º external rotation
(69±12 cm/s). CONCLUSIONS: Vascular parameters were largely
unaffected by arm movements in normal healthy adults. Only
at the extremes of range of motion were significant alterations
recorded in PSV. These responses were notably heterogeneous.
IMPLICATIONS: Clinically, signs of vascular insufficiency occurring
in the less extreme arm positions would better detect arterial
compromise than tests employing the extremes of range where
a high risk of false positives exists. Clinical decisions based on
false positive outcomes have serious implications for mistreatment
such as inappropriate surgical intervention. The heterogeneous
response of asymptomatic individuals with no past history of TOS
symptoms sheds uncertainty on the validity and reliability of positive
test responses from extreme arm positions. Further research is
required to ascertain the sensitivity of such manoeuvres and
discover means to improve the specificity. KEYWORDS: thoracic
outlet syndrome. FUNDING ACKNOWLEDGEMENTS: unfunded.
CONTACT: c.stapleton@2005.ljmu.ac.uk
ETHICS COMMITTEE: Liverpool John Moores University Ethics
Committee
Research Report Poster Display
22-23 Monday 4 June 15:30
VCEC Exhibit Hall B & C
INFLUENCE OF KYPHOSIS ON WALKING IN PARKINSON’S
DISEASE PATIENTS
Sakurai Y, Nagasawa H, Uchida K, Fujita M; Kanagawa University
of Human Services, 1-10-1 heiseicho, Yokosuka, Kanagawa, Japan
PURPOSE: We performed this study to clarify the relationship
between kyphosis and walking. RELEVANCE: Kyphosis is a major
symptom of Parkinson’s disease (PD). We may encounter PD
patients whose kyphosis gradually advances with walking until they
are unable to walk. However, there have been only a few reports
concerning the relationship between the degree of kyphosis and
walking in PD patients. PARTICIPANTS: The subjects were 12
PD patients (mean age: 65 years, mean disease duration: 6.7
years, Hoehn-Yahr stage: 1-3, UPDRS: 26.9) and 10 healthy adults.
METHODS: Infrared-reflecting markers were applied to C7, L4, the
most protruded point of thoracic kyphosis (T), shoulder, hip joint, knee
joint, lateral malleolus, and head of the 5th metatarsus, and measured
using a 3-dimensional motion analysis instrument, VICON612 (Vicon
Peak Co.). The lengths of a line, L, connecting C7 and L4, and
a perpendicular line, D, drawn from T to L were measured, and
the kyphosis index (KI)(D/L × 100) was calculated using the method
reported by Milne. The KI and lower extremities (L/E) joint angle
during walking were analyzed. ANALYSIS: Analysis of variance
(ANOVA) was used for statistical analysis with a significance level
S286
of 5% (SPSS, ver-13, Windows). RESULTS: The mean KI during
the gait cycle were 7.74 and 12.3 in the healthy and PD groups,
respectively. No regularity was noted in the changing pattern of the
KI in a gait cycle in the healthy group. When the KI increased in
the early stance phase, the hip and knee flexion angles increased,
and when the index decreased in the mid stance phase (M.S), the
knee joint extension angle increased. The PD group was classified
into 3 groups: A, the KI was almost constant throughout a gait cycle;
B, the KI was high at the time of landing the foot-flat and in the
terminal-stance phase, while the index was low in M.S, showing a
biphasic pattern; and C, variation was large among tests, showing no
regularity. The mean KI in M.S were 10.8, 13.3, and 17.41 in A, B,
and C, respectively, showing that the index increased in the order of
C, B, and A. The UPDRS score increased in the order of C, B, and A.
No significant difference was noted in the mean L/E joint angle in the
early stance phase, but the increase in variation (SD) with the number
of tests increased in the order of the PD-C, healthy, PD-A, and PD-B
groups, indicating that variation of L/E joint angle per step increased
in this order. CONCLUSIONS: Aggravation of kyphosis decreases
the variation of L/E alignment during walking, which may be a
cause of decreased walking ability in PD patients. IMPLICATIONS:
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
was destroyed in the PD patients, and they walked by reproducing
individually fixed forms of the trunk and L/E. KEYWORDS: Parkinson,
Kyphosis, Gait. FUNDING ACKNOWLEDGEMENTS: Aggravation of
kyphosis decreases the variation of L/E alignment during walking,
which may be a cause of decreased walking ability in PD patients.
CONTACT: sakurai-y@kuhs.ac.jp
ETHICS COMMITTEE: This study was approved by the Ethical
Review Board of Kanagawa University of Human Services.
Research Report Poster Display
23-03 Monday 4 June 15:30
VCEC Exhibit Hall B & C
EFFECTIVENESS OF DYNAMIC BALANCE SUPPORT DEVICE
FOR WALKING ON A TREADMILL: A CASE STUDY
Obreza P, Spoljar J, Skorjanc T, Savrin R, Matjacic Z; Institute
for Rehabilitation, Republic of Slovenia, Ljubljana, Slovenia
PURPOSE: Regaining of walking ability is one of the main goals
of rehabilitation following neurological disorder. An important aspect
of bipedal locomotion is efficient control of balance. RELEVANCE:
A dynamic balance support device that would enable walking on a
treadmill without upper extremities support on parallel bars, and at the
some time assure safety and facilitate balance control would enable
more functional training. The aim of this case study was to evaluate
the effectiveness of walking on a treadmill with the dynamic balance
support device in an incomplete spinal cord injury (SCI) patient.
PARTICIPANTS: A 32 years old male patient with an incomplete
SCI (level C5) and grade C on American Spinal Injury Association
Impairment Scale, 13 months after injury, participated in the study.
METHODS: Following a six months baseline period in which the
subject practiced overground walking, the subject completed 16
sessions of treadmill training while using upper extremities holding
on parallel bars for support (control treatment). Then the subject
completed additional 16 sessions of treadmill training while being
supported with the dynamic balance support device (experimental
treatment). Lower Extremities Motor Score (LEMS), Berg Balance
Scale (BBS), 10-m walking test (10MWT) and 9-minutes walking test
(9MWT) were used as outcome measures. ANALYSIS: Descriptive
statistics was used to compare the data between the baseline,
control, and experimental treatment periods and at one month
follow up. RESULTS: During baseline period BBS increased from
37 to 39, 10MWT decreased from 19 seconds to 17 seconds
while 9MWT increased from 240 meters to 265 meters. During the
control treatment BBS did not change, 10MWT decreased from 17
WCPT 2007, Research Reports
seconds to 14 seconds while 9MWT increased from 265 meters
to 280 meters. During the experimental treatment BBS increased
from 39 to 49, 10MWT decreased from 14 seconds to 12 seconds
while 9MWT increased from 280 meters to 360 meters. At follow-
up these values were retained. LEMS scores were similar in all
study phases and resulted in 35/50 (14/25 left lower extremity,
21/25 right lower extremity). CONCLUSIONS: During baseline period
subject’s balance and walking abilities improved, although during
treadmill training those parameters improved further. In comparison
to conventional treadmill training with upper extremities support on
parallel bars, treadmill training with the dynamic support device,
significantly improved studied balance and walking parameters, which
were retained at one month follow-up. IMPLICATIONS: These results
indicate that the dynamic balance support device for walking on a
treadmill might be useful addition to conventional treadmill training,
through its facilitation of balance control and more functional walking
without use of upper extremities for support. KEYWORDS: SCI, gait,
rehabilitation. FUNDING ACKNOWLEDGEMENTS: The work was
supported by the research grant P2-0228 from the Research Agency
of the Republic of Slovenia. CONTACT: pavla.obreza@mail.ir-rs.si
ETHICS COMMITTEE: Slovenian national etics commitee
Research Report Poster Display
23-07 Monday 4 June 15:30
VCEC Exhibit Hall B & C
MOVEMENT PATTERN AND ELECTROMYOGRAPHIC ANALYSIS
OF WHEELIE OVER DIFFERENT HEIGHTS IN SUBJECTS WITH
SPINAL CORD INJURY
Lin K1 , Lu T2 , Chen H3 , Liing R1 ; 1 School and Graduate Institute of
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,
College of Medicine, National Taiwan University, Taipei, Taiwan
PURPOSE: The purpose of this study was to investigate the
movement pattern and muscular activation in the negotiation of the
curbs with high and low heights in patients with spinal cord injury
(SCI). RELEVANCE: The ability of wheelie is a required skill for the
negotiation of obstacles (such as: curb) which become fairly common
in daily environment. The results of this study will provide the kinetic
and kinematic information of wheelie during obstacle-negotiation. The
movement pattern and electromyographic activities (EMG) during
wheelie can also be used as the index of bimanual coordination.
PARTICIPANTS: Eleven SCI (ASIA class A–D; age: 32.09 years old)
who could perform wheelie independently participated in this study.
METHODS: The subjects propelled the wheelchair on two force
plates (AMTI, USA), and performed the wheelie crossing over the
curb with 5 cm-height or 10 cm-height. Totally, 54 reflective markers
were attached on the anatomical landmarks of body surface and
the frame of wheelchair for three-dimensional motion analysis (Vicon
250, UK). ANALYSIS: The data were analyzed by Matlab programs
and SPSS software. The t-test was used for the comparison between
two-groups, and the Pearson correlation test was performed for the
relations between right and left upper extremities. RESULTS: The
pitch angle during wheelie was 19.73ºfor 5 cm-curb and was 22.48ºfor
10 cm-curb. The greatest acceleration occurred just before the
maximal tilted pitch angle that the acceleration was 317.9º/sec2 for 5
cm-curb and was 439.9º/sec2 for 10 cm-curb. However, the distance
between center of mass (COM) and center of pressure (COP) was
not affected by the height of the curb. During wheelie, the angles of
shoulder elevation and wrist pronation became larger with increasing
the height of the curb. Furthermore, the correlation between right and
left wrist extensor (r= 0.96–0.99) was higher than that of biceps and
triceps. CONCLUSIONS: The movement pattern of wheelie over the
curb depends on the height of the curb. The interlimb coordination
of shoulder and wrist joints was important for the control of wheelie
at different heights. IMPLICATIONS: The training of wheelie over the
Poster Displays, Monday 4 June
curb should emphasize the control of acceleration torque, shoulder-
wrist joint angles, and COM. KEYWORDS: Wheelie, Curb, Center
of Mass, Center of Pressure. FUNDING ACKNOWLEDGEMENTS:
This study was granted by National Science Council, Taiwan (Grant
# NSC94-2314-B-002-021). The authors thank Chia-Chieh Chang,
Yang-Chieh Fu, Chia-Cheng Lin and Ying-Chen Chen for the
assistance in data analysis. CONTACT: khlin@ntu.edu.tw
ETHICS COMMITTEE: Department of Medical Research, National
Taiwan University Hospital, Taiwan.
Research Report Poster Display
24-11 Monday 4 June 15:30
VCEC Exhibit Hall B & C
EARLY EXERCISE INTERVENTION AFTER STROKE
Tang A1−3 , Sibley K2,3 , Thomas S4 , Bayley M3 , McIlroy W1−3 ,
Brooks D1−3 ; 1 Department of Physical Therapy, University of
Toronto; 2 Institute of Medical Science, University of Toronto;
3 Toronto Rehabilitation Institute; 4 Faculty of Physical Education &
Health, University of Toronto
PURPOSE: To establish the feasibility of adding early aerobic training
to conventional stroke rehabilitation; and to determine its effects
on aerobic and functional capacity and health-related quality of
life RELEVANCE: Demonstrated benefit would support the addition
of aerobic training to conventional rehabilitation in the early post-
stroke phase PARTICIPANTS: Thirty-six participants (mean age ±
SE 65.4±2.0 years, 17±2.2 days post stroke) with moderate to mild
functional impairment from stroke recruited from an inpatient stroke
rehabilitation unit METHODS: Participants were allocated to Exercise
or Control groups and were matched on age and sex. Outcome
measures were taken at baseline and completion and included
aerobic capacity, 6-Minute Walk Test (6MWT) and Stroke Impact
Scale (SIS). The Exercise group participated in individualized cycle
ergometer training, in addition to conventional stroke rehabilitation
therapy, 30 minutes, 3 days per week until discharge from the
hospital. The Control group received conventional rehabilitation only.
ANALYSIS: Paired t-tests were used to compare Exercise and
Control groups. A two-factor repeated-measures analysis of variance
was used to determine interaction effects. RESULTS: The Exercise
group (n=18) completed 99% of scheduled sessions in 24.1±6.6
days, without adverse effects. Both groups demonstrated improve-
ment in aerobic capacity (VO2peak time effect p = 0.004, peak work
rate p = 0.008, heart rate 0.002), 6MWT distance (p < 0.0001) and
SIS Physical Domain scores (p < 0.0001) by discharge. While there
were no post-training differences between groups, there was a trend
towards greater improvement in peak VO2 and work rate in the
Exercise group compared to the Controls (12.6 vs. 8.2%, and 23.4
vs. 15.5% respectively), but less change in peak heart rate (4.5
vs. 11.4%) suggesting improved cardiovascular efficiency at higher
exercise intensities. CONCLUSIONS: Implementing a structured
aerobic training program after stroke is feasible and safe, even in the
sub-acute phase. Further, a trend towards greater cardiorespiratory
benefit was observed in those participating in the training program
compared to those receiving conventional therapy alone, despite the
small sample size and relatively short duration of training provided.
Ongoing work is focused on providing longer training duration with a
larger sample, and exploring novel training regimens to maximize
function in this important phase of recovery, and reduce the risk
for further cardiovascular events. IMPLICATIONS: Results from this
study contributes to our knowledge about the influence of structured
physical activity after stroke. The current work has implications on
shaping physical therapy practice for professionals working with
stroke survivors by providing evidence for aerobic training early
after stroke to minimize the decline in cardiorespiratory fitness
and functional implications of this. KEYWORDS: Stroke, exercise,
rehabilitation. FUNDING ACKNOWLEDGEMENTS: Supported by
the Canadian Institutes of Health Research (CIHR), Canada
Research Chair, CIHR New Investigator Award), Government of
S287
Ontario/Heart and Stroke Foundation of Ontario, Physiotherapy
Foundation of Canada, Toronto Rehabilitation Institute, Natural
Sciences and Engineering Research Council of Canada, and the
Provincial Rehabilitation Research Program, Ontario Ministry of
Health and Long Term Care. CONTACT: ada.tang@utoronto.ca
ETHICS COMMITTEE: Toronto Rehabilitation Institute Research
Ethics Board, University of Toronto Ethics Review Board
Research Report Poster Display
24-15 Monday 4 June 15:30
VCEC Exhibit Hall B & C
KNEE EXTENSOR FORCE CONTROL ABILITIES IN
POST-STROKE HEMIPARESIS
Kiyama R, Tetsuo M, Kiyohiro F, Akihide U, Toshiki H, Yoichi Y;
Course of Physical Therapy, School of Health Sciences, Faculty
of Medicine, Kagoshima University; Rehabilitation Center,
Kajiki-Onsen Hospital
PURPOSE: Since maximal strength is scarcely recruited in activities
of daily living, sub-maximal force control may be a more meaningful
parameter. To estimate force control ability, a force-tracking task
in which the patient applies a target force according to the
visual feedback is generally used.Evangelos found age effects on
knee extensor force control during rapid discrete isometric task.
Assessment of force control ability is expected to be useful for
evaluation of lower extremity function in post-stroke hemiparesis.This
study investigated the validity of sub-maximal isometric force
control abilities of the knee extensors in post-stroke hemiparesis.
RELEVANCE: Clinical evaluation of sub-maximal force control ability
may contribute to the improvement of the physical therapy practice
in stroke hemiparesis. PARTICIPANTS: Twenty patients with post-
stroke hemi-paresis (mean 61.1 (SD 16.1) years of age, mean 6.1
(SD 4.8) years post-stroke) with the ability to walk volunteered for
this study. In 13 cases, the patient’s right side was hemiplegic.
METHODS: For testing, subjects were seated in the chair with the
knee at a 90º angle. Strength data were measured using a hand-
held dynamometer EG-230 (SAKAI Medical Corp., Tokyo, Japan).
Sub-maximal voluntary isometric knee extensor force was obtained
on the affected leg. The dynamometer was placed above the medial
and lateral malleoli. The participant attempts to match the voluntary
knee extensor strength with the target force represented by a bar
chart for 60 seconds. The target force values during the trial period
varied over two frequencies (0.3 Hz, 0.5 Hz), which ranged from
0% to 20% of the participant’s maximal isometric knee extensor
strength. The strength data were transmitted to a computer at
a sampling rate of 20Hz. The difference between the voluntary
knee extensor strength and the target force was considered an
estimate of force control ability. Smaller values indicated a better
force control ability.We also assessed gait velocity with gait aids,
and Brunnstrom Recovery Stage. ANALYSIS: The Spearman’s rank
correlation was used to determine correlations of force control
abilities and Brunnstrom Recovery Stage, gait velocity. RESULTS:
The correlation between the force control ability at frequencies of
0.3 Hz and 0.5 Hz, and Brunnstrom Recovery Stage were −0.09
(n.s.) and −0.45 (p < 0.05), respectively. Similarly, the correlation
between force control ability at frequencies of 0.3 Hz and 0.5 Hz,
and gait velocity were −0.36 (n.s.) and −0.57 (p < 0.05), respectively.
CONCLUSIONS: We found that knee force control ability at a
frequency of 0.5 Hz correlated with Brunnstrom Recovery Stage and
gait velocity. It may be that the knee force control ability kept pace
qualitatively with motor recovery. The coordination of knee extensor
force is important to control the center of gravity during gait, therefore
knee extensor force control ability is associated with gait velocity.
Measuring knee extensor force control ability may be available as a
method of qualitatively evaluating motor recovery following stroke.
IMPLICATIONS: Clinical evaluation of sub-maximal force control
ability may contribute to the improvement of the physical therapy
practice in stroke hemiparesis. KEYWORDS: force control ability,
S288
hemiparesis, gait velocity. FUNDING ACKNOWLEDGEMENTS: This
work was supported by Grants-in-Aid for Scientific Research 2004-
2005, Japanese Ministry of Education, Culture, Sports, Science and
Technology. CONTACT: kiyama@health.nop.kagoshima-u.ac.jp
ETHICS COMMITTEE: The Institutional Review Board at the
Kagoshima University approved the procedures used in this study.
Research Report Poster Display
24-19 Monday 4 June 15:30
VCEC Exhibit Hall B & C
RECOVERY FOLLOWING STROKE – A ONE YEAR
PROSPECTIVE STUDY
Horgan F1 , O’Regan M2 , Finn A3 ; 1 School of Physiotherapy,
Royal College of Surgeons in Ireland, Dublin, Ireland; 2 Department
of Statistics, Trinity College Dublin, Ireland; 3 Department of
Physiotherapy, Trinity College Dublin, Ireland
PURPOSE: The aim of this study was to document the course
of recovery in a group of stroke patients over a one year period.
RELEVANCE: The course of recovery in the first three months
after stroke has been well documented. However, the outcome of
patients after this time is less well understood. PARTICIPANTS: All
patients with stroke of moderate severity, defined by the Orpington
Prognostic Score, admitted to two teaching hospitals over an eight-
month period were included. METHODS: 23 stroke patients were
assessed using measures of impairment, disability (Stroke Activity
Scale), handicap (Frenchay Activity Index) and quality of life (General
Well Being Schedule) on 15 occasions during the first year after their
stroke. ANALYSIS: Analysis was by repeated measures analysis
of variance. RESULTS: There were significant changes in recovery
throughout the one year period (F ratio 75.6 df 4 p  0.0001)
including after six months (t 4.5 p  0.0001). The patients made
significant gains in function (FAI) between six (mean 7.3 sd 5.4)
and 12 months (mean 12.6 sd 9.8) after stroke (t 3.8 p 0.0021)
but they did not attain their pre stroke functional levels (mean 28.5
sd 8.1). Quality of life scores indicated levels of severe distress
at six and 12 months and did not change significantly throughout
this period (t −0.391 p 0.7001).There were significant changes
in motor scores for the upper and lower hemiplegic limbs (Q
statistic 15.8-46.6 all p  0.01) during this period. CONCLUSIONS:
In this prospective study, recovery following stroke at all levels
was detected throughout a 12 month period. Despite this recovery
patients appeared to have a poor quality of life which did not
improve. IMPLICATIONS: An increased understanding of the course
of recovery following stroke could provide a basis for evaluating
the varied aspects of therapeutic intervention and the physical and
psychological aspects of recovery. KEYWORDS: Stroke, recovery,
quality of life. FUNDING ACKNOWLEDGEMENTS: Foundation
Fellowship University of Dublin, Trinity College Dublin and the
National Rehabilitation Board Ireland. CONTACT: fhorgan@rcsi.ie
ETHICS COMMITTEE: Federated Dublin Voluntary Hospitals
Research Ethics Committee
WCPT 2007, Research Reports
Research Report Poster Display
25-23 Monday 4 June 15:30
VCEC Exhibit Hall B & C
PROGNOSTIC INDICATORS FOR RETURN TO WORK OF
PATIENTS WITH SUB-ACUTE OCCUPATIONAL NECK OR BACK
PAIN – SYSTEMATIC REVIEW
Heitz C1,5 , Bachmann L2 , Hilfiker R3,5 , Joronen H1 , Lorenz T4 ,
Uebelhart D1 , Klipstein A1 ; 1 Department of Rheumatology and
Institute of Physical Medicine, University Hospital Zurich, 8091
Zurich, Switzerland; 2 Horten Centre, Zurich University, 8091
Zurich, Switzerland; 3 Hochschule Wallis für Gesundheit und Soziale
Arbeit, 3954 Leukerbad, Switzerland; 4 Rehazentrum Leukerbad,
3954 Leukerbad, Switzerland; 5 Physiotherapy Sciences Studies,
Department of Rheumatology and Institute of Physical Medicine,
University Hospital Zurich, Switzerland and Faculty of Health
Sciences, Maastricht University, the Netherlands
PURPOSE: Indicators for return to work (RTW) in patients with
back or neck pain have been discussed controversial. A systematic
literature review was performed to provide an evidence base
for clinical decision-making. RELEVANCE: Back pain, stress and
muscular pain and strain in the extremities are the most common
work health problems among the working population in Europe.
Employees performing physically demanding work have a higher
percentage of long-term disability than office workers. Prognostic
indicators (determinants of prognosis) could help to detect those
patients who would run the risk of developing long-term disabling
back problems and patients who would subsequently benefit most
from costly comprehensive treatment leading to improved prognosis.
PARTICIPANTS: We focused on publications reporting on patients
who performed physically demanding work and were on sick leave
(one to six month) due to non-specific sub-acute/chronic neck or back
pain. METHODS: We searched eight databases (Medline, Embase,
PsycINFO/PsycLIT, Cinahl, Central, PEDro, Psyndex, Sociofile)
without restrictions, checked reference lists of the publications
included and other relevant literature and contacted authors for
prospective studies on indicators predicting RTW. We screened
articles retrieved in duplicate for inclusion criteria, assessed quality
and extracted salient features of all studies included. ANALYSIS:
Due to lack of comparability of prognostic indicators of the studies
included, odds ratios (ORs) of the different predictive factors could
not be statistically pooled and therefore studies were only described
in the light of their methodological rigor. RESULTS: Nine publications
of moderate quality reporting in four different study publications and
patients with sub-acute low back pain were included. 85 medical,
ergonomic, psychological and socio-demographical variables were
analyzed. Numerous weak, two conflicting and several not relevant
indicators (described in at least two different study populations as not
relevant) resulted. Five authors developed models to predict patients’
future ability to work. All models (range of overall correct classification
67.9-87.4%; range of ORs 5.41-25.5) included several indicators out
of different biopsychosocial fields. CONCLUSIONS: The evidence
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: carolin.heitz@usz.ch
Poster Displays, Monday 4 June
Research Report Poster Display
26-03 Monday 4 June 15:30
VCEC Exhibit Hall B & C
ERGONOMICS AND AESTHETICS AT WORKPLACE –
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;
2 Karolinska Institutet, National Institute for Psychosocial Factors
and Health, and Center for Health Sciences, Stockholm, Sweden
PURPOSE: Pain and stress disorders are costly and have been
increasing the last decade. The aim was to study needs for
ergonomic and aesthetic improvement respectively in relation to
occupational and individual health factors. RELEVANCE: Efforts to
achieve early prevention implementations towards deteriorated work
health, need development, beyond traditional methods. A broad view,
also with aesthetic aspects might increase efficacy in occupational
health work within ergonomics/physiotherapy and other professionals
work. PARTICIPANTS: All employees in different occupations at a
Broadcasting Company for Television and a Symphony Orchestra
at a Radio Company were offered to participate in a mail distributed
prevalidated questionnaire. Persons on leave & sick-leave>6 months,
were excluded. Informed consent was included. METHODS: The
needs for ergonomic and aesthetic improvements were correlated
to socio-economic factors, work stress, musculoskeletal pain (MSP),
stress/depression, sleep, sick leave, treatment, occupation, educa-
tion, work environment and life-style. ANALYSIS: Chi-square test
for trend comparisons was performed. Student’s t-test and One-
way Anova. were used. Multivariate analyses were preformed with
linear logistic regression. RESULTS: The participation rate was
74% (n=1961). Non -participants did not differ significantly from
participants in age, gender and occupational level. Males were 57%,
female 43%, mean age 48 yrs (21-67 yrs), 53% had no sick-day.
Definite/high ergonomic and aesthetic needs were reported by 35%
and 40% respectively. No need at all was reported by 17% and 18%,
respectively. High executives and IT-staff were those who had the
lowest needs. Definite/high – ergonomic needs correlated directly
(p 0.001) to all pain and stress parameters including treatment
and sick-leave, work stress, worry about own health, sleeping
disturbances, disturbing noise, psychologically strenuous work, poor
influence on work, problems and dissatisfaction with work conditions
and with life conditions in general. Definite/high – aesthetic needs
correlated directly (p < 0.001-.040) to pain-parameters including
treatment, sick-leave due to pain, work stress, problems and
dissatisfaction at work, disturbing noise, psychologically strenuous
work. The aesthetic needs did not relate directly to treatment and
sick-leave due to stress, low influence on work, worry about own
health, sleeping disturbances and sick-leave due to any reason.
Definite/high need for both ergonomic and aesthetic improvements
correlated (p < 0.001) to younger age. Neither of them correlated
to alcohol intake, education level or gender. CONCLUSIONS: The
results confirm ergonomic needs’ direct relation to occupational
health and well being. Relation was found for aesthetic factors too.
Younger persons showed higher needs for both ergonomic and
aesthetic improvements than older ones (p < 0.001). No differences
in genders or education levels were found. The results indicate
that not only ergonomic, but also aesthetic design might contribute
in prevention of neck, shoulder and back pain, sick leave and
negative work conditions IMPLICATIONS: Physiotherapists meet
persons with different health problems, as MSPs and stress-
related work environment related symptoms. Subjective pain and
stress may be aggravated by unergonomic and ugly occupational
environment. Implementation of ergonomic improvements in pre-
vention and rehabilitation has earlier shown efficacy. To add an
aesthetic perspective on work place design may contribute to
better occupational health. KEYWORDS: Ergonomics, aesthetics,
S289
occupational health. FUNDING ACKNOWLEDGEMENTS: None.
CONTACT: e.schell@telia.com
ETHICS COMMITTEE: Ethics Committee North at Karolinska
Institutet, Sweden
Research Report Poster Display
26-07 Monday 4 June 15:30
VCEC Exhibit Hall B & C
QUALITY OF LIFE IN PATIENTS WITH SUBACUTE
WORK-RELATED LOW BACK PAIN
Mngoma N1,2 , Stevenson J1 , Symes A2 , Hopman W3 ; 1 Queen’s
University, Kingston, Ontario, Canada; 2 Providence Continuing Care
Centre, Kingston, Ontario, Canada; 3 Kingston General Hospital,
Ontario, Canada
PURPOSE: The main objectives of this study were to compare
quality of life (SF-36) scores before and after program participation,
and to compare the SF-36 scores to the Canadian norms. A
secondary objective was to determine associations with return-to-
work. RELEVANCE: Low back pain is one of the leading causes of
disability in the working age population, particularly in industrialized
countries. It is important for clinicians to understand the burden
of illness imposed by low back pain in order to gain greater
appreciation of the impact on patients’ lives. One of the main goals
of physiotherapy is to improve quality of life of our patients, therefore
if factors associated with quality of life were known, efforts could
be directed at improving these in order to improve quality of life.
PARTICIPANTS: Seventy-one patients with subacute low back pain
participated in the study. All patients received treatment for low
back pain in an outpatient, clinic-based return-to-work rehabilitation
program. METHODS: A pretest-posttest design was used in this
program evaluation project. In addition to demographic, work-related,
and clinical data, health-related quality of life (HRQOL) was assessed
on admission to (pre) and discharge from (post) the program
using the Medical Outcomes Study 36-item short form (SF-36).
Pre- and post-program scores were compared to the Canadian
norms. ANALYSIS: t-tests, at level of significance p < 0.05, were
used to detect pretest-posttest differences as well as differences
between those who had returned to work versus those who had
not. RESULTS: There were significant (p < 0.05)improvements in
quality of life after program participation. However, quality of life
scores at discharge were still considerably lower than the Canadian
population norms, particularly in the physical domains. Patients who
had returned to work at program completion reported significantly
better quality of life compared to those still off work. These differences
were found in six of the eight SF-36 domains: physical functioning,
pain index, general health perceptions, social functioning, role
emotional, mental health, as well as the two component scores.
CONCLUSIONS: Quality of life improved significantly during the
course of rehabilitation. However, when compared with Canadian
population norms, the discharge quality of life scores were still
markedly low. Moreover, those off work at program completion,
generally reported significantly poorer quality of life compared to
those who were working. IMPLICATIONS: Low back pain is a
complex problem that has a huge impact on society and the lives
of the individuals affected. Measuring quality allows for a more
comprehensive understanding of the burden of illness. Work is an
important part of adult life; therefore it is not surprising that poor
quality of life is reported where disruptions in the ability to work
have occurred. The therapeutic value of work has been suggested
in the work disability literature. These results seem to support this
notion. The facilitation of safe and timely return to work needs to
be a key goal of rehabilitation of injured workers with low back pain.
KEYWORDS: low back pain, quality of life, return-to-work. FUNDING
ACKNOWLEDGEMENTS: This study was made possible by the
S290
support provided by Providence Continuing Care Centre, Kingston,
Ontario. CONTACT: mngoma@post.queensu.ca
ETHICS COMMITTEE: Queen’s University and Affiliated Hospitals
Research Ethics Board
Research Report Poster Display
27-11 Monday 4 June 15:30
VCEC Exhibit Hall B & C
INTER-TRIAL AND TEST-RETEST RELIABILITIES OF TIMED
BRIDGE TESTS AMONG FRAIL OLDER ADULTS
Pilon M1,2 , Nadeau S2,3 , Piotte F2 ; 1 CSSS Bordeaux-Cartierville-
St-Laurent, Montréal, Québec, Canada; 2 École de réadaptation,
Université de Montréal, Québec, Canada; 3 Institut de réadaptation
de Montréal, Centre de recherche Interdisciplinaire en Réadaptation
(CRIR), Montréal, Québec, Canada
PURPOSE: To assess the reliability of three versions of the Timed
Bridge Test (TB Test) in frail older adults. RELEVANCE: Bridging
activities in bed are often performed by the geriatric population, which
often has a reduced mobility. Physical therapists also use this activity
to assess the hip muscle strength and lower-limb motor control in
various populations such as individuals with hemiparesis following
a stroke. However, the psychometric characteristics of bridging
have never been studied in a geriatric rehabilitation population.
PARTICIPANTS: A convenience sample of 30 frail older adults
(17 females, 13 males), aged from 65 to 94 years (mean age
±SD: 80.4 ±7.2), participated in the study. They were recruited
from the functional intensive rehabilitation centre (63%), the geriatric
evaluation unit (14%) and the geriatric day hospital program (23%)
of a Montreal health center. All gave their written consent prior to
the assessment. METHODS: The subjects performed three different
TB Tests: 1) a hold test(TB-Static), 2) a 5-repetitions dynamic
test (TB-5rep) and 3) a 60 seconds dynamic test (TB-60s). The
tests were repeated twice on two occasions separated by a 48-h
interval. For all trials, a physical therapist recorded the height of the
bridge with a pelvialtimeter, the time of execution (TB-Static and TB-
5rep) or the number of repetitions (TB-60s). ANALYSIS: Descriptive
statistics were calculated to establish the subjects’ characteristics and
performance in the TB Tests. The coefficients of dependability (÷)
and standard errors of measurement (SEMs) derived from the
generalizability theory were used to assess the test reliability.
RESULTS: For the three tests, the mean (±SD) height of the bridge
was 7.5 cm (±2.7) with values ranging from 2.8 to 13.5 cm. The
mean time to execute the test was 32.4 s (±24.1) and 16.4 s (±6.7)
for the TB-Static and TB-5rep, respectively, and the mean number of
repetitions for the TB-60s was 29.7 (±14.9). The inter-trial reliability
was almost perfect for heights of the bridge with coefficients (÷) higher
than 0.96 and SEMs all under 1 cm. A good inter-trial reliability was
also found (0.83 < ÷ < 0.94; SEMs 11.1 s, 2.3s and 4.2 rep) for the
duration (TB-Static and the TB-5rep) and the number of repetitions
(TB-60s). For the test-retest reliability, the height of the bridging test
showed ÷ indices varying from 0.87 to 0.91 (SEMs lower than 2 cm).
For the time or repetition parameters, the reliability was good for
the TB-60s dynamic test (÷ = 0.87; SEM=5.6 reps) and moderate
for TB-Static (÷ = 0.73; SEM=13.7 s) and for the TB-5rep (÷ = 0.70;
SEM=3.6 s). CONCLUSIONS: The TB Tests were simple to execute
and showed good clinical applicability in a geriatric population. All
parameters assessed showed acceptable to very good inter-trial and
test-retest reliability with several values higher than 0.80. Future
studies will now need to determine the factors associated with
the execution of these bridging activities. IMPLICATIONS: Physical
therapists often use bridging activities during rehabilitation. This study
showed that the performance of different standardized bridge tests
is reliable and might be part of the tests used to assess geriatric
patients. KEYWORDS: Elderly, reliability, assessment. FUNDING
ACKNOWLEDGEMENTS: This project was supported by the Ordre
professionnel de la Physiothérapie du Québec and the Fonds de
WCPT 2007, Research Reports
Marie-Anne Lavallée. The authors thank M. Beaudry and M. Labadie
for their technical support. CONTACT: felisa@sympatico.ca
ETHICS COMMITTEE: CSSS Bordeaux-Cartierville-St-Laurent
ethics’ committee
Research Report Poster Display
27-15 Monday 4 June 15:30
VCEC Exhibit Hall B & C
THE EFFECTS OF SHORT-TERM INTERVENTION ON FALLS
SELF-EFFICACY AND THE RELATIONSHIP BETWEEN
CHANGES IN PHYSICAL FUNCTIONS AND FALLS
SELF-EFFICACY
Arai T1,2 , Obuchi S2 , Inaba Y1 , Nagasawa H3 , Shiba Y4 ,
Watanabe S5 , Kimura K6 , Kojima M2 ; 1 Graduate School of
Medical Science, Kitasato University; 2 Department for Prevention
of Dependence on Long-term Care, Tokyo Metropolitan Institute
of Gerontology; 3 Faculty of Health and Social Work, School
of Rehabilitation, Kanagawa University of Human Services;
4 Department of Allied Health Science, Kitasato University;
5 Department of Gerontology, Graduate School of International
Studies, Obirin University; 6 Department of Humanities and Social
Sciences. Tokyo Denki University
PURPOSE: It is important to determine how to maximize the
effectiveness of short-term exercise intervention for elderly people.
The purposes of our study were to evaluate the effects of short-
term exercise intervention on falls self-efficacy and to evaluate the
relationships between baseline falls self-efficacy and changes in
physical functions in older people. RELEVANCE: Health promotion
of community-dwelling older people is now becoming a major field
in which physical therapy will play an important role. In particular,
preventing falls and slowing declines in physical function are
important areas for physical therapists. The results of this study are
aimed at providing information on how to maximize the effect of short-
term exercise intervention. PARTICIPANTS: The participants were
171 community-dwelling older people aged 65 and older. METHODS:
This study was a randomized controlled trial. The methodology of
this study was approved by the ethics committee. The subjects were
randomly assigned into an exercise intervention group or a health
education group. The subjects in the exercise intervention group
performed an exercise program that included strength and balance
training. The duration of the exercise program was 3 months, with
classes conducted for 1.5 hours, twice a week. The subjects in
the health education group, which functioned as a control group,
received 1.5 hours of lectures on health promotion for older people
twice a month for three months. Falls self-efficacy was measured
using the Falls Efficacy Scale (FES). The measurements of physical
functions included static and dynamic balance, walking velocity,
flexibility, and strength. ANALYSIS: After the randomization, we
evaluated the differences in each set of measurements between
the two groups using an unpaired t-test. The improvement of
measurements was evaluated by the Wilcoxon rank test. To evaluate
the relationships between the baseline FES score and the change in
these measurements after the intervention, we used the Spearman
rank-correlation coefficient. RESULTS: About half of the subjects
had perfect scores on the FES at the first investigation. There
was no difference between the exercise intervention group and the
control group in terms of FES score either before or after the
intervention period. Also, there was no significant improvement of
FES in either group. But there were significant negative correlations
between the baseline FES score and the change in maximum
walking velocity (r = −0.29, p < 0.018) and knee extensor strength
(r = −0.25, p < −0.040) in the exercise group. CONCLUSIONS: The
results suggest that a short-term exercise intervention had no effect,
possibly due to the high baseline FES scores of the participants, on
the confidence of community-dwelling older persons. However, the
negative association between baseline FES score and increases in
some measures of function suggest that short-term exercise may be
Poster Displays, Monday 4 June
beneficial to a subset of older persons with lower FES scores. The
results of our research might help in the planning of effective strate-
gies to improve the physical functions of community-dwelling older
people. IMPLICATIONS: For physical therapy practice. KEYWORDS:
falls self-efficacy, physical function, short-term exercise intervention.
FUNDING ACKNOWLEDGEMENTS: This work was not funded by
any foundation or company.
ETHICS COMMITTEE: This study was approved by the ethics
committees of the Tokyo Metropolitan Institution of Gerontology.
Research Report Poster Display
27-19 Monday 4 June 15:30
VCEC Exhibit Hall B & C
RANDOMIZED CONTROLLED TRIAL OF SENSORY-SPECIFIC
BALANCE TRAINING IN OLDER ADULTS: EFFECT ON
POSITION, MOVEMENT, AND VELOCITY SENSE AT THE ANKLE
Westlake K, Wu Y, Culham E; Queen’s University, School of
Rehabilitation Therapy, Kingston, Canada
PURPOSE: The purpose of this randomized controlled trial was
to investigate the effects of balance exercises on proprioception.
RELEVANCE: Age-related changes in proprioception contribute to
impairments in postural control and increased fall risk in older
adults. Few studies have examined the possibility of enhancing this
sensation through specific training interventions in this population.
PARTICIPANTS: Thirty-six healthy older volunteers and 24 healthy
younger volunteers. METHODS: Older participants were randomly
assigned to a balance exercise group (n=17) or a falls prevention
education group (n=19), each led by a physical therapist. Baseline
and post-intervention measurements of three proprioceptive mea-
sures (threshold to perception of passive movement, TPM; passive
joint position sense, P-JPS; threshold to velocity discrimination, TVD)
were obtained at the ankle in exercise and education groups. Follow-
up measurements of TPM, P-JPS, TVD were also taken in the
exercise group 8-weeks post intervention. For comparative purposes,
24 healthy younger participants underwent a one-time assessment
of TPM, P-JPS, and TVD. ANALYSIS: Analysis of variance
(ANOVA) was used to investigate the effects of the interventions on
proprioceptive outcomes and differences between younger and older
groups. Interaction effects were followed with Bonferroni adjusted
post-hoc tests. RESULTS: Improvements in TVD between baseline
and post-intervention in the exercise group, p = 0.014, and differences
between exercise and education groups post-intervention, p = 0.019,
were found. These improvements were not maintained 8-weeks
post exercise intervention. Comparisons with the younger group
revealed differences in TVD in both the exercise and education group
at baseline, p < 0.001, education group post-intervention, p < 0.001,
and exercise group at 8-weeks follow-up, p = 0.018. Differences
between TVD of the younger group and exercise group were no
longer present by post-intervention. TPM and P-JPS showed no
change as a function of the exercise intervention. CONCLUSIONS:
Results support short-term improvements in velocity sense following
a sensory-specific exercise program. Improvements in movement and
position sense were not supported. Further research is required to
determine the contributing physiological mechanisms and to confirm
the functional relevancy of this discovery. IMPLICATIONS: Given
that previous research has shown velocity input to be crucial and
more accurate than position and acceleration information for postural
corrections, the possibility to reverse age-related changes in velocity
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:
westlake@rrd.stanford.edu
ETHICS COMMITTEE: Queen’s University Health Sciences and
Affiliated Teaching Hospitals Research Ethics Board.
S291
Research Report Poster Display
28-23 Monday 4 June 15:30
VCEC Exhibit Hall B & C
FALLS PREVENTION IN THE ELDERLY. PARTICIPATORY
ACTION RESEARCH AS A FRAMEWORK TO IMPLEMENT
EVIDENCE-BASED KNOWLEDGE IN CLINICAL PRACTICE
Granbo R1 , Vaskinn A2 , Hansen A3 , Iversen S4 , Helbostad J5 ;
1 Sør-Trøndelag University College, Norway; 2 Department of
Physiotherapy, Trondheim, Norway; 3 Department of Physiotherapy,
Trondheim, Norway; 4 Dept. of Neuroscience, Faculty of Medisine,
Noewegian University og Science and Technology; 5 University
of Bergen, Norway
PURPOSE: The base of knowledge is ever developing and there
is a challenge in implementing new evidence-based knowledge
in clinical practice. To develop evidence-based practice, Physical
Therapists need to be able to search for relevant literature, as well
as interpret results and their relevance for current practice. The
present study aimed to investigate how recent, relevant knowledge
about fall prevention in elderly can be implemented as a part of
the daily clinical practice for Physical Therapists working in the
primary health care. RELEVANCE: To implement evidence-based
knowledge in the Physical Therapists practice. PARTICIPANTS:
All Physical Therapists (n=46) working in the primary health care
in the municipality of Trondheim, Norway participated. METHODS:
Action research was used as methodological framework. Methods
used were literature studies, case studies, dialogue seminars and
focus-groups. ANALYSIS: The study has been a process through
which the researchers together with the Physical Therapists have
identified needs for knowledge development, collected and analysed
information and acted upon these findings. Discussions and inter-
views were taped, transcribed and analysed through open coding.
In this way data collection, analyses and evaluation have been
parallel processes. RESULTS: The physiotherapists report increased
consciousness about their professional role and increased capacity
in questioning and reflecting on their own and their colleges’ clinical
reasoning process. The therapists show a more homogeneous
approach to older people with risk of falling than previous to the study.
There has been an agreement within the community of Physical
Therapists about how to identify people at risk of falling and how to
assess them. A model has been developed that illustrates the various
phases which must be present in order to make changes toward
a more evidence-based practice. CONCLUSIONS: Implementation
of results from research into practice requires active work with the
interpretation of the research results as well as a research community
based on confidence and support. The Physical Therapists’ own
clinical work experiences seemed to be good starting points for
discussing the relevance of research results. IMPLICATIONS: This
methodological framework seems to bee an appropriate way to
implement evidence-based knowledge and make changes towards
a more evidence based practice among Physical Therapists working
with elderly in primary health care. We hope that our model
can be useful in other working fields for Physical Therapists,
and also within other professionals. KEYWORDS: FallS prevention.
Participatory Action Research. Evidence-Based Practice. FUNDING
ACKNOWLEDGEMENTS: The present study has been financially
supported by The Norwegian Fund for Post-Graduate Training in
Physiotherapy, Sør-Trøndelag University College, Norway and the
Municipality of Trondheim, Norway. CONTACT: randi.granbo@hist.no
ETHICS COMMITTEE: Recommended by the Regional Committee
for Research Ethics in Norway. Approved by The Norwegian Social
Science Data Services.
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Research Report Poster Display
29-03 Monday 4 June 15:30
VCEC Exhibit Hall B & C
FALLS AND COGNITIVE FUNCTION IN OCOTOGENARIAN
COMMUNITY-DWELLING ELDERLY
Leonardi A1 , Teixeira D1 , Galceran N1 , Okuma L1 , Meidiros P1 ,
Uhler C1 , Lemos P1 , Driusso P2 , Perracini M2 ; 1 Physical Therapy
undergraduate students, City of São Paulo University, São Paulo,
Brazil; 2 Professor Department of Physical Therapy, Master of
Science Program, City of São Paulo University, São Paulo, Brazil
PURPOSE: To verify the association between history of falls in
the previous year and cognitive level in octogenarian community-
dwelling elderly. RELEVANCE: Cognitive decline has been pointed
out as one of the major risk factors for falls and recurrent falls in the
elderly, especially in frail subjects. But its association is poorly studied
among a very old community-dwelling population. PARTICIPANTS:
A cohort of 377 octogenarian subjects living in an urban area in São
Paulo, Brazil which is referred to an outpatient ambulatory preventive
follow-up. This study is based on a sample of 61 subjects, mean
age 84.25±2.98 both genders. METHODS: They were evaluated
through a standard multidimensional questionnaire containing socio-
demographic, clinical, functional, psycho-cognitive and health-related
quality of life data which accomplishes MMSE, GDS, Brazilian OARS
Multidimensional Functional Assessment Questionnaire – BOMFAQ,
WHOOQL, Timed up and Go Test. ANALYSIS: Simple and inferential
descriptive statistics were performed using Chi-Squared test and the
correlation between quantitative variables were verified by Pearson’s
Correlation test and Mann-Whitney non-parametric test. The level of
significance adopted was p < 0.05. RESULTS: It was verified that
23% had presented cognitive decline and that 57% of them had
suffered falls in the last year, however it was not found a significant
statistical association (p = 0.62). Considering the TUG performance,
there was a significant correlation to MMSE score (p = 0.005) and
its dimensions: orientation (p = 0.0001), attention (p = 0.01) and
language (p = 0.005). CONCLUSIONS: The results suggest that cog-
nition and falls are not independently related in octogenarians despite
the fact that mobility measured through TUG could be influenced by
cognitive decline. There must be other independent variables that
are confounding its relation and more extensive statistical analysis
should be conducted. IMPLICATIONS: Balance and mobility are a
typical concern among geriatric physical therapists and its relation
to cognitive decline should be carefully evaluated when considering
its implication to falls in very old subjects, since other factors have
to be accomplished. A multidimensional assessment can provide
essential key indicators. KEYWORDS: falls, cognitive function, octo-
genarian. FUNDING ACKNOWLEDGEMENTS: UNICID. CONTACT:
alininha_r@hotmail.com
ETHICS COMMITTEE: University protocol number: 13185589
Research Report Poster Display
30-11 Monday 4 June 15:30
VCEC Exhibit Hall B & C
FUNCTIONAL EVALUATION OF THE EFFECTS OF BOTULINUM
TOXIN TYPE-A INJECTION IN NON-AMBULATORY CHILDREN
WITH CEREBRAL PALSY
Megens A1 , Kealey L1 , McCormick A1 , Sveistrup H2 ; 1 Ottawa
Children’s Treatment Centre; 2 University of Ottawa
PURPOSE: The purpose of this prospective pilot study was to
investigate whether there are functional changes for non-ambulatory
children with cerebral palsy (CP) following injection with Botulinum
Toxin Type-A (Btx-A) to the lower extremity. RELEVANCE: Very
few studies have investigated functional skills in children with CP
who are not independently ambulatory following injection with Btx-
A to the lower extremity. PARTICIPANTS: Subjects included five
children with cerebral palsy who had Btx-A injection planned for
the lower extremity who were not independently ambulatory, or
WCPT 2007, Research Reports
were ambulatory for less than one year. Children who were not
able to participate actively in a therapy program, or who had
orthopaedic surgery within the past year were excluded from this
study. METHODS: Ethics approval was obtained from the University
of Ottawa Research Ethics Board. Subjects were assessed for a
total of four sessions: prior to injection, 1-month following, 3-months
following and 6-months following injection of Btx-A. At the initial
pre-injection assessment, the process for Goal Attainment Scaling
(GAS)was used to determine three goals of treatment. The subjects’
current functional ability with respect to the three functional goals
was assessed. Additional assessments included range of motion
(ROM) and Gross Motor Function Measure (GMFM). Based on the
goals of treatment and current functional ability a treatment program
was provided for families. Items were reassessed at one, three
and six months post Btx-A injection. ANALYSIS: Scores from ROM
and GAS data were compared between pre-injection and the three
post-injection data points. Scores from GMFM data were compared
between pre-injection and 6-months post-injection. ROM and GMFM
data were compared using paired t-tests. T-scores were used to
analyze changes in GAS scores for each subject. RESULTS: While
all five subjects had clinically significant differences in ROM scores
from pre-injection assessment to post-injection assessments at 1-
month and 3-months follow-up, none of the ROM changes were found
to be statistically significant (p values from 0.06–0.78). GMFM scores
from pre-injection assessment to 6-months post-assessment did not
change significantly (ranged between 0.6 and 5%). Five subjects
were evaluated on three goals of treatment each, using the process
for GAS (n-15 goals). From pre-injection to 1-month post, there was
improvement noted in 14 goals. From pre-injection to 3-months post,
improvement was noted in all 15 goals. From pre-injection to 6-
months post-injection, there was improvement noted for 14 goals.
The outcome for each goal was expressed as a T-score; a T-score
of 50 represents the level of attainment expected after intervention.
At the 6-month post-injection assessment, 5 of the goals obtained a
T-score of less than 50, for 6 goals the T-score was 50, and for 4
goals, the T-score was greater than 50. CONCLUSIONS: Injection
with Btx-A combined with a physical therapy treatment program can
result in functional changes for children with cerebral palsy who
are not independently ambulatory. These functional changes can
remain following the effectiveness period of Btx-A. IMPLICATIONS:
Functional skills that are not captured by the GMFM can be measured
using GAS. KEYWORDS: Functional assessment, botulinum toxin
type-A, cerebral palsy. FUNDING ACKNOWLEDGEMENTS: The
generous support of the Physiotherapy Foundation of Canada is
gratefully acknowledged. CONTACT: tmegens@octc.ca
ETHICS COMMITTEE: University of Ottawa Research Ethics Board
Research Report Poster Display
30-15 Monday 4 June 15:30
VCEC Exhibit Hall B & C
IS PAIN ASSOCIATED WITH DEMOGRAPHIC, PHYSICAL AND
LIFESTYLE FACTORS IN ADULTS WITH CEREBRAL PALSY?
Dumas F1,2 , Maltais D1,2 , Boucher N1,2 , Corriveau D3 ,
Beauregard L1 , Pelletier M3 , Pichard L3 , Robitaille N1,2 ,
Roy K1 , Richards C1,2 ; 1 Centre for Interdisciplinary Research in
Rehabilitation and Social Integration, Quebec City, Canada; 2 Laval
University, Quebec City, Canada; 3 Quebec Rehabilitation Centre,
Quebec City, Canada
PURPOSE: To determine, for adults with cerebral palsy (CP), if
pain is associated with selected demographic, physical, and lifestyle
factors. RELEVANCE: Although pain is known to interfere with
activities of daily living in adults with CP, very little is known about
factors associated with pain. A better understanding of the relevant
demographic, physical or lifestyle factors could guide future physical
therapy research and interventions designed to address pain in these
clients. PARTICIPANTS: Men (n=71) and women (n=69) aged 28
yr ±5.6 participated in the study. All were diagnosed with CP and
Poster Displays, Monday 4 June
were previous clients of the local pediatric rehabilitation centre. The
frequency distribution (%) across Gross Motor Function Classification
Levels (GMFCS) was: Level I=30.7; Level II=8.6; Level 3=15.7;
Level IV=31.4; Level V=13.6. There was no significant difference
in the distribution of age across the GMFCS levels. METHODS:
A questionnaire regarding health and lifestyle was administered to
the participants during either a telephone or face-to-face interview,
or as a form sent to the participant by mail. The questionnaire
was based on that used in a province-wide (Quebec) survey of
lifestyle and health (1998). ANALYSIS: Descriptive statistics were
used to summarize the demographic data. The relationships between
pain and the various factors of interest were analyzed using the
Chi-square test with significance set at p = 0.05. RESULTS: The
participants as a total group, whether men or women, had an equal
chance of having or not having pain (n=38 men, 40 women with
pain; n=33 men, 29 women with no pain, ns). Pain and whether
walking ability deteriorated or not over the last three years was also
assessed (n=86). Of the 33 individuals in this group who reported
a deterioration in walking, a significantly greater number of them
reported pain (n=28 pain; n=5 no pain, p < 0.001). With respect to
the participants’ level of physical activity (less active group = 20-
30 minute bouts of activity less than twice weekly, more active
group = 20-30 minute bouts of activity two or more times weekly),
the number who reported pain (n=78) was similar in the two activity
groups (n=43 less active; n=35 more active, ns). Of those who were
pain free (n=62), however, there were significantly more participants
in the active than in the less active group (n=42 active; 20 less
active, p = 0.004). Moreover, of those in the less active group (n=63),
significantly more participants reported having pain (n=43 pain;
n=20 no pain, p = 0.004). CONCLUSIONS: Individuals with cerebral
palsy have an equal chance of having and not having pain. Pain,
however, may be related to walking ability and the level of physical
activity. IMPLICATIONS: Although those with CP do not necessarily
report pain, for those who do, interventions which focus on walking
ability (for those who are able) or on physical activity, may be of
benefit to address pain. Further research is needed to test these
hypotheses and to clarify whether pain is the cause or effect of
decreased walking or physical activity. KEYWORDS: cerebral palsy,
pain, personal factors. FUNDING ACKNOWLEDGEMENTS: This
study was supported by the Centre for Interdisciplinary Research
in Rehabilitation and Social Integration, the Laval University Chair
in Cerebral Palsy Research, and the Cerebral Palsy Consortium.
CONTACT: francine.dumas@rea.ulaval.ca
ETHICS COMMITTEE: Institutional Review Board of Quebec
Rehabilitation Centre, Quebec City, Canada
Research Report Poster Display
30-19 Monday 4 June 15:30
VCEC Exhibit Hall B & C
EXERCISE GUIDANCE FOR CHILDREN WITH CEREBRAL PALSY
IN A SCHOOL FOR PHYSICALLY CHALLENGED CHILDREN
Osuda Y1 , Kozuka N2 , Sato Y3 , Takakura C1 , Kayukawa C4 ,
Kashiki M4 , Furukawa A4 ; 1 Graduate School of Health Sciences,
Sapporo Medical University. Sapporo. Japan; 2 School of Health
Sciences, Sapporo Medical University. Sapporo. Japan; 3 Division
of Rehabilitation, Tokeidai Memorial Hospital. Sapporo. Japan;
4 Hokkaido Makomanai School for the physical challenged, Sapporo
Unit. Sapporo. Japan
PURPOSE: The purpose of this study was to investigate the
relationship between percentage body fat and physical characteristics
of children with cerebral palsy (CP) in a school for physical challenged
children. RELEVANCE: It is important to know the relation between
body characteristics and gross motor function for children with CP
in school. Additionally, it may be possible to improve their fitness
conditioning with the view of managing their weight. PARTICIPANTS:
Forty students (male: 23, female: 17, mean age 14.2Y, [SD 2.7],
range 10Y-18Y) in Hokkaido Makomanai school for the physically
S293
challenged, Sapporo, Japan. All parents provided their informed
consent and the ethics commission of our university approved the
study. METHODS: Rohrer index (RI) and body-mass index (BMI)
was used as body characteristics criteria. Height and weight indices
were calculated. The subjects’ percentage body fat were measured
using a percentage body fat meter (Poke-NAVI II DF215 Yamato-
scale co., Ltd.). Three trials of percentage body fat were taken
for each subject, then the mean value for each subject was used.
Subjects were classified into five groups according to the Gross Motor
Function Classification System (GMFCS), and into three groups
according to their feeding ability (independent, partial assisted,
assisted). ANALYSIS: A Pearson’s correlation coefficient was used
to examine the relationship between their body characteristics and
the percentage body fat. A Spearman’s correlation coefficient was
used to examine the relationship between their GMFCS levels and
their percentage body fat, and between their feeding ability. A p
value of less than 0.01 was accepted for significance. All statistical
analyses were performed using SPSS for Windows. RESULTS: The
body fat percentage could not be measured in 6 children because
of operating errors. For the remaining subjects, the mean value
of the percentage body fat was 18.4% [SD9.3]. Two children were
judged obese children using the BMI. Subjects were classified into
level I (n=3), level III (n=20), level IV (n=6) and level V (n=5)
categories depending on the GMFCS. There was a significant
positive correlation between the body characteristics and the
percentage body fat (RI; r =0.89, BMI; r =0.77), and the feeding ability
and the percentage body fat (r = 0.65). There was significant negative
correlation between the GMFCS levels and the percentage body fat
(r = 0.47). CONCLUSIONS: The percentage body fat tended to rise in
children who had high GMFCS levels. This result may have occurred
because the high GMFCS level children had a better feeding ability,
they are able to feed themselves, while the low level children had
limited feeding ability. This finding is important for guiding children
with CP in managing their weight. It is possible to guide exercise
for children with CP by understanding physical characteristics of
each child with CP. The correlation suggests an appropriate fitness
conditioning in their school life. IMPLICATIONS: This report gives
the future plan for children with CP in a school from the perspective
of their health management. KEYWORDS: Cerebral palsy, health
management, GMFCS. FUNDING ACKNOWLEDGEMENTS: We
thank the parents and school for helping with this study. CONTACT:
y.osuda@sapmed.ac.jp
ETHICS COMMITTEE: the ethics commission of Sapporo Medical
university
Research Report Poster Display
31-23 Monday 4 June 15:30
VCEC Exhibit Hall B & C
DELAYED PAIN REACTIONS DUE TO STRESS IN PATIENTS
WITH COMPLEX REGIONAL PAIN SYNDROME
Allen R, Hulten J, Roelofson M, Martin T, McCormack S; University
of Puget Sound, Tacoma, WA, USA
PURPOSE: This study’s purpose was to determine the effect
of perceived stress on pain intensity, timing of episodic pain
increases, and related functional changes in patients with complex
regional pain syndrome (CRPS). RELEVANCE: Intensity of pain
associated with CRPS varies over time and may be exacerbated
by activity, temperature, stress, etc. Episodes of severe pain
intensity are often inexplicable, hard to predict, and markedly impact
therapy and function. Latent endocrine changes associated with
psychogenic stress can increase peripheral nerve excitability long
after the initiating event, possibly explaining delayed increases
in neuropathic pain intensity. PARTICIPANTS: This was a case
study design involving two functionally stable, male volunteers with
sympathetically mediated Type I CRPS. Patient 1 was an unemployed
49 year-old, with a six-year CRPS history affecting the right lower
extremity. Patient 2 was an employed 31 year-old with an eight-year
S294
history of CRPS affecting the left upper extremity. METHODS: To
track temporal fluctuations in perceived pain, stress, and function,
participants completed a visual analog pain and stress scales, the
Daily Stress Index, and the RAND 36-Item Health Survey daily for
ten weeks. ANALYSIS: Daily values for all scales were graphed
across the ten-week tracking epoch for each participant. Episodic
peaks were manifested on days when ratings exceeded 1.5 and 2.5
standard deviations above the participant’s ten-week means for pain
and stress, respectively. To analyze temporal relationships between
stress and delayed pain flares, serial lag correlations were performed
using 0-14 day lags. The same statistical comparisons were made
between stress and function. RESULTS: No clear relationship was
evident between ratings stress levels and perceived pain intensity
occurring on the same day (r = +0.04 & +0.14). However, serial
lag correlations revealed strong concordance between days of peak
stress and high pain intensity experienced ten days later for both
participants (r = +0.49 & +0.52). For each participant, every criterion
peak stress day was followed ten days later by a sharp pain
intensity increase. Notable reductions in measured function were
also reported ten days following each peak stress day. These
findings are consistent with timing of the thyroxine axis in the stress
response. Once released, thyroxine is bound by serum proteins,
whose timed dissociation results in peak effects ten days later.
Thyroxine’s relevant effect is increased peripheral nerve excitability,
thereby possibly heightening perceived neuropathic pain severity.
CONCLUSIONS: Based on findings from two participants measured
over ten weeks, these individuals with CRPS experienced delayed
increases in pain magnitude and decreased function occurring ten
days following stressful episodes. IMPLICATIONS: Patients and
therapists are frequently unable to explain debilitating CRPS pain
flares. Knowing that stressful episodes may lead to pain flares, and
related functional attenuation ten days later, patients could predict
the onset of particularly painful days, and better time and plan
activity. This may placate some patient fear and anxiety related
to latent pain increases. Therapists can use this information to
time treatment components and distinguish stress-related pain flares
from those induced by activity or treatment intensity. KEYWORDS:
Complex Regional Pain Syndrome, Stress, Delayed Pain. FUNDING
ACKNOWLEDGEMENTS: This study was supported by a Student
Research Award grant from the University Enrichment Committee
of the University of Puget Sound, Tacoma, WA, USA. CONTACT:
rallen@ups.edu
ETHICS COMMITTEE: Institutional Review Board, University of
Puget Sound, Tacoma, WA, USA
Research Report Poster Display
32-07 Monday 4 June 15:30
VCEC Exhibit Hall B & C
EFFECTS OF LOW-FREQUENCY VISITING PHYSICAL THERAPY
ON ACTIVITIES OF DAILY LIVING AND FAMILY RELATIONSHIPS
OF SUBJECTS IN REHABILITATION-DEPRIVED REGIONS
Morita H1 ,ItoH2 , Sakuragi Y1 ,Lee S1 ,
Kanbayashi H1 ,
Saito K3 ,
Kanazawa Y4 ; 1 Department of Physical Therapy, Aomori University
of Health and Welfare, Aomori, Japan; 2 Formerly, Aomori
University of Health and Welfare, Akita, Japan; 3 Department of
Physical Therapy, Kibi International University, Okayama, Japan;
4 Department of Physical Therapy, Mejiro University, Saitama, Japan
PURPOSE: In Japanese regions deprived of home or facility
rehabilitation resources (rehab-deprived regions), visiting physical
therapy is difficult to implement despite the presence of subjects
needing it. Visiting physical therapy has been reported to be effective
even at a frequency of 1-2 times a week, but its frequency is often
below this level in rehab-deprived regions. This study was designed to
prospectively evaluate the effects of low-frequency visiting physical
therapy continued over a period on activities of daily living (ADL)
of home-cared disabled people in rehab-deprived regions and their
relationships with caregivers (family relationships). RELEVANCE:
WCPT 2007, Research Reports
This study demonstrated the effectiveness of low-frequency visiting
physical therapy for supporting home-cared disabled people in rehab-
deprived regions. PARTICIPANTS: The subjects were 84 home-
cared disabled people in 5 towns or villages of rehab-deprived
regions in Aomori Prefecture, Japan. The subjects were selected
with cooperation by the local governments. They were divided into
an intervention group (57 subjects; mean age 69.5±10.7 years)
and a control group (27 subjects; mean age 70.5±8.5 years).
METHODS: Visiting physical therapy was conducted by a team
consisting of a physical therapist and a health care specialist such
as a public health nurse once every 1-3 months. ADL were evaluated
using a modification of the Barthel Index (BI) by Granger et al.,
and the family relationships were evaluated using the Evaluation
Scale for Family Relationships of the Home-Cared Disabled (family
relationship scale) of Ito et al., at 2 points, i.e., the point of
initial evaluation during the intervention period (initial) and the
point 6-24 months after the initial evaluation (second). ANALYSIS:
The c2 -test, residual analysis, Cramer’s measure of association,
structural equation modeling (mean structure models), logit loglinear
analysis, and Wilcoxon signed-ranks test were used for statistical
analyses. RESULTS: The mean BI was significantly higher at the
second measurement (68.3±34.1) than at the initial measurement
(63.2±33.0) in the intervention group (Z=-3.781, P = 0.000), but no
significant difference was noted in the control group. Whether the
subjects received visiting rehabilitation or not was moderately related
to changes in ADL (c2 (2) = 8.347, P = 0.015) (Cramer’s V=0.315,
P = 0.015), and improvements in ADL were observed more frequently
in the intervention group. ADL of the intervention group improved
even after adjustment of unevenness in subject assignment for the
SEM, and the improvement rate was 3.89 times higher than in the
control group. The score of family relationship scale was significantly
higher at the second measurement than at the initial measurement
in the intervention group, but this improvement was not ascribed to
visiting physical therapy (c2 (2) = 0.645, P = 0.725). CONCLUSIONS:
Visiting physical therapy by physical therapists was suggested to
improve the independence level of ADL even when it is performed
at a frequency of once every 1-3 months in a rehab-deprived region.
Therefore, low-frequency visiting physical therapy is considered to be
necessary in order to support home-cared disabled people. However,
the improvements in the family relationships may have been caused
by factors other than visiting physical therapy. IMPLICATIONS: non.
KEYWORDS: Visiting physical therapy, activities of daily living, family
relationships. FUNDING ACKNOWLEDGEMENTS: This study was
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
Welfare.
Research Report Poster Display
35-03 Monday 4 June 15:30
VCEC Exhibit Hall B & C
ATTITUDES TOWARDS THE PHYSICALLY CHALLENGED
(ATPC): RELIABILITY AND VALIDITY OF A JAPANESE VERSION
OF ATPC-FORM O
Yoneyama M1,2 , Ogiwara S2 ; 1 Department of Medical Rehabilitation
Services, Osaka Saiseikai Nakatsu Hospital, Osaka, Japan;
2 Division of Rehabilitation Science, Department of Health Sciences,
Graduate School for Health Studies, The University of Kanazawa,
Kanazawa, Ishikawa, Japan
PURPOSE: Studies on attitudes towards the physically challenged
(ATPC) have involved the use of a variety of measuring instruments.
Out of ATPC-Forms A, B, and C developed by Yuker et al., the latter
has the highest validity amongst the three. The Japanese version
of ATPC-Form O (Form O) has been available since 1999, and
an attempt was made to test it and verify its use. RELEVANCE:
Attitudes are conceptualised as feelings, knowledge, and readiness
Poster Displays, Monday 4 June
to act, all of which are amenable to change. These concepts are
considered important when applied to professional practice and
in the education of physiotherapists. Psychometric measures must
possess high reliability and validity to enable evidence-based study of
ATPC. Verification of Form O would therefore be conducive to future
research on the physically challenged in Japan. PARTICIPANTS:
A convenience sample of 154 out of 350 physiotherapists in Fukui
Prefecture, Japan participated in this mailed survey. METHODS: We
used Form O that measured the affective attitude component of the
views towards the physically challenged and contained 20 Likert-
type statements to be responded to in a six-point range. ANALYSIS:
The reliability of Form O was assessed as homogeneity using the
Spearman’s rank correlation coefficient, followed by the calculation of
the Cronbach’s alpha reliability estimates. As for construct validity, the
responses to the statements were submitted to a principal component
factor analysis with varimax rotation. The number of factors was
determined by using the factor scree plot, followed by a second-
order factor analysis using the factors from the first-order factor
analysis and then by calculation of the alpha reliability coefficients
in order to verify the internal consistency of each of the factors. In
order to address convergent validity the authors used the multiple
regression analysis on the respondents’ background information as
independent variables and Form O as the dependent variable. This
was accompanied by the use of the two-tailed Mann-Whitney U
test. RESULTS: The rate of return was 47.5%, and all but 1 of the
20 items were found to have significant item-to-total correlations.
The alpha reliability estimate for Form O was 0.76 with some
evidence for construct validity, which explained 30.9% of the variance.
The obtained factors were labelled as ‘prejudice,’ ‘differing view,’
and ‘self-concept’, with the rate of contribution (Cronbach’s alpha)
being 20.27% (.73), 6.41% (.66), and 4.25% (.69), respectively.
Evidence for construct validity was demonstrated in Form O’s ability
to differentiate between genders and also between physiotherapists
who preferred treating clients with conditions or diseases that would
lead to a permanent disability and those who preferred treating
clients with conditions or diseases that would lead to a full recovery.
Convergent validity, as a form of construct validity, was also supported
for Form O. CONCLUSIONS: The Japanese version of ATPC-Form
O can be considered a reliable and valid measure of documenting
trends of importance in regards to the physically challenged.
IMPLICATIONS: ATPC-Form O is a means of measurement
of ATPC before and/or after ATPC modification, which can be
used for both cross-sectional and longitudinal studies of ATPC.
KEYWORDS: Attitudes towards the physically challenged (ATPC)-
Form O, Reliability, Validity. FUNDING ACKNOWLEDGEMENTS:
This work was unfunded, and ethics approval was not required.
CONTACT: mahomahomaho123@hotmail.com
Research Report Poster Display
35-07 Monday 4 June 15:30
VCEC Exhibit Hall B & C
PHYSICAL THERAPIST ASSISTANT AND BUSINESS STUDENTS’
ATTITUDES TOWARD PERSONS WITH DISABILITIES
Liles A, Schlachter R, Seymour J, Spencer K, Dutton L; The
University of Findlay, Findlay, OH, USA
PURPOSE: The primary purpose of this study was to examine
the influence of factors such as age, gender, academic major and
contact with persons with disabilities on physical therapist assistant
and business students’ attitudes toward persons with disabilities.
RELEVANCE: The attitudes of health care professionals can
positively or negatively influence the patient-therapist relationship and
significantly impact goal setting and the outcomes of rehabilitation.
In addition, these attitudes affect physical therapy practitioners’
approach to broader patient advocacy and social policy issues.
There is limited research examining attitudes toward persons with
disabilities in physical therapy and no studies to date that have
addressed the attitudes of physical therapist assistant (PTA) students
S295
or practitioners. PARTICIPANTS: 186 first and second year students
(94 PTA and 92 business students) at two community colleges
in the Midwest United States participated. This was a sample of
convenience. Thirteen returned surveys were incomplete resulting
in a final response rate of 93% (n=173). The mean age of the
participants was 24; 60% were female; and 81% possessed a high
school diploma or GED as their highest earned degree. METHODS:
Form A of the Attitude Toward Disabled Persons scale (ATDP-A) and
a brief demographic survey were distributed to the participants by
one of the investigators. The ATDP-A is a reliable and valid tool
that includes 30 items designed to provide an objective measure
of participants’ attitudes toward persons with physical disabilities.
Scores can range from 0 to 180 with lower scores indicating
more negative attitudes. ANALYSIS: Descriptive statistics were used
to compile demographic information about the participants. Group
differences based on gender and major were examined with t-
tests and the relationship between age and ATDP-A score was
assessed with a Pearson correlation coefficient. A one-way ANOVA
with Tukey post-hoc testing was used to investigate differences
based on amount of contact with persons with disabilities. RESULTS:
There was a significant positive relationship between age and total
ATDP-A score. While there were no differences in ATDP-A scores
based on gender, academic major was a significant factor. PTA
students (mean ATDP-A score = 125.11) held significantly more
positive attitudes than the business students (mean ATDP-A score
= 115.10). In addition, students with 10 or more contacts per week
with persons with disabilities had significantly more positive attitudes
as measured on the ATDP-A than did students who reported no
contact per week with persons with disabilities. CONCLUSIONS:
Student attitudes toward persons with disabilities appear to be
influenced by age, academic major, and the amount of contact that
an individual has with persons with disabilities. Further research
is needed to examine the influence of the type of contact that
takes place between students and persons with disabilities as
well as the potential role of the curriculum in shaping student
attitudes. IMPLICATIONS: A better understanding of the factors
that influence student attitudes toward persons with disabilities
can lead to improved academic curricula as well as enhanced
patient and societal outcomes. KEYWORDS: Attitudes, Persons
with Disabilities, Social Values. FUNDING ACKNOWLEDGEMENTS:
Unfunded. CONTACT: dutton@findlay.edu
ETHICS COMMITTEE: Institutional Research Review Board, The
University of Findlay, Findlay, OH, USA
Research Report Poster Display
36-11 Monday 4 June 15:30
VCEC Exhibit Hall B & C
CROSS-CULTURAL ADAPTATION AND VALIDATION OF THE
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
Professions, Technological Educational Institute (T.E.I) of Lamia,
Greece
PURPOSE: The purpose of this study was the cross-cultural
adaptation and validation of two falls-efficacy measures, the
Falls Efficacy Scale-International (FES-I) and the Confidence in
Maintaining Balance Scale (CONFbal) in a community dwelling
elderly sample in Greece. RELEVANCE: Fear of falling has recently
been identified as one of risk factors for recurrent falling and
one of the compromising factors of physical function and quality
of life amongst the elderly. One of the most important falls-
related outcomes is the self-efficacy and confidence measures.
PARTICIPANTS: A sample of 89 community dwelling elderly (50
males, 39 females) aged 60-90 years old (Mean: 72.87, SD: 6.045)
was included in the study. METHODS: Subjects were requested
to complete 4 questionnaires; the 2 falls-related ones (FES-I &
CONFbal) as developed in their final Greek version, and 2 generic
S296
ones already adapted into Greek, the SF-36v2 and the General
Health Questionnaire. Questionnaires were personally administered
and completed via structured interviews by two physiotherapists. In
addition, 3 functional mobility and balance tests were performed
to compare against the specific instruments; Functional Reach,
Timed Get up and Go and TURN180 tests. An average of 3
repeated performances for each test following a practice trial was
considered in the analysis. The above procedure was repeated 7-
10 days following initial testing to explore the repeatability of the
measures. For the cross-cultural adaptation, the back-translation
procedure was utilised, comprising forward and backward translations
by 4 bi-lingual translators. ANALYSIS: Pearson’s correlations and t-
tests were used. RESULTS: Content validity of the Greek versions
of the FES-I and CONFbal questionnaires was achieved as all
participants (including the ones in the pilot) found the questionnaires
appropriate and comprehensible. Concurrent validity of FES-I and
CONFbal demonstrated an almost strong correlation (r = 0, 694,
p < 0.01). Test-retest reliability of both questionnaires was excellent
(Pearson’s r = 0.950 & 0.928, t-test p = 0.421 & 1.00 for FES-I and
CONFbal, respectively). Responsiveness across fallers and non-
fallers yielded a medium effect size value for the CONFbal (0.66) and
a large one for the FES-I (0.95). Both questionnaires demonstrated
moderate to strong correlations (r ranging between 0.402-0.740)
with two of the SF-36 physical scales (Physical Function and Role
Physical). CONFbal yielded moderate to strong correlations with all 3
functional tests (r ranging between 0.520-0.622), whereas the FES-I
correlated only with the Get Up and Go test (r = 0.553). These scores
appear somewhat comparable with findings across other countries.
CONCLUSIONS: The Greek versions of the FES-I and CONFbal
questionnaires have proven to be valid, reliable, comprehensible
and acceptable for the Greek community-dwelling sample tested.
IMPLICATIONS: The FES-I and CONFbal questionnaires can be
used in future trials and in cross-cultural comparisons when practicing
physical therapy assessment. KEYWORDS: Questionnaires, Falls,
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.
ETHICS COMMITTEE: The Ethical commitee of the Technological
Educational Institute of Lamia. An official ethics system does not
exist in Greece.
Research Report Poster Display
36-15 Monday 4 June 15:30
VCEC Exhibit Hall B & C
VALIDITY OF THE RT3 ACCELEROMETER IN THE ASSESSMENT
OF ENERGY EXPENDITURE DURING EXERCISE
O’Dwyer J, Langford S, Hussey J; Discipline of Physiotherapy,
School of Medicine, Trinity College Dublin
PURPOSE: To investigate the validity of the RT3 accelerometer as
a measure of energy expenditure in adults during treadmill walking
and jogging. RELEVANCE: In validating the RT3 previous authors
have often used inappropriate assessments of agreement between
the RT3 and a reference measure which may hinder accurate
interpretation of results. With a design similar to previous studies in
this field, this investigation utilizes an analysis approach advocated to
detect agreement between measurement tools. PARTICIPANTS: A
sample of convenience comprising 20 healthy adults (Age = 26.2
+/− 3.7yr, BMI = 23.7 +/− 3.45 kg.m−2 ) were recruited for this
study METHODS: Participants completed six activities (watching TV,
browsing the internet, treadmill walking at 3kmph, 6kmph, 6kmph at
a 10% incline and treadmill jogging at 9kmph) each for a duration
of 5 minutes with seated rest periods in between. Simultaneous
estimates of energy expenditure (EE) were made by the RT3 worn
on the waistband and indirect calorimetry (Oxycon Mobile) recorded
continuously through out the protocol. ANALYSIS: The agreement
between measurement modalities was assessed using the limits of
WCPT 2007, Research Reports
agreement method described by Bland and Altman with indirect
calorimetry (IC) serving as the criterion measure RESULTS: EE
estimated by the RT3 is in agreement with the IC estimation for
sedentary activities; watching TV (Bias 0.11, LOA −0.43 to 0.65
Kcal.min−1 95% CI +/−0.21) and internet browsing (Bias 0.12, LOA
−0.27 to 0.5 Kcal.min−1 95% CI +/−0.15). During level walking and
jogging the RT3 overestimated EE and the measurement error
increase with augmenting workloads; 3km (Bias −0.65, LOA −2.05
to 0.75 Kcal.min−1 95% CI +/−0.54), 6Km (Bias −1.77, LOA −3.86
to 0.32 Kcal.min−1 95% CI +/−0.8) and 9km (Bias −2.29, LOA
−7.24 to 2.67 Kcal.min−1 95% CI +/−1.97). During uphill walking
data from 9 participants were excluded from analysis as they
exceeded anaerobic threshold. Resonant of previous work, the RT3
underestimated EE during walking at this gradient (Bias 3.67, LOA
0.19 to 7.14 Kcal.min−1 , 95% CI +/−1.35). CONCLUSIONS: The
results of this study confound the findings of similar works in that
IC and RT3 estimates of EE during periods of activity cannot be
used interchangeably. The RT3 exceeds the IC measure of EE during
level walking and the degree of difference increases with activities
of increasing intensity. Although an inaccurate measure of EE at
higher workloads, the RT3 can identify periods of acute activity and
differentiate between activities of variable intensities. That said, this
may only be applicable to walking/jogging on level ground as the RT3
underestimates EE and activity counts during walking at an incline.
Additional research is needed to clarify its validity during other forms
of free-living and structured activity. IMPLICATIONS: The RT3 can
be used clinically to monitor activity levels but it should not be used
as a measure of actual EE. It consistently underestimates EE during
level walking/jogging and the discrepancies are increasingly variable
as the workloads increase. The device, capable of quantifying
activity duration and relative level of activity on a minute by
minute basis, is useful as a measure of activity for those with
an habitually sedentary lifestyle KEYWORDS: Energy Expenditure,
Physical Activity. FUNDING ACKNOWLEDGEMENTS: N.A.
Research Report Poster Display
36-19 Monday 4 June 15:30
VCEC Exhibit Hall B & C
GERMAN TRANSLATION AND RELIABILITY OF THE WOLF
MOTOR FUNCTION TEST (WMFT) FOR ASSESSING UPPER
EXTREMITY FUNCTION AFTER STROKE
Mey S1 , Kool J2 , Jann B1 , Rutz L1 , Guertler L3 ; 1 Rheinburg-Klinik,
Walzenhausen, Switzerland; 2 Klinik Valens, Valens, Switzerland;
3 MIS Trend, Lausanne, Switzerland
PURPOSE: The Wolf Motor Function Test (WMFT) is known
as an assessment used in clinical and research evaluation of
Constraint-Induced Movement Therapy (CIMT). Our intention was
to make a German version of the WMFT available for rehabilitation
specialists in German speaking countries. RELEVANCE: The goal
of interdisciplinary rehabilitation is to have patients return home
as independent as possible. Therefore reliable instruments are
needed to assess change. The Wolf Motor Function Test (WMFT)
is an instrument which takes into account speed and actual
performance of an activity. PARTICIPANTS: 16 post-stroke subjects
were recruited from the patient population of the Rheinburg-Klinik,
Switzerland. All participants met the inclusion criteria and gave
written informed consent to participate in the study. METHODS: We
used forward-backwards translation to develop the German version.
The WMFT contains 17 items and is hierarchically structured. One
therapist administered the WMFT’s which were videotaped. Three
random raters rated videotapes twice within a two week time
span. ANALYSIS: Statistical analysis using SPSS was performed
to analyse the inter-and intrarater reliability (ICC) and internal
consistency (Cronbach’s Alpha) of the WMFT for performance time
and funtional ability. RESULTS: Interrater reliability was 0.93 for
functional ability and 0.99 for performance time for the first rating
and 0.89 respectively 0.99 for the second rating. Intrarater reliability
Poster Displays, Monday 4 June
was 0.95 for functional ability scores and 1 for performance time.
Internal consistency for functional ability was 0.68 and 0.82 for
performance time for rating 1 and 0.69 respectively 0.82 for rating 2.
CONCLUSIONS: The German version of the WMFT is a valuable
additional tool to assess motor function of the upper extremity
in post-stroke patients during rehabilitation. IMPLICATIONS: It is
important to make reliable and valid assessments available in
physical therapy. This may provide evidence for the efficacy of
therapy concepts as well as document progress. It may also enhance
communication between therapists, interdisciplinary personal and
other involved institutions. KEYWORDS: Wolf Motor Function Test,
cerebro vascular accident, rehabilitation, reliability of results, motor
activity. FUNDING ACKNOWLEDGEMENTS: The work was not
funded. support was given by the Rheinburg-Klinik. CONTACT:
stefanie.mey@rheinburg.ch
ETHICS COMMITTEE: Ethics committee of Kanton Appenzell
Aussenrhoden, Switzerland
Research Report Poster Display
37-23 Monday 4 June 15:30
VCEC Exhibit Hall B & C
OUTPATIENT HEMODIALYSIS PHYSICAL THERAPY PATIENT
SATISFACTION SURVEY ADMINISTERED AT THE TORONTO
GENERAL HOSPITAL
Hoy F1 , Carol H2 ; 1 University Health Network, Toronto Canada;
2 University Health Network, Toronto Canada
PURPOSE: The purpose in administering an Outpatient Hemodi-
alylsis Physical Therapy (PT) Patient Satisfaction Survey was to:
1) evaluate patients’ satisfaction with their exercise program during
hemodialysis 2) determine the patients’ perception of whether the
program was effective in maintaining or improving their functional
mobility and 3) solicit suggestions to improve the current PT
exercise program. RELEVANCE: Studies have increasingly shown
the benefits of exercise during hemodialysis. These benefits range
from improving overall physical performance and enhancing toxin
clearance. The Toronto General Hospital has one of the largest
outpatient hemodialysis programs in North America. To date, patients’
satisfaction with physical therapy exercise programs, consisting
of bicycle ergometry and strengthening, that were implemented
approximately three years ago as a part of physical therapy care have
not been evaluated. PARTICIPANTS: Thirty hemodialysis outpatients
received the satisfaction survey in June 2006. To be included,
participants had to be English speaking, on PT exercise program
and attending first or second shift hemodialysis. The exclusion
criteria included diminished cognitive status, non-English speaking,
PT following for issues other than exercise program, and attending
third shift hemodialysis. Consent was obtained from all eligible
participants prior to completing the survey. METHODS: The physical
therapist recruited eligible participants from the current caseload. A
survey consisting of nine questions was distributed to the sample
over a two-week time frame by two University Health Network
volunteers. The survey collected information on demographics, type
and duration of program, patients’ perceptions on impact of program
on ambulation ability, ambulation distance, and stair climbing ability.
Patients rated their overall satisfaction with the program using a
10-point Likert scale. In addition, patients were also asked to
provide any suggestions for improvement of the program. ANALYSIS:
Descriptive statistics were used for data management purposes
using an Excel. RESULTS: Thirty outpatients (sixteen males) were
included in the survey. Majority of the participants were age 60
or older (63.3%), had been on hemodialysis for 4.2 ±2.5 years,
and were on the strengthening program (56.6%) for between one
to six months (46%). The majority of the participants reported
improvement in their ambulation ability (60.0%), ambulation distance
(53.3%), and stair climbing ability (43.3%). A moderate number of
participants reported no change in their functional performance,
ambulation ability (30.0%), ambulation distance (33.3%), and stair
S297
climbing ability (36.6%). A small number reported that there is a
decrease in their physical function. The average overall satisfaction
score was 7.9 ±1.8. Some suggestions for improvement in the
program included increasing the frequency of PT, providing more
variety of exercises and securing an exercise room for patients’ use.
CONCLUSIONS: Results of the survey indicated that outpatients
participating in the PT exercises program were overall satisfied
and they believed that the program was beneficial in improving
or maintaining their physical function. Needs assessments should
be done to determine if their suggestions for improvement are
feasible for the program. IMPLICATIONS: It is worthwhile expanding
the PT exercise program during hemodialysis. Future proposals
should include increasing staff and equipment to allow more
patients to participate more frequently in this exercise program.
KEYWORDS: Physical therapy; Hemodialysis; Exercise Program.
FUNDING ACKNOWLEDGEMENTS: No funding was received for
this quality assurance initiative. CONTACT: frances.hoy@uhn.on.ca
ETHICS COMMITTEE: Research Ethics Board, University Health
Network
Research Report Poster Display
38-03 Monday 4 June 15:30
VCEC Exhibit Hall B & C
DAILY HOME CANALITH REPOSITIONING PROCEDURE DOES
NOT REDUCE RECURRENCE OF BENIGN PAROXYSMAL
POSITIONAL VERTIGO
Helminski J1,4 , Janssen I2 , Hain T3,4 ; 1 Midwestern University,
Downers Grove USA; 2 Rush University Medical Center, Chicago
USA; 3 Northwestern University Medical Center, Chicago USA;
4 Chicago Dizziness and Balance, Chicago USA
PURPOSE: To determine if daily performance of the home canalith
repositioning procedure increases the time to recurrence and reduces
the rate of recurrence of benign paroxysmal positional vertigo
involving the posterior semicircular canal (BPPV-PC). RELEVANCE:
BPPV is the most common cause of dizziness. BPPV-PC is treated
effectively with particle repositioning maneuvers such as the canalith
repositioning procedure (Epley,1992). The average success rate of
a single treatment session is 76% (Harvey, Hain, & Adamic, 1994).
Of patients treated successfully, 44% redevelop BPPV within 2 years
(Hain, Helminski, Reis, & Uddin, 2000). Whether or not daily particle
repositioning maneuvers can prevent recurrence of BPPV-PC is not
know. Although widely used, the Brandt-Daroff exercise is minimally
effective in the treatment of BPPV-PC with a 23% success rate at 1
week (Radtke, von Brevern, Tiel-Wilck, Mainz-Perchalla, Neuhauser,
Lempert, 1999) and does not prevent recurrence of BPPV-PC
(Helminski, Janssen, Kotaspouikis, Kovacs, Sheldon, McQueen, &
Hain, 2005). The home canalith repositioning procedure is effective
in the treatment of BPPV-PC with a success rate of 95% at one week
(Radtke, von Brevern, Tiel-Wilck, Mainz-Perchalla, Neuhauser, &
Lempert, 2004) but it is not know if it is effective in preventing
recurrence of BPPV-PC. PARTICIPANTS: 39 subjects with BPPV-
PC successfully treated with the canalith repositioning procedure.
METHODS: Patients were assigned to the treatment group based on
willingness to perform daily exercises. Patients in the treatment group
(n = 17) performed daily the home canalith repositioning procedure
while patients in the no-treatment group (n = 22) performed no
exercises. Patients were followed for as long as 2 years. Every
2 months patients were mailed a questionnaire. If BPPV had
recurred, patients contacted the principal investigator within 24 hours.
Within 1 to 2 weeks of recurrence, patients were evaluated in the
clinic with the Dix-Hallpike maneuver. ANALYSIS: The demographic
characteristics of the groups were compared. The difference in
frequency of recurrence was calculated (Pearson c2 ). To determine
whether the time to recurrence differed between the treatment and
no-treatment groups and to account for patients entering the study
at different times, the Kaplan-Meier product-limit method was used
to estimate the survival function and the log rank test was used to
S298
determine if there was a significant difference. RESULTS: There was
no significant difference in age, sex, duration of symptoms prior to
treatment, or history of recurrence of BPPV between the groups.
Symptoms recurred in 16 (41%) of the 39 subjects, 6 (35%) of
the 17 in the treatment group and 10 (46%) of the 22 in the no-
treatment group. There was no significant difference in the frequency
of recurrence (Pearson c2 , P = 0.522) or the time to recurrence
(survival analysis, log-rank test, P = 0.242). CONCLUSIONS: Results
suggest that daily home canalith repositioning procedure does not
increase the time to recurrence or decrease the rate of recurrence
of BPPV. IMPLICATIONS: Daily particle repositioning maneuvers do
not prevent recurrence of BPPV. KEYWORDS: Benign Paroxysmal
Positional Vertigo, Vertigo. FUNDING ACKNOWLEDGEMENTS:
Supported by National Institute of Health, National Institute on Aging,
1 R15 AG17567-01A1. CONTACT: jhelmi@midwestern.edu
ETHICS COMMITTEE: Midwestern University Internal Review Board
Research Report Poster Display
38-07 Monday 4 June 15:30
VCEC Exhibit Hall B & C
NORMATIVE DATA FOR THE GAZE STABILIZATION TEST (GST)
PROTOCOLS ON THE INVISION® FOR HIGH PERFORMANCE
ATHLETES
Tyner T, Robbins D, Trueblood P, Sailor S, Cleary B; California
State University, Fresno
PURPOSE: This study was conducted to establish normative data,
mean scores (degrees/second) of maximal head velocity for gaze
stabilization for high performance athletes. Normative data exists
for the general population, but not for athletes. RELEVANCE: Gaze
stabilization maintains gaze direction of the eyes and visual acuity
on an object during activities involving head and body movements.
The vestibular system is responsible for gaze stability by sensing
motion of the head, maintaining stability of images on the fovea of
the retina, and controlling posture during motion. Gaze stabilization
at velocities greater than 60 degrees per second is maintained by
the vestibulo-ocular reflex (VOR). When functioning normally, the
VOR provides accurate information for balance control. This stability
is critical for safe, efficient and coordinated movements required
for high performance sports. PARTICIPANTS: 47 NCAA Division
I athletes from the Fresno State Athletic Department representing
several sports. METHODS: NCAA Division I athletes were recruited
and tested using the inVision, manufactured by NeuroCom Inc.,
in all three head motions; horizontal, vertical, and roll. Data was
collected and then analysed. ANALYSIS: Quantitative anaylsis was
completed. RESULTS: Mean scores for all sports were found to
be: 139 deg/sec with a SD of 33 for horizontal, 113 deg/sec with
a SD of 30 for vertical, and 100 deg/sec with a SD of 26 for
roll. CONCLUSIONS: High performance athletes have higher mean
scores compared to non-athletes at motions ranging between 80
to 100 deg/sec. IMPLICATIONS: If high performance athletes with
higher visual and balance demands require a higher maximum
head velocity for gaze stabilization to meet the demands of their
sport. Data from this study could provide an effective tool in
determining when an athlete could safely return to play folwing a mild
brain injury. KEYWORDS: Athletes, Gaze stabilization, Vestibulo-
Ocular Reflex (VOR). FUNDING ACKNOWLEDGEMENTS: None.
CONTACT: tonit@csufresno.edu
ETHICS COMMITTEE: California State University, Fresno – Protec-
tion of Human Subjects
WCPT 2007, Research Reports
Research Report Poster Display
39-11 Monday 4 June 15:30
VCEC Exhibit Hall B & C
CONTINENCE STATUS FIVE YEARS AFTER CESSATION OF
ORGANIZED PELVIC FLOOR MUSCLE TRAINING
Mørkved S1,2 , Fjørtoft T1 , Lindland M1 , Bø K3 ; 1 Clinical service, St.
Olavs Hospital, Trondheim University Hospital; 2 Dept. of Community
Medicine and General Practice, Norwegian University of Science
and Technology, Trondheim, Norway; 3 Norwegian School of Sport
Sciences, Department of Sports Medicine, Oslo, Norway
PURPOSE: The purpose of the study was to assess the continence
status in a group of women five years after cessation of 6 months
organised pelvic floor muscle training. RELEVANCE: The present
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
incontinence (1). PARTICIPANTS: All women who had participated
in the randomised controlled trial and a previous one year follow up
study (2) were invited to take part in the five year follow up study.
Across the time of the study, several physical and social constraints
resulted in some women being unable to meet for the follow up
assessment. Five years after cessation of the training program 80
of 94 women (85%) in the original study returned the questionnairs.
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
was 10 (1-25) years. No specific characteristics of the group of
withdrawals were found. METHODS: The primary outcome measure
at five years follow up was self report of urinary incontinence. Women
reporting urinary leakage once weekly or more were classified as
incontinent. The training program of the original study consisted
of six months of pelvic floor muscle training comprising three
sets of 10 contractions three times per day. All participants met
a physiotherapist for individual training sessions, motivation and
monitoring of pelvic floor muscle strength, once per week during
the first month, and every second week during the next 4 months.
ANALYSIS: The statistical software program used for analyses was
SPSS (version 13.0). Results are given as mean values and range
and persentages (%). RESULTS: At the five-year follow up 45% of
the women were classified as continent. Thirteen women had in the
meantime had surgery due to their incontinence problem, and seven
women conservative treatment. Pelvic floor muscle exercises was still
conducted weekly or more by 49% of the women. Sixty-one percent
reported that the problems related to their urinary incontinence
was lower at the five year follow up than before treatment, 25%
that the problems was unchanged, and 14% that the problems
was worse. CONCLUSIONS: Five years after cessation of the six
months pelvic floor muscle training program nearly half of the women
were still continent, and 61% reported improvement compared to
before the training period. However, the percentage of continent
women at the five year follow up was slightly reduced compared
to immediately after cessation of the pelvic floor muscle training
program. IMPLICATIONS: The effects of pelvic floor muscle training
in the treatment of urinary incontinence is still present five years after
cessation of the training program. References: 1. Effect of adding
biofeedback to pelvic floor muscle training to treat urodynamic stress
incontinence. Obstet Gynecol 2002;100:730-9. 2. Continence status
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.
CONTACT: siv.morkved@ntnu.no
ETHICS COMMITTEE: The Regional Committee for Research Ethics
in Sør-Trøndelag, Norway
Platform Presentations, Tuesday 5 June
Research Report Poster Display
39-15 Monday 4 June 15:30
VCEC Exhibit Hall B & C
WOMEN WITH PELVIC AND LOW-BACK PAIN DURING
PREGNANCY – AN INTERVIEW STUDY
Nilsson-Wikmar L1 , Franke C1,2 , Biguet G1 ; 1 Department of
Neurobiology, Care Sciences and Society, Division of Physiotherapy,
Karolinska Institutet, Stockholm, Sweden; 2 Söderkliniken, Stockholm
PURPOSE: Pelvic and low back pain is common during pregnancy.
Half of all women are on sick leave during pregnancy and more
women than normal rate their quality of life as lower. Different
treatments and measurements have been developed and evaluated,
however, little is known about the experiences expressed by the
women themselves. Thus the purpose of this study was to explore
and describe the experiences of women with pelvic and low back
pain during pregnancy. RELEVANCE: It could be useful in the
clinician’s work, to understand what the women’s experiences and
needs are, and a help in the development of more effective healthcare
programs. PARTICIPANTS: Fourteen pregnant women with pelvic
and low back pain were interviewed. The women were recruited
strategically from a specialist physical therapy outpatient clinic.
METHODS: A qualitative multiple case study design was chosen
and data collection was performed by semi-structured interviews.
ANALYSIS: A qualitative analysis was conducted using the cross-
case method, which implies that the contents of all the interviews
are compared with each other in order to identify patterns of
regularity. RESULTS: Four categories emerged from the data. The
main category was the experience of interrupted normal activities
due to physical limitation, which resulted in feelings of insufficiency,
anxiety and lack of control, as well as the need for, acceptance.
The other three categories were each individual’s relation to time,
to self and to significant others. These contribute to and influence
the overall experiences of the main category in both positive and
negative ways. CONCLUSIONS: Pregnant women with pelvic and
low back pain are affected by the interruption of their normal activities
due to physical limitation, which has an impact on their relation to
time, to their self and their significant others. Health professionals,
including physical therapists, should take this into account when
choosing treatment or considering sick leave. The results could also
be looked upon as a theoretical framework, which offers possibilities
to facilitate more adequate and suitable strategies on how to cope
in a new situation. IMPLICATIONS: There are several areas in
a pregnant woman with pain that are affected. It is not only the
quality of life that gets lower, many other aspects have to be taken
into account. Sick leave is a common used strategy to handle
the situation. The result in the present study indicates that there
are other strategies that can be considered when dealing with
pain during pregnancy. KEYWORDS: Experiences, phenomenology,
womens’ health. FUNDING ACKNOWLEDGEMENTS: The work was
unfunded. CONTACT: lena.nilsson-wikmar@ki.se
ETHICS COMMITTEE: The ethical approval was obtained from
the Research Ethics Committee at Huddinge University Hospital in
Sweden.
S299
Platform Presentations, Tuesday 5 June
Research Report Platform Presentation
614 Tuesday 5 June 08:30
PP Crystal Pavilion B & C
WAIT TIMES FOR PEDIATRIC REHABILITATION
Grilli L1−3 , Ehrmann Feldman D1−4 , Swaine B1,2 , Gosselin J1,5 ,
Champagne F4 , Pineault R4 ; 1 Université de Montréal, École
de réadaptation; 2 Centre de recherche interdisciplinaire en
réadaptation (CRIR); 3 McGill University Health Center: Montreal
Children’s Hospital; 4 Université de Montréal, Groupe de recherche
interdisciplinaire en santé (GRIS); 5 Centre de recherche Hôpital
Sainte-Justine
PURPOSE: To describe waiting time to receive physical therapy (PT)
and occupational therapy (OT) services at pediatric rehabilitation
centers for prechool-aged children with physical disabilities. To
examine factors associated with these waiting times. RELEVANCE:
Early therapy intervention for children with disabilities may improve
functional outcomes. Access to pediatric rehabilitation services
can sometimes be difficult. PARTICIPANTS: Our study population
included parents of 206 children with physical disabilities, aged
6-72 months, referred in 2002-2004 from the Montreal Children’s
Hospital and Sainte-Justine Hospital to pediatric rehabilitation
centers. METHODS: A prospective cohort study. Data on date of
referral, age, gender, and diagnosis were obtained from the hospital
computer databases. Data on date of first PT or OT appointments
at the rehabilitation center, family socio-demographics, and diasbility
severity (Functional Independence Measure for Children) were
obtained during parental interviews. ANALYSIS: Descriptive statistics
to summarize the characteristics of the cohort were calculated.
Cox proportional hazard regression (survival) analysis was used to
determine the association between earliest time to rehabilitation (i.e.
waiting times for PT or OT) and the various factors. RESULTS:
Half of the sample waited more than 7 and 11 months for PT
and OT services, respectively. Shorter waiting time was significantly
associated with younger child’s age (adjusted HR = 0.5; 95% CI
= 0.37-0.82) and referral to one particular rehabilitation center
(adjusted HR = 2.8; 95% CI = 1.7-4.4). Maternal education or
severity of a child’s functional disability did not appear to influence
waiting times. CONCLUSIONS: Children with physical disabilities
experience long waiting times before receiving appointments for
PT and OT rehabilitation services. Despite provincial governmental
recommendations for implementation and assurance of coordinated
programs in the early 1990’s, our findings suggest that in the past
several years there has been an increase rather than a decrease
in waiting times for delivery of PT and OT services in rehabilitation
centers. IMPLICATIONS: The findings may support the need to
augment PT and OT resources in pediatric rehabilitation centers.
There may be a need for the development of alternative models
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.
CONTACT: lisa_grilli@muhc.mcgill.ca
ETHICS COMMITTEE: Montreal Children’s Hospital and Hôpital
Sainte-Justine Ethic Committees.
S300
Research Report Platform Presentation
945 Tuesday 5 June 08:30
VCEC Meeting Rooms 8&15
THE ACCESS TRIAL: RANDOMISED CONTROLLED TRIAL OF
PUBLIC HOSPITAL-BASED VERSUS PRIVATE COMMUNITY-
BASED PHYSIOTHERAPY FOR LOW BACK PAIN:INTERIM
RESULTS
Casserley-Feeney S1 ,
Bury G2 ,
Daly L3 ,
Hurley D1 ; 1 School
of
Physiotherapy & Performance Science; 2 School of Medicine &
Medical Science; 3 School of Public Health & Population Science,
University College Dublin, Ireland
PURPOSE: This pragmatic randomised controlled trial aimed to
investigate any differences in the clinical outcomes of patients with
low back pain (LBP) receiving physiotherapy in (i) the current publicly-
funded hospital-based secondary healthcare model (H) versus (ii) a
private community-based primary healthcare model (P). Patient costs
will also be investigated. RELEVANCE: The current two-tier health
care service in the Republic of Ireland results in high waiting times for
patients receiving physiotherapy in publicly-funded hospital settings
compared to privately-funded community settings, and the outcomes
and cost effectiveness of these different physiotherapy settings have
not been previously established for LBP in any jurisdiction. Public
community-based physiotherapy for LBP is not widely available
due to the delayed implementation of Ireland’s Health Strategy
(2001). PARTICIPANTS: Between March 2005 and May 2006, 160
consenting subjects [110F, 50M; mean age (SD) yrs: 41.28 (12.83)],
referred by general practitioners (GPs) for physiotherapy for non-
specific LBP were recruited across three clinical centres within
Ireland. METHODS: Subjects completed a baseline interview and
baseline outcome measures (Roland Morris Disability Questionnaire
(RMDQ), SF-36 V2, Fear Avoidance Beliefs Questionnaire, Back
Beliefs Questionnaire), were stratified (acute: <3/12; chronic: >3/12),
and randomised to one of the two groups (i.e. H: n=80; P:
n=80). Patients were treated as necessary by the participating
physiotherapists based on assessment findings and followed up
by post at 3, 6 and 12 months post randomisation. ANALYSIS:
Data were coded and questionnaires scored, then analysed using
the Statistical Package for the Social Sciences (SPSS, Version
11). An intention-to-treat analysis was conducted. RESULTS: Both
groups were comparable for all baseline demographic variables
and questionnaire scores. Response rates are 82% (n= 131/160)
and 76% (n= 84/110) for 3 and 6-month follow ups respectively.
Current descriptive analysis of mean change scores (SD), from
baseline to 3-months: RMDQ: [H = 4.68 (−1.27); P = 4.74 (−0.91)]
and SF-36 Bodily pain: [H = −7.51 (−3.81); P= −9.58 (−3.03)]
and from baseline to 6-months: RMDQ: [H = 5.87 (−0.27); P =
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
time days (SD) between groups [H = 48.87 (49.43); P = 12.64
(15.77); p < 0.001]. Despite this, the number of treatments (H =
4.93; P = 5.83), and the treatment packages being delivered were
comparable, comprising patient education, manual therapy, exercise-
therapy and home exercises. The 12-month follow-up is underway
and will also be presented at the conference. CONCLUSIONS: and
IMPLICATIONS: The findings may influence future health policy
regarding the funding and provision of physiotherapy services in
Ireland. KEYWORDS: Randomised Controlled Trial, Physiother-
apy, Low Back Pain. FUNDING ACKNOWLEDGEMENTS: Health
Research Board, Ireland for Research Project Grant. CONTACT:
sarah.casserley@ucd.ie
ETHICS COMMITTEE: Ethics Committee, Mater Misericordiae
Hospital, Eccles Street, Dublin 7
WCPT 2007, Research Reports
Research Report Platform Presentation
2387 Tuesday 5 June 08:30
VCEC Meeting Room 16
THE BERG BALANCE SCALE: INTRA-RATER RELIABILITY
IN OLDER PEOPLE DEPENDENT IN ADL AND LIVING IN
RESIDENTIAL CARE FACILITIES
Conradsson M1 , Lundin-Olsson L1 , Lindelöf N1,2 , Littbrand H1 ,
Malmqvist L1 , Gustafson Y1 , Rosendahl E1,2 ; 1 Umeå University,
Department of Community Medicine and Rehabilitation, Geriatric
Medicine and Physiotherapy, Umeå, Sweden; 2 Luleå University
of Technology, Department of Health Sciences, Physiotherapy
Unit, Luleå, Sweden
PURPOSE: To investigate the absolute and the relative intra-rater
reliability of the Berg Balance Scale (BBS) among older people
who are dependent in activities of daily living (ADL) and living
in residential care facilities. RELEVANCE: The BBS is frequently
used to measure balance and to evaluate treatment effects in older
people. It is crucial for the clinician to know whether a change in
score is due to a real change of balance function or due to a
measurement error. PARTICIPANTS: 45 older people, 36 females
and 9 men, dependent in ADL and living in three residential care
facilities. Their mean age ± SD was 82.3±6.6 (range 68-96) and
mean score ± SD of the Mini Mental State Examination score was
17.5±6.3 (range 4-30). METHODS: The BBS was assessed twice
by the same assessor, at approximately the same time of day,
and with 1-3 days in between. ANALYSIS: The absolute reliability
for the difference in score between the two test occasions was
calculated with the Bland and Altman analysis of variance with 95%
confidence level. The relative reliability was calculated with Intraclass
Correlation Coefficient (ICC). RESULTS: The mean score ± SD of
the first test of the BBS was 30.1±15.9 (range 3-53) and of the
retest 30.6±15.6 (range 4-54). The absolute difference between the
two test occasions was in mean ± SD 2.8±2.7 (range 0-11). The
absolute intra-rater reliability was 7.7 points and the ICC value was
0.97. CONCLUSIONS: Despite a high ICC value, the result of the
absolute reliability shows that a change of 8 BBS points is required
to reveal a genuine change of balance function among older people
who are dependent in ADL and living in residential care facilities.
IMPLICATIONS: In older people living in residential care facilities, it
seems important for clinicians to be careful when using the BBS
to draw conclusion of an individual’s change in balance function
over time. KEYWORDS: Geriatric assessment, Observer variation,
The Berg Balance Scale. FUNDING ACKNOWLEDGEMENTS: This
work was supported by grants from the Swedish Research Council
K2005-27VX-15357-01A, Erik and Anne-Marie Detlof’s Foundation,
and the European Union (Interreg Kvarken-MittSkandia). CONTACT:
erik.rosendahl@ltu.se
ETHICS COMMITTEE: The study was approved by the Ethics
Committee of the Medical Faculty of Umeå University (§439/03).
Research Report Platform Presentation
737 Tuesday 5 June 08:30
VCEC Meeting Room 17
THE EFFECT OF PATTERN OF REPETITIVE EXERCISE ON
CORTICAL EXCITABILITY IN NORMAL SUBJECTS
Sorinola I1 , Oliver K; 1 Division of Applied Biomedical Research,
School of Biomedical & Health Science, King’s College London
PURPOSE: This study was designed to determine whether different
parameters of repetitive movement affect motor cortical excitability as
measured by motor evoked potentials (MEPs) elicited by transcranial
magnetic stimulation (TMS). The purpose was to identify optimal
repetitive exercise parameters for rehabilitation of central paresis e.g.
stroke. RELEVANCE: Previous studies have shown that repetitive
exercise is crucial for motor learning and recovery from stroke
(Bütefisch et al 1995, Hummelsheim et al 1996, 1997) and there
are suggestions that the type, frequency and intensity of repetitive
Platform Presentations, Tuesday 5 June
exercise may determine its therapeutic impact (Hauptmann et al
1996, 1997, Samii et al 1996). However the optimal characteristics
of repetitive exercise for rehabilitation are unknown. PARTICIPANTS:
Eleven healthy normal subjects were recruited from students and
staff of Kings College London. METHODS: The mean amplitude
of 5 motor evoked potentials in the extensor carpi radialis muscle
elicited by TMS at 1.2 times motor threshold (Mills & Nithi 1997) was
used as an index of cortical excitability. This was measured before
and immediately after 9 different exercise interventions and after 3
and 5 min recovery. The interventions were isometric contractions
of the wrist extensions of different durations (2, 6 & 8 mins),
frequencies (10, 20 & 30 min.-1) and loads (10, 20 & 30% of
maximum voluntary isometric contraction (MVC) force. ANALYSIS:
Peak to peak amplitudes of MEPs at each time point were averaged.
Pre and post values were compared using repeated measures
ANOVA to determine significant differences (a = 0.05). Bonferonni
corrections were applied for post hoc t-test analysis. RESULTS:
Increased excitability occurred only after 8 minutes exercise duration
(72.3 + 22.1%, P = 0.025) and contractions with 10% MVC load
(161.3 + 100.1%, P = 0.013) throughout the 5 minutes recovery
period. Decreased excitability was observed after contractions with
30% MVC load (32.1 + 8.40%, P= 0.03) but, frequency had no
effect. CONCLUSIONS: This study indicates that both duration and
force of repetitive exercise influence cortical excitability. Repetitive
exercise of longer durations and low force was most effective in
facilitating cortical excitability. IMPLICATIONS: These data suggest
that the addition of low force repetitive exercise for approximately
8 min may be effective additions to the rehabilitation programmes
of patients with central paresis. KEYWORDS: motor evoked
potentials, transcranial magnetic stimulation, motor cortex, repetitive
exercise, cortical excitability. FUNDING ACKNOWLEDGEMENTS:
None. CONTACT: isaac.sorinola@kcl.ac.uk
ETHICS COMMITTEE: King’s College London Ethics Committee
Research Report Platform Presentation
545 Tuesday 5 June 08:30
VCEC Meeting Room 18
PREVENTION OF PULMONARY COMPLICATIONS IN HIGH RISK
PATIENTS UNDERGOING CABG SURGERY BY PREOPERATIVE
INSPIRATORY MUSCLE TRAINING: A RANDOMIZED CLINICAL
TRIAL
Hulzebos E1,2 , Helders P2 , Favie N1 , de Bie R3 , Brutel de la
Riviere A4 , van Meeteren N1,5 ; 1 Department of Neurology and
Neurosurgery, Rudolf Magnus Institute of Neuroscience, University
Medical Center Utrecht, the Netherlands; 2 Department of Pediatric
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,
Amsterdam, the Netherlands; 5 Department of Physical Therapy-
Research, Academy of Health Sciences Utrecht, the Netherlands
PURPOSE: To study the prophylactic efficacy of preoperative
physical therapy on the incidence of postoperative pulmonary
complications (PPCs) in patients at high risk of developing PPCs
who underwent CABG surgery. RELEVANCE: The rate of PPCs
has remained stable, possibly because CABG is now performed
in more fragile (high risk) patients at greater risk of PPCs as a
consequence of their comorbid conditions. Physical therapy was
usually given after the operation, whereas the preferred strategy is
to identify, on the basis of known risk factors, and treat patients who
might benefit the most before surgery. PARTICIPANTS: Two hundred
sixty-zeven high risk patients awaiting elective, primary CABG were
eligible for inclusion and were randomly assigned to the two study
groups. METHODS: Included patients were closely monitored during
their entire hospital stay until discharged. The intervention group (n=
139) received preoperatively individualized, tailored exercises and the
control group (n= 137) received care as usual the day before surgery.
S301
ANALYSIS: All collected data were checked for completeness and
normality. Analysis was undertaken on an intention-to-treat basis. We
created a dichotomous variable for existence of a PPC, which was
compared between the intervention and control group with the Odds
Ratio. Differences in continuous variables between the intervention
and the control group were tested with the Pearson c2 test. Length of
postoperative hospital stay was compared between the two groups
with the Mann-Whitney test. Statistical tests were two-sided, and a P
value 0.05 was considered statistically significant. RESULTS: Both
groups had a similar preoperative cardiac and pulmonary history. The
duration of surgery, number of coronary vessels affected by disease,
and cardiopulmonary bypass time were not significantly different
in the two groups. Patients in the intervention group exercised
preoperative without any report of adverse events during and after
training-sessions in their diaries. Primary Outcome: The incidence
of pneumonia was 6.5% (9 of 139 patients) in the IMT group and
16.1% (22 patients of 137) in the usual care group (OR= 0.40;
95% CI 0.19 to 0.84). Secondary Outcome: The median duration
of postoperative hospitalization was 7 days, range 5 to 41 days, in
the IMT group and 8 days, range 6 to 70 days, in the usual care
group, which was significantly different (Mann-Whitney U; Z = −2.42;
p = 0.015). CONCLUSIONS: Preoperative physical therapy reduces
the incidence of PPCs (e.g. pneumonia) in patients at high risk of
developing a PPC undergoing CABG. IMPLICATIONS: Postoperative
pulmonary dysfunction after CABG may cause a longer duration of
mechanical ventilation, difficulty weaning the patient, and prolonged
hospitalization, and may be associated with a higher mortality. We
found that preventive physical therapy with IMT given to patients at
high risk of PPCs before CABG, decreased the incidence of PPCs
and shortened the duration of mechanical ventilation and hospital-
ization. KEYWORDS: Preoperative Physical Therapy, Postoperative
Pulmonay complications, Coronary Artery Bypass Graft Surgery,
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
of the University Medical Center Utrecht, the Netherlands, [3]
AGIS Health Insurance House, Amersfoort, [4] the Royal Dutch
Association of Physical Therapy supported the IMT training and [5]
PT-medical supported the Threshold Loading Devices. CONTACT:
h.hulzebos@umcutrecht.nl
ETHICS COMMITTEE: The protocol was approved by the institu-
tional Review Board and Ethics Committee of the University Medical
Center Utrecht, the Netherlands.
Research Report Platform Presentation
3173 Tuesday 5 June 08:30
VCEC Meeting Rooms 19-20
RELATION OF MUSCLE STRENGTH AND FUNCTIONAL
WALKING CAPACITY AMONG STROKE PERSONS
Moriello C, Mayo N; School of Physical and Occupational Therapy,
McGill University, Montreal, Quebec Canada
PURPOSE: To estimate the extent to which muscle strength is
independently associated with functional walking capacity among
stroke patients. RELEVANCE: Muscle strength is an important
construct to understand in the stroke population because it is required
in performing activities, including walking and basic activities of
daily living. PARTICIPANTS: Sixty three patients with stroke onset
between 3 to 12 months. METHODS: Muscle strength of six lower
extremity muscles (hip flexors, hip extensors, knee flexors, knee
extensors, ankle plantarflexors: gastrocnemius and soleus) were
assessed using hand held dynamometry. They were tested bilaterally
in various gravity related positions. Functional walking capacity
was assessed using the 6 Minute Walk Test (6MWT). ANALYSIS:
Principal component analysis (PCA) was used to create a global
index of muscle strength. The relationship between walking and
muscle strength was determined using multiple linear regression.
S302
RESULTS: A principal components analysis (PCA) resulted in a
global index of lower extremity position-specific muscle strength. The
results showed that a global index of muscle strength, balance, tone
and comorbids explain 70% of the variability of the 6MWT. Moreover,
the muscle strength of the affected side in gravity related positions,
as an index, explain most of the variability (37%), in comparison
to the other positions. In addition, the hip flexor in an alternate
against gravity position, as an individual muscle, explains the most
variability of walking capacity. CONCLUSIONS: The observation
that global strength was strongly associated with distance walked
supports strength training in functional tasks in addition to specific
training programs for individual muscles. IMPLICATIONS: Clinically,
this study can help optimize the treatment and time of the
therapists and the patients. During an assessment, a therapist
now has the option of assessing only the gravity related muscles,
or at a minimum, the hip flexors in an alternate against gravity
position. KEYWORDS: muscle strength, walking, stroke. FUNDING
ACKNOWLEDGEMENTS: Canadian Stroke Network.
ETHICS COMMITTEE: Faculty of medicine McGill University
Institutional Review Board
Research Report Platform Presentation
1188 Tuesday 5 June 08:50
PP Crystal Pavilion A
SITUATED LEARNING: AN EVALUATION OF STAKEHOLDER
PERSPECTIVES AND ACADEMIC ACHIEVEMENT OF THE FIRST
PHYSIOTHERAPY GRADUATES FROM THE PROGRAMME
Baldry Currens J1 , King R1,2 ; 1 University of East London, London,
UK; 2 Homerton University Hospital NHS Foundation Trust, London,
UK
PURPOSE: In the Situated Learning Programme (SLP), students
attend university two days per week and work as ‘interns’ three
days. Established in 2003 as an alternative to traditional under-
graduate physiotherapy programmes, original ideals focussed on
enhancing university and hospital partnerships, student diversity
and theory-practice integration. Evaluation was undertaken as the
first student cohort graduated. The prime research aim was to
explore stakeholders’ perceptions regarding value, effectiveness, and
operational aspects of implementation. Secondary aims considered
whether original development ideals had been fulfilled, and compared
intern achievement with traditional students. RELEVANCE: Whilst
situated learning (Lave and Wenger,1991) is relevant to many
professions, there has been no previous evaluation of its application
to physiotherapy education. SLP represents a unique and innovative
model. PARTICIPANTS: Study participants were 5 graduating
students, 3 physiotherapy managers, 3 trust-based coordinators and
6 clinical educators as key informants. METHODS: Qualitative, semi-
structured interviews were conducted by an independent interviewer.
Key interview topics addressed: stakeholder perceptions; programme
strengths and needs; implementation challenges; partnership issues;
intern employability; placement availability; human resource issues;
funding arrangements. All interviews were audio-taped, transcribed
and summarised within each topic area. ANALYSIS: Transcriptions
were sent to participants for respondent validation of accuracy
and interpretation. Key issues were identified and coded by two
researchers, cross-checked with the original interviewer and each
other. Data were analysed through thematic content analysis of
issues arising, and considered against original programme ideals.
Module assessment marks were compared between traditional and
SLP programmes. RESULTS: Students recognised SLP was inten-
sive and required organisational skills but appreciated greater clinical
experience. They recognised their confidence in the workplace
and their transferable skills. Trust-based coordinators recognised
the importance of their role in supporting programme delivery and
valued the experience of close working with university colleagues
to ‘demystify the academic world’. Clinical educators recognised
initial uncertainty regarding their role in relation to interns, resolved
WCPT 2007, Research Reports
through discussion and clearer programme documentation. They
acknowledged interns’ familiarity with the workplace as beneficial.
Managers valued improved relationships with the university and
involvement in the student selection process. Assurance of continued
funding remained a foremost concern. They viewed SLP as
enhancing graduates’ fitness for practice, but questioned whether
ideals of greater diversity had been fully realised. SLP strengthened
university and hospital relationships. The importance of the SLP
programme leader as a central source of communication and support
was widely acknowledged and valued. Challenges centred around
overlap between placement availability with traditional students, and
assurance of continued funding. CONCLUSIONS: Feedback from all
stakeholders was positive and recommended continuation of SLP.
Original ideals were becoming realised, and SLP was comparable
with the traditional programme. SLP was aided by a dedicated
lead within the university and at each clinical site to develop the
programme together. IMPLICATIONS: Assuming commitment from
academic and clinical stakeholders, SLP is a successful model which
is widely applicable to undergraduate education in Physiotherapy.
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
Ethics Committee
Research Report Platform Presentation
880 Tuesday 5 June 08:50
PP Crystal Pavilion B & C
A SYSTEMATIC REVIEW ON THE EFFECTS OF EXERCISE
PROGRAMS DESIGNED TO IMPROVE STRENGTH FOR PEOPLE
WITH DOWN SYNDROME
Shields N, Dodd K; School of Physiotherapy, La Trobe University,
Melbourne, Australia
PURPOSE: To determine if participation in programs designed to
improve muscle strength are safe and beneficial for people with
Down syndrome. RELEVANCE: Muscle weakness can contribute to
disability in people with Down syndrome and can also impact on
their ability to work, perform activities of daily living, or participate
in recreational activities. As their work-place activities typically
emphasise physical rather than cognitive skills, decreased strength
can also negatively impact on the vocational development of adults
with Down syndrome. It is possible that participation in programs
designed to improve strength could lead to detrimental outcomes for
people with Down syndrome as hypotonia and ligamentous laxity
commonly associated with Down syndrome might increase their
risk of soft-tissue injury. This systematic review therefore aimed
to determine the benefits and risks of such programs for people
with Down syndrome. PARTICIPANTS: Not applicable METHODS:
Eleven electronic databases were searched from inception to July
2006 using the following key words: Down syndrome, Trisomy
21 or mental retardation in combination with exercise, exercise
therapy, therapeutic exercise, resistance, strength, rehabilitation,
physical training, motor intervention and physical therapy. Additional
articles were identified through manual searching and citation
tracking. Two reviewers independently assessed the full text articles
identified for the following inclusion criteria: (1) participants with
Down syndrome, (2) an intervention program designed to improve
strength and (3) assessed changes in muscle strength, activity
limitation or societal participation. Trials of low methodologic quality
(Pedro <3) including case studies were excluded. Of the 1564
articles initially identified, five trials examining programs designed
to improve strength met the inclusion criteria. ANALYSIS: Data
from included trials relating to body structure and function, activity
limitation, societal participation and contextual factors were extracted
independently by two reviewers on a standardized form. Trial
quality was rated using the Pedro scale. Effect sizes and 95%
confidence intervals were calculated for all trials. RESULTS: Four
Platform Presentations, Tuesday 5 June
trials reported increases in strength after progressive resistance
strength training (d=3.08, 95% CI 2.16-4.00 to d=7.52, 95% CI 6.46-
8.58), circuit strength training (d=1.94, 95% CI 1.02-2.86 to d=5.06,
95% CI 4.14-5.98), combined strength and cardiovascular fitness
training (d=1.16, 95% CI 0.61-1.81 to d=1.21, 95% CI 0.57-1.75) and
a 25-week treadmill walking program (d=2.68, 95% CI 1.62-3.73 to
d=11.20, 95% CI 10.48-11.92). No improvement was reported in one
trial for peak torque in the quadriceps muscles (d=0.47, 95% CI
−0.34-1.28) and the hamstring muscles (d=0.68, 95% CI −0.14-
1.50) after a combined strength and dynamic balance program. Two
trials reported improvements in activity outcomes including walking
(d=2.95, 95% CI 2.42-3.48 to d= 4.67, 95% CI 4.14-5.20). No trials
investigated the effects of programs on participation restrictions.
No adverse effects from training were reported. CONCLUSIONS:
Programs designed to improve strength appear to be safe and
beneficial for adults with Down syndrome, however, these results
should be interpreted with caution as only three of the five included
trials reported control group data. IMPLICATIONS: High quality
randomized controlled trials should be completed in the future to
determine the effect of programs designed to improve strength on
activity limitations and societal participation, particularly in females
with Down syndrome. KEYWORDS: Down syndrome, systematic
review, strength. FUNDING ACKNOWLEDGEMENTS: This work
was unfunded. CONTACT: N.Shields@latrobe.edu.au
Research Report Platform Presentation
611 Tuesday 5 June 08:50
VCEC Meeting Rooms 11-12
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
of Physiotherapy, School of Biomedical Sciences Kings College,
London SE1 1UL, UK; 2 School of Allied Health Professions,
University of East Anglia, Norwich NR4 7TJ, UK; 3 Sheffield Hallam
University, Sheffield S1 1WB, UK
PURPOSE: Changes in healthcare brought about by the increased
incidence of chronic conditions and changing views of disability
have resulted in an increased focus on patient self-directed
care. This study explores how certain types of therapist/patient
interactions influence success or contribute to meeting patients’
self-selected goals and therefore a positive clinical outcome, on
a pain management unit. RELEVANCE: In contrast to previous
studies this research sought to link the therapists’ perspectives of
their patient interactions with clinical outcomes. PARTICIPANTS:
A team of physiotherapists of different levels of seniority working
on an in-patient pain management programme in a U.K. teaching
hospital. METHODS: An ethnographic approach was chosen with its
emphasis on observing and understanding people’s everyday social
interactions. The team members were observed individually, with
their patients, and collectively over a period of eight months. Their
interactions were audiotaped and fieldnotes were recorded alongside
the researcher’s memos. Interviews were carried out following the
observations to gain the therapists’ perspectives in an open critical
exploration of assumptions and ideas. ANALYSIS: Triangulation of
data was provided by the transcriptions of the interactions, the
follow-up interviews and the relevant sections of the field notes. The
analysis was iterative. Features in that reflected certain types of
patient/therapist interactions were looked for and cross referenced
to the fieldnotes and interviews. Codes were assigned to segments
of sentences that summarized their content and emerging patterns
in the interactions were noted. These were grouped into categories.
The final stage of the analysis identified themes representing the
relationship between the categories. The researcher assumed a
reflexive stance throughout. RESULTS: Patient goals, reviewed at
three months and a year, post programme, were the benchmarks by
which a successful clinical outcome of the programme was judged.
S303
The team judged their successful patients,those who achieved
positive clinical outcomes, as entering into interactions typified by
assertiveness, negotiation and critical reflection. These patients
responded to the team’s adoption of an interpretive and critical
paradigm in which they, with their individual experience, informed
the decision making process in the former and reframed their
perspectives with new understanding in the latter. However,even
the most able team will not be able to inspire and create a
collaborative framework unless their patients are willing to grasp the
opportunity offered to them and they judged their least successful
patients as adopting passive and unrealistic interactions which had
consequences in clinical outcome. CONCLUSIONS: Themes of
dependence and interdependence were identified. Resistance by
the patients or an inability to carry over problem solving skills
into their lives, led to an intense form of dependence, which had
negative clinical consequences for them and a stunting of the team’s
potential. Alternatively, interdependent positions between patients
and the team showed positive clinical outcomes. IMPLICATIONS:
A model of practice that enables therapists and their patients to
question their actions and thoughts, collaboratively, will construct a
knowledge of practice in which they can move forward, together, in
an innovative manner drawn from their own ideas and experiences.
Further research needs to explore the perceptions of patients judged
to be resistant to this model. KEYWORDS: Ethnography, professional
practice, patient/therapist interactions, clinical outcomes. FUNDING
ACKNOWLEDGEMENTS: This work was unfunded. CONTACT:
Diane.thomson@kcl.ac.uk
ETHICS COMMITTEE: Royal National Orthopaedic Hospital Stan-
more Middlesex HA7 4LQ
Research Report Platform Presentation
2425 Tuesday 5 June 08:50
VCEC Meeting Room 16
MEASUREMENT ERROR IN THE BERG BALANCE SCALE –
WHAT CHANGE IS REAL CHANGE?
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
Hospital, Kildare, Ireland; 2 Royal Hospital Donnybrook, Dublin,
Ireland; 3 Sacred Heart Hosdpital, Castlebar, Ireland; 4 Connolly
Hospital, Dublin, Ireland; 5 Loughlinstown Hospital, Dublin, Ireland;
6 St. Vincent’s University Hospital, Dublin, Ireland; 7 St. James’s
Hospital, Dublin, Ireland; 8 Sacred Heart Hosdpital, Castlebar,
Ireland; 9 St. James’s Hospital, Dublin, Ireland; 10 Department of
Physiotherapy, School of Medicine, Trinity College Dublin, Ireland
PURPOSE: The purpose of this study was to calculate the Minimal
Detectable Change (MDC) for the Berg Balance Scale in a group
of older people, with balance problems, undergoing physiotherapy
rehabilitation. RELEVANCE: Reliability can be reported in two ways –
relative reliability (inter & intra reliability) and absolute reliability.
The standard error of measurement (SEM), returns a value for
measurement error in the same units as the measurement itself i.e. it
is an indication of absolute reliability. SEM also allows us to calculate
the minimal detectable change (MDC) i.e. the amount a patient’s
score needs to change, to be sure the change is greater than simply
measurement error. The calculation of the MDC is important for day-
to-day clinical decision-making. The Berg Balance Scale (BBS) is
a tool designed to measure balance that has demonstrated relative
reliability. The MDC has only been reported in the BBS for older
people with stroke and not for the general population of older people.
PARTICIPANTS: People aged greater than 65 years and attending
for physiotherapy rehabilitation were eligible for inclusion in the study.
People who were recently post hip replacement or who were unable
to give informed consent were excluded. 61 older people participated
(35% female). METHODS: Ethical approval was obtained from the
relevant committees. The balance performance of each participant
was measured using the BBS at time 1 (T1) and again a second
time (T2) within 48 hours and their scores calculated. At T2, the
S304
researcher was blind to the T1 score on the BBS. ANALYSIS: The
SEM Was calculated using the formula: SEM = s• (1 − r), where s =
the standard deviation for the test, r = the reliability coefficient for
the test i.e. Pearson’s correlation co-efficient between T1 & T2. The
MDC95 (95% confidence interval) was calculated using the formula:
MDC95 = SEM × • 2 × 1.96 (as per Stratford, 2004). RESULTS: The
mean age of the participants was 80 years (sd 6.5, range 65-95
years). The MDC for people who were able to walk unassisted was
3 and for people who required assistance i.e. physical or an aid was
5 CONCLUSIONS: This preliminary report suggests that in older
people, who are having rehabilitation and who require no assistance
of an aid or physical help to mobilise, require a change of at least
3/56 points on the BBS for the change to be ‘true’ change and
not measurement error. It also suggests that in older people who
are having rehabilitation and who require assistance of an aid or
physical help to mobilise a change of at least 5 points on the BBS is
required for the change to be ‘true’ change and not measurement
error. IMPLICATIONS: Changes in scores in outcome measures
should be reported to indicate true change in performance and not
measurement error. The results of this study will enhance clinical
decision making for older people when their performance is measured
using the BBS. KEYWORDS: Berg Balance Score; Older people;
Outcome measurement. FUNDING ACKNOWLEDGEMENTS: None.
CONTACT: estokes@tcd.ie
ETHICS COMMITTEE: Local ethics commitees in each of the centres
involved
Research Report Platform Presentation
745 Tuesday 5 June 08:50
VCEC Meeting Room 17
RECOVERY OF MOTOR CORTEX AND UPPER EXTREMITY
MOVEMENT DURING ACUTE STAGE AFTER STROKE
Puh U1 ,Suput D2 ; 1 University
of Ljubljana, University College
for Health Studies, Ljubljana, Slovenia; 2 University of Ljubljana,
Medical Faculty, Ljubljana, Slovenia
PURPOSE: The purpose of the current study was to investigate
the brain cortex activation characteristics 1 week, 3 weeks and
3 months after stroke and to establish the relationship between
the recovery of primary motor cortex (M1) and motor functions
of the upper extremity. RELEVANCE: Following stroke, recovery
of upper extremity control is generally poor. Although there is
evidence for cerebral cortex reorganization on animal models, the
mechanisms of motor recovery after stroke in humans are not
clear. Understanding of the neurophysiological process underlaying
cerebral cortex reorganization will increase the effectiveness of
therapeutic techniques and improve the outcome of rehabilitation of
patients following stroke. PARTICIPANTS: 12 patients, aged 65 years
(SD 15), 2-8 days after stroke, where included in the study. All had
partially impaired function of the right (8) or left (4) upper extremity
and were right-handed prior the stroke. From the first to the third week
after stroke, they were included in a functional training program. 13
healthy subjects, aged 41.5 years (SD 11) participated as a control
group. METHODS: A 1.5 T scanner was used to collect functional
magnetic resonance imaging (fMRI) data during upper extremity
functional tasks. Healthy subjects were evaluated only in one fMRI
session. In patients, motor characteristics of upper extremity were
evaluated by hand-held dynamometry, hand and pinch grip strength
measurements, Nine Hole Peg Test, timed ARAT and AMPS. Patients
with a stroke were evaluated in the first, and third week, and 3 months
after stroke. ANALYSIS: Intensity and area of cortex activation
were calculated for brain regions using AFNI software. Wilcoxon,
Friedman and Mann-Whitney U tests were conducted to compare
cortex activation between the brain hemispheres, measurement
sessions and groups of subjects. Spearman correlation with upper
extremity functions was calculated. RESULTS: In comparison to
healthy subjects, an attenuated activation of some brain regions
in the ipsilesional or contralesional hemisphere was observed in
WCPT 2007, Research Reports
patients during hemiparetic extremity (HPE) performance in the first
and third week, and up to 3 months in the patients with stroke
in the right hemisphere (p  0.05). Cortex activation was changed
(p  0.05) also during performance with the nonhemiparetic extremity
(NHPE). The differences between hemispheres gradually normalized
with time, however the activation remained different from healthy
subjects (p  0.05). Concomitantly the motor characteristics of both
upper extremities improved. Recovery of HPE correlated well with
the intensity and/or area of M1 activation in the ipsilesional or
contralesional hemisphere (r = 0.6-0.9; p  0.05). More correlations
were observed with dexterity than with muscle strength, and were
increasing with time. CONCLUSIONS: In stroke patients with partially
impaired upper extremity function, the normalization of brain cortex
activation in both hemispheres during tasks performed with either
HPE or NHPE, occurred gradually during first 3 months after
stroke. The recovery of M1 cortex, predominantly in the contralateral
hemisphere, correlated well with the recovery of upper extremity
function. IMPLICATIONS: Changes in activation of both brain
hemispheres during first three months after stroke indicate the
importance of functional training and use of HPE in promoting the
process of cortex reorganization. For future research, comparison of
different therapeutic techniques is suggested. KEYWORDS: stroke,
acute stage, motor recovery. FUNDING ACKNOWLEDGEMENTS:
The current work was supported by the postgraduate fellowship from
Ministry of Higher Education and Science, and by the research grant
P3-0019 from the Research Agency of the Republic of Slovenia.
CONTACT: urska.puh@vsz.uni-lj.si
ETHICS COMMITTEE: National Etics Committee of the Republic of
Slovenia
Research Report Platform Presentation
796 Tuesday 5 June 08:50
VCEC Meeting Room 18
PHYSIOTHERAPY SUPERVISED WALKING PROGRAM IMMEDI-
ATELY FOLLOWING CABG RESULTS IN EARLIER RETURN OF
FUNCTIONAL CAPACITY. A RANDOMIZED CONTROLLED TRIAL
Hirschhorn A1,3 , Richards D2 , Mungovan S1 , Morris N3 , Adams L3 ;
1 Westmead Private Physiotherapy Services, Westmead Private
Hospital, Sydney, Australia; 2 Westmead Private Cardiology,
Westmead Private Hospital, Sydney, Australia; 3 School of
Physiotherapy and Exercise Science, Griffith University, Gold Coast,
Australia
PURPOSE: We aimed to investigate whether a moderate intensity
walking exercise program, performed under direct physiotherapy
supervision, would improve functional outcomes such as sub-
maximal exercise capacity and self-reported health, and/or vital
capacity, at discharge from hospital following coronary artery
bypass graft surgery (CABG). We also sought to investigate
whether supplementary respiratory and musculoskeletal exercises
might further benefit patient outcomes. RELEVANCE: Research
investigating physiotherapy following CABG has focused largely on
respiratory measures of outcome, such as pulmonary complication
rates. We hypothesized that the achievement of positive outcomes,
such as improved ability to walk and self-reported health, is more
relevant following CABG than measures of respiratory morbidity
(which is presently minimized with routine peri-operative care).
There is no research available to date investigating the effect of
physiotherapy and/or exercise prescription on functional outcomes
acutely after CABG. PARTICIPANTS: Patients awaiting first-time
CABG at Westmead Private Hospital were invited to participate in
the study. Exclusion criteria included planned concomitant surgery,
significant musculoskeletal or neurological impairment, non-English
speaking background and emergency surgery. 92 patients (80 men,
12 women), mean age 63±9 years were enrolled having given
written, informed consent. METHODS: The study was a prospec-
tive, single-blinded, randomized controlled trial with 3 treatment
arms. Patients were allocated prior to pre-operative physiotherapy
Platform Presentations, Tuesday 5 June
assessment to one of: a) a ‘minimal’ intervention group, receiving
gentle post-operative mobilization (n=31); b) a ‘walking’ group,
receiving a physiotherapy-supervised, moderate intensity walking
program (n=31); or c) an ‘exercise’ group, receiving the same
walking program, musculoskeletal and respiratory exercises (n=30).
Primary outcomes were 6-minute walking assessment distance
(6MWA), self-rated health and recovery (using SF-36v2, EQ-5D and
QoR-40 questionnaires) and vital capacity. These outcomes were
measured pre-operatively, at hospital discharge and at 4 weeks
following discharge. ANALYSIS: Linear mixed effects models were
fitted to outcome variables. In these models, patient identifier was
considered as a random effect, and time and intervention group
as fixed effects. For those outcome measures where the p-value
for interaction between time and intervention group approached
significance, the effect of intervention group was analysed separately
at discharge and at follow-up. Two-tailed tests with a 5% signifi-
cance level were used throughout. RESULTS: 6MWA distance at
discharge from hospital for both walking (452±70m) and exercise
(431±98m) groups were significantly better than that of the minimal
(377±90m) intervention group (p = 0.005, p = 0.022 respectively).
These differences were not sustained at 4 week follow-up. There
were no differences in self-reported health or vital capacity between
minimal, walking and exercise groups at discharge or at 4 week
follow-up. CONCLUSIONS: A physiotherapy-supervised, moderate
intensity walking program in the inpatient setting following first-time
CABG improves sub-maximal exercise capacity at discharge from
hospital. Additional respiratory and musculoskeletal exercises confer
no further benefits to the assessed outcomes. Further investigation
is required to determine the optimal level or dosage of physiotherapy
intervention and aerobic exercise following CABG. IMPLICATIONS:
The role of physiotherapy following CABG is evolving from one of
prophylaxis against respiratory complications to one of fostering
early return to exercise and functional activity. KEYWORDS:
Exercise, cardiac surgery. FUNDING ACKNOWLEDGEMENTS: Nil.
CONTACT: andrew.hirschhorn@bigpond.com.au
ETHICS COMMITTEE: Sydney West Area Health Service Human
Research Ethics Committee
Research Report Platform Presentation
1075 Tuesday 5 June 08:50
VCEC Meeting Rooms 19-20
ELECTROMECHANICAL-ASSISTED TRAINING FOR WALKING
AFTER STROKE: A SYSTEMATIC REVIEW FOR THE
COCHRANE COLLABORATION
Mehrholz J1,3 , Werner C2 , Kugler J3 , Pohl M1 ; 1 Department of Early
Rehabilitation, Klinik Bavaria, Kreischa, Germany; 2 Department
of Neurological Rehabilitation, Klinik Berlin, Germany; 3 Department
of Public Health, Technical University, Dresden, Germany
PURPOSE: The purpose of the present study was to review
the available literature systematically to assess effectiveness and
acceptability of these electromechanical devices. RELEVANCE:
Stroke is a leading of serious, long-term disability in adults.
Restoration of walking ability and gait rehabilitation is therefore highly
relevant for patients who are unable to walk independently after
stroke, as well as for their relatives. In recent years automated
electromechanical gait machines were developed, consisting either of
a robot-driven exoskeleton orthosis or an electromechanical solution
with two driven footplates simulating the phases of gait. Until now
scientific evidence for the benefits of these technologies, which
could justify their relative high cost, is lacking. PARTICIPANTS: We
included studies with participants of any gender over 18 years of age
after stroke. METHODS: We included all trials that evaluate robotic-
assisted or automated electromechanical gait training devices, or
both, for regaining and improving walking after stroke. Automated
electromechanical devices were defined as any device with an
electromechanical solution designed to assist (by supporting body
weight and automating the walking therapy process) stepping cycles
S305
in patients after stroke. This category includes any mechanical or
computerised device, or both, designed to improve walking function.
However, trials testing the effectiveness of treadmill training or
other approaches such as repetitive task training in physiotherapy
or electrical stimulation were not included in this review. We
searched the Cochrane Stroke Group Trials Register, CENTRAL,
MEDLINE, EMBASE, CINAHL, AMED, SPORTDiscus, PEDro and
COMPENDEX and INSPEC. Additionally, we handsearched po-
tentially relevant conference proceedings, screened reference lists
and searched ongoing trials and research registers. Furthermore,
we contacted trialists and researchers in our field of study to
identify published, unpublished and ongoing trials not available in the
major databases. ANALYSIS: We included randomised, controlled
trials and randomised controlled cross-over trials in this review.
For all statistical analyses we used The Cochrane Collaboration’s
Review Manager software (RevMan 4.2). RESULTS: Seven trials
with a total of 332 patients were included in the review. The
reported data suggested that electromechanical-assisted walking
training after stroke might improve walking ability of non-ambulatory
patients after stroke. However, the number of patients is too small
to be certain whether electromechanical-assisted walking training
is effective for treatment after stroke. Results from much larger
randomised trials are needed to assess accurately the benefits and
harms of electromechanical-assisted walking after stroke. At least a
more detailed review will be published and updated in the Cochrane
Database of Systematic Reviews. CONCLUSIONS: There was
some evidence that electromechanical-assisted walking training may
improve walking of non-ambulatory patients after stroke. Larger trials
are needed evaluating the effectiveness of electromechanical devices
for patients who cannot walk after stroke. IMPLICATIONS: For non-
ambulatory patients after stroke, there is some evidence for the use
of electromechanical-assisted devices to improve walking function,
but further research is needed. KEYWORDS: Walking – Stroke –
Training. FUNDING ACKNOWLEDGEMENTS: None declared.
Research Report Platform Presentation
1560 Tuesday 5 June 09:10
PP Crystal Pavilion A
FEEDBACK IN PHYSIOTHERAPY CLINICAL EDUCATION:
IMPLICATIONS OF A MONOLOGIC PROCESS
Molloy E1 , Webb G2 , Remedios L, Clarke D; 1 Monash University,
Melbourne, Australia; 2 The University of Melbourne, Melbourne,
Australia
PURPOSE: Formal feedback in physiotherapy clinical education
is an important process in shaping students’ learning and pro-
fessional identity. Despite the health education literture’s claim
for the importance of feedback in learning, no empirical studies
have investigated the feedback sessions in situ. This research
aimed to fill these gaps in understanding. What do the feedback
sessions look like? What are the rights and duties of the student
and the clinical educator as enacted through the conversation?
How much agency do students have in shaping their learning
experience in feedback sessions and what are the implications of
the feedback style for students’ immediate learning and long-term
professional development? RELEVANCE: The feedback process
is valued highly in the education and health education literature.
Such skills are important for maximising the student’s learning, for
maxismising the clinician’s lifelong professional learning, and to aid
the therapeutic patient-clinician interaction. Prior to this research,
the recommendations on ‘best-practice’ feedback were largely
speculative, rather than empirically- based claims. PARTICIPANTS:
In Phase One, 102 clinical educators affiliated with the School
of Physiotherapy, The University of Melbourne participated in a
questionnaire (RR=88%). Nine students and 12 clinical educators
across three hospital institutions and three practice domains were
‘purposively selected’ to participate in the qualitative Phase Two
of the project. METHODS: The project consituted two phases. In
S306
Phase One, clincial educators were asked to respond to an 18-item
questionnaire designed to elicit their understanding of current and
‘effective’ feedback practice. Phase Two involved the videotaping
of formal, student-clinical educator feedback sessions at the half-
way and completion point of the clinical placement. Seperate, semi-
structured interviews were conducted with participants following
the feedback sessions. ANALYSIS: The questionnaire, videotape
and interview data were analysed for themes using a Grounded
Theory Methodology. Such analysis lead to a structured charac-
terisation of formal feedback practice, and highlighted perceived
constraints to effective practice. RESULTS: Despite both students’
and clinical educators’ support of the importance of a two-way
feedback exchange, the feedback sessions were monologic in
practice. The clinical educators assumed the position as ‘expert
diagnostician’ and did not provide sufficient opportunities for students
to self-evaluate their learning and performance. Of note was that
students conspired with clinical educators to generate this one-
way feedback exchange. Attempts to elicit student self-evaluation
were viewed as ‘tokenistic invitations’ by both parties in the
educational relationship. CONCLUSIONS: The formal feedback
sessions observed in physiotherapy clinical education were educator-
driven, one-way encounters, despite the participants’ intentions
to engage in conversation. Both students and clinical educators
were responsible in generating this monologic feedback culture.
IMPLICATIONS: This pattern, whereby educators assumed the
position as ‘expert diagnostician’ did not privilege the students’ self-
evaluative and self-reflective skills which are central to professional
development in a continually changing health care climate. The lack
of development of students’ self-evaluative skills has implications
in both the educational and clinical practice setting. KEYWORDS:
Feedback; Learning; Self-evaluation; Clinical education; Professional
Development. FUNDING ACKNOWLEDGEMENTS: The authors
would like to acknowledge the help of the Australian Postgraduate
Award(APA) and the Australian and New Zealand Association for
medical education (ANZAME)in funding this project. CONTACT:
Liz.Molloy@med.monash.edu.au
ETHICS COMMITTEE: HREC University of Melbourne, August 2003
Research Report Platform Presentation
2159 Tuesday 5 June 09:10
VCEC Ballroom A
STUDENT PROFESSIONAL DEVELOPMENT PLANS: A
LONGITUDINAL STUDY
Collins J; Nazareth College, Rochester, New York, USA
PURPOSE: The purpose of this study was to determine whether
graduates of a physical therapist program met goals for professional
development one and three years following graduation. It described
changes in goals over the three years, and events that contributed
to not meeting or changing goals. RELEVANCE: APTA emphasizes
the professional values and behaviors necessary for a doctoring
profession. Lifelong learning and professional development are
essential behaviors. This study helps educators to understand if
goals for professional development set as students are realized by
graduates one and three years later, and if not, what factors interfere
with goals. PARTICIPANTS: Thirty two students in one entry-
level, MSPT program participated in an activity to set professional
development goals before graduation. These 32 students were
surveyed one and three years after graduation. METHODS: Following
class sessions discussing the importance of setting goals for
professionl development in the areas of employment, education,
and community/professional service, the participants were asked
to set goals for one and three years following graduation. At one
and three year timeframes, students were surveyed to ascertain if
goals had been met. If not, students were asked an open ended
question about what factors contributed to the goal not being met.
In depth, follow up interviews were completed with five students to
better understand reasons for not meeting goals and the value of
WCPT 2007, Research Reports
goal setting for professional development. ANALYSIS: Descriptive
analysis revealed frequency of responses to questions about whether
goals had been met. Open ended questions about factors that
contributed to goals not being met were grouped into common
themes. Interviews were transcribed and analyzed for themes using
Ethnograph v. 2.0. RESULTS: One year following graduation, there
were 11 survey responses, for a response rate of 34%. Three
years following graduation, 19 of 32 responded for a rate of 59.3%.
One year following graduation, 72.7% had met employment goals,
63.6% met education goals, and 36.4% met goals for community
service. Three years after graduation, 47.4% had met goals for
employment, 42.7% had met educational goals, and 36.3% had met
service goals. Reasons for not meeting goals stated most often
were: change of job or preference for patient population, lack of
monetary resources for education, or other priorities, such as family,
interfering with goal accomplishment. CONCLUSIONS: The results
suggest that goals for professional development set by students are
met more often for one year following graduation than for three years.
Interviews suggest that students close to graduation do not recognize
the many factors that may interfere with goal accomplishment.
Interviews indicate that the interests for newly practicing therapists
change between graduation and three years later. In spite of
these changes, graduates found the exercise of explicitly developing
measurable goals for their professional development to be useful.
IMPLICATIONS: Educators and new employers can expect that
new graduates are likely to have specific goals for employment,
education, and service. However, as their views of the profession and
personal goals change over time, goals for professional development
may be delayed or change. KEYWORDS: Professional development,
education. FUNDING ACKNOWLEDGEMENTS: Nazareth College
supported this study with a summer research grant. CONTACT:
jcollin9@naz.edu
ETHICS COMMITTEE: Nazareth College Human Subjects Review
Committee
Research Report Platform Presentation
1292 Tuesday 5 June 09:10
VCEC Meeting Rooms 8&15
INTER-RATER RELIABILITY EVALUATION OF PHYSIOTHERAPY
PRIORITY INTERVENTION CRITERIA IN ACUTE HOSPITALS: A
MULTI-CENTRE EVALUATION
Brolin S1 , Francis T2 ; 1 Fraser Health, Royal Columbian Hospital;
2 Fraser Health, Surrey Memorial Hospital
PURPOSE: This study is aimed at evaluating inter-rater reliability
of physiotherapist priority value assignments for patients in acute
hospital settings, using a standard tool – Physiotherapy Priority In-
tervention Criteria (PPIC). RELEVANCE: Physiotherapy services are
in high demand in acute hospitals. With increasing patient numbers
and complexity it is important for physiotherapists to reliably prioritize
patients for service. In this way, targeting physiotherapy services
toward patients in the greatest need may serve to maximize patient
flow through the health care system, thereby maximizing efficiency
of service. PARTICIPANTS: Twenty-one physiotherapists took part
in the inter-rater reliability evaluation, randomly selected from three
acute hospitals in the Vancouver area. METHODS: Approximately
25% of all patients on active physiotherapy caseload, in each hospital,
were randomly selected. Two therapists independently assigned a
priority value, according to the PPIC to selected patients. ANALYSIS:
Inter-rater reliability was evaluated by analysis of percent agreement
and measurement of kappa statistic. RESULTS: Percent agreement
of priority assignment was determined to be 82.2% agreement for
all cases involved in the study (n=90). All three hospitals were
relatively similar in priority assignment reliability (80.0%-agreement
[n=19 cases], 81.2%-agreement [n=32 cases] and 84.6%-agreement
[n=39 cases]). Kappa statistic measurement revealed a value of
0.737 for all cases, across all three hospitals. CONCLUSIONS:
Physiotherapists in acute settings demonstrate an excellent ability
Platform Presentations, Tuesday 5 June
to reliably prioritize patients for assessment and treatment using
the PPIC. IMPLICATIONS: The current study demonstrates that the
PPIC is an effective tool that ensures that scarce physiotherapy
resources can be directed to patients that need it the most in the
acute care setting. KEYWORDS: prioritization, reliability, criteria.
FUNDING ACKNOWLEDGEMENTS: This study was supported by
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:
scott.brolin@fraserhealth.ca
ETHICS COMMITTEE: Fraser Health Research Ethics Board
Research Report Platform Presentation
849 Tuesday 5 June 09:10
VCEC Meeting Rooms 11-12
A STUDY OF LIMITED ENGLISH PROFICIENCY (LEP) IN
PATIENTS SERVED BY PHYSICAL THERAPY PRACTICES IN
NORTHERN CALIFORNIA
McGinty S, Avalos L, Bhim M, Lopez T, Osborne R; California
State University Sacramento, Sacramento, California, USA
PURPOSE: This study was conducted to determine the extent of
multiple languages being encountered in patients seeking services in
Physical Therapy practices in Northern California and to determine
the means of communication being utilized to serve patients with
Limited English Proficiency (LEP). RELEVANCE: Language barriers
can interfere with all processes involved with the provision of health
care. Effective cross cultural communication and cultural competency
is impossible without understanding and addressing the importance
of language in culture. PARTICIPANTS: Participating clinics were
randomly selected from a list of 493 clinics compiled from online
phone directories in 28 counties in Northern California. METHODS:
A survey instrument was developed to determine whether or not
clinicians were encountering patients with LEP and if so, which
languages were most often heard. The survey sought information
about whether or not clinicians, or their staff, were bilingual, and
what methods were utilized to communicate with patients with LEP.
The top 25 languages from the 137 languages spoken in California
were selected from the 2000 United States of America census data.
A stratified, random sample of 216 clinics was selected from the
493 clinics identified. A minimum of 1 clinic was selected from
each of the 28 counties in Northern California with the exception
of Colusa, Sierra, Alpine, and Trinity for which no clinics were
listed. ANALYSIS: SPSS version 13.0 was utilized for analysis
of quantitative data. Qualitative analysis of written responses was
completed to identify common themes. RESULTS: 33 of 216 surveys
were returned to sender. 111 of the remaining 183 were returned
and usable for a 60.7% return rate. 85% of all Northern California
counties were represented. 85% of clinics reported encountering
patients with LEP. 89.9% of those patients speak Spanish, followed
by Vietnamese, Hindi, Chinese, Russian and Tagalog. 40% of
clinicians report they are bilingual; 34% speak Spanish. 45% of
non-licensed staff are bilingual; 37% speak Spanish. 46% of clinics
state they provide patient education in another language and 49%
state they provide written information. Many clinics report they
commonly use patients’ family members (including children) to serve
as interpreters, some utilize contracted interpreter services, and
some rely on English/other language dictionaries, pictures, and
demonstration to instruct patients. CONCLUSIONS: Although 85%
of participating clinics report treating patients with LEP, less than
half provide instruction in another language (written or oral). Only
46% of clinics offer instruction in Spanish despite the fact that almost
90% of patients with LEP speak Spanish. Bilingual clinicians and
staff skills often do not match the languages encountered in the
clinics. IMPLICATIONS: Clinicians may not be aware of ethical and
legal requirements to provide instruction to patients in their primary
languages. Education about patients’ rights to be provided services in
their primary language should be included in entry-level education. In
S307
addition, the possible negative consequences of using patients’ family
members as interpreters should be discussed. KEYWORDS: Limited
English Proficiency. FUNDING ACKNOWLEDGEMENTS: This work
was unfunded. CONTACT: mcgintys@csus.edu
ETHICS COMMITTEE: California State University, Sacramento
Committee for the Protection of Human Subjects
Research Report Platform Presentation
2481 Tuesday 5 June 09:10
VCEC Meeting Room 16
THE ICELANDIC VERSION OF THE ACTIVITIES-SPECIFIC
BALANCE CONFIDENCE SCALE: PSYCHOMETRIC
PROPERTIES EVALUATED BY RASCH ANALYSIS
Arnadottir S1 , Gunnarsdottir E2 , Fisher A3 ; 1 University of Akureyri,
Iceland, Faculty of Health Sciences; 2 University of Akureyri, Iceland,
Faculty of Law and Social Sciences; 3 Umeå University, Sweden,
Department of Community Medicine and Rehabilitation, Division
of Occupational Therapy
PURPOSE: The Activities-Specific Balance Confidence (ABC) scale
is widely used to evaluate how confident people are in moving
around in the environment. The aim of this study was to use
the analytical features of Rasch modeling to investigate if the
Icelandic version of the ABC rating scale (ABC-IS) demonstrates
acceptable psychometric properties. RELEVANCE: Low balance
confidence or fear of falling is one of the remediable barriers to older
persons’ mobility and participation in various activities. Quantifying
balance confidence or fear of falling is therefore necessary for
physical therapists to be able to measure the impact of this health
problem and effectiveness of interventions aimed at reducing it.
Although psychometric evidence for the ABC scale is promising,
further evaluation is warranted to answer questions that have been
raised about the suitability of the 11-point rating scale and the
appropriateness of adding up the ordinal scores of the scale to
obtain a summary score. Additionally, each time the test is used
in a new context the validity and reliability needs to be examined.
PARTICIPANTS: 183 community-living individuals, aged 65 to 88
years (mean+/−SD=73.8+/−6.2 years) and 47.5% were females. They
were randomly selected from the national registry from one urban
and two adjacent rural areas in Northern Iceland. METHODS: An
interview format of the ABC-IS was administered by trained field
technicians. ANALYSIS: Winsteps computer program was used to
implement Rasch rating scale analysis in order to transform the
ordinal ABC-IS to an interval measure and to evaluate internal
validity and reliability of the scale. RESULTS: Participants were not
able to differentiate reliably between the 11 rating scale categories
of the ABC-IS scale. Additionally, three items on ABC-IS failed to
show acceptable levels of goodness-of-fit to the ABC-IS rating scale
model. However, by collapsing categories and creating a new 5-point
scale, only one item failed to demonstrate acceptable goodness-of-fit.
Removing the misfitting item of “balance confidence when bending
over to pick up a slipper from the front of a closet floor” resulted in a
modified version of ABC-IS with five rating scale categories. Both
item goodness-of-fit statistics and principal components analysis
supported the unidimensionality of the ABC-IS items. Items reliably
separated the sample of older people into at least three statistically
distinct strata of balance confidence. The hierarchical order of item
difficulties was consistent with theoretical expectations. Finally, the
items on the modified test were well targeted towards the balance
confidence of the persons tested although ceiling effects were
present (26 persons received a maximum score). CONCLUSIONS:
The findings provide preliminary evidence that the modified ABC-
IS, with five rating scale categories, demonstrates internal scale
validity and good separation reliability. These findings indicate that
the modified scale is suitable to measure balance confidence of
community-living older Icelanders in research and clinical settings.
IMPLICATIONS: Improving the psychometric properties of the ABC-
IS scale and transforming it to a linear measure potentially affects the
S308
quality of physical therapists’ evaluations of balance confidence and
subsequent interventions. The measurement properties of the ABC in
other cultural contexts may be improved through modifications based
on Rasch analyses. KEYWORDS: aging, balance, measurement.
FUNDING ACKNOWLEDGEMENTS: University of Akureyri, KEA
University Founding and RANNIS. CONTACT: saa@unak.is
ETHICS COMMITTEE: The Icelandic National Bioethics Commit-
tee(§ 04-037-V2) and the Icelandic Data Protection Authorities
(§ S1948).
Research Report Platform Presentation
1306 Tuesday 5 June 09:10
VCEC Meeting Room 17
EFFECT OF BODY WEIGHT-SUPPORTED TREADMILL
TRAINING ON CARDIOVASCULAR ENDURANCE EARLY AFTER
STROKE: A RANDOMIZED CONTROLLED TRIAL
MacKay-Lyons M1 ,McDonald A2 ,
Matheson J2 ,
Howlett J3 ; 1 School
of Physiotherapy, Dalhousie University, Halifax, Nova Scotia,
Canada; 2 Nova Scotia Rehabilitation Centre, QEII Health Sciences
Centre, Halifax, Nova Scotia, Canada; 3 Department of Cardiology,
QEII Health Sciences Centre, Halifax, Nova Scotia, Canada
PURPOSE: To examine the effects of body weight-supported
treadmill training (BWSTT) on cardiovascular endurance of people
early after stroke. RELEVANCE: Aerobic training has been shown
to improve exercise capacity of individuals in the chronic post-
stroke period (i.e. >6 months after stroke). What has not been
investigated, but clearly warrants attention, is the effectiveness
of such training earlier post-stroke, when physical rehabilitation
typically takes place and when the potential for functional recovery
is maximized. PARTICIPANTS: 46 patients (60.6±11.3 years of age;
26 males, 20 females) with a post-stroke interval of <1 month were
assigned, by block randomization according to ambulatory ability,
to 1 of 2 treatment groups (BWSTT, usual care). METHODS: All
subjects received 12 weeks of physiotherapy – 6 weeks as in-
patients for 60 min/day, 5 days/wk, and 6 weeks as out-patients for
60 min/day, 3 days/wk. Control subjects (C) participated in usual care
therapy; sessions were audited periodically to ensure adherence to a
standard protocol. Physiotherapy sessions for experimental subjects
(E) incorporated 20-30 minutes of BWSTT, initiated using 40% body
weight support. Exercise training guidelines (e.g., use of individual
target heart rate (HR) and on-going monitoring of HR, blood pressure,
perceived exertion, and levels of hydration) were strictly followed.
Independent evaluators, blinded to group assignment, conducted
maximal, symptom-limited treadmill exercise tests at baseline, post-
training, and 6-month follow-up. Prior to exercise testing, HR (HRrest)
and systolic and diastolic blood pressure (SBPrest, DBPrest)
were measured. At peak exercise intensity oxygen consumption
(VO2 peak), heart rate (HRpeak), and rating of perceived exertion
(RPEpeak) were recorded. ANALYSIS: Intention to treat analysis was
conducted using repeated measures analysis of variance with one
within-subject factor (time: baseline, post-test, 6-month followup) and
one between-subject factor (group: E, C) to determine effects of the
intervention on dependent variables. Bonferroni post hoc testing was
applied to detect statistically significant differences in the dependent
variables. The significance level was set at p < 0.05. Normality of
distribution of the data was verified using the Kurtosis and Skewness
tests. RESULTS: No adverse events occurred during the testing
and training sessions. 5 subjects (3 E, 2 C) did not complete the
12-week program. HRpeak and RPEpeak did not change across
tests, suggesting similar effort was exerted on repeat testing. HRrest
decreased over time for both groups (p = 0.02), as did DBP (p < 0.001)
while SBPrest remained stable. VO2 peak increased from baseline to
post-training in both groups (p < 0.001) but significantly more for E
subjects (from 13.2±3.5 to 16.3±4.9 ml O2 /kg/min; 23.5% increase)
than C subjects (from 14.3±4.7 to 15.2±4.2 ml O2 /kg/min; 6.3%
increase). VO2 peak did not change in either group between post-
training and 6-month follow-up. CONCLUSIONS: BWSTT is a safe
WCPT 2007, Research Reports
and effective intervention to improve exercise capacity of patients
in the early post-stroke period. Gains in aerobic capacity were
maintained at 6-month follow-up. Effects of BWSTT on gait, activity-
level attributes, and health-related quality of life will be reported
separately. IMPLICATIONS: Patients undergoing stroke rehabilitation
are woefully deconditioned. The findings of this study demonstrate
that BWSTT is an effective method of safely increasing exercise
capacity during the period in which physical rehabilitation is typically
offered. KEYWORDS: stroke, exercise, aerobic training. FUNDING
ACKNOWLEDGEMENTS: Heart and Stroke Foundation, Canadian
Stroke Network. CONTACT: m.mackay-lyons@dal.ca
ETHICS COMMITTEE: Research Ethics Board, Capital District
Health Authority, Halifax, Nova Scotia
Research Report Platform Presentation
1030 Tuesday 5 June 09:10
VCEC Meeting Room 18
RANDOMISED CONTROLLED PILOT STUDY COMPARING
PHYSIOTHERAPY TECHNIQUES OF BREATHING AND MOBILITY
AFTER OPEN ABDOMINAL SURGERY ON HIGH RISK PATIENTS
Silva Y, Li F; Concord Hospital, Sydney, Australia
PURPOSE: Breathing and secretion clearance techniques have been
shown to minimise incidence of post pulmonary complications (PPC)
after open abdominal surgery. Physiotherapists use mobility as a
treatment but it has not been compared with other physiotherapy
treatment techniques in line with clinical practice. This study aimed
to determine if the addition of deep breathing and coughing to
a physiotherapy directed mobility programme altered PPC and
restoration of mobility in high risk patients after open abdominal
surgery. RELEVANCE: Results from this study may provide evidence
which can be applied to post operative physiotherapy practice.
PARTICIPANTS: Forty four subjects undergoing open abdominal
surgery, at high risk of developing PPC were recruited. All patients
gave written informed consent. METHODS: Subjects were randomly
assigned to three groups prior to surgery. Group A only received
physiotherapy directed early mobility. Group B in addition to early
mobility received deep breathing and coughing. Group C received
deep breathing and coughing but were only mobilised by the
physiotherapist on day three. The breathing exercises and the
intensity of mobility were quantified to all three groups. The
patients were blinded to the treatment. Documentation of a PPC
and restoration of independent mobility were recorded. ANALYSIS:
Results were analysed using intension to treat. Statistical analysis
was performed using a SPSS package. RESULTS: Groups A, B and
C had similar mean age (71, 75 and 72 years), body mass index
(29.6, 28.7 and 28.8), American Society of Anaesthesiologists (ASA)
score (2.55, 2.64 and 2.3) and length of anaesthesia (3.9, 4.6 and
5.3 hours). There were more patients with pulmonary disease and
reduced lung function in group B compared to the other groups with
a significant level p = 0.019. Subjects in group C had no pulmonary
disease. The PPC rates were 25%, 42% and 10% and the day
restoration of independent mobility were 5.6, 11.6 and 9.11 for groups
A, B and C. The rate of PPC was correlated to the ASA score
(p = 0.02). CONCLUSIONS: The pilot study showed the addition of
deep breathing to an early mobility programme or mobilising on day
three does not significantly alter the incidence of PPC. However
this resulted from a relatively small sample size. Also there were
possible contributing factors such as a greater number of patients
with lung disease, older patients and higher ASA scores in group B
compared to the other groups which may have resulted in the higher
incidence of PPC. There is a decrease in lung volumes and altered
mucus clearance post surgery which may lead to PPC. Previous
studies have shown high sitting, deep breathing with coughing
and mobility improve lung volumes, enhances alveolar ventilation,
mucous clearance and restoration of independent mobility. As all
three groups did one or combination of these techniques there was
no significant differences between the groups PPC or restoration
Platform Presentations, Tuesday 5 June
of independent mobility. IMPLICATIONS: PPC develops in high risk
patients after abdominal surgery and physiotherapy techniques of an
addition of deep breathing to an early mobility or mobilising on day
three is equally effective in improving recovery. KEYWORDS: post
operative pulmonary complications, early mobilisation, deep breath-
ing exercise. FUNDING ACKNOWLEDGEMENTS: nil. CONTACT:
silvay@email.cs.nsw.gov.au
ETHICS COMMITTEE: Concord Hospital Ethics Committee, Concord
Hospital Road, Concord, NSW 2139, Australia approved the study.
Research Report Platform Presentation
1991 Tuesday 5 June 09:10
VCEC Meeting Rooms 19-20
MOTOR IMAGERY PRACTICE FOR GAIT REHABILITATION OF
CHRONIC POST-STROKE HEMIPARESIS
Dunsky A, Dickstein R, Deutsch J; University of Haifa, Haifa, Israel
PURPOSE: To study the contribution of motor imagery practice to the
walking performance of community dwelling individuals with chronic
post-stroke hemiparesis. RELEVANCE: Following a stroke, many
patients rapidly re-enter the community with residual impairments and
disabilities that interfere with community ambulation. Because of lack
of community services, and in order to avoid falling, these patients
are often discouraged from independently practicing gait activities
at home. Consequently, their limited mobility predisposes them to
a sedentary lifestyle, which further reduces functional capacity and
affects their quality of life. The practice of motor tasks via imagery has
been proposed as a mode of exercise therapy which is safe, bears
little cost, and is not dependent on other persons. PARTICIPANTS:
Seventeen individuals (15 men, 2 women, mean age 57.5 ±9 years,
eleven of them with right and six with left hemiparesis) volunteered
to participate. They were afflicted by a stroke (ischemic in 14 and
hemorrhagic in 3 participants) 46±27 months before enrolment. All
subjects signed and informed consent, as required by the IRB of the
ministry of health who had approved the study. METHODS: Each
subjects received 15 minutes of imagery gait practice in their homes,
three days a week for six weeks. The intervention addressed gait
impairments of the affected lower limb and task-specific gait training.
Specifically, imagery practice focused on increasing the force of push
off and lengthening stance duration of the affected lower extremity
as well as increasing walking speed. Walking ability was evaluated
in the lab before the intervention (Pre), at three weeks (mid-term), at
the end of the intervention (post), and at three weeks after its end
(follow-up). Lab measurements included: walking speed, step and
stride length, cadence, single and double support time and sagittal
kinematics of the knees and ankle joints. Walking ability was also
assessed using clinical and functional scales administered by an
independent tester. ANALYSIS: Descriptive and ANOVA statistics
were applied, using SPSS RESULTS: Walking speed increased 40%
at post test. This improvement was largely maintained at follow-
up. The effect-size of the intervention on walking speed was found
to be moderate (0.641). Significant increase was found in stride
length, cadence, and single-support time on the affected lower
limb, while double-support time significantly decreased. Gait pattern
assessed with Tinetti gait scale, and gait independence judged by the
Modified Functional Walking Categories Index also improved as well.
CONCLUSIONS: Walking speed and independence improved after a
six week home based mental practice training program. The findings
justify the ongoing imagery practice of gait activities as a mean to
decrease deterioration and enhance walking ability of home dwelling
individuals with hemiparesis. IMPLICATIONS: An impairment and
task based mental practice home based program that produced
positive effects for walking of individuals post-stroke may be now
tested on other tasks and rehabilitation populations. KEYWORDS:
Stroke, Gait, Mental Practice. FUNDING ACKNOWLEDGEMENTS:
None.
ETHICS COMMITTEE: The IRB of the Flieman Geriatric Rehabilita-
tion Hospital, Haifa, Israel
S309
Research Report Platform Presentation
2657 Tuesday 5 June 09:30
PP Crystal Pavilion A
STUDENT PERCEPTIONS OF PEER LEARNING IN THE
PRACTICE SETTING: A Q-METHODOLOGICAL STUDY
Baldry Currens J; University of East London, London, UK
PURPOSE: This study explored undergraduate physiotherapy stu-
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
response to placement scarcity, recognition of enhanced learning
with PL is growing. Research has explored placement outcome,
though less is known of students’ perceptions regarding PL, and
whether these vary across different programmes of study. This
study also supports evaluation of the Situated Learning programme
(SLP), a new physiotherapy education model involving work-based
learning. PARTICIPANTS: Student volunteers were recruited from
two physiotherapy programmes in one institution. Group A comprised
students undertaking traditional block placements with a peer
(n=54), whilst Group B comprised SLP students who work with the
same peer throughout the degree (n=25). Gender, age, ethnicity
and educational attainment were comparable across groups: 34
(63%) and 15(60%) respectively were female; mean age was 23.3
and 27.8 years; 39 (72.2%) and 19 (76%) self-defined as white
British; and 23 (42.6%) and 15 (60%) had previously studied
at degree level. METHODS: Q methodology (Stephenson, 1935;
Brown, 1980) was used to explore patterns of perceptions. A
balanced set of sixty statements were developed from qualitative
interviews and current literature. Students were asked to sort
statements according to those they ‘Most Agreed’, ‘Most Disagreed’
or felt ‘Neutral’ about, and their configurations were recorded. Post
Q-sort interviews, taped and transcribed, asked respondents to
explain their Q-sorts. ANALYSIS: Data were analysed using PQ
method software (Schmolk, 2002). For each group, factor analysis
using Principal Components Analysis and Varimax Rotation was
undertaken. Emerging factors represented characteristic perceptions
of PL within each group. These were combined in a second
order analysis, producing factors relevant to both groups. Factors
were explored with reference to post Q-sort transcripts. RESULTS:
Factor correlation across groups was evident (0.52, 0.6, 0.93).
After second order analysis, three factors represented both groups’
perceptions. Factor One (34% of variance, EV=2.0428) portrayed
a collaborative view of learning. PL was valued highly, seen as
bouncing ideas, rehearsing techniques, reinforcing understanding,
modelling appropriate behaviour and providing support. Factor Two
(26% of variance, EV=1.552) portrayed a more conditional view
of PL. Peer explanation was considered helpful and confidence-
building, though possible only if peers were compatible, had similar
levels of ability and showed trust and respect. Factor Three (25%
of variance, EV=1.4755) portrayed PL as involving comparison and
competition. Being compared, feeling exposed, and a peer knowing
more, were perceived uncomfortable, though measuring oneself
against another or showing greater knowledge were viewed positively.
Each factor had at least 16 statements that significantly discriminated
it (p < 0.05)from others. CONCLUSIONS: Shared perceptions of PL
across both programmes suggests mode of study is not significant to
PL. Emerging factors support literature locating PL as a constructivist
activity that enhances learning (Factor One), and acknowledges
pre-conditions that support development of a learning relationship
(Factor Two). A contested view of competition is suggested in Factor
Three. IMPLICATIONS: Awareness of student perceptions of PL
will aid preparation by students, programme designers and clinical
educators. KEYWORDS: Q-method; peer learning; practice-based
learning. FUNDING ACKNOWLEDGEMENTS: University of East
London. CONTACT: j.baldrycurrens@uel.ac.uk
ETHICS COMMITTEE: University of East London Research Ethics
Committee
S310
Research Report Platform Presentation
2732 Tuesday 5 June 09:30
VCEC Ballroom A
MEASUREMENT OF ETHICAL DECISION MAKING ABILITY
OF UNIVERSITY OF NORTH DAKOTA PHYSICAL THERAPY
STUDENTS
Mabey R, Salzbrun C, Fox R, Danks M; University of North Dakota,
Grand Forks, ND, USA
PURPOSE: This study measures the ethical decision making ability
of Physical Therapy (PT) students at Years 1 and 3 of a three-year
program. RELEVANCE: Literature of other professions suggests a
relationship between the ethical decision making ability of students
and future ethical practice. Few published studies address the ethical
decision making ability of PT students. PARTICIPANTS: PT students
completed the Defining Issues Test 2 (DIT2) upon admission to the
program and as they completed their final semester of academic
course work. The DIT2 is part of routine departmental outcomes
assessment activities. METHODS: The DIT2 was given to students
entering the program in 2003, 2004, and 2005. A second DIT2 was
given to the 2003 admission cohort in the final semester of their
academic course work. The DIT2, developed at the University of
Minnesota (UMN), is considered valid and reliable. Tests were scored
at the UMN and the file returned to the department for analysis.
ANALYSIS: Traditional statistics described findings and analyzed
differences in scores. Analyses were performed with SPSS version
11.0; alpha was set at 0.05. RESULTS: There were no differences
in students’ N2 (moral development) or P scores (post-conventional
schema scores) between admit years [N2 scores: F(2,126) = 0.025,
p = 0.975. P scores: F(2,126) = 0.162, p = 0.850]. Entering students
were further analyzed as a single sample (n=129). For entering
students, the mean N2 score was consistent with the national
average (t(128)= −1.713, p = 0.089). The mean P score (35.32) was
lower than the national mean of 37.80 (t(128)= −2.053, p = 0.042).
Students with a conservative political preference demonstrated lower
N2 scores than those with a liberal preference (F(4.121)=3.068,
p = 0.019). Post hoc analysis revealed a difference between very
conservative (M=21.13) and somewhat liberal (M=39.68) groups.
Similar findings were found for P scores [F(4,121) = 3.553, p = 0.009],
with differences between very conservative (M=24.33) and somewhat
liberal (M=41.21) groups. There were no differences in scores
between males and females (N2 scores: t(126)=-.960, p = 0.339; P
scores: t(126)=-.448, p = 0.655), or between students  23 or 
24 years of age (N2 scores: t(123)= -.274, p = 0.785; P scores:
t(123)=-.108, p = 0.914). For students tested twice, the mean N2
score was higher at Year 3 (41.15) than at Year 1 (35.11) (t(88)=-
2.152, p = 0.034). There was no difference in P scores between
years (t(88)=-1.281, p = 0.203). Finally, the Year 3 N2 (M=41.14)
and P (M=37.89) scores were lower than national averages of
44.97 and 44.87, respectively (N2 scores: t(46)=-2.230, p = 0.031
and P scores: (t(46)=-3.938, p < 0.001). CONCLUSIONS: This study
is preliminary and includes students from a single site. Several
concerns are raised: Why are several mean scores lower than
national averages? Are scores site specific, or would a multi-
program study produce similar results? If skills of PT students
are limited, should ethics courses be added to the curricula?
Would additional ethics education improve scores? IMPLICATIONS:
Educational programs prepare future practitioners. Selected literature
suggests a relationship between the ethical decision making ability of
students and future ethical practice. The students in this study scored
lower than national averages. Whether this will effect clinical practice
is not known. KEYWORDS: ethical decision making; DIT2; physical
therapy. FUNDING ACKNOWLEDGEMENTS: None. CONTACT:
rmabey@medicine.nodak.edu
WCPT 2007, Research Reports
Research Report Platform Presentation
1688 Tuesday 5 June 09:30
VCEC Meeting Rooms 8&15
THE COST-EFFECTIVENESS OF PRIMARY THERAPIST MODEL
FOR THE MANAGEMENT OF PATIENTS WITH RHEUMATOID
ARTHRITIS
Li L1−4 , Maetzel A3,5 , Davis A3,6 , Lineker S6 , Bombardier C3,4 ,
Coyte P3 ; 1 University of British Columbia, Vancouver, Canada;
2 Arthritis Research Centre of Canada, Vancouver, Canada;
3 University of Toronto, Toronto,; 4 University Health Network, Toronto,
Canada; 5 Canada Amgen Europe GmbH, Lucerne, Switzerland;
6 Arthritis Community Research & Evaluation Unit, Toronto, Canada
PURPOSE: To estimate the incremental cost-effectiveness of ser-
vices delivered by rheumatology-trained primary therapists compared
with those provided by traditional physical and / or occupational
therapists for managing rheumatoid arthritis (RA). Under the
primary therapist model (PTM), rheumatology-trained rehabilitation
therapists, regardless of their disciplinary background, provide both
physical therapy (PT) and occupational therapy (OT). RELEVANCE:
This is one of the first studies that examine the economic value
of an innovative rehabilitation model involving physical therapists.
The results can inform health care administrators’ decisions on
health services delivery for patients with RA. PARTICIPANTS:
Between November 1999 and May 2002, 143 patients with RA,
referred by 25 rheumatologists, were randomized to the PTM
or traditional treatment (TT) group. Eligible patients were adults
requiring rehabilitation treatment and not receiving PT / OT in the
past 2 years. METHODS: The economic evaluation was conducted
within the context of a randomized controlled trial. Health outcomes
were expressed in terms of quality-adjusted life years (QALYs),
which were measured with the EuroQol Instrument (EQ-5D) at
baseline, discharge (6 weeks), and 6-months. Direct and indirect
costs, including patients’ visits to health professionals, use of
investigative tests, hospital visits, use of medications, purchases of
adaptive aids, and the productivity loss incurred by patients and
their caregivers, were collected monthly. ANALYSIS: Incremental
cost-effectiveness was calculated by dividing the additional costs of
the PTM into the marginal benefits gained with the PTM approach.
Bootstrap samples were used to determine the robustness of the
findings. RESULTS: From 143 consenting patients, 32 dropped out
after baseline assessment, to leave 111 for analysis (PTM=63,
TT=48). Majority female (PTM=87.3%, TT=79.2%), with mean age
of 54.2 years and 56.8 years for PTM and TT groups, respectively.
Average disease duration was 10.6 years and 13.2 years for
each group, respectively. A statistically significant difference in
the EQ-5D of 0.107 was observed at baseline (PTM: 0.463 +/−
0.52; TT: 0.57 +/− 0.59). Consequently, QALYs were calculated
by adjusting for the baseline values. From a societal perspective,
PTM generated higher mean QALYs (0.068 +/− 0.04) and resulted
in a higher average cost (CAN$6,848, interquartile range (IQR):
$1,984, $9,320) compared to TT (QALY = −0.017 +/− <0.001;
costs = CDN$6,266, IQR: $1,938, $10,194) in 6 months, although
differences in both measures were not statistically significant.
This yielded an estimated incremental cost-effectiveness ratio of
CDN$13,675 / QALY gained (95% non-parametric CI: −$73,469
to $230,334). CONCLUSIONS: The PTM appears to be a cost-
effective alternative to the traditional PT / OT, and its integration into
rheumatology care over the short term comes at reasonable societal
costs. IMPLICATIONS: Further investigations will be required to
assess the long-term economic consequences of the care model
in managing RA and other rheumatologic conditions. KEYWORDS:
Rheumatoid arthritis, Rehabilitation, Cost-effectiveness analysis.
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: lli@arthritisresearch.ca
ETHICS COMMITTEE: University Health Network Research Ethics
Board
Platform Presentations, Tuesday 5 June
Research Report Platform Presentation
1524 Tuesday 5 June 09:30
VCEC Meeting Rooms 11-12
PEDAGOGICAL RELATIONSHIP AMONG CLIENT AND EXPERT
Piirainen A; Helsinki University and Laurea University of Applied
Sciencis, Espoo, Finland
PURPOSE: This thesis is a phenomenological study of relationships
experienced between client and expert. The aim of this research was
to determine client-expert relationships in physiotherapy situations.
RELEVANCE: Experts’ relationships in physiotherapy situations
have been studied earlier as being healing, health promotion or
interaction. PARTICIPANTS: The study explored the experiences
of 16 physiotherapists and 16 clients of physiotherapy situations
in special healthcare, in a private physiotherapy facility, and in
a primary health care setting. METHODS: Data were collected
through separate open-ended one-to-one interviews with clients
and physiotherapists immediately after the encounter at the same
premises where the physiotherapy session had taken place. The
open-ended interviews key question was to describe what the
interviewer had experienced in the situation just ended. ANALYSIS:
The study’s first step was the individual description of the experienced
situation. After description, analysis continued to individual meanings
and meaning units and synthesis. In the second part of the research,
client and expert standpoints were established by compared and
united individually experienced meaning units.The interpretation
was done by uniting and comparing clients’ and physiotherapists’
individual meaning nets to get the two points of view of the
interaction. RESULTS: The client’s standpoint was directed by
the essential strangeness of her body. From the physiotherapy
experts standpoint was directed the essential goal to cure the
client through exercises or action. From the shared experience’s
point of view the situation was a process which had spontaneous
shared security, shared trust and active common understanding
and common language parts. From those two standpoints, the
relationships between client and expert seemed to be pedagogical
relationships. In pedagogical relationships there is importance in
ethical, epistemological, existential and aesthetical standpoints. It
was evident as result of the research that the pedagogical process
can progress thru in a short time from spontaneous to active or it
can stop at the spontaneous area. The spontaneous, making visible
communication and creating language dialogues can change the
direction of the pedagogical process. CONCLUSIONS: According to
the results of this thesis only the active language creative dialogue
can promote a client’s welfare so that she can discuss it with her
family or colleagues IMPLICATIONS: The research results provide
a challenge to develop client-expert relationships in physiotherapy
so that a meaningful pedagogical process can take place in
different kinds of physiotherapy relationships. The other challenge
is to study how the pedagogical process takes place in other
professions relationships and how education can prepare experts
to identify and instruct the pedagogical process. KEYWORDS:
Client-expert-relationship, pedagogical relationship, phenomenology,
experience, meaning analyse, dialogue, physiotherapy. FUNDING
ACKNOWLEDGEMENTS: The Finnish Work Environment Found;
Laurea University of Applied Sciences.
ETHICS COMMITTEE: Helsinki University Hospital’s ethical commit-
tee
S311
Research Report Platform Presentation
2618 Tuesday 5 June 09:30
VCEC Meeting Room 16
PREVALENCE AND ASSOCIATED FACTORS OF URINARY
INCONTINENCE IN COMMUNITY-DWELLING ELDERLY: OURO
PRETO STUDY, BRAZIL
Dias R1 , Marques L2 , Machado-Coelho G3 , Barbosa J2 , Freitas S4 ,
Nascimento Neto R5 , Silva A6 , Chaimowicz F6 ; 1 Physical Therapy
Department, Federal University of Minas Gerais, Belo Horizonte,
Brazil; 2 Health and Biological Science Department, UNI-BH,
Belo Horizonte, Brazil; 3 Pharmaceutic Science School, Federal
University of Ouro Preto, Ouro Preto, Brazil; 4 Clinical and Social
Nutrition School, Federal University of Ouro Preto, Ouro Preto,
Brazil; 5 Instituto de Hipertensão Arterial; 6 Medicine Department,
Federal University of Minas Gerais, Belo Horizonte, Brazil
PURPOSE: The prevalence of urinary incontinence (UI) in the elderly
population is frequently underestimated. The aims were: estimate
prevalence of UI in community-dwelling elderly; analyze if making
three questions about a probable UI enhance diagnose accuracy;
and identify associated factors to symptoms of UI. RELEVANCE:
UI has a significant physical, social and psychological impact on
elderly individuals, but proper and early diagnose could prompt
Physical Therapy intervention. PARTICIPANTS: 198 community-
dwelling elderly consented to participate (Ethics Approval Number
UFOP 2001/26). METHODS: A population-based, cross-sectional
study of a randomly representative sample. Probable cognitive
deficits (Informant Questionnaire of Cognitive Decline in the Elderly-
IQCODE) was investigated, elderly with positive screening were inter-
viewed with a proxy. Participants were submitted to a comprehensive
assessment: depression screening (Geriatric Depression Scale),
functional disability assessment (Health Assessment Questionnaire),
questions about UI, falls, oral health, vision and hearing problems,
social isolation and prevention, and to a clinical assessment of
urinary symptoms and history of obstetric, gynecologic, urinary and
proctologic problems. ANALYSIS: Pearson’s Qui-squared or Exact
Fisher test to verify proportion differences in demographic and
clinical variables; Odds ratio (OR) with 95% CI to test power of
associations; Multiple Logistic Regression with significant (p < 0.10)
and plausible variables to determine independent effect. RESULTS:
179 elderly (90.4% of the sample) were assessed. Median age
was 69.89±7.6 years, 76% were women, and 63.9% presented
incontinence (women 68.8%; men: 54.9%). UI prevalence, assessed
by the elderly comprehensive assessment, was 63.9%. Making three
questions, instead of only one, about urinary loss increased the
prevalence of UI from 53.7% to 63.9% (p < 0.01). Related to UI
symptoms, urgency urinary loss was the most frequent condition
among the incontinents. The majority of the incontinents reported
mild symptoms, but more than 50% had reported discomfort related
to that condition. The logistic regression analysis has yielded an
independent association between UI and age (70+ years; OR =
2.98; CI = 1.16–7.61; p = 0.02) and economic status (low; OR =
7.7; CI = 1.66–35.57, p < 0.01), adjusted by probable depression,
bowel constipation and disability to stand from a sitting position.
The multivariate analysis stratified by age has yielded, in those
with less than 70 years, an independent association between
UI and gender (female; OR = 3.56; CI = 1.12–11.30; p = 0.02).
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
S312
solution. KEYWORDS: Elderly, Urinary Incontinence, Prevalence.
FUNDING ACKNOWLEDGEMENTS: Financial support: CNPq –
Brazilian Funding Research Agency. CONTACT: rcd@ufmg.br
ETHICS COMMITTEE: Ethics Committee of the Federal University
of Ouro Preto, Brazil – Nr:2001/26
Research Report Platform Presentation
1565 Tuesday 5 June 09:30
VCEC Meeting Room 17
ADAPTATION TO PROGRESSIVE RESISTANCE TRAINING (PRT)
IN CHRONIC STROKE POPULATION
Lee M1 , Davis G1 , Kilbreath S1 , Fiatarone Singh M1,2 , Zeman B3 ;
1 Faculty of Health Sciences, University of Sydney; 2 Faculty of
Medicine, University of Sydney; 3 Coorabel Adult Service, Royal
Rehabilitation Centre
PURPOSE: This study investigated the time-course of muscle
adaptation as a consequence of PRT in persons following stroke.
RELEVANCE: It is well known that high intensity PRT is the optimal
exercise modality to improve muscle strength in other cohorts;
however, the time-course of adaptation to PRT has not been defined
in persons following stroke. PARTICIPANTS: Forty-eight chronic
stroke survivors (mean age:63±9 yrs, time since stroke: 57±54
months) were recruited from the community who were able to
walk independently. METHODS: A single-blinded, sham exercise-
controlled factorial design with an intention-to-treat analytic strategy
was employed for this randomized clinical trial. Participants were
randomly allocated amongst PRT + cycling, PRT + sham cycling,
sham PRT + cycling, or sham PRT + sham cycling groups. PRT
Training consisted of 30 exercise sessions, conducted over a 10–
12 week period, with 3 sessions per week. The training resistance
was re-adjusted according to a new 1RM every 2nd week and
perceived exertion every session. The outcomes were unilateral
muscle strength assessed by 1 repetition maximum (1RM) measured
on pneumatic resistance machines (leg press, knee extension, knee
flexion, hip abduction, ankle plantarflexion). ANALYSIS: Simple
descriptive statistics were used to summarize the progression of
training. To examine the semi-weekly changes that occurred with
training, repeated measures ANOVA with Helmert contrasts was
performed for each lower limb muscle group tested only in subjects
who were in the PRT group (PRT + cycling, PRT + sham cycling).
RESULTS: The intensity of strength training was on average above
80% of the most recent 1RM (the intended intensity) for those in
the PRT groups. Overall, participants in the PRT group significantly
improved both their affected and unaffected lower limb muscle
strength during the first 6-8 weeks of training (66-76%), but then
plateaued in the final 2-4 weeks (Repeated-measures ANOVA
with Helmert contrasts: p < 0.05). A posteriori statistical analyses
revealed that the leg press and knee flexion demonstrated significant
improvement semi-weekly until Week 8, but then plateaued (ie, no
further improvement on average) thereafter (p > 0.05). In contrast,
knee extension and hip abduction showed significant improvements
semi-weekly until Week 6 (p < 0.05), but plateaued during the final
four weeks (p > 0.05). Analysis of intended versus actual intensity
showed that the actual loads used were above the theoretical
intended progression (3% per session) up to approximately 6 weeks
for most exercises and then fell below the intended progression.
CONCLUSIONS: High intensity PRT effectively strengthens both
affected and unaffected lower limb muscles in older chronic stroke
survivors almost 5 years post-stroke. Adaptation was linear in the
first 6-8 weeks of training, during which time progressive overload
was possible each session. IMPLICATIONS: A rehabilitation program
targeting muscle strength in chronic stroke, as in other cohorts, will
produce musculoskeletal adaptations as long as progressive high-
intensity loading techniques are used. KEYWORDS: CVA, exercise,
lower limb. FUNDING ACKNOWLEDGEMENTS: The project was
financially supported by the National Health and Medical Research
Council of Australia (Project 302013). Keiser K400 Electronics were
WCPT 2007, Research Reports
donated by Keiser Sports Health Inc, Fresno, CA. CONTACT:
mj.lee@fhs.usyd.edu.au
ETHICS COMMITTEE: Human Research Ethics Committee of the
University of Sydney, Australia
Research Report Platform Presentation
1112 Tuesday 5 June 09:30
VCEC Meeting Room 18
TRUNK STABILISATION EXERCISES IN PATIENTS WITH
STERNAL INSTABILITY FOLLOWING CARDIAC SURGERY
El-Ansary D1,2 , Adams R2 , Waddington G1 ; 1 University of
Canberra, Australia; 2 University of Sydney, Australia
PURPOSE: Sternal instability following cardiac surgery is a post-
operative complication that impacts on the patient’s quality of life,
contributes to increased length of stay in hospital and overall cost
of care. Many of these patients do not have the option of surgical
repair due to the increased risks that are associated with further
surgery. RELEVANCE: It is proposed that contraction and activation
of the abdominal and anterior thoracic cage muscles may assist in
stabilising the sternum by reduction of excessive motion during trunk
movement. If the degree of excessive motion between the two sternal
edges in the patient with an unstable sternum can be minimised
this may also reduce the associated pain and discomfort reported
by patients and in turn offer a conservative management option
for sternal instability. PARTICIPANTS: Nine patients presenting with
sternal instability following cardiac surgery were included in this study.
METHODS: Subjects participated in a prospective, blinded clinical
trial. This involved a six-week exercise program as well as six weeks
of rest. Measures taken included: sternal separation by ultrasound,
patient self-reports (SFS) and video footage of two functional tasks.
In addition to set tasks subjects were asked to nominate other
tasks that they found difficult and these were incorporated into the
SFS. Rating scales were used to obtain measures of pain and
discomfort, and ease of performance. The resulting video footage
was assessed for movement control and quality by ten qualified
physiotherapists and twenty physiotherapy students. ANALYSIS:
Repeated measures Analysis of Variance was conducted to assess
effects, with contrasts written across occasions of measurement to
examine for trends in data over time. RESULTS: Sternal separation:
there was a significant difference in sternal separation measures
obtained by ultrasound in both the supine and seated positions
following a six week exercise program. Participants who trained
first maintained the gains of training in the supine position more
so than in the seated position. Patient self reports: there was a
significant difference in the ratings of pain and discomfort following
the exercise program (p < 0.03) noted for the group. This effect
was maintained in the subgroup that commenced the exercises
first (p < 0.04). In addition, for the group that commenced with a
rest period a significant change in reported ratings was observed
following the exercise program (p < 0.02). Video analysis: ratings
of movement quality and movement control did not differ with
rater experience, and showed the greatest change for everyday
movements such as going from supine to sitting and reaching
for an object in the seated position. CONCLUSIONS: A six week
program of specific stabilisation exercises of the trunk significantly
improved measures of: sternal separation, self report regarding pain
and discomfort, and movement quality and control. IMPLICATIONS:
Stabilisation exercises aimed at improving recruitment of muscles of
the anterior chest wall and abdomen may be an appropriate inclusion
in the rehabilitation program of patients with sternal instability
following cardiac surgery. On the basis of the data obtained in
the current study, training should incorporate positions patients find
primarily symptomatic (eg supine) in addition to those that simulate
functional tasks. KEYWORDS: Cardiovascular, Exercise, Ultrasound.
FUNDING ACKNOWLEDGEMENTS: University of Sydney, Australia.
CONTACT: dela2819@fhs.usyd.edu.au
ETHICS COMMITTEE: The University of Sydney, Australia.
Platform Presentations, Tuesday 5 June
Research Report Platform Presentation
2355 Tuesday 5 June 09:30
VCEC Meeting Rooms 19-20
STRUCTURED TREADMILL WALKING FOR STROKE PATIENTS:
THE IMPACT OF WALKING SURFACE AND CARDIOVASCULAR
DEMAND ON GAIT QUALITY
Kuys S1,2 , Brauer S3 , Ada L4 ; 1 Griffith University, Gold Coast,
Australia; 2 Princess Alexandra Hospital, Brisbane, Australia;
3 University of Queensland, Brisbane, Australia; 4 University of
Sydney, Sydney, Australia
PURPOSE: The purpose of this study was to determine if walking
quality in stroke patients was different: when walking overground
compared with walking on a treadmill; and when cardiovascular
demand was increased during treadmill walking. RELEVANCE:
Following stroke, most survivors are able to walk but few manage
this easily in the community significantly contributing to the ongoing
disability associated with stroke. While treadmill training is increasing
in popularity as a mode of retraining walking, the impact of this type
of training on gait quality has not been investigated. Results of this
project will be directly applicable to physiotherapists rehabilitating
walking in stroke survivors and should improve knowledge of the
impact of treadmill training on stroke survivors. PARTICIPANTS:
20 stroke survivors currently undergoing inpatient rehabilitation
were recruited to these studies. Gender was evenly distributed
with 45% being male. Average age of participants was 55.9
(±12) years with a range of 38-78 years. Participants were
medically stable, referred for physiotherapy, demonstrated walking
deficits, provided informed consent and scored at least 3 on
Motor Assessment Scale, Item 5, Walking. Equivalence analyses
indicated that 15-20 participants would be required to determine
minimum clinical differences. Ethical approval for study was granted
by institutional Medical Research Ethics Committees. METHODS:
Two counterbalanced descriptive studies were conducted. In the
first study, participants underwent a ten minute overground walking
intervention and a ten minute treadmill walking intervention (in
different sessions on different days) where heart rates during
each intervention were matched. In the second study, performed
on another day, participants walked at predetermined heart rates
equivalent to 40, 50 and 60% heart rate reserve, the minimum
intensity capable of improving cardiorespiratory fitness. For both
studies, spatial and temporal gait measures were taken pre
and post each intervention when walking over an 8m Gaitrite
mat. Hip, knee and ankle joint measures were taken at stance
and swing phases of gait via 2D posterior and lateral webcam
footage during overground and treadmill walking. Reliability of
using the webcam for angle measures has previously been
published, and will be confirmed for this population in this study.
ANALYSIS: In the first study repeated measures (RM) analysis
of variances (ANOVAs) were used to determine any task effect
(overground vs. treadmill) and time effect (pre vs post) in gait
parameters. RMANOVAs were also used to determine any effect of
increased cardiovascular demand on gait parameters. RESULTS:
No differences were found between an overground walking and
treadmill walking intervention on spatio-temporal gait parameters. No
differences were found in spatio-temporal gait parameters following
treadmill walking at increasing cardiovascular demand. There were
no differences in joint kinematics at hip, knee or ankle movement
during stance and swing phases of gait at increasing treadmill
speeds. CONCLUSIONS: Treadmill walking does not negatively
impact on gait spatial temporal parameters, joint kinematics or
walking pattern compared to overground walking or when walking
at increasing cardiovascular demands. IMPLICATIONS: It is feasible
to use treadmill walking during inpatient rehabilitation to retrain
walking capacity in stroke patients able to walk without compro-
mising gait quality. KEYWORDS: Professional Practice – Exercise.
FUNDING ACKNOWLEDGEMENTS: Australian Physiotherapy As-
sociation Queensland Branch Dorothy Hopkins Award for Clinical
S313
Study, Queensland Health Allied Health Research Grant. CONTACT:
s.kuys@griffith.edu.au
ETHICS COMMITTEE: Princess Alexandra Hospital Research and
Ethics Committee; University of Queensland Medical Research
Ethics Committee
Research Report Platform Presentation
2810 Tuesday 5 June 09:50
PP Crystal Pavilion A
POSITIONS THAT MATTER IN PROBLEM-BASED LEARNING:
CHARACTERISING STUDENT PERFORMANCE OF SOCIAL
INTERACTION THROUGH THEIR CONVERSATION IN
COLLABORATIVE GROUP WORK
Remedios L; University of Melbourne, Melbourne, Australia
PURPOSE: This study uses Positioning Theory (Harre and Van Lan-
genhove, 1991) to examine how students perform their collaboration
in a small group learning contexts. Positioning theory is a theoretical
framework that focuses on the way in which we position [identify]
others and ourselves through conversation. Individuals position
themselves relative to each other through adopting, assigning,
contesting and subverting positions within their social context through
communication/cultural conventions. This presentation examines the
key positions that were adopted by and assigned to students in a
PBL context in an Australian physiotherapy undergraduate setting.
RELEVANCE: Small group collaborative learning is increasingly
being used to promote the development of professional attributes
and competencies. In small group collaborative contexts such as
PBL, the educator is positioned as a facilitator who scaffolds the
development of student skills. A fine grained analysis of how
students operate within the learning context will add significantly
to educators’ understanding of how to best support each learner
to full engagement with the learning agenda. PARTICIPANTS:
Seventeen Australian-educated and 13 Asian-educated students
volunteered to participate in a qualitative research project on PBL.
Consent to videotape PBL sessions was gained from all members
of the groups to which these 30 students belonged. For this study,
the video data from seven PBL tutorial sessions were analysed.
In total, the conversational exchanges of seventy students and
seven tutors were analysed for identification of positioning practices.
METHODS: This study was a subset of a two-year ethnographic
study that examined the experiences and responses of overseas-
educated (Asian-educated) students to PBL learning in an Australian
learning context. Participant observation, semi-structured interviews,
videotape of PBL sessions and videotape stimulated recall interviews
were used. For this secondary analysis, video data of seven tutorials
were the major data source. ANALYSIS: Positioning theory involves
the examination of conversation between persons to interpret how
individuals position themselves relative to each other. An existed
list of positions commonly assigned and adopted in small group
collaborative work among senior school students (Barnes, 2003) was
expanded and modified into a list of positions commonly adopted
and assigned by students in PBL tutorials. RESULTS: A list of
12 positions with subsets was developed. Each position and its
subset were described in terms of social practice. The role of ‘ideal’
PBL student was defined as a flexible and responsive adoption
of all positions consistent with the PBL agenda and avoidance
of positions in conflict with the PBL agenda. CONCLUSIONS:
Students positioning activities provides a view on how students
negotiate their social context and the power their carry in shaping
their learning. The PBL context should be viewed as a space to
develop students’ skills in productive positioning activity. Data from
this study suggested that tutors have a powerful role in positioning
students and further research is needed into the positioning activity
of tutors. IMPLICATIONS: This study provides tutors with insights
into how students negotiate the sociocultural context of small
group learning. Knowledge of practice can inform tutors efforts to
further scaffold students’ learning. KEYWORDS: PBL,Positioning
S314
Theory,sociocultural contexts,. FUNDING ACKNOWLEDGEMENTS:
Australian Post-graduate Scholarship, The University Of Melbourne.
CONTACT: louisajr@unimelb.edu.au
ETHICS COMMITTEE: The University Of Melbourne, Faculty of
Education Human Research Ethics Committee.
Research Report Platform Presentation
1600 Tuesday 5 June 09:50
VCEC Meeting Rooms 11-12
SELF REFERRAL (DIRECT ACCESS)TO PHYSIOTHERAPY
VIEWS AND PERCEPTIONS OF SERVICE USERS AND
NON-USERS
Webster V1 , Holdsworth L2,3 ; 1 Glasgow Caledonian University,
Glasgow, Scotland, UK; 2 Tayside Primary Care Trust, Dundee,
Scotland, UK; 3 Forth Valley NHS, Stirlingshire, Scotland, UK
PURPOSE: The development of patient self referral (Direct Ac-
cess) to physiotherapy has prompted the demand for evidence
regarding appropriateness, cost effectiveness and efficacy of this
mode of access. This study aimed to investigate the views,
attitudes and experiences of General Practitioner(GP) and Self-
referral(SR) patients and to compare those with non-users(NU)
of physiotherapy services within the Scottish NHS. RELEVANCE:
Recent healthcare reforms have encouraged the involvement of
service users when designing or re-designing services. Patient self
referral to physiotherapy has been a significant development in
service delivery yet very little published evidence exists regarding
the views and perceptions of patients or the general public.
PARTICIPANTS: All patients attending the physiotherapy clinic in
one year were recruited. 264 GP and 76 SR with 82.8% (n=208)
and 92.1% (n=70) response rates respectively. In order to identify
the views and perceptions of the general public to physiotherapy
and Self referral a sample of non-users was included. A stratified
sample of 250 individuals(NU) with no experience of physiotherapy
during the previous five years were randomly selected from the
practice population 207 responded (82.8%). METHODS: A postal
questionnaire was developed to allow service users and non users to
be included. In addition this method allowed respondents to complete
the questionnaire anonymously which was hoped would encourage
open and honest responses. ANALYSIS: All questionnaires were
analysed using PinPoint software. Frequency distributions were
reported in percentages and non-parametric testing was used to
study differences between groups. Chi Squared testing examined
associations between groups. Ordinal and continuous data was
examined using Mann Whitney testing. The level of significance
was 5% and confidence levels 95%. RESULTS: Despite a publicity
campaign prior to the introduction of self referral 51% GP and 78.3%
NU were unaware they could refer themselves(p < 0.0001). Levels of
knowledge were not different between user groups but significantly so
between users and non users (p = 0.003). Approximately 65% of GP
and SR patients (p > 0.99) still had symptoms but a greater proportion
of SR were continuing to improve (p < 0.0001). Vast majority of
all groups were opposed to only doctors being able to refer to
Physiotherapy (76.5%GP, 85.9% SR, 69.5% NU). Despite low levels
of knowledge being perceived over 90% of all respondents agreed
physiotherapy was effective in the treatment of musculoskeletal
conditions (93.7%GP, 95.8% SR, 90.3 NU) with three quarters of
all groups happy for physiotherapists to make decisions regarding
fitness for work. Considerable differences between the groups
was identified in relation to ‘confidence to know when to refer
themselves’ with>70% User Group compared to 42.9% Non-Users
The highest level of agreement was expressed by the SR, 74.3%
CONCLUSIONS: The findings of this study indicate that both
previous users and non users are in favour of self referral to
physiotherapy but more work needs to be done by the profession to
market services and educate the public as to when a physiotherapist
should be the first point of contact for patients. IMPLICATIONS:
Knowledge of accessing and experiencing physiotherapy from the
WCPT 2007, Research Reports
patients’ perspective is essential to the future development of
physiotherapy services. KEYWORDS: Self Referral (Direct Access),
Patients views, Primary Care. FUNDING ACKNOWLEDGEMENTS:
Work was unfunded but supported by Tayside Primary Care Trust and
Glasgow Caledonian University. CONTACT: v.webster@gcal.ac.uk
ETHICS COMMITTEE: Ethical approval for this study was granted
by Tayside Research Ethics Committee and by Glasgow Caledonian
University Research Ethics Committee
Research Report Platform Presentation
2803 Tuesday 5 June 09:50
VCEC Meeting Room 16
THE DEVELOPMENT OF A MOBILITY OUTCOME MEASURE
FOR OLDER GENERAL MEDICAL PATIENTS IN THE ACUTE
CARE SETTING
de Morton N1,2 , Keating J1 , Berlowitz D2 , Davidson M3 ; 1 Department
of Physiotherapy, Monash University, Melbourne, Australia; 2 Northern
Clinical Research Centre, Northern Health, Melbourne, Australia;
3 School of Physiotherapy, La Trobe University, Melbourne, Australia
PURPOSE: Clinicians and researchers require an outcome measure
that can sensitively measure and monitor changes in mobility for
older acute general medical patients. This report describes the
development of a physical performance mobility measure specifically
designed for this patient population. RELEVANCE: Physiotherapists
commonly assess and treat older medical patients during acute
hospitalisation. Existing instruments for measuring mobility are
inadequate for assessing people across the broad spectrum of
abilities that exists in this patient population. PARTICIPANTS: 89
consecutive general medical patients aged 65 years and older who
were admitted to an acute care hospital. The mean patient age was
79.2 years (sd=7.1), 53% were female and 88% were admitted from
home. At hospital admission, mean Barthel Index and Hierarchial
Assessment of Balance and Mobility (HABAM) scores were 81.3
(sd=22.8) and 18.1 (sd=6.8) respectively. METHODS: Mobility items
were generated from existing scales, patient interviews and focus
groups with experts. A total of 51 items were pilot tested. Patients
were assessed every 48 hours during hospital admission. A head-
to-head comparison of the new mobility measure was performed
with the Barthel Index and the HABAM. ANALYSIS: Rasch analysis
was used to rank items in a hierarchy of difficulty from easiest to
hardest. Item response patterns that showed misfit to the Rasch
model were identified and the item excluded. Inter rater and test retest
reliability were quantified by the Minimum Detectable Change at
90% confidence (MDC90 ). Instrument responsiveness and Minimally
Clinically Important Difference (MCID) were calculated using criterion
and distribution based methods. Criterion based methods were
calculated by reference to an independently measured global rating of
change scale. RESULTS: 215 mobility assessments were performed.
Seventeen mobility items were selected for inclusion in the new
measure. The item hierarchy ranged from able to sit unsupported
(easiest item) to standing on one leg with eyes closed (hardest
item). The 17-item scale fitted the Rasch model and items operated
consistently across the scale spectrum regardless of patient age,
gender, cognition, primary language or time of administration during
hospitalisation. An interval-level scoring system was developed with
a score range from 0 to 100. The MDC90 and MCID were calculated
to be approximately 10 points. The new mobility measure removes
the ceiling effects of the Barthel Index and HABAM and is more
responsive to change than the Barthel Index. Although not directly
compared in this research, the new mobility measure also overcomes
the known floor effect of the Timed Up and Go (TUG) in this patient
population. CONCLUSIONS: This new mobility measure is a broad
unidimensional measure of mobility that produces interval level data,
has minimal equipment requirements, is quick and easy to administer
in the acute care setting and has superior measurement properties
to the Barthel Index, HABAM and the TUG. IMPLICATIONS:
The new mobility measure provides clinicians and researchers
Platform Presentations, Tuesday 5 June
with an advanced method for monitoring and measuring patient
mobility in the acute care setting. KEYWORDS: Measurement,
Aged Care. FUNDING ACKNOWLEDGEMENTS: This research was
funded by The HCF Health and Medical Research Foundation
and the National Health and Medical Research Council (NHMRC).
CONTACT: natalie.demorton@med.monash.edu.au
ETHICS COMMITTEE: The Northern Hospital and Monash Univer-
sity Human Research Ethics Committees
Research Report Platform Presentation
1601 Tuesday 5 June 09:50
VCEC Meeting Room 17
CHANGES IN MOTOR NETWORK IN PERSONS WITH
ACUTE STROKE EVALUATED WITH FUNCTIONAL MRI AND
FUNCTIONAL TESTS
Askim T1,2 , Indredavik B3,4 , Haraldseth O5 , Håberg A5 ; 1 Department
of Community Medicine and General Practice, Faculty of Medicine,
Norwegian University of Science and Technology, Trondheim,
Norway; 2 Clinical Services, University Hospital of Trondheim,
Norway; 3 Stroke Unit, University Hospital of Trondheim, Norway;
4 Department of Neuroscience, Faculty of Medicine, Norwegian
University of Science and Technology, Trondheim, Norway;
5 Department of Circulation and Medical Imaging, Faculty of Medicine,
Norwegian University of Science and Technology, Trondheim, Norway
PURPOSE: Most patients suffering from stroke experience some
functional recovery for the first three months following the injury.
The knowledge about factors facilitating this recovery is very limited
and the knowledge about changes in motor network during this time
is limited as well. The purpose of this study was to investigate
the relationship between functional recovery and brain activation
patterns in persons with unilateral hand impairment after ischemic
stroke in the acute and chronic phase. RELEVANCE: Functional
MRI (fMRI) is increasingly used to study brain activation during
motor tasks. More knowledge about motor network activation is
of major interest to understand the motor recovery after stroke
and to develop more effective interventions to regain function in
patients with unilateral upper extremity paresis. PARTICIPANTS:
11 right handed persons with the diagnosis of stroke (4 women),
aged from 69 to 74 years old, with unilateral hand paresis and
intact language were included. METHODS: All patients were treated
in an acute stroke unit combined with early supported discharge.
They underwent diagnostic MRI, fMRI and functional hand/arm tests
within 4-7 days from first sign of symptoms and three months later.
The functional tests were Nine Hole Peg Test, Frenchey Arm Test,
Motor Assessment Scale (arm and hand function items) and grip
strength. ANALYSIS: fMRI data was analyzed in SPM5 using the
general linear model, second level random effects analysis and T-test.
Motor recovery data was used in a covariate analysis. RESULTS: All
patients had subcortical infarction. Two strokes also included cortex,
but not primary motor cortex. There was significantly improved hand
function as measured with all functional tests from acute to chronic
phase. In self paced finger tapping significantly increased activation
was found in ipsilateral primary motor and somatosensory cortex in
the chronic compared to the acute phase. The covariate analysis
demonstrated that contralateral primary motor cortex activation was
connected to increased grip strength. Contralateral supramarginal
gyrus and bilateral parietooccipital sulcus activation were associated
with increased performance in all tests. CONCLUSIONS: In all
patients with acute impaired hand function and infarction not
encompassing primary motor cortex, improved hand function lead to
increased activation in primary motor cortex in the chronic compared
to acute phase. The increased parietal activation corresponding
to improved functional tests demonstrated the importance of the
posterior right parietal cortex in motor attention and preparation.
IMPLICATIONS: We suggest further examination of posterior parietal
cortex to investigate its importance for hand function recovery.
KEYWORDS: stroke, motor recovery, brain activation. FUNDING
S315
ACKNOWLEDGEMENTS: This study has received financial support
from The Norwegian Fund for Post-graduate Training in Physio-
therapy and from Clinical Services, Trondheim University Hospital,
Norway. CONTACT: torunn.askim@ntnu.no
ETHICS COMMITTEE: Regional Committee for Medical Research
Ethics in Norway, REK
Research Report Platform Presentation
2693 Tuesday 5 June 09:50
VCEC Meeting Room 18
DEVELOPMENT OF A RISK ASSESSMENT MODEL TO
PREDICT PULMONARY RISK FOLLOWING UPPER ABDOMINAL
SURGERY
Scholes R1 , Denehy L2 , Sztendur E3 , Browning L2 ; 1 Physiotherapy
Department, School of Primary Health Care, Faculty of Medicine,
Nursing and Health Sciences, Monash University, Melbourne,
Australia; 2 School of Physiotherapy, Faculty of Medicine, Dentistry
and Health Sciences, The University of Melbourne, Melbourne,
Australia; 3 School of Computer Science and Mathematics, Victoria
University, Melbourne, Australia
PURPOSE: The incidence of post-operative pulmonary complica-
tions (PPC) following upper abdominal surgery (UAS) has been
reported in recent years as between 9-40%. The presence of pre-
operative, intra-operative and post-operative risk factors have all
been reported to contribute to the development of PPC. However,
finding absolute predictors of PPC remains elusive. The ability to
identify patients at high risk of PPC could prioritise care for those
who would benefit most from respiratory physiotherapy. The aim
of this study was to identify key risk factors associated with the
development of PPC following elective upper abdominal surgery and
to formulate a weighted, clinically viable risk assessment model to
predict the development of PPC in patients undergoing elective upper
abdominal surgery. RELEVANCE: This prospective, multicentre
study identified risk factors associated with the development of PPC
and developed a weighted risk prediction model to predict UAS
patients at high risk of PPC. PARTICIPANTS: Two hundred and
seventy-two consecutive elective upper abdominal surgey patients
were recruited pre-operatively into the study from three major tertiary
teaching hopsitals in Melbourne, Australia. Patients were included if
they understood written and spoken English and were scheduled
for elective UAS, which was defined as “an incision above or
extending above the umbilicus”. All patients were given written
and verbal information on the project and written informed consent
was obtained. METHODS: All patients were assessed across 17
pre-operative and intra-operative risk factors for the development
of PPC. PPC was defined and diagnosed using multiple clinical,
radiological and pathological criteria in order to identify clinically
significant PPC. Patients received standardised written pre-operative
education on deep breathing exercises and the importance of
early mobilisation. In addition, patients received one standardised
post-operative physiotherapy treatment on the first post-operative
day. Patients were monitored daily until discharge for signs of
PPC. ANALYSIS: Data was analysed using univariate analysis
and forward stepwise logistic regression to determine the variables
for inclusion in a risk prediction model for PPC. RESULTS: The
incidence of PPC was 13% (n=35). Five risk factors were idenitifed
by univariate analysis as significant predictors of PPC: duration of
anaesthesia (odds ratio (OR)=4.322); surgical category (OR=2.272);
current smoking (OR=2.109); respiratory co-morbidity (OR=2.057)
and predicted VO2 max (OR=2.027). Logistic regression was used
to develop a weighted PPC risk prediction model. The risk prediction
model predicted 82% of patients who developed a PPC. High
risk patient were 8.4 times more likely to develop a PPC than
low risk patients. CONCLUSIONS: These results provide a model
for predicting clinically significant PPC in the upper abdominal
surgery population. Further validation of the risk prediction model
could allow prioritised pre-operative and post-operative respiratory
S316
care for high risk patients. IMPLICATIONS: The ability to identify
and manage patients at high risk of PPC, with exclusion of
lower risk groups from post-operative physiotherapy, could reduce
unnecessary intervention, improve cost effectiveness and prioritise
care for those who would benefit most from physiotherapy through
the implementation of evidence based practice. KEYWORDS:
upper abdominal surgery, post-operative pulmonary complications,
risk prediction. FUNDING ACKNOWLEDGEMENTS: St. Vincent’s
Hospital, Melbourne Research Grant.
ETHICS COMMITTEE: The study was approved by Melbourne
Health Human Research Ethics Committee and St. Vincent’s Health
Human Research Ethics Committee.
Research Report Platform Presentation
835 Tuesday 5 June 09:50
VCEC Meeting Rooms 19-20
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
Department, Gwent Healthcare NHS Trust, Newport, UK;
2 Department of Physiotherapy Education, School of Healthcare
Studies, Cardiff University, Cardiff, UK; 3 Department of Neurology,
Opthalmology and Audiological Medicine, School of Medicine,
Cardiff University, Cardiff, UK
PURPOSE: Many patients with stroke who regain the ability to
walk do so with abnormal gait patterns. To improve abnormal gait
patterns physiotherapists must determine the underlying causes in
order to provide effective treatment. There is a wealth of literature
describing gait deviations commonly seen following stroke. However,
the relationship of these common gait deviations with underlying
neurological impairments remains unclear. Therefore, this study
aimed to determine the neurological impairments of patients with
hemiparetic stroke, explore their relationship to gait deviations and
test whether observation of an individual patient’s gait deviation
helps determine their underlying impairments and therefore guide
rehabilitation. RELEVANCE: The challenge for physiotherapists is
to determine the underlying impairments leading to an individual
patients gait pattern in order to provide appropriate and effective
interventions to improve that patients gait. This study provides
further knowledge to aid physiotherapists in their assessment and
treatment of abnormal gait patterns. PARTICIPANTS: A cross-
sectional study design was used and included a convenience sample
of 31 patients who had a unilateral single stroke, no major lower
limb joint pathology and the ability able to walk with or without aid.
METHODS: Gait deviations were identified through observational
gait analysis. Neurological impairments were identified from a
comprehensive clinical examination including muscle bulk, range of
movement and resistance to passive movement measures, and from
the measurement of EMG responses of four lower limb muscles
to quick and slow stretch, isometric force-EMG relationships and
muscle activation during gait. ANALYSIS: Patients with and without
particular gait deviations were compared in terms of their clinical
examination results in particular contracture and muscle wasting,
EMG stretch responses as a measure of spasticity, weakness and
agonist/antagonist coactivation during isometric force production, and
abnormal muscle activation patterns during gait. Data analysis used a
range of non-parametric and parametric procedures and was carried
out using SPSS v10. RESULTS: Certain gait deviations appear to
be related to particular underlying impairments. Sustained pelvic
rotation was related to gastrocnemius spasticity (p < 0.05), knee flexor
weakness (p < 0.0005) and quadriceps weakness (p < 0.005). Knee
hyperextension during stance was related to quadriceps spasticity
(p < 0.05) and knee flexor weakness (p < 0.001). Excessive knee
flexion in stance was related to an inability to fractionate (p < 0.05) and
in some patients knee flexor contracture. Reduced or absent knee
extension during swing was related to knee flexor spasticity (p < 0.05),
WCPT 2007, Research Reports
knee flexor contracture (p < 0.05) and quadriceps spasticity (p < 0.01).
CONCLUSIONS: Some gait deviations are linked to underlying
neurological impairments and this knowledge may help to guide phys-
iotherapy treatment. This was an exploratory study involving multiple
variables therefore increasing the likelihood of a type I statistical error.
Further research should focus on particular results and test only
selected variables i.e. the relationship of knee flexor weakness and
knee hyperextension and further test the relationships with specific
intervention programmes i.e. the effects of knee flexor strengthening
and knee hyperextension. IMPLICATIONS: These results may help
to guide physiotherapeutic assessment and treatment intervention
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:
allison.cooper@gwent.wales.nhs.uk
ETHICS COMMITTEE: Gwent Local Research Ethics Committee
Research Report Platform Presentation
2335 Tuesday 5 June 10:10
PP Crystal Pavilion B & C
OUTCOME MEASUREMENT OF “COMMUNITY” WEIGHT-
BEARING ACTIVITY IN YOUNG PEOPLE WITH NON-
PROGRESSIVE NEUROLOGICAL DISABILITIES: A SYSTEMATIC
LITERATURE REVIEW
Dickens W1 , Tripathi C1 , Featherstone J1 , Croot E2 , Price F1 ;
1 Sheffield Children’s Hospital NHS Foundation Trust; 2 University
of Sheffield
PURPOSE: Physiotherapists in the UK routinely measure weight
bearing activity in young people with non-progressive neurological
disabilities using a range of published measurement tools. A
systematic review was required to identify the most appropriate
measurement tool(s) for use by physiotherapists in the community
setting with this patient group. RELEVANCE: The use of appropriate
outcome measures is fundamental to determine effective practice.
The results of this project will be used to inform decisions about
current best practice and therefore impact on the delivery of
therapy to this patient group. This will ultimately impact upon clinical
effectiveness. PARTICIPANTS: N/A METHODS: A two phase review
was required. In phase one, an extensive systematic review of the
medical, nursing and social sciences literature was undertaken to
identify and evaluate specific tools for measuring weight bearing
activity in young people with non-progressive neurological disabilities.
A comprehensive search strategy was developed in collaboration
with expert clinicians. Papers were identified according to explicit
inclusion and exclusion criteria. Relevant papers were obtained and
reviewed. Results were entered into a Reference Manager® version
11 database. Phase two, to identify the most appropriate tool(s) and
eliminate unsuitable tools through assessment of scientific rigor, is
still underway. This will be reported at a later date. Ethical approval
was obtained from South Sheffield Research Ethics Committee. The
study was registered with the NHS Trust research office for research
governance purposes. ANALYSIS: Key data were elicited from the
included studies using a pre-determined data extraction form. Data
extraction was undertaken independently by two reviewers and any
discrepancies were resolved by discussion. RESULTS: 514 papers
were identified from the initial search. 82 fulfilled the strict inclusion
criteria, covering 55 measurement tools. A further nine tools were
identified from the grey literature. Initial assessment identified a range
of problems with these tools: excessively broad or too restrictive (e.g.
diagnosis, age); an absence of activities of specific interest and/or
requiring a standardised environment that would be inappropriate
to a community setting. The level of scientific rigor with which
the tools had been developed and validated was also extremely
variable. CONCLUSIONS: The literature reveals a bewildering choice
of outcome measurement tools with many being advocated without
specific validation. Our analysis has identified a list of candidate
Platform Presentations, Tuesday 5 June
tools that require rigorous critical appraisal against common criteria.
Phase two will extend the analysis by reviewing these identified
tools systematically. IMPLICATIONS: Findings from the review
will enable therapists to make an informed choice between the
outcome measurement tools available for use with this patient group.
KEYWORDS: Paediatric, neuro-disabilities, outcome measurement.
FUNDING ACKNOWLEDGEMENTS: Sheffield Health and Social
Research Consortium. CONTACT: wendy.dickens@sch.nhs.uk
ETHICS COMMITTEE: Approved by South Sheffield Research Ethics
Committee. Study registered with the NHS Trust research office for
research governance purposes.
Research Report Platform Presentation
821 Tuesday 5 June 10:10
VCEC Meeting Rooms 11-12
ARE SELF REFERRING (DIRECT ACCESS) PATIENTS
DIFFERENT FROM THOSE REFERRED BY THEIR GP?:
RESULTS OF A NATIONAL TRIAL
Holdsworth L1,3 , Webster V2,3 ; 1 NHS Forth Valley, United Kingdom;
2 Glasgow Caledonian University, United Kingdom; 3 The Scottish
Physiotherapy Self Referral Study Group, United Kingdom
PURPOSE: Since 1997, United Kingdom (UK) healthcare reforms
have encouraged the development of primary care, widening of
access and urged for innovation in service delivery models to benefit
patient care. RELEVANCE: The ability of patients to refer themselves
to physiotherapy, although used widely in private practice has not
been the traditional mechanism within UK National Health Services
(NHS) with access controlled by GPs acting as gatekeepers. This
was primarily due to concerns that services would be overwhelmed
by the resultant demand. Pilot data indicated that this may not be the
case and that self-referring patients were different. It was decided
to undertake a national trial of patient self-referral (SR) to NHS
physiotherapy providers to either confirm or refute these findings
PARTICIPANTS: 3,010 patients (>16 ys) and 100 physiotherapists
from 29 primary care locations representing a range of socio-
economic and geographical settings throughout Scotland were
included. METHODS: Self-referral was introduced in each site in
parralel to GP (open) access. Demographic and clinical data relating
to all referrals was collated over a full year. All patients were followed
up one month after discharge by questionnaire to ascertain their
status and views about access and physiotherapy. The GP workload
and associated NHS costs by referral category were also established.
ANALYSIS: Quantitative analysis was carried out using appropriate
non-parametric tests (Chi squared & Mann Whitney) while qualitative
data was processed and analysed using PinPoint Questionnaire
software package which included appropriate descriptive and non-
parametric tests RESULTS: There was no relationship between
gender, age group, outcome as determined by both physiotherapist
and patient or number of physiotherapy contacts and referral group.
However greater proportions of SR’s: presented with low back and
neck conditions (54% vs. 42.5%, p < 0.001), reported having their
symptoms for less than 14 days (14% vs. 8.5% p = 0.011), were
absent from work in lower proportions, 19.5% vs. 27.5%, p = 0.048)
and were absent for half the mean time (2.5 days vs. 6 days);
completed their treatment (76% vs. 68.5% p = 0.002) and despite
non preferential treatment waiting time, were seen within two weeks
(44% vs. 35.5%, p < 0.001). SR’s reported having fewer similar levels
of continuing symptoms but that they were improving to a greater
extent. They were more: satisfied with their intervention, confident in
their knowledge of and when to access physiotherapy and supportive
of autonomous behaviours and ease of access (p < 0.001). In terms
of costs, SR’s had lower NHS associated costs per episode (£66.31
vs. £88.99 (GP) attributed to lower prescribing, referral for x-ray
and to secondary care, GP & physiotherapy contacts (p < 0.001).
CONCLUSIONS: SR’s would appear to have a different profile from
that of GP referrals however the reason/s why patients choose
to refer themselves or not is unknown and represents an area
S317
for future study. IMPLICATIONS: Being able to widen access to
physiotherapy services in the UK and allow self referral has significant
implications for services, NHS costs, society in terms of employment
and patient choice, empowerment and satisfaction, implications that
are also of global interest. KEYWORDS: Self referral, direct access,
national trial. FUNDING ACKNOWLEDGEMENTS: This work was
undertaken with the support of the participating sites and from our
employer organisations, NHS Forth Valley and Glasgow Caledonian
University. CONTACT: lesley.holdsworth@fvpc.scot.nhs.uk
ETHICS COMMITTEE: Ethical approval for the study was granted
by the Multi-centred Research Ethics Committee (Scotland) ref. No.
MREC/02/0/37.
Research Report Platform Presentation
3231 Tuesday 5 June 10:10
VCEC Meeting Room 16
THE RELIABILITY AND VALIDITY OF LOWER EXTREMITY SEN-
SORY TESTING IN OLDER COMMUNITY-DWELLING ADULTS
Shaffer S1 , Harrison A1,2 , English M2 , Brown K2 , Brennan K2 ,
LeFever C2 ; 1 University of Kentucky, Doctoral Program in
Rehabilitation Sciences, Lexington, United States; 2 University of
Kentucky, Division of Physical Therapy, Lexington, United States
PURPOSE: Various forms of lower extremity sensory testing (LEST)
exist, and debate continues as to the most efficient, reliable,
and meaningful protocol for screening older adults. Therefore,
the objectives of this study were to assess the reliability and
validity of LEST measures, and their relationship to balance and
falls in older community dwelling adults. RELEVANCE: Further
clarification of the psychometric properties of sensory testing and
the influence that such measures have on fall risk in older adults
will enhance the current level of physical therapy evidenced based
practice. PARTICIPANTS: Thirty-one (18 females and 13 males)
community dwelling elders (mean+ standard deviation=67.1+9.9
years)volunteered and completed sensory testing in a health fair
setting. METHODS: The sensory protocol included light touch, reflex
(knee and ankle), monofilament, and quantitative vibration perception
threshold (QVPT) testing. Monofilament (5.07/10-g) testing (MT)
was conducted bilaterally at the lateral ankles, dorsal great toes,
and various sites on the plantar aspect of the feet. Quantitative
vibration perception thresholds were obtained from the great toe
and served as the reference standard for distal sensory neuropathy
(DSN). Sensory testing was repeated by a second examiner
who was blinded to prior test results. Fall history and balance
measures (four square step test, functional reach, and timed up
and go) were also collected by additional examiners. ANALYSIS:
Data analysis included descriptive statistics, intraclass correlation
coefficients(ICC), standard error of measurement(SEM), kappa
statistics, and Spearman rank correlations. Sensitivity, specificity,
and likelihood ratios for sensory measures were also calculated
to assess the accuracy for DSN and fall risk. RESULTS: Reflex
(kappa=.39-.73), light touch (kappa=.35-.74), and individual sites for
MT (kappa=.32-.79) exhibited poor to excellent inter-rater reliability.
Agreement on QVPT (ICC=.79-.95; SEM=2.9-6.2 V; kappa = 0.86)
and collective MT sites (kappa = 0.68-0.84) demonstrated good to
excellent inter-rater reliability. Utilizing multiple monofilament trials
and sites resulted in sensitivity of 72%, specificity of 100%, a
positive likelihood ratio (+LR) of 6.0, and a negative likelihood ratio
(−LR) of 0.36. Monofilament testing was also highly specific (95%;
+LR=6.3) and the only sensory measure with a significant (rs= 0.47;
p = 0.008) relationship to falls in the previous year. CONCLUSIONS:
Monofilament and QVPT testing were reliable measures in this
sample of older community dwelling adults. Monofilament testing
also demonstrated a high degree of specificity, but lacked adequate
sensitivity as a sole screening procedure for DSN. Finally, the
correlation between falls and monofilament testing warrants further
investigation. IMPLICATIONS: Findings imply that the selected QVPT
and MT protocols were reliable between raters. Monofilament testing
S318
was also specific for identifying older adults with DSN and a past
history of falling. Further prospective research is needed to validate
these findings and the relationship between sensory impairments and
falls in older adults. KEYWORDS: Sensory testing, neuropathy, falls.
FUNDING ACKNOWLEDGEMENTS: This research was not funded.
CONTACT: scott.shaffer@uky.edu
ETHICS COMMITTEE: University of Kentucky Institutional Review
Board
Research Report Platform Presentation
3070 Tuesday 5 June 10:10
VCEC Meeting Room 17
MUSCLE POWER PERFORMANCE AFTER STROKE
Stavric V, McNair P; Physical Rehabilitation Research Centre,
Auckland University of Technology, Auckland, New Zealand
PURPOSE: After stroke, muscles lose strength and the ability to
generate force. While it is accepted that muscle force is lost after
stroke, little is known about the effect a stroke has on the ability to
generate muscle power. The aims of this study were to investigate
muscle power performance at differing loads and to determine at
what load muscle power is best elicited. A secondary aim was to
ascertain whether there is a relationship between muscle power
and certain functional tasks. RELEVANCE: Power may be important
in functional activities requiring fast joint movement. As such, a
better understanding of how muscles after stroke produce power
can better direct rehabilitation approaches whose aim is to improve
functional mobility. PARTICIPANTS: 58 hemiplegic and age and
gender matched control participants were recruited from community
stroke groups and via newspaper advertisements that were run
in the greater Auckland area. METHODS: A cross-sectional study
design was used to investigate muscle power performance and
functional tasks. Leg muscle power was measured using a modified
leg press machine at 30, 50 and 70% of 1 repetition maximum
(RM) load. Participants were positioned on the leg press machine
and asked to push, with a single leg, as hard and as fast as they
could. Data was collected via a transposed force platform mounted
on the leg press and a linear transducer connected to the trolley.
From these, power was able to be calculated. Maximum speed
was also recorded for the following functional tests: walking 10
metres; standing up from a chair 10 times; and climbing 10 steps.
ANALYSIS: 3x3 ANOVA was used to compare the values of the
paretic leg, non-paretic leg and control leg power outputs over the
three percentages of 1RM. Pearson product moment correlation
coefficient analysis was performed between the each of the peak
power outputs and each of the functional tasks. RESULTS: The
results showed that peak muscle power values differed significantly
within paretic and non-paretic and control legs. Peak leg power in
all three leg groups was greatest when pushing against a load of
30% of 1RM. Paretic leg peak power tested at 30% of a 1RM
(Mean=401.7; SD=242 W) was significantly lower (p < 0.05) than the
non-paretic leg (Mean=844.1; SD= 405 W). Both the paretic and
non-paretic legs generated significantly lower peak power (p < 0.05)
than the control leg (Mean=1219.1; SD=509.8 W). Correlations were
found between the paretic leg peak power and gait speed and stair
climbing (R= 0.6-0.7, p < 0.05). No correlation was found between
paretic leg peak power and chair stands. CONCLUSIONS: There
are significant differences between the paretic and the non-paretic
leg in power production after stroke. As well, there are significant
differences between the non-paretic, or good, leg and legs of those
not affected by stroke. Power appears to be related to a number of
functional activities. IMPLICATIONS: Strength training alone may not
be enough for people affected by stroke to achieve functional mobility.
An understanding of how muscle power can be assessed and trained
may have added benefits to muscle strengthening and functional
retraining in stroke rehabilitation. KEYWORDS: stroke, muscle
power. FUNDING ACKNOWLEDGEMENTS: Auckland University
of Technology, Auckland, New Zealand and the Neurology Group
WCPT 2007, Research Reports
of the New Zealand Society of Physiotherapists Inc. CONTACT:
vernasmail@gmail.com
ETHICS COMMITTEE: Auckland University of Technology Ethics
Committee (AUTEC) approved this project August 2004.
Research Report Platform Presentation
2834 Tuesday 5 June 10:10
VCEC Meeting Room 18
PREVENTION OF PULMONARY COMPLICATIONS AFTER
UPPER ABDOMINAL SURGERY BY PREOPERATIVE PHYSICAL
THERAPY: A RANDOMIZED CONTROLLED PILOT STUDY
Dronkers J1 , Veldman A2 , Hoberg E3 , van der Waal C4 , van
Meeteren N5 ; 1 Physiotherapist and Human Health Scientist,
Department of Physiotherapy, Gelderse Vallei Hospital, Ede, The
Netherlands Member of the Department of Physiotherapy Research,
Academy of Health Sciences Utrecht. University teacher, Master
of Physiotherapy Research, Utrecht University, The Netherlands;
2 Physiotherapist, Head of the Department of Physiotherapy,
Gelderse Vallei Hospital, Ede; 3 Physiotherapist, Department
of Physiotherapy, Gelderse Vallei Hospital, Ede; 4 Surgeon,
Department of Surgery, Gelderse Vallei Hospital, Ede; 5 Associate
Professor Section Rehabilitation, Department of Neurology and
Neurosurgery, Rudolf Magnus Institute of Neuroscience, University
Medical Center Utrecht, The Netherlands Head of the Department
of Physiotherapy Research, Academy of Health Sciences Utrecht.
Head of the Master of Science in Physiotherapy Research of the
Utrecht University, The Netherlands
PURPOSE: The purpose of this pilot study was to investigate the
feasibility and effects of preoperative inspiratory muscle training (IMT)
on the incidence of atelectasis in patients at high risk of postoperative
pulmonary complications (PPCs) scheduled for elective abdominal
aortic aneurysm (AAA) surgery. RELEVANCE: PPCs frequently
occur after upper abdominal surgery and are the leading cause of
postoperative morbidity and mortality and increase hospital length
of stay, medical consumption, and hence costs. Improvement of the
respiratory function by preoperative IMT may reduce the incidence
of PPCs. In that case, this treatment has to be implemented in the
multidisciplinary perioperative care. PARTICIPANTS: Twenty high-
risk patients were recruited from the surgery outpatient department
of the Gelderse Vallei Hospital in Ede, the Netherlands. The
primary inclusion criteria were elective surgery for aneurysm of
the abdominal aorta (AAA) with a scheduled delay until surgery
of at least 2 weeks, and at least one of the following risk factors:
age >65 years, smoking, chronic obstructive pulmonary disease
(COPD), and overweight. METHODS: In this single-blind randomized
controlled pilot study, the patients were randomly assigned to receive
preoperative IMT or usual care. Effectiveness outcome variables
were atelectasis and inspiratory muscle strength, and feasibility
outcome variables were adverse effects and patient satisfaction
with IMT. ANALYSIS: Incidence and prevalence outcomes were
analyzed with the Fisher exact test and the Mann-Whitney U test,
respectively. Differences within and between the intervention and the
control groups were tested with the paired and independent t-tests,
respectively. Postoperative outcomes were analyzed by repeated
measures analysis of variance with treatment as the between subject
factor. RESULTS: Despite randomization, patients in the intervention
group were significantly older than the patients in the control group
(70 ±6 years versus 59 ±6 years, respectively; p = 0.001). Eight
patients in the control group and three in the intervention group
developed atelectasis (p = 0.07). The median duration of atelectasis
was 0 days in the intervention group and 1.5 days in the control
group (p = 0.07). No adverse effects of preoperative IMT were
observed and patients considered that IMT was a good preparation
for surgery. Mean postoperative inspiratory pressure was 10% higher
in the intervention group. Patients had no adverse effects and
were satisfied with IMT. CONCLUSIONS: Preoperative IMT is well
tolerated and appreciated and, based on the borderline significant
Platform Presentations, Tuesday 5 June
differences between both groups differing in age at the expense of
the intervention group, seems to reduce the incidence of atelectasis
in patients scheduled for elective AAA surgery. IMPLICATIONS:
A controlled trial will be performed to test, in a sufficient number
of patients randomized by means of a stratified randomization
procedure, whether IMT has a positive effect on other PPCs, such
as pneumonia. KEYWORDS: Inspiratory muscles; Preoperative care;
Frail Elderly. FUNDING ACKNOWLEDGEMENTS: This work was
funded by Hospital Gelderse Vallei. CONTACT: DronkersJ@zgv.nl
ETHICS COMMITTEE: The research protocol was approved by the
Medical Ethics Committee of the University Medical Center Utrecht,
the Netherlands.
Research Report Platform Presentation
3220 Tuesday 5 June 10:10
VCEC Meeting Rooms 19-20
THE RELATIONSHIP BETWEEN DEMOGRAPHIC AND
PHYSICAL IMPAIRMENT MEASURES AND GAIT SPEED IN
COMMUNITY DWELLING PERSONS WITH STROKE
Sullivan P; MGH Institute, Boston, MA, USA
PURPOSE: The purpose was to examine if demographic and
impairment measures were related to gait speed in community
dwelling persons with stroke. RELEVANCE: Improved gait speed is
an outcome for many patients. Understanding which interventions
enhance function is critical. One approach integrates exercise
procedures focused on improving physical impairments with practice
of the function. The task-oriented perspective practices the functional
activity while progressing feedback and learning variables. If
impairment measures are found to contribute to gait speed increased
support for that intervention approach would exist. PARTICIPANTS:
50 community dwelling persons with stroke METHODS: Subjects
completed a demographic questionnaire and were assessed on
measures of lower extremity function, strength, balance and gait
speed. The demographics included age, gender, height, weight, time
since stroke, side of involvement, use of device, and co-morbidities.
Impairment measures were Fugl-Meyer Assessment Lower Extremity
Function (FM), timed sit to stand (STS) for lower extremity strength,
and Berg Balance Scale (BBS). Gait speed was the time to
walk 10-meters at preferred and fastest safe speed. ANALYSIS:
Descriptives provided frequency and mean values; correlations
compared demographics and impairment measures to gait speed.
A series of multiple regression analyses determined the variables
that accounted for gait speed variance. RESULTS: The mean age
was 59.8 yrs; 19 were female, 27 did not use assistive device. The
10 meter preferred speed: females 18.5 sec (sd=12.8), males 14.9
sec (sd=10.3), maximum speed: females 14.1 sec (sd=10.6), males
11.6 sec (sd=8.4). The demographic and impairment measures
were correlated to gait speed: age r=.43, FM r=.53, STS r=.70,
and BBS r=-.82. Age was the only significant demographic and
accounted for 15% of gait speed variance. Of the impairment
measures, the total BBS, STS and FM scores accounted for 80%
of gait speed variability. Individual FM and BBS items that explained
walking speed were: combining movement synergies, and standing:
unsupported, feet together, reaching forward, and alternate foot stool
touching. These accounted for 88% of walking speed variance.
CONCLUSIONS: Our subjects gait speed is similar to other reports
of persons with stroke. Gender, height and weight did not influence
gait speed, dissimilar to reports of healthy elderly. Gait in persons
with stroke seems more related to disease specific impairments than
anthropometric factors. The combination of recombining synergistic
movement, maintaining standing with usual and narrow base, forward
weight shifting, standing unilaterally, and transitioning between sitting
and standing were highly related to gait speed. IMPLICATIONS:
Measures of physical impairments are highly related to gait speed in
community dwelling persons with stroke. Support for an intervention
program to improve relevant impairments is provided. The treatment
procedures that would enhance this combination of impairments
S319
may form the bases for an intervention to improve gait speed.
Future intervention research needs to examine which impairment
and functional changes occur with different types of interventions.
KEYWORDS: stroke, impairment, function, gait speed. FUNDING
ACKNOWLEDGEMENTS: N/A. CONTACT: psullivan8@mghihp.edu
ETHICS COMMITTEE: Partners Health Care, Spaulding Hospital
IRB
Research Report Platform Presentation
550 Tuesday 5 June 10:45
PP Crystal Pavilion A
THE IMPACT OF URBAN OR RURAL RESIDENCE ON HEALTH
RELATED QUALITY OF LIFE IN XHOSA SPEAKING PEOPLE
WITH DISABILITIES
Jelsma J1 , Eide A2 , KaToni M3 , Loeb M2 , Maart S1 ; 1 University of
Cape Town, South Africa; 2 Sintef Research Organisation, Norway;
3 Disabled People Organisation, South Africa
PURPOSE: This study aimed to establish the determinants of Health
Related Quality of Life (HRQoL) in rural and urban samples of
South African Xhosa-speaking people with disability. RELEVANCE:
As physical therapists become more holistic in their approach to inter-
vention, HRQoL increasing becomes a valid measure of outcome. In
addition, the importance of environmental factors on the experience
of disability is now well recognised [1]. PARTICIPANTS: Samples of
convenience were drawn from 15 rural districts of the Eastern Cape
and two urban areas in the Western Cape. The Eastern Cape is a
resource poor area with the majority of the population resident in rural
communities. The infrastructure is undeveloped with poor roads and
limited electricity and water supply to households. The urban sample
was drawn from informal settlement areas in both Cape Town and a
smaller town in the Western Cape that is undergoing rapid industrial
development and has consequently attracted many migrant workers.
The sample was identified through a “snowballing” process initiated
by enumerators who were all members of Disabled People South
Africa, an organisation of people with disabilities that advocates
for the rights of their members. METHODS: Instrumentation: The
validated Xhosa version of the EQ-5D [2] [3] was utilised. The EQ-
5D has five descriptor domains; mobility, self-care, usual activities,
pain/discomfort and anxiety/depression. In addition there is a Visual
Analogue Scale (VAS) which ranges from 0 (worst imaginable health
state) to 100 (best imaginable health state). ANALYSIS: Multiple
regression analysis was used to establish which variables were
predictive of the VAS score. Gender, area of residence and presence
of problems in each descriptor domain were entered in a stepwise
regression model. RESULTS: The sample consisted of 244 rural and
61 urban respondents, demonstrating a preponderance of physical
disabilities (77% of rural and 62% of urban respondents). The
urban sample reported more problems in each of the descriptor
domains. The VAS score showed a bimodal distribution. The results
of the multiple regression analysis indicated that the presence
of pain detracted most from HRQoL (−20%), followed by anxiety
and depression (−10%) and difficulty with performance of usual
activities (−10%). Rural participants, with the same impairment level,
reported 8% poorer HRQoL. CONCLUSIONS: Urban living, even
within a resource poor, informal settlement appears preferable to
rural living for people with disabilities. Many of the respondents
reported good HRQoL despite having disabilities and it appears
that the presence of a disability per se does not necessarily lead
to a poor HRQoL. IMPLICATIONS: Intervention aimed at reducing
pain and alleviating anxiety and depression are most likely to
improve the HRQoL of people with disability who are similar to
this sample. The effect of place of residence would need to be
factored in when planning and evaluating programmes such as
the provision of disability grants or physical therapy in the urban
and rural settings. 1. World Health Organisation. The International
Classification of Functioning and Disability – Beta-2 Draft. Geneva:
WHO, 1999. 2. Brooks R, Group EuroQol. EuroQol: the current
S320
state of play. Health Policy 1996; 37:53-72. 3. Jelsma J, Amosun
D, Mkoka S, Nieuwveld J. The reliability and validity of the Xhosa
version of the EQ-5D. Disability and Rehabilitation 2004; 26:103-
108. KEYWORDS: Health related quality of life, disability, urban/rural.
FUNDING ACKNOWLEDGEMENTS: The Norwegian and South
African Research Foundations funded this project through Grant
Number: 158166/V10. CONTACT: jjelsma@uctgsh1.uct.ac.za
ETHICS COMMITTEE: University of Cape Town Medical Research
Ethics Committee.
Research Report Platform Presentation
1290 Tuesday 5 June 10:45
PP Crystal Pavilion B & C
THE ROLE OF COGNITIVE FACTORS IN CHRONIC NECK PAIN
Thompson D1,2 ,
Urmston M1,2 ,
Watson P3 ,
Oldham J2 ,
Woby S1,2 ;
1 1. Physiotherapy Department, North Manchester General Hospital,
Manchester, M8 5RB, UK; 2 2. Centre for Rehabilitation Science,
The University of Manchester, Manchester, M13 9WL, UK; 3 3.
Division of Pain Management and Rehabilitation, University of
Leicester, Leicester, LE5 4WP, UK
PURPOSE: Pain intensity alone does not appear to fully explain the
disability levels exhibited by individuals with chronic neck pain (CNP)
(Webb et al, 2003). Therefore the aim of this study was to examine the
extent to which cognitive factors contributed to the levels of disability
exhibited by individuals with CNP. RELEVANCE: Although the
strong association between cognitive factors and disability has been
documented within the low back pain literature, such an association
has not been adequately demonstrated in individuals with CNP. De-
lineating the importance of specific cognitive factors in patients with
CNP is imperative as it would elucidate which factors practitioners
need to target during treatment and allow interventions which target
these factors to be developed. PARTICIPANTS: Data were collected
from 123 patients with CNP referred for physiotherapy at three
hospitals. Exclusion criteria were inability to read English, signs of
serious pathology or psychiatric illness. The mean age of participants
was 46.9 yrs (SD=15), 56% were female and average pain duration
was 46 months (SD=79). METHODS: All participants completed
validated measures assessing fear of movement, catastrophizing,
hypervigilance, anxiety, depression and self-efficacy. Neck pain
and disability were assessed with the Neck Disability Index (NDI).
ANALYSIS: Analyses were carried out in two stages. Firstly, principal
component analysis (PCA) with oblimax rotation was performed
on the cognitive factors. In the second stage, multiple regression
analysis was performed with NDI scores as the dependant variable.
Age, sex and pain duration (demographics) were entered in step one,
pain intensity in step two and the factors identified in the PCA in step
3. This allowed us to determine the extent to which cognitive factors
contributed to disability after adjusting for demographics and pain
intensity. RESULTS: The PCA identified a two factor solution, which
explained 68% of the variance in the cognitive factors. Factor one
was labelled pain related fear (PRF) and included fear of movement,
catastrophizing and hyper-vigilance. Factor two included Self-Efficacy
and Depression and was labelled as such (SED). In step one of the
regression analysis demographic factors did not explain a significant
proportion of the variance in disability. In step two, current pain
intensity explained 23% (p < 0.001) of the variance after accounting
for demographics. The cognitive factors explained a further 35%
(p < 0.001) of the variance in disability beyond that explained by
demographics and pain intensity. Examination of the beta weights
revealed that both PRF (b=0.26, p < 0.001) and SED (b = −0.55,
p < 0.001) explained unique variance. The final model explained 59%
of the variance in disability. CONCLUSIONS: Cognitive factors were
a stronger predictor of disability than pain intensity. Specifically,
higher levels of catastrophizing, pain related fear, hypervigilance
and depression, and lower levels of self-efficacy were associated
with greater disability. Further studies should explore whether
modifying cognitive factors reduces disability in patients with CNP.
WCPT 2007, Research Reports
IMPLICATIONS: When treating patients with CNP physiotherapists
should assess and attempt to modify cognitive factors, which may
bring about important reductions in disability. KEYWORDS: Neck,
cognitive factors. FUNDING ACKNOWLEDGEMENTS: This study
was funded by the Physiotherapy Research Foundation (CSP, UK).
CONTACT: david.thompson@pat.nhs.uk
ETHICS COMMITTEE: Ethical approval was granted by the North
Manchester Local Research Ethics Committee (Manchester, UK).
Research Report Platform Presentation
1614 Tuesday 5 June 10:45
VCEC Ballroom A
IMPLICIT LEARNING OF MOTOR SEQUENCES BY PERSONS
WITH PARKINSON’S DISEASE IN HOEHN & YAHR STAGE III
Kerckhofs E1 , Deroost N2 , Coene M1 , Soetens E2 ; 1 Vrije
Universiteit Brussel, Dept. Physical Therapy; 2 Vrije Universiteit
Brussel, Dept. Cognitive and Biological Psychology
PURPOSE: We wanted to investigate 1) to what extent persons
with Parkinson’s Disease (PD) in Hoehn & Yahr stage III, are able
to learn implicitly in a Serial Reaction Time (SRT)-task, 2) to what
extent they can improve on a functional buttoning task by training,
and 3) if a relation can be found between the eventual learning
effects in both tasks. RELEVANCE: there is an ongoing controversy
in the literature about the question to what extent, persons with PD
are able to learn implicitly motor sequences. PARTICIPANTS: 16
persons with PD were recruited from the Flemish Parkinson League.
They were compared with 16 controls who were matched for gender,
age and education level. METHODS: all participants performed two
tasks (each with two levels of complexity) in each of two sessions
with an interval of 1 week. The first task was a SRT-computer task
after Nissen & Bullemer (1987): they had to press a key as fast as
possible with one of four fingers corresponding to the spatial location
of a stimulus on the computer screen. Unknown to the participants,
the order of stimulus locations followed a certain repeating (first
order or second order) sequence. The reaction times were recorded.
As a measure for implicit learning we took the sudden increase of
the reaction time when the stimulus location sequence was set ad
random. In the second task, the participants had to button as quickly
as possible a cardigan with 6 large or 6 little buttons (diameter of
28 or 18 mm). ANALYSIS: reaction times were analysed by means
of a mixed ANOVA with groups as a between-subjects factor and
with blocks of trials and sequence order as within-subjects factors.
Buttoning times were analysed analogously with a mixed ANOVA but
with type of button as a within-subjects factor. RESULTS: In the SRT-
task, the group of persons with PD did learn implicitly only the second
order location sequence. A post hoc analysis showed that a subgroup
of persons with PD with lower cognitive functioning as measured by
the SCOPA-COG, didn’t learn implicitly, while persons with PD with
a higher level of cognitive functioning learned both sequences to
the same extent as the healthy controls. On the functional buttoning
task however, the persons with PD improved with training to the
same extent as the controls and that was also the case for the
patients who didn’t show implicit learning on the SRT-task. We found
a significant negative correlation between the implicit learning index
and the buttoning time. CONCLUSIONS: the ability of persons with
PD to learn implicitly motor sequences, is associated with their level
of general cognitive functioning. Persons with PD in H&Y stage III
can become quicker in buttoning by training. There is a significant
correlation between the ability to implicit learning and the improve-
ment in buttoning time by training. IMPLICATIONS: the controversy
in the literature about the ability to learn implicitly in persons with PD,
can be explained at least partially by the fact that cognitive functions
have to be considered. KEYWORDS: implicit learning, Parkinson’s
disease, motor learning. FUNDING ACKNOWLEDGEMENTS: This
researched was supported by grant 0ZR994 of the Vrije Universiteit
Brussel. CONTACT: ekerckh@vub.ac.be
Platform Presentations, Tuesday 5 June
Research Report Platform Presentation
2204 Tuesday 5 June 10:45
VCEC Meeting Room 16
INFLUENCE OF FORWARD HEAD POSTURE ON BALANCE,
FALL SELF-EFFICACY, AND PHYSICAL ACTIVITY IN
COMMUNITY-DWELLING WOMEN 60 AND OLDER
Nemmers T; Langston University, Langston OK, USA
PURPOSE: This research was designed to investigate the influence
of the forward head posture on the known fall risk variables of
balance, fall self-efficacy, and physical activity levels in healthy
older women living independently in the community. RELEVANCE:
Physical Therapists work with the elderly, and the aged population
worldwide in progressively increasing. Age-associated postural
decline is often assumed to be inevitable and incontrovertible. One
significant decline appears to be a progressive forward movement of
the head in relation to the body, a component of the “senescent”
posture. Older women who develop a significant forward head
posture may experience functional consequences in terms of loss
of balance stability and an increased fear of falling. Additionally,
a decrease in activity may be perceived by the individual as
“protective” in nature. Identification of the forward head posture
as a specific contributor to any one of these known fall risk
factors will assist physical therapists in developing more specific
and effective evidence-based protocols for both prevention and
intervention programs.6 PARTICIPANTS: One hundred twelve (112)
healthy community-dwelling women ranging in age from 60 to
95 years volunteered for this study. METHODS: Each subject
completed two surveys: the Activity-specific Balance Confidence
Scale (ABC) and the Physical Activity Scale for the Elderly (PASE).
Each subject’s balance was assessed utilizing the Berg Balance
Scale (BBS). The FHP was assessed via analysis of a profile
photograph taken during the balance test. ANALYSIS: This study was
a prospective correlational research design. Descriptive indices were
completed for each variable. Bivariate correlations were completed
to compare relationships among the variables of age, ABC, PASE,
BBS, and FHP. RESULTS: The FHP was significantly inversely
correlated to the balance score (r = −0.598, p = .000); that is, a
more severe forward head posture was associated with diminished
balance stability. Inverse correlations were also found between
the FHP and the variables ABC (r = −0.274, p =.002) and PASE
(r = −0.436, p =.000). A significant positive correlation was found
between the FHP and age (r = 0.417; p = .000). CONCLUSIONS:
The significant inverse relationship between the FHP and BBS
supported the underlying premise of the study which postulated
that the FHP placed the head near or outside the limits of
the balance stability envelope, and would adversely influence an
elderly woman’s balance capability. The inverse relationship between
the forward head posture and balance confidence and activity
level indicated that those women experiencing severe FHP also
experienced diminished balance confidence and decreased activity
levels. The positive relationship between the FHP and age does
reflect evidence of the senescent posture. IMPLICATIONS: This
study provides a first tier of evidence to support the incorporation of
postural exercises for head position in balance training programs for
women 60 years and older. The findings further support the potential
protective effect of high activity levels for balance stability and fall
self-efficacy in this subject population. KEYWORDS: forward head
posture, balance, falls. FUNDING ACKNOWLEDGEMENTS: none.
CONTACT: tmnemmers@lunet.edu
ETHICS COMMITTEE: Institutional Review Board, Oklahoma State
University, Stillwater, OK, USA
S321
Research Report Platform Presentation
616 Tuesday 5 June 10:45
VCEC Meeting Room 17
HIGH-INTENSITY INSPIRATORY MUSCLE TRAINING REDUCES
DYSPNEA AND FATIGUE AND IMPROVES EXERCISE CAPACITY
IN SUBJECTS WITH CHRONIC OBSTRUCTIVE PULMONARY
DISEASE
Hill K1−3 , Jenkins S1,3,4 , Philippe D2 , Cecins N1,3,4 , Hillman D2 ,
Eastwood P1,2,5 ; 1 School of Physiotherapy, Curtin University of
Technology, Perth, Australia; 2 Department of Pulmonary Physiology,
Sir Charles Gairdner Hospital, Perth, Australia; 3 Physiotherapy
Department, Sir Charles Gairdner Hospital, Perth, Australia;
4 Asthma and Allergy Research Institute, University of Western
Australia, Perth, Australia; 5 School of Anatomy and Human Biology,
University of Western Australia, Perth, Australia
PURPOSE: To investigate the effects of interval based high-
intensity inspiratory muscle training (H-IMT) in subjects with chronic
obstructive pulmonary disease (COPD). RELEVANCE: Optimizing
function is a key goal in the management of patients with COPD.
Inspiratory muscle dysfunction is common in these patients and
has been implicated in the origin of the symptoms (dyspnea) and
disability (reduced exercise tolerance) characterizing the disease.
Therefore, interest has emerged in the role of specifically training
the inspiratory muscles in patients with COPD. Previous studies of
inspiratory muscle training in this population have yielded mixed
results, reflecting a number of methodological shortcomings. This
study is unique in its methodological rigor. PARTICIPANTS: Subjects
were recruited that had a diagnosis of COPD, a smoking history
greater than 10 pack years and a forced expiratory volume in one
second (FEV1 ) of between 15 and 70% predicted. Exclusion criteria
were based on co-morbid conditions thought to adversely affect
test performance. METHODS: A double-blind randomised controlled
trial compared H-IMT with sham inspiratory muscle training (S-
IMT). Training was performed using a modified threshold training
device and took place 3 times a week for 8 weeks. Each session
was fully supervised and comprised 7 cycles of 2 minutes loaded
breathing separated by 1 minute rest. The H-IMT group trained
at the maximum load tolerable for a two-minute work interval and
the load was increased as rapidly as symptoms permitted. The
S-IMT group trained at 10% of the maximal inspiratory pressure
(PImax) and was not increased. Outcome measures were: PImax,
inspiratory muscle endurance (highest pressure sustained during
an incremental threshold loading task; Pthmax), functional exercise
capacity (6 minute walk distance; 6MWD), dyspnea and fatigue
(Chronic Respiratory Disease Questionnaire; CRDQ). ANALYSIS:
Differences between and within groups were analysed using two-way
repeated measures analysis of variance (ANOVA). RESULTS: 16
subjects (11 males, FEV1 37% predicted) underwent H-IMT and 17
subjects (11 males; FEV1 36% predicted) underwent S-IMT. Over the
8-week training period, the training load in the H-IMT group increased
from 45% to 101% of pre-training PImax (p < 0.001) and was
unchanged in the S-IMT group. Following H-IMT, PImax increased
by 29% (i.e. 18.0 ±12.6 cmH2 O; p < 0.001), Pthmax increased by
56% (i.e. 21.6 ±10.8 cmH2 O; p < 0.001), 6MWD increased by 6%
(i.e. 27.1 ±20.4 m; p < 0.001) and dyspnea and fatigue improved by
1.4 and 0.9 points per item, respectively (p < 0.02). Following S-IMT,
PImax increased by 8% (i.e. 5.2 ±8.6 cmH2 O; p = 0.023), dyspnea
improved by 0.9 points per item (p < 0.001) and Pthmax, 6MWD
and fatigue were unchanged. The magnitude of change in PImax,
Pthmax, 6MWD, dyspnea and fatigue was greater following H-IMT
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
S322
ACKNOWLEDGEMENTS: National Health and Medical Research
Council, Australia. CONTACT: kylie.hill@westpark.org
ETHICS COMMITTEE: Human Research Ethics Committees of
Curtin University of Technology, Sir Charles Gairdner Hospital and
Royal Perth Hospital.
Research Report Platform Presentation
718 Tuesday 5 June 10:45
VCEC Meeting Room 18
ENVIRONMENTAL BARRIERS EXPERIENCED BY URBAN AND
RURAL DISABLED PEOPLE IN SOUTH AFRICA
Maart S1 , Eide A2 , Jelsma J1 , Loeb M2 , kaToni M3 ; 1 University of
Cape Town, South Africa; 2 Sintef Research Organisation, Norway;
3 Disabled People Organisation, South Africa
PURPOSE: The aim of the study was to investigate the experience
of disabled people with regard to environmental barriers in an urban
as opposed to rural setting. The specific objectives were to identify
which items within the ICF (International Classification of Functioning,
Disability and Health) checklist of environmental factors presented
people with disability with the most barriers and to see whether
the barriers were different for those living in a rural opposed to
urban setting. RELEVANCE: Despite the fact that the disabling
effect of environmental factors is acknowledged, little research has
been done to explore the impact of the environment on varying
degrees of disability and different impairments. Physiotherapists
must be aware of the barriers posed by the specific environments
people with disabilities will be returning to post rehabilitation. The
International Classification of Functioning, Disability and Health (ICF)
provide the framework for describing and analysing the interaction
between a person’s health condition and the context in which they
find themselves. PARTICIPANTS: The study was conducted amongst
isi- Xhosa speaking people in the Eastern and Western Cape of
South Africa which respectively have a 5.8% and 4.1% disability
prevalence. The sample was a convenience sample and was
identified through a “snowballing” process initiated by enumerators
who were all members of Disabled People South Africa. METHODS:
A descriptive, analytical, cross-sectional study was used to gather
the data. The primary data collection tool was the isi-Xhosa version
of the ICF checklist. Ethical approval was obtained from the UCT
Research Ethics Committee. ANALYSIS: The computer software
programme STATISTICA was used for data analysis. The chi-square
test was used to compare proportions between urban and rural areas.
RESULTS: The sample consisted of 468 respondents, with 375 living
in the Eastern Cape, and 93 in the Western Cape. The prevalence of
the different types of impairments between the two areas was similar
(Chi-square = 2.96, DF=5, p=NS). Specific barriers identified by 40%
or more of the urban respondents included climate e225 (55%), public
buildings e150 (54%), labour e590 (47%), education e585 (46%) and
housing e525 (43%). The two individual items that were reported
most frequently as barriers by the rural sample were labour e590
(43%) and education e585 (35%).Respondents from the urban area
reported experiencing more barriers in the categories of Products
and technology (p= 0.046), and the Natural and built environment
(p = 0.001) and the respondents from the rural area experienced
more barriers with attitudes (p = 0.054). An equivalent number of
people in the respective areas identified barriers in the Services
category. CONCLUSIONS: It would appear to be more challenging
for a person with a disability to live in an informal settlement
within an urban area, than in a rural area. The ICF did allow
for the identification of the majo IMPLICATIONS: The information
regarding barriers gained through the use of the ICF can be used
by disabled people’s organisations and the government in terms
of ensuring the equalisation of opportunities for disabled people
in South Africa. KEYWORDS: Environmental barriers, Disability,
ICF,. FUNDING ACKNOWLEDGEMENTS: The Norwegian and
WCPT 2007, Research Reports
South African Research Foundations – Grant Number: 158166/V10.
CONTACT: maarts@uctgsh1.uct.ac.za
ETHICS COMMITTEE: Medical Research Ethics Committee of the
University of Cape Town
Research Report Platform Presentation
1369 Tuesday 5 June 10:45
VCEC Meeting Rooms 19-20
ALTERED MOTOR CONTROL OF TRAPEZIUS IN THOSE WITH
NON TRAUMATIC SHOULDER INSTABILITY
Alexander C1,2 , Harrison P2 ; 1 Hammersmith Hospitals NHS Trust,
London, UK; 2 University College London, London, UK
PURPOSE: If the scapula fails to be anchored to the chest,
the glenoid can move away from the humeral head leading to
instability. Trapezius is one muscle that assists in this stability. The
purpose of this investigation was to examine whether the control of
trapezius in subjects with non-traumatic shoulder instability (NTSI)
differs to that of healthy subjects. RELEVANCE: Patients with NTSI
complain of pain and recurrent dislocations, which lead to significant
problems with every day activities. At present, little is understood
about the underlying causes of this condition. Without a better
understanding, targeted treatment programmes are difficult to design.
PARTICIPANTS: With local ethics approval, 11 subjects with NTSI
and 15 healthy subjects were recruited and gave informed consent.
METHODS: Group I muscle afferents of the forearm and hand
evoke facilitatory reflexes in trapezius, which assist in stabilising
the shoulder girdle during use of the hand. These reflexes were
evoked using electrical stimulation of the ulna nerve at elbow level
(with a Digitimer and CED system). Surface EMG was recorded
from upper (UTr) and lower trapezius (LTr). The conduction velocity
of the effective afferents was recorded by additional stimulation of
the ulna nerve at the level of the wrist. Secondly, the descending
control of trapezius was investigated using magnetic stimulation of
the contralateral motor cortex to record the latency and threshold
of the motor evoked potential (MEP) of trapezius. Finally, the M
response and H reflex of trapezius was recorded by electrically
stimulating the spinal accessory nerve and the cervical nerve of
C3/4. ANALYSIS: The conduction velocity of the afferents, latency
and threshold of the evoked responses were compared to the data
from a healthy population using un-paired t tests. The frequency of
occurrence of the reflex data was compared using the Mann Whitney
U Test. RESULTS: The control of LTr differed between the two groups.
The long latency reflex occurred less frequently in LTr in those with
NTSI (27% v 87% (instability v healthy); p < 0.002). In addition, the
latency of the MEP of LTr is longer (16.7ms ±4.7ms v 11.2ms
±1.8ms; p < 0.006) and the threshold to evoke the LTr MEP is higher
(57% ±15.8% v 36% ±7.6% of the stimulator output; p < 0.003) in
people with NTSI. Although the latency of the M response of LTr was
the same (p < 0.52), the H reflex of LTr was longer (p < 0.03). However,
the control of UTr did not differ between these two groups. The long
latency reflex was evoked equally in UTr (82% v 87% (instability v
healthy); p < 0.41) and the latency (9.4ms ±1.2ms) and threshold of
the UTr MEP (47% ±14.4%) were not different to that of a healthy
population (p < 0.21 and p < 0.11 respectively). Finally, the average
conduction velocity of the arm afferents did not differ (p < 0.35).
CONCLUSIONS: The control of LTr differs in subjects with shoulder
instability. These factors may contribute to the prolongation of this
debilitating condition. IMPLICATIONS: Knowledge of a change to the
control of a particular part (LTr) of a muscle will assist in the design of
appropriate treatment strategies. KEYWORDS: Shoulder, instability,
motor control. FUNDING ACKNOWLEDGEMENTS: Hammersmith
Hospitals NHS Trust Research Committee Grant number 40616.
CONTACT: CMAlexander@hhnt.nhs.uk
ETHICS COMMITTEE: Hammersmith, Queen Charlotte’s and
Chelsea Research Ethics Committee.
Platform Presentations, Tuesday 5 June
Research Report Platform Presentation
776 Tuesday 5 June 11:05
PP Crystal Pavilion A
PREDICTORS OF OUTCOMES IN PATIENTS WITH CHRONIC
WHIPLASH WHO UNDERGO INTENSIVE REHABILITATION: A
PILOT STUDY
Baltov P1 , Feldman D1 , Côté J2 , Truchon M3 , Beaton D4 ;
1 School of Rehabilitation, University of Montreal Montreal, Canada;
2 Department of Kinesiology and Physical Education, McGill
University Montreal, Canada; 3 Department of Industrial Relations,
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
associated disorders (WAD) develop chronic symptoms and psy-
chosocial factors may play an important role in the development of
chronicity. Evidence suggests that multidisciplinary rehabilitation is
beneficial for persons with chronic WAD. Despite this, little is known
regarding psychosocial and socio-demographic factors associated
with improved outcomes in those who undergo intensive multimodal
treatment. Our study objectives are: 1) to evaluate whether patients
improved after intensive multidisciplinary rehabilitation, and 2) to
determine whether psychosocial and socio-demographic factors are
associated with outcomes. RELEVANCE: It is crucial to investigate
factors which predict the prognosis of chronic WAD in order to identify
patients at risk of poor outcomes and guide treatment selection
and patient counseling. PARTICIPANTS: Twenty-two persons with
chronic WAD of grades I, II and III (Quebec Task Force classification)
who were undergoing an intensive interdisciplinary rehabilitation
program were selected to participate in this study. They met the
following inclusion criteria: 18-65 years of age, diagnosed with
WAD by a doctor at least 12 weeks prior to their entrance into
the program, no concurrent pathology in the cervical region, no
prior whiplash episode and speak and understand English or
French. Ethics approval was obtained and subjects signed an
informed consent form. METHODS: Participants completed the
Neck Disability Index (NDI) documenting self-perceived pain and
disability and the General Health Questionnaire (GHQ) describing
psychological distress, at entry to and completion of the rehabilitation
program. They also completed questionnaires on coping, social
support at work, kinesiophobia, life satisfaction, patient expectations,
agreement regarding responsibility for the accident, and general
socio-demographic information at the baseline interview. ANALYSIS:
Paired t tests were used to evaluate whether patients improved
after rehabilitation. We investigated the effect of each one of the
predictor variables measured at baseline on the main outcome,
level of self-perceived pain and disability at follow-up, with simple
linear regressions. Promising variables (p < 0.2) were entered into a
backward multiple linear regression model and significant predictors
(p < 0.05) were identified. The same process was repeated for the
secondary outcome: level of psychological distress at follow-up.
RESULTS: Patients improved in terms of self-perceived pain and
disability post treatment (p < 0.01). A higher disability level at follow-
up was predicted by a higher baseline disability score (p < 0.001).
Greater psychological distress post-rehabilitation was associated
with: catastrophizing, a negative coping behavior (p < 0.001), fewer
days since the accident occurred (p = 0.02) and less hours of work
per week prior to the accident (p = 0.04). CONCLUSIONS: Patients
improved in terms of self-perceived disability after the intensive
multidisciplinary treatment. The psychosocial factors measured here
were not predictive of self-perceived pain and disability post-
rehabilitation in persons with chronic WAD, but were related to
the level of psychological distress. IMPLICATIONS: Counseling
on coping strategies with an adverse prognostic effect should be
implemented in the rehabilitation of persons with chronic WAD.
Physiotherapists and other rehabilitation professionals may need
to provide more services to patients with higher baseline self-
perceived pain and disability, and to those whose accident occurred
more recently. KEYWORDS: chronic, whiplash, prognosis. FUNDING
S323
ACKNOWLEDGEMENTS: Mr. Baltov was supported by scholarships
from the Faculty of Graduate Studies of the University of Montreal and
the Mentor program of the Canadian Institutes for Health Research.
Dr. Feldman holds a salary award from The Arthritis Society of
Canada. Dr. Côté is funded by CFI, REPAR and NSERC grants and
holds a FRSQ junior 1 salary award. Dr. Truchon is funded by IRSST
and REPAR grants. Dr. Beaton is supported by a New Investigator’s
award from CIHR. CONTACT: pbaltov@yahoo.com
ETHICS COMMITTEE: Ethics committee of the Centre for Interdis-
ciplinary Research in Rehabilitation of Greater Montreal (CRIR)
Research Report Platform Presentation
1958 Tuesday 5 June 11:05
PP Crystal Pavilion B & C
OCCURRENCE AND TYPE OF NECK PAIN AMONG DRIVERS
OF FOREST MACHINES AND THE ASSOCIATION WITH
WHOLE-BODY VIBRATION EXPOSURE
Rehn B; Physiotherapy, Dep. Community Medicine and
Rehabilitation, Umeå University, Sweden
PURPOSE: The purpose of this study was to investigate if
musculoskeletal symptoms in the neck among forest machine drivers
were related to their whole-body vibration (WBV) exposure. It was
hypothesised that the occurrence of neck pain would be higher with
higher exposure to WBV and that existence of radiating symptoms
would be related to WBV exposure. RELEVANCE: The logging
industry is important for many countries such as Sweden, Finland,
Germany and Canada. Drivers of forest machines frequently report
musculoskeletal problems from the neck, shoulders and lower back.
These symptoms could be a result of a bad seated posture but
exposure to WBV has also been suggested as a likely risk factor.
Type of musculoskeletal neck disorder important for decision of
treatment and prognosis and may be associated with the exposure
situation. More epidemiological research necessary to explore the
association between WBV exposure and neck disorders among
drivers in general. PARTICIPANTS: 529 forest machine drivers
in northern Sweden participated, which comprises the census of
the working group in the region. Cases were defined as subjects
reporting neck pain both previous 7 days and previous 12 months
according to the Nordic Questionnaire on musculoskeletal symptoms.
Non-cases were defined as subjects reporting no symptoms during
the previous 7 days or 12 months. Radiating neck pain was defined
radiating symptoms in arm or arms. METHODS: A self-administered
questionnaire containing items on musculoskeletal symptoms and
self-reported exposure time was sent to the participants. The
final response rate was 63%. The magnitude of WBV exposure
was measured in a representative sample of forest machines.
ANALYSIS: From exposure data and questionnaire 14 various WBV
doses were calculated for each driver such as exposure time, root
mean square and vibration dose value etc and compared between
cases and non-cases. RESULTS: The prevalence of neck pain
was reported to be 35% and almost half of them (43%) reported
radiating symptoms in one or both arms. Univariate analysis showed
no relation between neck pain and WBV doses. Further, there
were no relation between WBV doses and type of neck pain
(radiating vs non-radiating). CONCLUSIONS: The conclusion from
this study is that individual WBV doses can’t explain neither the
occurrence of neck pain nor the type of neck disorder among
the group forest machine drivers. IMPLICATIONS: It seems as if
characteristics of WBV can’t predict occurrence or type of neck
pain. However, prevalence among this group should be compared to
other driver categories and with other seated jobs not involving WBV
exposure (e.g. office work). KEYWORDS: Musculoskeletal, vibration,
neck. FUNDING ACKNOWLEDGEMENTS: Vibrisks – Risks of
occupational exposure. CONTACT: borje.rehn@physiother.umu.se
ETHICS COMMITTEE: Umeå University
S324
Research Report Platform Presentation
1827 Tuesday 5 June 11:05
VCEC Ballroom A
HOME EXERCISE PROGRAM FOR PATIENTS WITH
PARKINSON’S DISEASE: IMPROVEMENT IN MOTOR
PERFORMANCE AND QUALITY OF LIFE
Pimentel Piemonte M, Almeida D, Melo M, Burgi K, Morimoto M,
Barbosa E; Department of Physical Therapy of Medical School,
University of Sao Paulo
PURPOSE: The purpose of this study was to verify the long term
effectiveness of a physiotherapeutic program, based on a weekly
home-exercise schedule and supervised through fortnightly check-
ups, for patients with Parkinson’s disease (PD) in early and advanced
stages, on both motor performance and quality of life. RELEVANCE:
PD is a progressive and degenerative condition of the nervous
system that causes impaired movement leading to varying degrees
of functional incapacity. Physical Therapy in PD seeks to minimize
the motors difficulties arising from symptoms, and improve the
quality of life of patients. Physiotherapeutic studies on PD have
already discussed the necessity of practicing daily exercises and the
continuity of these exercises throughout the patients life to achieve
favorable and persistent results. As the costs of physiotherapeutic
programs fulfilling these characteristics are high. Home exercise
programs specifically developed for PD are very important in that
they allow the number of visits of patients to assistance health
centers to be reduced, thereby lowering costs for patients and
health services. PARTICIPANTS: Sixty patients with idiopathic PD,
comprising 24 females and 36 males with an mean age of 66.6
years, 30 in early evolution stages (EPD) according to the Hoehn
and Yahr (HY)and 30 in advanced evolution stages (APD). EPD and
APD patients were randomly divided into an Experimental Group
(EG) and a Control Group (CG). METHODS: Patients from the EG
were assessed individually by UPDRS and PDQL scales, before
and after 3, 6 and 12 months on the home exercise program.
The program consisted of 50 exercises, developed specifically for
motor problems of PD, and was divided into 5 blocks (one for
each day of the working week). Exercises were demonstrated
individually to all patients. The exercises were performed at home
and corrected every 15 days by a physiotherapist. Patients from the
CG were assessed periodically and received only general guidance
on PD. ANALYSIS: The data obtained was compared employing the
ANOVA variance analysis model for repeated measurements. Those
factors yielding category differences on mean comparison then
underwent the Scheffé post-hoc test to verify level of significance,
two by two. RESULTS: There was a progressive increase in both
the number of remembered exercises (p < 0.005) and the number
of correct exercises (p < 0.0005), as number of visits grew for
patients, indicating good adhesion of patients to the program.
Comparison of the initial evaluation vs. final evaluation scores
in sections II and III UPDRS, and PDQL showed a significant
difference in the EG only (p < 0.0001). Additionally, there was a
significant difference in the end scores on the PDQL between
the groups (p < 0.0005). CONCLUSIONS: Home exercise programs
specifically developed for PD can help patients to improve their motor
performance and consequently their quality of life. IMPLICATIONS:
As the study progressed, motor improvements presented by the
patients at initial and advance stages of PD were seen to be
maintained, showing that the daily practice of exercises, set against
the inactive state that the patients were hitherto submitted to, can
minimize the consequences of disease evolution. KEYWORDS:
Parkinson’s disease, exercises program, quality of life. FUNDING
ACKNOWLEDGEMENTS: HCFMUSP. CONTACT: elisapp@usp.br
ETHICS COMMITTEE: All patients signed the term of consent
approved by the Hospital das Clinicas da FMUSP Ethical Committee
WCPT 2007, Research Reports
Research Report Platform Presentation
2189 Tuesday 5 June 11:05
VCEC Meeting Rooms 1-3
EXPLORING PHYSIOTHERAPISTS’ PARTICIPATION IN PEER
REVIEW IN NEW ZEALAND. EVALUATION OR DEVELOPMENT
OF PRACTICE?
Rolland T, Hocking C, Jones M; Auckland University of Technology,
Auckland, New Zealand
PURPOSE: The aim of this qualitative study was to explore
physiotherapists’ experience of participating in peer review, in order
to stimulate debate about the benefits and costs of peer review for
individual practitioners and the profession as a whole. RELEVANCE:
Peer review has become accepted practice for physiotherapists
in New Zealand. Accordingly, much professional effort has been
expended on developing peer review systems and implementing
review processes in both public health services and private practices,
yet the benefits of peer review are uncertain. In addition, while the
literature identifies competing focuses on professional development
and accountability, there is lack of clarity about which model of
peer review is being implemented in this country, and which might
serve the profession better. This study is a first step in clarifying the
issues, by identifying the personal, professional and organisational
factors that influence how health professionals participate in peer
review. PARTICIPANTS: The participants were 7 physiotherapists
working in the public or private health system in New Zealand,
who had participated in a peer review process within the last 3
years as either a reviewer or as the practitioner being reviewed.
They were recruited following brief presentations of the nature and
intent of the study given to professional meetings in the greater
Auckland region. METHODS: A qualitative descriptive approach
within a post-positivist paradigm was the methodology used. After
ethical approval was granted by the AUT ethics committee, semi-
structured interviews of 40-60 minutes in duration were conducted,
guided by broad questions relating to central themes identified
during an extensive literature review. Interviews were audiotaped and
transcribed verbatim to form the data. ANALYSIS: Transcripts were
analysed using thematic analysis and qualitative descriptive tech-
niques. This involved identifying themes from the text that seemed
to represent one complete thought or idea. The labelled groups
were analysed into sub-themes. Finally, the general themes that
arose were described. RESULTS: The findings indicate that while
peer review systems have been developed, and are carried out as
prescribed, therapists lack clarity about the intended outcomes. While
recognising the benefits of receiving feedback on practice, many
manage the review process to maintain positive working relationships
with reviewers and ensure their practice is favourably reviewed.
The strategies they employ and the consequences of managing
peer review in these ways are described. CONCLUSIONS: Current
peer review processes in New Zealand may not provide trustworthy
information about competence to practice. Neither do they fully
achieve their potential as a professional development tool. Therefore,
the professional emphasis and effort expended on peer review
needs to be revisited. IMPLICATIONS: The findings highlight the
need for consultation amongst physiotherapy managers, professional
associations, colleges and the Physiotherapy Registration Board, to
negotiate whether regulatory or professional development needs will
drive the development of peer review processes in New Zealand.
KEYWORDS: Peer Review Quality Assurance Continuing Profes-
sional Development (CPD). FUNDING ACKNOWLEDGEMENTS:
Auckland University of Technology (AUT) Waitemata District Health
Board. CONTACT: ta-mera.rolland@waitematadhb.govt.nz
ETHICS COMMITTEE: Auckland University of Technology Ethics
Committee (AUTEC)
Platform Presentations, Tuesday 5 June
Research Report Platform Presentation
2599 Tuesday 5 June 11:05
VCEC Meeting Room 16
RELATIONSHIP BETWEEN FALLS EFFICACY SCALE
INTERNATIONAL (FES-I), PHYSICAL PERFORMANCE,
PHYSICAL ACTIVITY AND AVOIDANCE OF ACTIVITIES IN
OLDER PERSONS AT RISK
Beyer N1 , Hauer K2 , Piot-Ziegler C3 , Todd C4 , Yardley L5 ,
Kempen G6 ; 1 Institute of Sports Medicine – Copenhagen & Dept.
Physical Therapy, Copenhagen University Hospital Bispebjerg,
Copenhagen, Denmark; 2 Robert-Bosch-Krankenhaus, Stuttgart
and Bethanien-Krankenhaus, University of Heidelberg, Germany;
3 Institut de Psychologie, Université de Lausanne, Switzerland;
4 School of Nursing, Midwifery and Social Work, University of
Manchester, United Kingdom; 5 School of Psychology, University
of Southampton, United Kingdom; 6 Department of Health Care
Studies, Maastricht University, The Netherlands
PURPOSE: Fear of falling is a common concern of older people
and can lead to decline in physical function, activity restriction, and
greater falling risk. The Falls Efficacy Scale International (FES-I) a
modified version of the Falls Efficacy Scale was developed to assess
both easy and difficult physical and social activities. FES-I has shown
to be acceptable with respect to reliability and construct validity in
different samples in different countries. The aim of this study was
to investigate whether a significant relationship exist between FES-I
and measures of functional ability, physical activity and avoidance of
activities in older persons treated in a falls clinic. RELEVANCE: There
is a need for measures that can determine the degree of fear of falling
and indicate which activities are most feared and should therefore
be targeted for physical therapy rehabilitation. PARTICIPANTS: 57
consecutive falls clinic patients referred to exercise training as part
of a targeted individualized intervention. METHODS: Following a
medical examination the participants went through assessments
carried out by a trained physical therapist. These consisted of a) a
structured interview with filling in questionnaires including the FES-
I (scores 16-64) to measure fear of falling, the Modified Survey of
Activities and Fear of Falling in the Elderly scale (SAFFE, scores
16-64) to determine avoidance of activities due to fear of falling, the
Composite Physical Function scale (CPF, scores 12-36) to assess
functional ability, and additionally self-reported balance, and physical
activity level, and b) measurement of functional ability including the
Berg Balance Scale (BBS, scores 0-56), standing balance from the
Short Physical Performance Test (standing balance, 0-30s) and 30-
s chair stand test (Chair stand, # in 30s). ANALYSIS: Because
data were skewed they are presented as median (interquartile
range). The relationship between the FES-I and the other measures
were analysed with bivariate correlations using Spearman’s rho.
RESULTS: The participants were 85(9)yr and 70% were women.
74% had fallen at least twice during the previous year and 96%
reported that they had balance problems. 74% used walking aid and
46-58% had problems walking 400m, climbing stairs and carrying 5
kg. 84% performed light physical activity at least 2 h/w. The median
and interquartile ranges were FES-I: 22(12.5); SAFFE: 25(12); CPF:
22(7); BBS: 44(12); standing balance: 23(8)s. There was a strong
relationship between FES-I and SAFFE (rs = 0.712, p < 0.001) and
a moderate relationship between FES-I and self-reported balance
(rs = 0.538, p < 0.001). The relationship between FES-I and self-
reported functional ability and physical activity level was weaker
(rs = 0.382, p = 0.004; rs = −0.359, p = 0.006; rs = 0.307, p = 0.020) as
was the relationship between FES-I and BBS, standing balance and
Chair stand (rs = −0.385, p = 0.003; rs = −0.375, p = 0.004; rs = −0.368,
p = 0.006). CONCLUSIONS: There were significant relationships
between FES-I and measures of functional ability, physical activity
level and avoidance of activities. Particularly the association between
FES-I and SAFFE was strong indicating that concern about falling
potentially leads to activity restrictions. However, studies on the
responsiveness of FES-I are needed. IMPLICATIONS: Information
from FES-I could potentially be a useful when planning an individually
S325
targeted physical therapy intervention in older people at risk of falling.
KEYWORDS: Fear of falling. FUNDING ACKNOWLEDGEMENTS:
This study was part of PROFANE and supported by an EC
grant under the Fifth Framework Program QLK6-CT-2002-02705
(www.profane.eu.org). CONTACT: nb01@bbh.hosp.dk
Research Report Platform Presentation
1318 Tuesday 5 June 11:05
VCEC Meeting Room 17
AN EXPLORATION OF BARRIERS AND ENABLERS TO
PARTICIPATE IN CARDIAC REHABILITATION IN RURAL
VICTORIA, AUSTRALIA
De Angelis C1 , Bunker S2 , Schoo A2 ; 1 Physiotherapy Department,
Western District Health Services; 2 Greater Green Triangle University
Department of Rural Health, Flinders and Deakin Universities
PURPOSE: The objectives of this study were to identify (i) local barri-
ers and enablers to participation in hospital-based cardiac rehabilita-
tion (CR) programs, and (ii) preferred options for the delivery of CR.
RELEVANCE: Coronary heart disease (CHD) is the largest single
cause of years of life lost and disability life adjusted years in Victoria.
In rural Victoria rates of CHD deaths and hospital admissions are
significantly higher than in the metropolis. CR program participation
is associated with a 35% survival advantage at 5 years compared with
non-participators. Unfortunately, only 24% of eligible Victorians begin
CR. PARTICIPANTS: Ninety seven patients (27 females, 70 males)
with CHD who were referred to CR, and their carers; health profes-
sionals working within the local CR programs at six regional hospitals
in south west Victoria. METHODS: A questionnaire administered
by CR coordinators, and focus groups to obtain participant and
health professional views on current CR programs and to explore the
receptiveness of various delivery options. The focus group sessions
also allowed further exploration of issues identified in the question-
naires. ANALYSIS: Data analysis was conducted using descriptive
statistics and Mann-Whitney U-Test for quantitative data. A qualitative
approach was utilised to report on key themes identified in the focus
groups and questionnaires. RESULTS: Distance to travel was the
only statistically significant factor in determining commencement of
CR (p = 0.008, 2-tailed). Enablers to CR participation were easy
access to transport (63%), family support (49%) and work flexibility
(43%). More than one third (38%) of participants was receptive to
alternative methods of CR, for example, evening-based programs,
programs in outlying communities, home-based programs with or
without a handbook, or telephone support. Family responsibilities,
inability to drive self, and self-consciousness were put forward as
potential barriers by decliners. Focus groups identified CR decliners
as being less motivated to attend. The stoicism and gender related
barriers were proposed as influencing a person’s decision to reject
hospital-based CR. Females were more likely to support partners with
cardiac problems to attend sessions, although less likely to attend CR
due to lack of home support. It was noted that depression and anxiety
may influence a person’s decision to attend or decline CR. Both
patient and health professional focus group participants reported
that dealing with psychological health care is a key component of
CR. CONCLUSIONS: Distance to travel was a significant factor
influencing attendance at current hospital-based CR. Strategies have
been identified that have the potential to increase utilisation of
and improve patient satisfaction with rural CR. IMPLICATIONS:
Home-based CR combined with a handbook and telephone support,
intensive short courses or CR after business hours may offer viable
alternatives to current hospital-based programs during day time. The
need for hospital-based CR will remain, particularly for those who
prefer a higher level of supervision. The provision of different types
of CR delivery will have implications for resources such as staffing.
Psychosocial factors are currently the focus of much CR attendance
research. KEYWORDS: Cardiac rehabilitation, rural, attendance.
FUNDING ACKNOWLEDGEMENTS: Primary Health Care Research
and Development. CONTACT: steve.bunker@greaterhealth.org
S326
Research Report Platform Presentation
1192 Tuesday 5 June 11:05
VCEC Meeting Room 18
ASSESSMENT OF FUNCTIONING IN THE ACUTE HOSPITAL:
OPERATIONALIZATION AND RELIABILITY TESTING OF ICF
CATEGORIES RELEVANT FOR PHYSICAL THERAPISTS’
INTERVENTIONS
Gloor-Juzi T1,2 ,
Grill MPH E3 ,
Huber E1,4 ,
Stucki G3,5 ; 1 Department
of Rheumatology and Institute of Physical Medicine, University
Hospital Zurich, Switzerland; 2 Physiotherapy Science Studies,
Department of Rheumatology and Institute of Physical Medicine,
University Hospital Zurich, Switzerland and Faculty of Health
Sciences, Maastricht University, the Netherlands; 3 ICF Research
Branch of the WHO FIC Collaborating Centre (DIMDI), IHRS,
Ludwig-Maximilian University, Munich, Germany; 4 Swiss Association
of Physiotherapy, Sursee, Switzerland; 5 Department of Physical
Medicine and Rehabilitation, Ludwig-Maximilian-University, Munich,
Germany
PURPOSE: Up to date there is no proof whether specific categories
of the International Classification of Functioning, Disability and
Health (ICF) can be operationalized in a way that the resulting
items are useful and reliable when applied by physical therapists.
The objective of this study was to write items based on the ICF
relevant to physiotherapeutic interventions and to test their reliability
in the hand of physical therapists. RELEVANCE: Interventions
from physical therapists are focused on the patient’s loss of
functioning. For identification and classification of these problems
in the acute hospital and for efficient communication between
health professionals, the International Classification of Functioning,
Disability and Health (ICF) arguably is the appropriate basis for
assessment in an interdisciplinary environment. PARTICIPANTS:
28 patients (16 women) mean age 59.6 years (range 27 to 88)
with diverse acute health conditions requiring physical therapy
treatment in the acute hospital. METHODS: Items were written in
a formal experts’ decision-making and consensus process based
on 124 ICF categories relevant to physiotherapeutic interventions.
Inter-rater reliability of operationalized ICF categories was tested
with repeated measurement by two independent observers in a
convenience sample of patients. ANALYSIS: The inter-rater reliability
was analyzed using the percentage of raw agreement and Cohen’s
kappa for nominal scales. RESULTS: All of the 49 ICF categories
of the component of Body Functions and Structures (100%) showed
a raw agreement of 0.7 or above, 73% of the categories showed a
kappa value 0.7 or above. 59% of the categories of the component
Activities and Participation showed a raw agreement 0.7 or above,
17% of the categories showed a kappa of 0.7 or above. 39% of the
categories of the component Environmental Factors showed a raw
agreement 0.7 or above, none of the categories showed a kappa
value 0.7 or above. CONCLUSIONS: This study shows that it is
possible to adapt the ICF to individual profession and setting specific
needs. Physical therapists may use the ICF as a checklist and tool
to assess patients and monitor the results of interventions. Further
research is needed on the development of reliable instruments for
physical therapists based on the ICF. IMPLICATIONS: Using the
ICF as a unifying framework to communicate patients’ needs to
other health professionals is very important for physical therapists.
Additionally, this standardized instrument can be implemented in
management studies to describe the goals of physical therapy
and highlighting aspects of quality. KEYWORDS: Assessment,
Reproducibility of Results. FUNDING ACKNOWLEDGEMENTS: We
gratefully acknowledge the Swiss Physiotherapy Association, Sursee,
Switzerland for financial support of the operationalization conference
in Ermatingen (CH). CONTACT: thomas.gloor@usz.ch
ETHICS COMMITTEE: ethic committee of Zurich
WCPT 2007, Research Reports
Research Report Platform Presentation
1556 Tuesday 5 June 11:05
VCEC Meeting Rooms 19-20
ULTRASOUND ASSISTED EXAMINATION OF HUMERAL TOR-
SION: IMPLICATIONS FOR PHYSIOTHERAPY MANAGEMENT
OF THROWING-RELATED SHOULDER DISORDERS
Whiteley R1 , Ginn K2 , Nicholson L1 , Adams R1 ; 1 University of
Sydney, Faculty of Health Sciences, Discipline of Physiotherapy;
2 University of Sydney, Faculty of Medicine, School of Medical
Sciences
PURPOSE: The aim of this study was to ascertain the extent of side-
to-side differences in humeral torsion in throwing athletes compared
to a non-throwing sample. Athletes included mature males who began
their participation in throwing sports either before or after skeletal
maturity and skeletally immature male throwers. RELEVANCE:
Altered rotational range of motion is increasingly implicated in the
aetiology of shoulder injuries. As the degree of torsion in the humerus
influences the measurement of shoulder rotational range, athletes
who present with reduced range need to be assessed in light of
this torsion. Knowing the contribution of humeral torsion to shoulder
rotational range indicates whether a shift in range is structural or
injury-related and thereby guides treatment. There is debate as to
the contribution activity plays in the genesis of humeral torsion so its
measurement and relation to pre-pubertal activity are of interest. The
development of a reliable, safe clinical measure of humeral torsion
makes this possible without the use of expensive potentially danger-
ous ionising radiation methods such as CT. PARTICIPANTS: Sixteen
adult subjects without a history of participation in throwing sports,
70 mature male throwing athletes who commenced participation in
throwing sports prior and subsequent to skeletal maturity and 35
adolescent male throwers were recruited for this study. METHODS:
Humeral torsion was measured bilaterally using a method which has
previously shown excellent reliability. Each of the subjects completed
a questionnaire describing their history of participation in throwing
and other overhead sports. ANALYSIS: Comparisons of side-to-
side differences in humeral torsion between the populations of
throwing athletes and non-throwing normal subjects were made using
descriptive statistics. RESULTS: Athletes participating in throwing
sports had greater humeral retrotorsion in their dominant arms than
did non-athletic adult subjects. The average (± S.E.M.) side-to-side
differences were: non-athletic adults 1.3º (8.9º); adolescent throwers:
11.2º (1.2º); adult males throwers: 12.8º (1.4º). Very few of the
121 subjects examined in this study demonstrated symmetry in
the degree of humeral torsion in their dominant/throwing and non-
dominant shoulders. The largest variation in individual side-to-side
difference in humeral torsion was 38 degrees in the adult throwing
subjects, 29 degrees in the adolescent throwers and 15 degrees
in the non-throwing control subjects. CONCLUSIONS: Almost all of
the subjects examined displayed a side-to-side difference in humeral
torsion implying physiotherapists cannot use the contralateral arm
for comparison when measuring shoulder rotational range of motion.
Humeral torsion displays an activity-related effect: those participating
in throwing-related sports displayed a greater degree of humeral
retrotorsion in their dominant arm, while non-athletic adults showed
no systematic dominance effect. IMPLICATIONS: Humeral torsion
should be routinely measured in the clinical setting because the
apparent rotational range of motion measured with a goniome-
ter/inclinometer will be significantly affected by this torsion. Physio-
therapists cannot assume shoulder rotational symmetry with humeral
torsional symmetry only displayed in less than 10% of subjects.
Accordingly treatment aimed at restoring shoulder rotational range of
motion must take humeral torsion into consideration. KEYWORDS:
Humeral torsion; Ultrasound; Throwing injuries; Shoulder. FUNDING
ACKNOWLEDGEMENTS: Funding was received through a PhD
scholarship from the Faculty of Health Sciences, University of Sydney.
ETHICS COMMITTEE: Human Research Ethics Committee of the
University of Sydney.
Platform Presentations, Tuesday 5 June
Research Report Platform Presentation
2045 Tuesday 5 June 11:25
PP Crystal Pavilion A
DO THE ATTITUDES AND BELIEFS OF HEALTH CARE
PRACTITIONERS INFLUENCE THEIR MANAGEMENT OF
PATIENTS WITH LBP?
Bishop A, Foster N, Thomas E, Hay E; Primary Care Musculoskeletal
Research Centre, Keele University, Keele, Staffs. UK. ST5 5BG
PURPOSE: The aim of this study was to describe the attitudes,
beliefs and practice behaviour of UK physiotherapists (PTs) about
low back pain (LBP) and to explore the relationship between their
attitudes and beliefs and their practice behaviour. RELEVANCE:
Guidelines for the management of LBP have been in existence for
many years, but adherence to these by health care practitioners
(HCPs) remains sub-optimal. The attitudes and beliefs that HCPs
hold about LBP have been shown to influence the advice given to
patients and may be a barrier to uptake of guideline recommenda-
tions. PARTICIPANTS: A simple random sample of 2000 UK based
PTs identified from the professional register of the Chartered Society
of Physiotherapy. METHODS: A postal cross-sectional survey using
a questionnaire consisting of an attitudes and beliefs measure, the
Pain Attitudes and Beliefs Scale (PABS.PT), which differentiates
between biomedical (range 10–60) and behavioural (range 9–54)
orientations of HCPs towards back pain and a vignette describing
a patient with non-specific LBP with questions relating to clinical
management of the described patient. ANALYSIS: Descriptive and
inferential analyses were carried out using SPSS. RESULTS: The
response rate was 55% (n = 1091) of which 580 were currently
involved in the management of patients with LBP and were used
in the analysis. Of these applicable responders, 81% were female,
52% worked exclusively in the National Health Service and 70%
reported having received specific postgraduate training in back
pain. On the PABS.PT subscales, the mean biomedical score
was 31.1 (SD 7.2) and the mean behavioural score was 32.5
(SD 4.8). For the clinical management items, 16% of respondents
reported they would advise the patient described in the vignette
to ‘return to normal work’ and 22% reported they would advise
avoiding bedrest entirely as a form of treatment. A large majority
(82%) reported they would advise the described patient to ‘perform
activities within the patient’s tolerance’ with 10% recommending
‘perform usual activities’. The PABS.PT scores and work advice
show a significant linear trend with higher biomedical [F(1,561) = 51.7,
p < 0.001] and lower behavioural [F(1,559) = 25.65, p = 0.001] scores
being associated with advice to not return to work. CONCLUSIONS:
PTs hold a wide variety of attitudes and beliefs about back pain.
We have shown an association between PTs’ attitudes and beliefs
and their reported practice behaviour. PTs’ operating within a
predominantly biomedical framework were less likely to adhere to
current guideline recommendations regarding advising a patient
with back pain about early return to work. Future research needs
to focus on approaches to help implement best practice and
guideline recommendations into clinical practice. IMPLICATIONS:
Guideline dissemination methods are having only limited success
in encouraging best practice in physiotherapy for back pain. The
attitudes and beliefs held by PTs are related to what they do
in practice. KEYWORDS: Physiotherapists, attitudes, guidelines.
FUNDING ACKNOWLEDGEMENTS: This study was funded by the
Arthritis Research Campaign. Nadine Foster is funded by a Primary
Care Career Scientist Award from the Department of Health and NHS
Research and Development. CONTACT: a.bishop@cphc.keele.ac.uk
ETHICS COMMITTEE: West Midlands Multi-Centre Research Ethics
Committee
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Research Report Platform Presentation
2278 Tuesday 5 June 11:25
PP Crystal Pavilion B & C
TRANSLATING NECK PAIN AND DISABILITY QUESTIONNAIRES
INTO THE KOREAN LANGUAGE: CROSS-CULTURAL
ADAPTATION AND PSYCHOMETRIC TESTING
Lee H1 , Nicholson L2 , Adams R2 , Maher C2 , Halaki M3 , Bae S4 ;
1 Dept of Physical Therapy, College of Medical Life Science, Silla
University, Busan, Korea; 2 School of Physiotherapy, Faculty of
Health Sciences, University of Sydney, Sydney, Australia; 3 School of
Exercise and Sport Science, Faculty of Health Science, University
of Sydney, Sydney, Australia; 4 Dept of Physical Therapy, College
of Rehabilitation Science, Daegu University, Daegu, Korea
PURPOSE: To translate three neck and spinal pain disability
questionnaires – the NDI, NPDS, and FRI – into the Korean
language, and evaluate reliability, face validity and item response
patterns to achieve a good cross-cultural adaptation. RELEVANCE:
Although measuring health status is important for research and
clinical practice, few validated neck pain and disability scales exist.
Further, non-English speakers are often excluded from clinical
trials and epidemiological studies due to the lack of valid and
reliable cross cultural measurements. There are no Korean language
neck pain and disability measures. Direct translations may fail
to achieve questions comparable to the meaning of the original
English, so it is important to consider conceptual matters and
cultural relevance. PARTICIPANTS: Forty (23 males, 17 females)
subjects, aged from 15 to 64 years old, participated to examine test-
retest reliability. One hundred and eighty (76 males, 104 females)
subjects with a primary diagnosis of non-specific neck pain and 81
healthy volunteers were recruited to examine internal consistency,
discriminative validity and longitudinal construct validity. METHODS:
Versions of each questionnaire in idiomatic modern Korean were
developed with a process involving initial independent translation,
synthesis of the translations, independent back translation and review
by an expert committee to achieve equivalence with the original
English. Psychometric testing of the questionnaires was undertaken
to examine test-retest reliability, internal consistency, discriminative
validity and longitudinal construct validity. The questionnaires were
administered twice to the clinical subjects; on their first treatment
(baseline) and the last treatment day (post treatment). A 7-point
global perceived effect scale was also completed at the last treatment
and served as the external criterion of clinically important change.
The healthy group completed the questionnaires once only. Prior
to testing, ethical approval was obtained from the University of
Sydney, and each subject gave informed consent. ANALYSIS: To
assess reliability, the intraclass correlation coefficient [ICC(2,1)] was
calculated. Internal consistency was evaluated by Cronbach’s alpha.
Discriminative validity was examined with independent-groups t -
tests. Internal responsiveness was tested by calculating the effect
size and standardized response mean for each questionnaire, and
external responsiveness was measured using Pearson’s r and ROC
analysis. RESULTS: Test-retest reliability of the translated versions
of the three disability questionnaires was excellent [ICC(2,1) = 0.86-
0.90]. High internal consistency was found in the three disability
questionnaires (Cronbach’s alpha was 0.88 for the FRI, 0.96 for
the NPDS and 0.82 for the SFMPQ). The VAS subscale of the
SFMPQ was found to be the most responsive subscales (ES=1.44,
SRM=1.37). The VAS was also the most responsive pain and
disability index in internal responsiveness analysis, although disability
indices showed marginally better responsiveness when compared
with external standards. CONCLUSIONS: We conclude that the
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.
S328
FUNDING ACKNOWLEDGEMENTS: None of authors have any
financial support for the current study that may lead to a conflict
of interest. CONTACT: hjlee@silla.ac.kr
ETHICS COMMITTEE: University of Sydney
Research Report Platform Presentation
2514 Tuesday 5 June 11:25
VCEC Ballroom A
GROUP EXERCISE THERAPY FOR MOBILITY AND BALANCE
IN PEOPLE WITH MULTIPLE SCLEROSIS:A RANDOMISED
CONTROLLED PILOT STUDY
Lennon S1 , MacAuley S2 , Hill C3 , Lowe-Strong A1 ; 1 University
of Ulster, Newtownabbey, Northern Ireland; 2 Belfast City Hospital,
Belfast, Northern Ireland; 3 Musgrave Park Hopsital, Belfast,
Northern Ireland
PURPOSE: The purpose of this study was to evaluate the effect
of group exercise therapy on mobility and balance and in people
with multiple sclerosis (MS). RELEVANCE: Restrictions in mobility
and balance are common in people with MS. A recent Cochrane
review (Rietberg et al, 2005) suggests that exercise therapy can
improve strength, fitness, mobility and balance in individuals with MS,
with no evidence of deleterious effects, yet access to such therapy
remains limited. Outpatient based group exercise therapy would thus
appear to be a realistic service delivery option to ensure that exercise
therapy becomes more readily available. PARTICIPANTS: Ethical
approval was obtained from the University of Ulster’s Research
Ethical Committee. Inclusion criteria were that all participants had
a definite diagnosis of MS, were over 18 years of age with an
Expanded Disability Status Scale (EDSS) of 7 or less. Participants
were excluded if they were currently experiencing a relapse of
MS, had received steroids within the last month, were due to
receive them during the period of the study, or relapsed during
the study requiring hospitalisation. METHODS: 14 participants were
randomised, stratified by walking ability, into an Exercise or Control
group for twice-weekly sessions of exercise therapy over a four-
week period. A blinded assessor measured the Rivermead Mobility
Index (RMI-the primary outcome measure), and the Step Test and
10m Timed Walk (the secondary outcome measures) at baseline
and weeks 5, 10 and 16 post intervention. The Barthel Index (BI)
and the Multiple Sclerosis Quality of Life-54 instrument (MSQoL-
54) were measured at baseline and week 16. A focus group
was undertaken at the end of the intervention period to obtain
the users’ perspective. ANALYSIS: Data were analysed on an
intention to treat basis using independent-samples T-tests on the
differences of the means of each outcome measure at each time point
compared to the baseline. RESULTS: Differences between groups
were not statistically significant for any of the outcome measures
(p > 0.05). However, there was a positive effect in terms of walking
speed following intervention; in addition, participants reported an
improvement in functional activity as well as psychosocial benefits.
CONCLUSIONS: Findings from this pilot study would suggest
that outpatient based group exercise therapy has beneficial effects
on mobility and balance, and thus warrants further investigation.
IMPLICATIONS: This small randomised controlled pilot study is one
of the first to evaluate the effect of group exercise therapy on mobility
and balance in people with multiple sclerosis. The clinical importance
of this study is that the group format may be an effective approach
to ensure that exercise therapy is available to a greater number
of patients, and may be more resource efficient. KEYWORDS:
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: s.lennon@ulster.ac.uk
ETHICS COMMITTEE: University of Ulster Ethics Comiittee
WCPT 2007, Research Reports
Research Report Platform Presentation
1610 Tuesday 5 June 11:25
VCEC Meeting Rooms 1-3
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
PURPOSE: Patient satisfaction and participation have become
important issues in health care. This is due to legislation and
consumer awareness.In 2003 we carried out a survey on patients
with muscular skeletal disorders in our outpatient clinic. One of the
results was that patients not having a Scandinavian language as
their mother tongue were overall significantly less satisfied than
the other patients. The purpose of this study is to find out why
this was so, and to assess with which factors the patients were
most dissastisfied. RELEVANCE: There is an increasing number of
patients with a minority background in our country. An essential factor
in health care is equality in services. The way in which health care is
delivered and puts patients at the centre is essential in physiotherapy.
PARTICIPANTS: From Part I of this study we included the 30 patients
with a non-Scandinavian mother tongue (16 woman and 14 men,
mean age 46.6, SD 10.6), who had completed their physiotherapy
treatment. Another group of patients, with a non-Scandinavian mother
tongue, participated in focus group interviews. METHODS: We
analysed data from the questionnaire the 30 patients had filled out in
Part I of the study.The questionnaire consisted of three global effect
variables: overall satisfaction, improved condition following treatment,
and whether the patients would reccomend our clinic. In addition it
included 22 variables in the following quality dimensions; professional
conduct, accessibility, physical environment and expectations. We did
qualitative focus group interviews to get access to the experiences
patients had and the meaning or value these had for them. In this
way we used a triangulation of methods – both quantitative and
qualitative. ANALYSIS: In the quantitative analyses, the significance
of association between the global effect variable, overall satisfied
and the other variables were investigated by means of univariate
regression analyses. The results of the quantitative analyses were
used as background material for an interview guide. The qualitative
interviews were analysed by the methods of phenomenograpy.
RESULTS: We found a significant association between age and
satisfaction (p < 0.04) older patients were more satisfied. There was
no significant association between gender and satisfaction. The main
dissatisfaction factors were: no improvement following treatment, high
parking fees and poor follow up. Questions that had significant impact
on the overall satisfaction score were: competence/professional skills
(p < 0.0001), information (p < 0.0001),communication (p < 0.0006).
The focus group interviews supported these findings to a certain
extent. However the patients appeared to be more satisfied in
the interviews than in the quantitative survey. CONCLUSIONS:
Although many patients reported that there were no improvement,
they were satisfied on overall basis. Patient satisfaction among
minority groups is an issue that should be given more attention –
by identifying areas of dissatisfaction and finding ways of measuring
this. IMPLICATIONS: We must adress the issue on how to improve
treatment service to people from minority groups in order to better
meet their needs. Qualititive methodology should be used more in
patient surveys. KEYWORDS: Patient satisfaction, minority health-
care. FUNDING ACKNOWLEDGEMENTS: No external funding.
CONTACT: grea@uus.no
Platform Presentations, Tuesday 5 June
Research Report Platform Presentation
1665 Tuesday 5 June 11:25
VCEC Meeting Rooms 11-12
CARDIORESPIRATORY RESPONSES OF INDIVIDUALS WITH
SPINAL CORD INJURY DURING UPPER AND LOWER
EXTREMITY EXERCISE
Pollack S1 , Moffat M2 , Dijkers M1 ; 1 Department of Rehabilitation
Medicine, Mount Sinai Hospital, New York, NY, USA; 2 Department
of Physical Therapy, New York University, New York, NY, USA
PURPOSE: To analyze the cardiorespiratory responses of adults with
paraplegia at the spinal cord levels T6-T12 and adults with tetraplegia
at the spinal cord levels C4-C6 following three different exercise
training phases: voluntary upper extremity armcrank ergometry;
electrically induced lower extremity ergometry; and voluntary upper
extremity armcrank ergometry combined with electrically induced
lower extremity ergometry. RELEVANCE: Exercise capability in
adults with spinal cord injury (SCI) has not been been adequately
researched. It is unclear whether they can develop the physiological
capacities required to perform differing degrees of work. The
limited literature available leads to the prediction that the exercise
capacity of adults with SCI, specifically those with lesions above
the fifth thoracic nerve, is limited due to autonomic nervous system
interruption. However, this issue has not been directly examined,
and the exercise capacity of adults with SCI remains virtually
unknown. PARTICIPANTS: Nine adults with SCI participated in a
three phase exercise training and testing program. Six of these
individuals had a spinal cord level of injury between T6 and T12
(Group 1) and three were between C4 and C6 (Group 2). All three
individuals in Group 2 but only two individuals in Group 1 (T6-T7)
completed the entire protocol. METHODS: The exercise program
consisted of 12 sessions of upper extremity armcrank ergometry,
12 sessions of electrically induced lower extremity ergometry and
12 sessions of upper extremity armcrank ergometry combined with
electrically induced lower extremity ergometry. The cardiorespiratory
capability of the participants was assessed before and after each
phase of exercise training. Peak oxygen consumption (VO2 ) and
exercise run times were calculated for each participant. ANALYSIS:
Independent samples t-tests were used to determine whether there
was a significant difference between the groups. Additionally, all
participants’ cardiorespiratory parameters were plotted to loof for
appearance of trends. RESULTS: There may have been a difference
between the groups in peak VO2 and run time, however, statistical
significance was not always found. Analysis of each individual’s data
over time revealed that as peak VO2 increased, carbon dioxide
production (VCO2 ) increased as well, indicating corresponding
increases in peak cardiorespiratory performance and physical work
capacity. These increases in peak VO2 and VCO2 were accompanied
by increases in minute ventilation (VE) which indicated that ventilation
probably did not limit oxygen uptake. CONCLUSIONS: The small
sample size may explain the lack of statistically significant differences
between the groups. Furthermore, the participants with thoracic
injuries at T6 and T7 may have had autonomic nervous system
interruption. Therefore, statistically significant differences between
the means may not have occurred because the two groups were
more similar than dissimilar. Reviewing each individual’s data
over time revealed interesting trends with regard to VO2 , VCO2
and VE. IMPLICATIONS: Thoracic injuries at T6 or T7 are just
below the cutoff for autonomic nervous system interruption. This
cut off may not be precise. Additional tests may need to be
employed in future research to truly segregate individuals with SCI
that have an intact autonomic nervous system from individuals
who do not. KEYWORDS: spinal cord injury, cardiorespiratory,
exercise. FUNDING ACKNOWLEDGEMENTS: None. CONTACT:
momeszf@hotmail.com
ETHICS COMMITTEE: 1. New York University Committee on
Activities Involving Human Subjects. 2. Mount Sinai Institutional
Review Board
S329
Research Report Platform Presentation
2776 Tuesday 5 June 11:25
VCEC Meeting Room 16
REFERENCE VALUES AND EFFECTIVENESS OF SEVEN
COMMONLY USED BALANCE AND FALL RISK SCREENING
TESTS FOR COMMUNITY DWELLING OLDER ADULTS
Boulgarides L1 , Yali B, Edward B1 ; 1 California State University,
Sacramento, CA, USA
PURPOSE: The purpose of the study was to determine whether
scores on seven balance tests were related to fall status in community
dwelling older adults and how mean scores compared to those found
in the literature. RELEVANCE: Falls in older adults are a major cause
of fracture, disability, and death in addition to costing millions of
health care dollars. The ability to effectively determine whether older
adults have decreased balance and/or increased fall risk important
for identifying at-risk seniors and offering timely intervention in the
clinical and community wellness settings. The data from this study
assists in interpretation of common tests currently used in the
clinical and community settings. PARTICIPANTS: Subjects included
255 community dwelling adults 65 years and older (82 male and
173 female) who attended health fairs between 2001 and 2004.
METHODS: Data collected included sex, age, history of falls, and
scores on seven different balance tests: the Functional Reach Tests
(FRT), Tandem Stand (TS), Single Leg Balance (SLB), Timed Up and
Go Test (TUGT), Composite Test for Sensory Interaction with Balance
(CTSIB), the Four Square Step Test (FSST), and the 30 second chair
stand (TSCS). ANALYSIS: Correlations determined relationships
between test scores and demographic variables (age, sex, location.
Mean test values were compared to those reported in the literature,
univariate analysis determined relationship between test scores and
fall status, and logistic regression was done to determine whether
any tests or combined tests predicted fall status. RESULTS: Scores
on the following tests were related to fall status: TUGT (P = 0.02),
FSST (P = 0.007), TS ability (P = 0.0003), SLB (P = 0.0008), eyes
closed component of the CTSIB (P = 0.0.02), and TSCS (P = 0.0.02).
Logistic regression analysis revealed the TSCS (more repetitions
per 30 second period predicted less liklihood of falls) and location
(the location with primarily African American sujects predicted less
liklihood of falls) as the only combination of variables significantly
predictive of falls (P = 0.02). Means of the tests (TUGT for fallers =
9.8, non-fallers = 8.3; FSST for fallers = 14.7, non-fallers = 10.8;
TSCS for fallers = 10.3, non-fallers = 12.9; SLB for fallers = 8.8,
non-fallers = 15.2) were similar in the current investigation to those
of some studies. Variations in sample characteristics and methods
of reporting prevented statistical comparison. CONCLUSIONS: Five
of the seven tests (TUGT, FSST, TS time and ability, SLB, eyes
closed component of the CTSIB,and TSCS) are related to fall
status. Some similarities exits in mean values of balance tests
compared to comparative studies, though there is considerable
variability between mean values reported in the literature for the
different tests. IMPLICATIONS: Mean values reported here and in
related literature are useful for the practitioner to be able to compare
individual performance to a larger active community dwelling older
population. As most of these tests are found to be related to fall
status, performance that falls a standard deviation below the mean
for these tests will allow clinicians and participants to identify potential
problems related to balance, function, and possible future falls.
Further research should focus on establishing norms for different age
groups and levels of disability. KEYWORDS: Fall Prediction; Older
Adults; Balance. FUNDING ACKNOWLEDGEMENTS: This research
was funded in part by the department of Research and Sponsored
Projects at California State University, Sacramento. CONTACT:
boulgarides@csus.edu
ETHICS COMMITTEE: Committee for the Protection of Human
Subjects, California State University, Sacramento
S330
Research Report Platform Presentation
1379 Tuesday 5 June 11:25
VCEC Meeting Room 17
EDUCATION IN PULMONARY REHABILITATION: THE PATIENTS’
PERSPECTIVE
Wilson J1 , O’Neill B2 , Reilly J3 , MacMahon J1 , Hall M2 , Bradley J1,2 ;
1 Department of Respiratory Medicine, Belfast City Hospital Trust,
N. Ireland; 2 Health and Rehabilitation Sciences Research Institute,
University of Ulster, N. Ireland; 3 UNESCO Centre, University of
Ulster, N. Ireland
PURPOSE: To ascertain from the patients’ perspective what should
be included in the educational component of pulmonary rehabilitation
(PR) and how this should be delivered. RELEVANCE: There is
limited research to direct the content and delivery of the educational
component of pulmonary rehabilitation. Current guidelines give no
indication about which, of many topics, are essential for inclusion,
nor of the specific content and method of delivery. Importantly
these proposed topics are not based on the patients’ perspective.
PARTICIPANTS: A purposive sample of 32 (25 male) patients with
COPD were recruited from the regional respiratory centre at the
Belfast City Hospital (8 mild, 20 moderate, 4 severe). METHODS:
Six focus groups were conducted (2 groups had attended PR, 2 non-
PR groups and 2 mixed groups). A structured schedule of topics
was used to guide the discussion, which was led by an experienced
moderator. All focus groups were videotaped and field notes taken
by an assistant moderator. Debriefing followed each focus group and
a transcript was prepared. ANALYSIS: Data was analysed using
a grounded approach. Data was coded and sorted into categories
and subcategories. Results were summarised and verified by means
of a follow up report which elicited participants’ comments on
the findings. RESULTS: The physical and psychosocial impact of
COPD was described extensively. Patients reported considerable
lifestyle adjustments and frustration as a result of their symptoms.
Key topics identified by participants were: disease education (what
is COPD and causes); management of breathlessness and of
the physical impact of COPD (practical strategies for activities of
daily living and walking, pacing and panic reduction); medication
(how, when and why to use medications); welfare and benefits
system (disability entitlements, access to home aids and appliances);
exacerbation management (recognition of worsening of symptoms,
when and where to seek help). There was ambivalence concerning
the importance of disease progression and end of life issues.
The majority of patients felt these along with a range of other
topics should be included in supplementary information, which
they could choose to access. Patients preferred a group format
as practical demonstrations and peer support were considered
important aspects of learning. The location could be hospital
based or otherwise, as long as the sessions were delivered by
a knowledgeable/credible individual. CONCLUSIONS: This study
has identified deficits in patients’ knowledge, understanding and
management of their COPD. IMPLICATIONS: Physiotherapists
should ensure that educational components are included in PR
programmes which meet the needs of patients, and in a format that
is acceptable to patients. KEYWORDS: Pulmonary rehabilitation,
Education. FUNDING ACKNOWLEDGEMENTS: This research is
funded by the Northern Ireland Chest, Heart and Stroke Association.
CONTACT: b.oneill@ulster.ac.uk
ETHICS COMMITTEE: Research Ethics Committee, Queens Univer-
sity Belfast, Northern Ireland
WCPT 2007, Research Reports
Research Report Platform Presentation
1545 Tuesday 5 June 11:25
VCEC Meeting Room 18
PATIENT CONCERNS IN THE FIRST SIX WEEKS FOLLOWING
PRIMARY TOTAL KNEE ARTHROPLASTY
Rastogi R1 , Davis A2 , Chesworth B1 ; 1 University Of Western
Ontario, London, Canada; 2 Toronto Western Research Institute,
Toronto, Canada
PURPOSE: The primary objective of this study was to identify
what patients believe is important during their recovery in the first
six weeks following primary total knee arthroplasty (TKA). These
patient-reported important items were linked to components of the
International Classification of Functioning, Disability and Health
(ICF) and then mapped to commonly used outcome measures.
RELEVANCE: To date, no researchers have investigated what is
important to patients in the first six weeks following primary TKA.
An understanding of what is important to patients at a time when
physical therapists are involved in the treatment of these patients will
aid clinicians in providing patient-centered care. Linking of patient-
reported important items to the ICF allows for comparison and
sharing of data amongst researchers, as the ICF is the accepted
framework for evaluating disability in rehabilitation. PARTICIPANTS:
The sample comprised of thirty patients (18 females) from a tertiary
care hospital who were in the first six weeks of recovery following
primary TKA. METHODS: Individual interviews were conducted to
identify what patients believe is important during their recovery
following primary TKA. ANALYSIS: Items identified by patients were
analyzed for content and linked to the components of the ICF using
the operational definitions of the ICF components. These items were
mapped to the Western Ontario McMaster Universities Osteoarthritis
Index (WOMAC), Knee Injury and Osteoarthritis Outcome Score
(KOOS) and Oxford knee scale by manually comparing the content of
each patient-reported item to each item on these outcome measures.
Items that linked to the ICF and those that matched with the outcome
measures were counted. Frequencies of matching items were then
generated for each ICF component, each outcome measure and
their cross-tabulation. RESULTS: Thirty-two items were identified
as being important by patients. Forty-seven percent (n=15) of the
items linked to the Activity component, 22% (n=7)to Body Function,
13% (n=4) to Participation, and 13% (n =4) to the Environmental
factors component of the ICF. Six percent(n=2) of the items did not
link to the ICF. Of the 32 items identified by patients 14 mapped
to the KOOS, 11 to the WOMAC and, 4 to the Oxford knee scale.
CONCLUSIONS: Items important to patients linked to four different
components of the ICF indicating that patients are involved in or are
thinking of multiple aspects of life even in this early phase of recovery.
The KOOS was found to be the most appropriate for use based on
the patients’ perspective. However, less than half of the importance
items identified by patients were covered by the KOOS, WOMAC
or Oxford Knee Scale indicating that further investigations need to
be conducted to either develop new measures or modify existing
measures to evaluate outcome during this early phase of recovery
following primary TKA. IMPLICATIONS: Currently, we recommend
using the KOOS as well as evaluating additional concerns of
individual patients using the patient-specific scale or other alternative
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: rrastogi100@hotmail.com
ETHICS COMMITTEE: University of Western Ontario Research
Ethics Board for Health Sciences Research Involving Human
Subjects
Platform Presentations, Tuesday 5 June
Research Report Platform Presentation
1930 Tuesday 5 June 11:25
VCEC Meeting Rooms 19-20
PRE-ACTIVATION OF MUSCLES DURING SHOULDER
ABDUCTION IN NORMALS
Pizzari T1 , Wickham J2 , Stansfeld K1 , Djoneff M1 ; 1 School of
Physiotherapy, La Trobe University, Melbourne, Australia; 2 School
of Human Biosciences, La Trobe University, Melbourne, Australia
PURPOSE: Current shoulder electromyography (EMG) studies that
attempt to quantify shoulder muscle activity in planar movements
typically have small subject numbers, analyse limited muscle activity
characteristics and lack reproducibility. In particular, the temporal
characteristic of muscle onset has not been fully explored in shoulder
movements. The purpose of this experiment was to identify invariant
temporal and intensity muscle EMG characteristics in a sample of
healthy shoulders to allow a reference database to be developed.
This database will be used for comparison with pathological
shoulders in the future. RELEVANCE: The identification of impaired
muscle activity in various shoulder pathologies will allow the devel-
opment of truly evidence-based rehabilitation programs to restore
shoulder muscle function. PARTICIPANTS: 24 participants (13 male,
11 female) with healthy shoulders aged between 18 and 37 years
(Mean ±SD = 23.8yrs ±5.2) were included. METHODS: Surface
and intramuscular fine wire electrodes recorded EMG activity from 15
shoulder muscles segments (deltoid x 3, trapezius x 3, subscapularis
x 2, latissimus dorsi, pectoralis major and minor, supraspinatus,
infraspinatus, serratus anterior and rhomboids). Each participant
performed 10 dynamic coronal plane abduction movements from 0
to 180º with a light dumbbell. ANALYSIS: A linear envelope (6Hz
low pass Butterworth 4th Order filter) enabled onset determination,
time of peak amplitude, termination and % MVC determination of
the activation period for each muscle. The average and standard
deviation of each muscle characteristic for the 24 subjects was
calculated. RESULTS: Three muscles were activated before the
movement onset. Supraspinatus (−0.102 sec before movement
onset), middle trapezius (−0.019 sec) and middle deltoid (−0.014
sec) demonstrated consistent pre-emptive activation. Analysis of the
time to peak amplitude, termination and %MVC showed a pattern
emerging where the prime movers (supraspinatus and middle deltoid)
were among the first to reach peak amplitude, turn off last or display
the highest % MVC values. CONCLUSIONS: Patterns of activation
are apparent in the normal shoulder with the most reproducible
patterns of activation arising from the more prime mover muscle
sites in all EMG variables analysed. It is these characteristics
(muscle onset, peak EMG and deactivation sequencing between
several of the muscles investigated) that will provide the robust
data upon which to compare the EMG waveforms between this
normative database and that of the pathological shoulder. The pre-
activation of supraspinatus, middle trapezius and middle deltoid
could potentially be the most significant contribution to a pain-free
shoulder considering the evidence of the importance of muscle pre-
activation in other joints of the body (e.g. transversus abdominis
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
exist. KEYWORDS: Electromyography, shoulder joint, muscle activity.
FUNDING ACKNOWLEDGEMENTS: A small grant was received
from the Faculty of Health Sciences, La Trobe University, Melbourne,
Australia. CONTACT: T.Pizzari@latrobe.edu.au
ETHICS COMMITTEE: Faculty Human Ethics Committee, La Trobe
University, Melbourne, Australia.
S331
Research Report Platform Presentation
2941 Tuesday 5 June 11:45
PP Crystal Pavilion A
PREVALENCE OF BACK PAIN AND THE RELATION TO
PSYCHOSOCIAL AND SOCIOECONOMIC FACTORS AMONG
45-69 YEAR OLDS IN A GENERAL POPULATION
Skargren E1 , Larsson M1 , Kristensson M2 ; 1 Department of Health
and Society Physiotherapy, Linköpings universitet; 2 Department of
Health and Society Social Medicine and Public Health, Linköpings
universitet
PURPOSE: To describe the prevalence of back pain at present and
over the past five years, and to compare persons reporting back pain
with those without such pain in relation to health-related quality of
life, co morbidity, psychosocial and socioeconomic factors, a further
purpose was to examine whether there were any differences between
men and women with back pain in this regard. RELEVANCE: Recent
research has shown that back pain is a complex phenomenon
related to many factors. Psychosocial- and socioeconomic factors,
and co morbidity seem to be of importance for the perception of
back pain. PARTICIPANTS: The study comprised 1007 persons
between 45-69 years of age listed at 10 primary care centers.
The persons were selected at random. METHODS: The study was
a cross-sectional, general population study, part of the LSH (Life
circumstances, stress and health study) studying self-rated health,
back pain, heart disease and premature death. The data in this study
was based on questionnaires. ANALYSIS: Comparisons between
groups and regression analysis. Data were standardized for age.
RESULTS: The point prevalence of back pain was 44%. The five-
year prevalence was 69%. Prevalence was slightly higher among
women (49% and 79%). Persons with back pain at present and over
the past five years were more often on sick-leave and reported a
worse financial situation than people without back pain. Those with
back pain at present also reported lower education level, poorer
health-related quality of life (SF-36), self-esteem and coping ability,
together with a higher degree of perceived stress, vital exhaustion
and depression than people without back pain. Women with back
pain at present reported less well-being than the men with back pain
at present. CONCLUSIONS: Back pain was common among 45-69
year olds in a general population and more frequent among women.
A relation was seen between reported back pain and reported
worse socioeconomic situation, less well-being, lower psychosocial
status as well as being a women. IMPLICATIONS: The results need
to be taken into account in public health promotion programmes.
This study is aimed to form a basis for further analysis of the
prognosis for back pain in relation to psychosocial, stress and
socioeconomic factors. Relation to biological stress markers will
also be analyzed. KEYWORDS: neck and/or low back pain, SF-
36, gender. FUNDING ACKNOWLEDGEMENTS: The LSH study is
supported by the Swedish Research Council and Swedish Heart-
Lung Foundation. CONTACT: elisabeth.skargren@ihs.liu.se
ETHICS COMMITTEE: The Research Ethics Committee at Linköping
University
Research Report Platform Presentation
2729 Tuesday 5 June 11:45
VCEC Ballroom A
CAN EXTERNAL CUES IMPROVE THE BALANCE OF PATIENTS
WITH PARKINSON’S DISEASE?
Capato T, Mathias M, Piemonte M; Universidade de São Paulo
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
S332
in PD since the pharmaco approach brings little benefits to these
motor alterations. A number of studies have shown that external
cues associated to motor treatment may yield important benefits
to the gait of PD patients, yet few have investigated the effect of
these cues on balance. DESCRIPTION: Forty two patients with
idiopathic PD took part in this study, with a mean age of 65.91+
6.51 years, at stages 2 to 3 of the Hoehn and Yahr Classification
(HY), randomly assigned into one of 3 groups: one group receiving
motor training associated to visual and auditory cues (ET), one group
performing motor training only (MT) and a third group receiving
no treatment. Performance in gait and balance were assessed by
a blinded examiner, before and after 10 training sessions (two
45-minute sessions per week) for the ET and MT groups, and
before and after 5 weeks for the CG, using the BERG test (BT)
and Postural Stress test (PST). Patients were also assessed for
independence in daily life activities and motor performance using
section II and III of the Unified Parkinson’s Disease Rating Scale
(UPDRS); for Quality of Life using the Parkinson’s Disease Quality of
Life (PDQL), and for emotional state by Beck’s Depression Inventory
(BDI). The data obtained was compared employing the ANOVA
variance analysis model for repeated measurements. Those factors
yielding category differences on mean comparison then underwent
the Scheffé post-hoc test to verify level of significance, two by
two. EVALUATION: Results obtained differed amongst groups where
ET and MT groups presented significant improvement in scores
after training on the BT p < 0.006007), PST (P = 0.034311), UPDRS
(P = 0.000640), PDQL(P = 0.000001) and BDI (P = 0.001446), in
contrast to the CG which presented no improvement. However, the
ET group presented a significantly greater improvement in scores on
the BT (P = 0.021562) and the PST (P = 0.036423). CONCLUSIONS:
Training associated to visual and auditory cues proved beneficial
to balance performance in PD patients, in comparison to motor
training only. IMPLICATIONS: Visual and auditory cues can enhance
results achieved through physiotherapeutic treatment of dysfunctions
in balance of PD patients, might consider as additional resources
in the physical therapy practice for PD KEYWORDS: Parkinson’s
Disease,balance,gait. FUNDING ACKNOWLEDGEMENTS: None.
CONTACT: taminec@yahoo.com.br
ETHICS COMMITTEE: Ethical Committee of Hospital das Clinicas
da Faculdade de Medicina da USP
Research Report Platform Presentation
1888 Tuesday 5 June 11:45
VCEC Meeting Rooms 11-12
LOCOMOTOR TRAINING IN INDIVIDUALS WITH SPINAL CORD
INJURY IS ASSOCIATED WITH MORE TYPICAL SPINAL
REFLEX ACTIVITY AND IMPROVED LIMB COORDINATION
Field-Fote E1,2 ,
Khan M2 ,
Lindley S2 ; 1 University
of Miami Miller
School of Medicine, Department of Physical Therapy; 2 The Miami
Project to Cure Paralysis
PURPOSE: In animal models of spinal cord injury (SCI), locomotor
training has been shown to be associated with plasticity of spinal
reflex activity and improved limb coordination. However, little is known
about the effects of training on spinal reflexes in individuals with
SCI. The purpose of this investigation was to assess the changes in
spinal reflex activity and inter- and intralimb coordination associated
with locomotor training in individuals with chronic, incomplete SCI.
RELEVANCE: Disordered neural control following spinal cord injury
is associated with movement dyscoordination and bothersome
involuntary motor output such (e.g., spasticity, clonus, flexor spasms,
and etc). Repeated practice of locomotor activities is associated
with improved neural control, this should be reflected in measures
of coordination and reflex activity. PARTICIPANTS: Forty-three (43)
individuals with chronic (>1 year) motor-incomplete SCI participated
in this study. METHODS: Subjects were trained 5 days/week for 3
months following assignment to one of four different body-weight
supported (BWS) locomotor training protocols: 1) treadmill training
WCPT 2007, Research Reports
with manual assistance (TM), 2) treadmill training with peroneal
nerve stimulation (TS), 3) treadmill training with robotic assistance
(Lokomat robotic orthosis; LR), and 4) overground training with
peroneal nerve stimulation (using a Walkaide2 stimulator; OG).
Prior to and following participation we assessed soleus H-reflex
excitability, reciprocal Ia inhibition, presynaptic (D1) inhibition, post-
activation depression, flexor reflex excitability and responsiveness
to mechanical stretch. To assess motor control of limb movement
during walking, we quantified intra- and interlimb coordination and
step symmetry. We also evaluated muscle strength and function-
related parameters. ANALYSIS: Vector coding techniques were used
to quantify the degree of interlimb (hip-hip) and intralimb (hip-knee)
coordination. Repeated measures analysis of variance (ANOVA)
was used to assess changes in coordination values and change
in reflex activity following training. Pearson correlation was used
to assess the association between measures of coordination and
reflex activity. RESULTS: In the TS and TM training groups there
was a statistically significant improvement in the efficacy of tibialis
anterior-to-soleus reciprocal Ia inhibition. This measure was highly
variable in the TS group and the LR group. There was a trend toward
decreased flexor reflex excitability, decreased H-reflex excitability,
and a decrease in the responsive of the quadriceps to mechanical
stretch (with greatest change observed in the TS group). There
were no changes or trends noted in presynaptic (D1) inhibition or
post-activation depression. The consistency of intralimb coordination
improved across all groups as did step symmetry. There was a
moderate correlation between change in response to mechanical
stretch and change in intralimb coordination, there was also a fair
correlation between change in intralimb coordination and change in
reciprocal Ia inhibition. CONCLUSIONS: In individuals with motor-
incomplete SCI, task-related practice appears to be associated
with changes in efficacy of selected spinal reflex circuits, with few
differences among the different training approaches. Further, there
may be relationships between control of gait-related limb movement
and some aspects of spinal reflex activity. IMPLICATIONS: These
results suggest that locomotor training is associated with alterations
in the control of walking function which is reflected in improved
limb coordination and more typical reflex activity. KEYWORDS:
Locomotion, activity-dependent plasticity, task-specific, practice.
FUNDING ACKNOWLEDGEMENTS: Support Contributed By: NIH
grant HD41487, the Schumann Foundation and The Miami Project
to Cure Paralysis. CONTACT: edee@miami.edu
ETHICS COMMITTEE: University of Miami School of Medicine
Human Subjects Institutional Review Board
Research Report Platform Presentation
2790 Tuesday 5 June 11:45
VCEC Meeting Room 16
SPATIO-TEMPORAL RISK FACTORS FOR FALLS AND
FRACTURE FALLS IN RESIDENTIAL AGED CARE
Barker A1 , Haines T1,2 , Nitz J1 , Low Choy N1 ; 1 The Division of
Physiotherapy, School of Health and Rehabilitation Sciences, The
University of Queensland, Brisbane, Australia; 2 Princess Alexandra
Hospital, Brisbane, Australia
PURPOSE: To identify spatio-temporal characteristics of falls and
fracture falls in residential aged care. RELEVANCE: Falls remain a
major source of disability and accident related mortality for people
living in residential aged care. Physiotherapists are at the forefront
of designing and delivering falls prevention interventions. Information
on falls characteristics offers insight into high risk, locations, activities
and times in residential aged care. Knowledge of these factors
facilitates development of risk management strategies which are
evidence-based, and likely to offer reductions in falls and fracture
falls. PARTICIPANTS: Information from the charts of 98 people
living in 4 residential aged care facilities in Australia was collected.
METHODS: A retrospective chart audit was conducted. ANALYSIS:
Event rates for falls and fracture falls were calculated. Descriptive
Platform Presentations, Tuesday 5 June
statistics were used to describe circumstances and frequencies
of falls and fracture falls. To explore the relationships between
circumstances and fracture falls, a logistic regression was performed
with fracture fall as the dependent variable and location, precipitating
activity and fall time as the independent variables. As multiple events
per person were possible, the model was adjusted to cluster by
resident. RESULTS: The mean age of residents was 81.47 years
(SD = 9.35). Data on 362 falls and 20 fractures from falls were
obtained. The mean observation period was 2.40 years (SD =1.44).
The most common location for both falls and fracture falls was the
bedroom, where 228 (64.41%) falls and 11(57.89%) fracture falls
occurred. Outside was the location associated with the highest risk
of sustaining a fracture from a fall OR 5.50 (95% CI: 1.85-16.35). Falls
and fracture falls whist walking were the most common, accounting
for 153 (42.38%) falls and 13 (68.42%) fracture falls. Walking was the
activity with the highest risk of sustaining a fracture from a fall OR
8.94 (95% CI: 1.27-62.76). Fracture falls most commonly occurred
while walking in the bedroom, between midday and 4pm. Fracture
falls while walking outside were most common between midday and
4pm. CONCLUSIONS: A profile of spatio-temporal characteristics of
falls and fracture falls was established. The bedroom is the most
common location for falls and fracture falls. Outside is the location
with the highest risk of sustaining a fracture from a fall. Walking
is the most common precipitating activity for falls and fracture falls,
and is also the activity with the highest risk of sustaining a fracture
from a fall. IMPLICATIONS: Further investigation should be directed
towards identifying environmental factors that contribute to increased
fracture rates in the afternoon, in the bedroom and outside such
as levels of staff supervision and floor surfaces. Falls prevention
interventions should target residents who are ambulant and spend
periods of time unsupervised in their bedroom or outside in the
afternoon. KEYWORDS: Accidental falls, risk factors and residential
aged care. FUNDING ACKNOWLEDGEMENTS: Nill. CONTACT:
a.barker@shrs.uq.edu.au
ETHICS COMMITTEE: The University of Queensland, Medical
Research Ethics Committee.
Research Report Platform Presentation
2031 Tuesday 5 June 11:45
VCEC Meeting Room 17
ENCOURAGING ATTENDANCE AT PULMONARY
REHABILITATION: A QUALITATIVE EXPLORATION
Bulley C1 , Salisbury L2 , Whiteford S3 , Donaghy M1 , Mackay E3 ;
1 Queen Margaret University College, Edinburgh, Scotland;
2 Edinburgh University, Centre for Integrated Healthcare Research,
Edinburgh, Scotland; 3 NHS Greater Glasgow and Clyde, Glasgow,
Scotland
PURPOSE: Chronic Obstructive Pulmonary Disease (COPD) is
a limitation of airflow that leads to reduced participation in life.
Pulmonary rehabilitation uses individually-tailored exercise and
multidisciplinary education to help people manage their symptoms
optimally and be as independent as possible. However, not all
individuals referred to pulmonary rehabilitation participate. This
qualitative study aimed to analyse patient views regarding attendance
at pulmonary rehabilitation to explore influences on their decisions.
RELEVANCE: Better understanding of influences on attendance
at pulmonary rehabilitation will enable health professionals to take
actions that increase the likelihood of participation; this will increase
the numbers of individuals with COPD who take the opportunity
to learn better ways of managing their condition. PARTICIPANTS:
Individuals with COPD who were referred to a pulmonary rehabili-
tation service were invited to participate in a single interview prior
to joining the programme. It was emphasised that their decision
would not impact on any future treatment. Purposive selection of
men and women ensured a variety of experiences. Five women
and four men aged 59 to 82 completed interviews. All were white
Caucasians living in Glasgow, Scotland. METHODS: The study was
S333
carried out within the framework of Interpretative Phenomenological
Analysis. Semi-structured interviews (50-90 minutes) were carried
out in participants’ homes. A topic guide was developed to focus
on experiences of COPD and views regarding future attendance
at pulmonary rehabilitation. Ethical approval was granted by the
Multi-Region Ethics Committee in Scotland. ANALYSIS: Transcribed
interviews were analysed using the QSR N6 computer package.
Two researchers were involved in developing themes, iteratively
developing a classification or typology of views and experiences, pro-
gressing to locate relationships between themes. Three overarching
master themes emerged. RESULTS: Master themes are labelled to
reflect views or needs described by interviewees. The first describes
contrasting experiences and attitudes: ‘Exercise will kill me’ versus ‘I
can’t let it beat me.’ Some individuals developed fear and avoidance
of exercise, translating into wariness about attending pulmonary
rehabilitation. Others refused to dwell on negative experiences,
were determined to overcome symptoms, and expressed willingness
to attend rehabilitation. The second master theme is called: ‘A
waste of my time’ versus ‘Doctors know best.’ Participants with
previous negative experiences of management often described low
expectations of pulmonary rehabilitation. Others expressed faith in
health professionals as a result of positive experiences, and were
willing to follow their recommendations. The last theme was labelled:
‘I want to walk and breathe better.’ This reflects individuals’ desire for
professional advice and support in coping better with their condition.
CONCLUSIONS: Individuals frequently recognise that they could
be helped to cope better with their COPD symptoms. However,
some fear that the burden of attending pulmonary rehabilitation
will outweigh the benefits. IMPLICATIONS: It is important that
the aims and content of pulmonary rehabilitation are carefully
explained on referral in order to motivate patients and allay any
fears. Positive and informative communications about pulmonary
rehabilitation are likely to lead to increased uptake and benefit to
more patients. KEYWORDS: Pulmonary; rehabilitation; participation.
FUNDING ACKNOWLEDGEMENTS: Queen Margaret University
College. CONTACT: cbulley@qmuc.ac.uk
ETHICS COMMITTEE: Multi-Region Ethics Committee in Scotland
Research Report Platform Presentation
2486 Tuesday 5 June 11:45
VCEC Meeting Room 18
FACTORS ASSOCIATED WITH THE AMOUNT OF
INTERVENTIONS PROVIDED BY PHYSICAL THERAPISTS IN
THE ACUTE HOSPITAL
Grill E1 , Huber E2,3 , Strobl R1 , Gloor-Juzi T2,4 , Stucki G1,5 ; 1 ICF
Research Branch of the WHO FIC Collaborating Centre (DIMDI),
IHRS, Ludwig-Maximilian University, Munich, Germany; 2 Department
of Rheumatology and Institute of Physical Medicine, University
Hospital Zurich, Switzerland; 3 Swiss Association of Physiotherapy,
Sursee, Switzerland; 4 Physiotherapy Science Studies, Department of
Rheumatology and Institute of Physical Medicine, University Hospital
Zurich, Switzerland and Faculty of Health Sciences, Maastricht
University, the Netherlands; 5 Department of Physical Medicine and
Rehabilitation, Ludwig-Maximilians-University, Munich, Germany
PURPOSE: To identify the factors associated with intervention
time provided by physical therapists RELEVANCE: Common to all
hospitalized patients are a number of risks including complications
of diagnostic procedures and interventions, thrombosis, ulcer and
hospital infections, to name just a few. Consequently, patients
are at risk of experiencing a significant loss of functioning. Early
identification of risks and decrements in functioning and consequently
early physiotherapeutic interventions should thus complement med-
ical and surgical care in the acute hospital. The goals of these
interventions are to minimize the loss of functioning, to facilitate
recovery and to promote early independence. The recognition of
mechanisms and the origin of patients’ problems are an essential
part of the daily work of physical therapists. Physical therapists
S334
decide about how frequent and how long they treat individual
patients based on a number of considerations. However, there are
no studies that have examined the factors that influence decision
making and consequently the amount of resources provided. 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.
PARTICIPANTS: Patients with musculoskeletal conditions from a
representative sample of 23 primary, secondary and tertiary care
hospitals in different regions of Switzerland METHODS: The following
data were collected prospectively on functioning at admission
to hospital: socio-demographic characteristics, comorbidities, and
hospital characteristics. The outcome was measured as total time
of physiotherapeutic (PT) intervention during the inpatient stay.
ANALYSIS: Generalized linear mixed models were used to identify
the factors associated with PT intervention time. RESULTS: On
average, 234 patients (mean age 56.1 years, 50.0% female) had
364.2 hours of PT intervention time (median 272.5, 95% CI 320.9-
407.5). There was significant variation in intervention time across
hospital sites. About 30% of variation in the total sample could
be explained by site. Type of hospital (primary and secondary
care) and specialty (physical medicine and rehabilitation) were
variables associated with increased intervention time on the hospital
level. Single body function, body structure and activity categories
accounted for 36% of variation in intervention time within hospitals.
CONCLUSIONS: The amount of PT resources provided to patients
with musculoskeletal conditions is associated with several functioning
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
functioning instead of relying on summary scores. KEYWORDS: ICF,
International Classification of Functioning, Allocation of resources,
Intervention time. FUNDING ACKNOWLEDGEMENTS: We gratefully
acknowledge the Swiss Physiotherapy Association for its financial
support and the cooperation of all participants in this study.
ETHICS COMMITTEE: ethic committee of Zurich
Research Report Platform Presentation
2609 Tuesday 5 June 11:45
VCEC Meeting Rooms 19-20
DIAGNOSTIC ACCURACY OF CLINICAL DIAGNOSTIC TESTS
FOR SHOULDER IMPINGEMENT SYNDROME
Dale R, Bounds M, Crager K, Merkel B, Moore K; Department
of Physical Therapy, University of South Alabama, Mobile, AL, USA
PURPOSE: To determine the diagnostic accuracies of clinical tests
for assessing shoulder impingement syndrome (SIS) across the
Neer stages of impingement. RELEVANCE: Shoulder impingement
syndrome is one of the most common conditions of the shoulder,
resulting in pain and loss of function. Several clinical tests are fre-
quently utilized in diagnosing SIS, but little evidence exists describing
their diagnostic accuracy. Pooling sensitivity, specificity, and likelihood
ratios are indicators of diagnostic accuracy but their interpretation
is difficult when heterogeneity is present. Diagnostic odds ratios
(DOR), however, are relatively robust to heterogeneity. We therefore
performed a meta-analysis of the literature describing the diagnostic
accuracy of various clinical tests for SIS. PARTICIPANTS: Meta-
analysis of peer-reviewed investigations. METHODS: MEDLINE,
CINAHL, EMBASE, and SPORTDiscus were searched and the
references of various studies were subsequently reviewed to identify
other potential investigations. Studies included in the meta-analysis
were selected on the basis of comparing at least one clinical test
to arthroscopy. Studies were excluded if data were undeterminable
for extraction or it was the only study validating a particular test.
ANALYSIS: Data were extracted and pooled for various indicators of
diagnostic accuracy using Meta-disc for Windows (Barcelona, Spain).
WCPT 2007, Research Reports
RESULTS: Seven studies examining the accuracy of SIS clinical
tests met the criteria for inclusion. Of these seven studies, eight
clinical tests were described and many of the study results were
heterogenous. Among all clinical tests, the Hawkins-Kennedy test
demonstrated the highest pooled sensitivity of 83% for assessing
Stage I (95% CI, 74-89) and 74% Stage III (95% CI, 68-79). For
assessing Stage II, the Hawkins-Kennedy and the Neer test had
pooled sensitivities of 80% (95% CI, 74-89) and 82% (95% CI, 74-
88), respectively. The Drop Arm test showed the highest specificity for
Stage I, II, and III (82%, 87%, 94%, respectively). Pooled DOR data
was similar to sensitivities for Stage I and II, but Stage III pathology
was best detected with tests containing an active component and
this included the Supraspinatus test (4.8, 95% CI: 2.3-9.7), Drop
Arm (4.7, 95% CI: 1.7-12.9), and Painful Arc (4.5, 95% CI: 2.8-7.1).
CONCLUSIONS: Based on the results from this meta-analysis, either
the Hawkins-Kennedy or Neer tests had the highest sensitivities
for all stages of SIS. The Drop Arm test consistently had the
highest pooled specificities across all impingement stages. DOR data
supports the pooled sensitivities findings except in Stage III pathology
where the Supraspinatus, Painful Arc, and Drop Arm tests were
best. IMPLICATIONS: This study provides new information about the
diagnostic accuracy of various clinical tests across the various stages
of SIS pathology. Passive maneuver tests such as the Hawkins-
Kennedy and Neer test are best for detecting Stage I or II pathology,
whereas tests with an active component are superior for Stage
III. KEYWORDS: Shoulder, impingement, examination. FUNDING
ACKNOWLEDGEMENTS: No external funding was received for this
project.
Research Report Platform Presentation
3326 Tuesday 5 June 12:05
PP Crystal Pavilion B & C
ASSESSMENT OF MECHANICAL NECK FUNCTION IN A
VIRTUAL ENVIRONMENT: RELIABILITY STUDY
Sarig-Bahat H1 , Laufer Y2 , Weiss T3 ; 1 School of Physical Therapy,
University of Haifa, Israel; 2 School of Physical Therapy, University
of Haifa, Israel; 3 School of Occupational Therapy, University of
Haifa, Israel
PURPOSE: To assess the test-retest and inter-rater reliability of a
novel virtual reality (VR) assessment tool, and to evaluate the effect
of a single VR training session on cervical range of motion (ROM).
RELEVANCE: Mechanical Neck Disorders (MND) such as Whiplash
Associated Disorders (WAD) constitute a major cause of disability.
There is a need for an objective evaluation of the impairments
and disabilities associated with these injuries, in particular for
WAD, where secondary gains may have a significant effect on
assessment results. PARTICIPANTS: Fifteen subjects, aged 22-55
years, with no known neuromuscular pathology, history of spinal
disorders, visual or vestibular complaints. METHODS: The study
was approved by the Institutional Review Board. A three-dimensional
(3D) game-like virtual environment was developed to assess neck
function. A light-weight Head Mounted Display was worn by subjects
to view the game. A 3D two-sensor tracking system was used
to collect head motion data which controlled the game cursor.
Subjects were assessed twice during one session by two different
assessors, and then again during a second session, 3-7 days later.
ANALYSIS: ANOVAs were used to determine test-retest and inter-
rater reliability, and to determine the effect of a VR training session
on cervical ROM. Significance was set at p0.05. RESULTS: Tests
for inter-rater reliability showed no significant difference between
raters in all movement directions with 95% repeatability ranging
between 13-16 degrees. Test-retest analysis of flexion-extension
and side flexion (right and left) movements showed no significant
differences with 95% repeatability ranging between 17-18 degrees.
However, for rotational movements there were significant differences
between testing sessions. A significant increase of cervical ROM was
demonstrated in all movements following a single VR training session.
Platform Presentations, Tuesday 5 June
CONCLUSIONS: This novel paradigm has been demonstrated to
have good test-retest and inter-rater reliability in the assessment of
all neck movements except for rotation which failed to support test-
retest reliability. The single VR session training had a significant
effect on increasing neck ROM. IMPLICATIONS: The developed
neck assessment tool uses a virtual environment to reliably measure
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.
A study of the ability of this VR paradigm to reveal functional
neck disability in patients with MND is now underway. This may
also contribute to a greater understanding of normal and abnormal
cervical kinematics. The ultimate goal is to adapt the system for
the treatment of patients with MND. KEYWORDS: neck, reliability,
virtual reality. FUNDING ACKNOWLEDGEMENTS: Dean’s Research
Grant from the Faculty of Social Welfare and Health Studies at the
University of Haifa. Caesarea-Rothschild Institute at the University of
Haifa. CONTACT: hbahat@research.haifa.ac.il
ETHICS COMMITTEE: Ethics committee at University of Haifa, Israel
Research Report Platform Presentation
2949 Tuesday 5 June 12:05
VCEC Ballroom A
RAPID IMPROVEMENT IN BALANCE AND GAIT OF PATIENTS
WITH PARKINSON’S DISEASE THROUGH TRAINING ON
BALANCE AND DIVIDED ATTENTION
Capato T, Silva J, Lanzillo J, Piemonte M; Universidade de São Paulo
PURPOSE: The aim of this study was to assess the efficiency
of balance training carried out simultaneously with a cognitive
task, on balance and gait in patients with Parkinsons Disease
(PD patients). RELEVANCE: Of all PD motor symptoms, postural
instability is one of the most incapacitating, where loss of motor
independence by patients marks a significant stage of disease onset.
Physiotherapy, in conjunction with medication, plays an important
role in the treatment of this symptom, although no consensus has
been reached on the best approach to the problem. Recently, several
studies have proposed that deficiency in dividing attention associated
to the disease, may be one of the factors responsible for this
postural instability. Therefore, studies exploring the clinical potential
of treatment of divided attention are important for rehabilitation in
these patients. DESCRIPTION: A total of 14 PD patients participated
in this study, 8 men and 6 women, with a mean age of 70.5
years, and between stages 2 and 3 of disease evolution according
to the Hoehn and Yahr Classification. Results obtained through
the Berg Balance test, Time up go and Postural Stress test were
compared by paired test-t, before and after six individual 30-minute
training sessions. Training comprised 3 series of exercises, with 8
repetitions, performed in different situations of imbalance and in
parallel to a cognitive task, in which patients had to discriminate
random auditive signals. All patients agreed to and signed the
term of consent, approved by the ethics committee. EVALUATION:
Following training, significant improvements were seen in anticipatory
(Berg test: 49.57–53.57; T-value= 6.54; p-value= 0.0001), and
compensatory balance responses (Postural Stress test – 5.28–7.0; T-
value= 3.24; p-value=0.006), as well as in gait performance (Up to Go
Test: 8.80–7.80; T-value=4.93; p-value=0.0001). CONCLUSIONS:
The balance training carried out simultaneously with a cognitive
task was efficient to improve the balance and gait in PD patients.
IMPLICATIONS: Motor training, in conjunction with cognitive tasks
requiring division of attention, may improve balance and gait in
PD patients, stimulating the automatic motor control fundamental
for these tasks and should be consider in the elaboration of
physical therapy treatment for PD patients. KEYWORDS: Parkinson’s
S335
Disease, Balance, attention. FUNDING ACKNOWLEDGEMENTS:
None. CONTACT: taminec@yahoo.com.br
ETHICS COMMITTEE: ETHICAL COMMITIE OF HOSPITAL DAS
CLINICAS DA FACULDADE DE MEDICINA DA USP
Research Report Platform Presentation
944 Tuesday 5 June 12:05
VCEC Meeting Rooms 1-3
PATIENT SATISFACTION WITH PRIVATE PHYSIOTHERAPY IN
IRELAND
Casserley-Feeney S1 , Phelan M2 , Duffy F1 , Roush S3 , Cairns M2 ,
Hurley D1 ; 1 School of Physiotherapy & Performance Science,
University College Dublin, Ireland; 2 School of Health & Emergency
Professions,University of Herfordshire, Herts, UK; 3 Physical
Therapy Department, University of Rhode Island, Kingston, USA
PURPOSE: To establish patient satisfaction with private physiother-
apy in Ireland using the Physical Therapy Outpatient Satisfaction
Survey (PTOPS), a valid and reliable measure of patient satisfaction
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
measured within clinical settings, and there is no universally accepted
measure of patient satisfaction in physiotherapy. PARTICIPANTS:
Participants & Methods: The study comprised two stages: (1) A cross-
cultural translation/adaptation of the original PTOPS (developed in
USA) was undertaken by three Irish physiotherapists experienced in
musculoskeletal management, collated by the Ireland team leader
(DH), sent to the US team leader (SR) for retranslation by three
comparable American physical therapists. The retranslated US
version was found to be equivalent to the original PTOPS and
was used in this study. (2) A cross-sectional survey of patients
attending private physiotherapy clinics in Ireland was undertaken.
A sample of convenience of 40 private physiotherapy clinics were
selected, of which 24 agreed to participate. METHODS: Between
Sept 2005-April 2006 each clinic was sent 10 questionnaire
packages to be distributed to patients for anonymous completion
and return to the research team. ANALYSIS: Descriptive data
analysis was conducted using the Statistical Package for the Social
Sciences (SPSS, v.11). RESULTS: There was a 55% response
rate (n=131/240). Respondents were predominantly male (53.4%,
n=70), married (56.5%, n=74), employed (74.8%, n=98), with a
higher degree or professional qualification (54.2%, n=71), who
had attended physiotherapy for back pain (37.4%; n=49), and had
previous experience of physiotherapy (65.6%, n=86). Their mean
age (SD) was 37.69 years (12.44). The mean (SD) number and
total cost of treatments were 9 (8.67) and €352.86 (€322.86)
respectively, at an average cost per treatment of €40. The mean
(SD), optimum scores and scoring range for each PTOPS dimension
were:‘Enhancer’ 41.24 (3.78), 50, 10-50; ‘Detractor’ 19.38 (4.38), 10,
10-50; ‘Location’ 27.95 (4.11), 35, 7-35; ‘Cost’ 18.92 (2.82), 7, 7-35].
The results for, i) enhancers(i.e. satisfactory physical environment
and therapist-client interaction) and ii) clinic location were comparable
to the ‘ideal’ scores, whilst respondents were very dissatisfied with
the cost of private physiotherapy, and somewhat dissatisfied with
detractors (i.e. issues that, if not present, create negative feelings, but
if present, are not necessarily associated with positive feelings e.g.
the clinic being too crowded). The modal responses for the following
statements, which were scored on a five point scale from “excellent to
poor”, were: Overall rate of improvement: Very Good (40.5%; n=53).
Chance of recommending practice to a friend: Excellent (60.2%;
n=80). Overall Satisfaction: Very Good (42%; n=55). Chances of
returning to this clinic: Excellent (62.6%; n=82). CONCLUSIONS:
Conclusions & Implications: This study confirmed the feasibility of
measuring patient satisfaction and has provided values for private
physiotherapy in Ireland. IMPLICATIONS: A national comparative
survey of patient satisfaction with publicly-funded physiotherapy is
S336
underway. KEYWORDS: Private Physiotherapy, Patient Satisfaction.
FUNDING ACKNOWLEDGEMENTS: Health Research Board, Ire-
land for Research Project Grant. CONTACT: sarah.casserley@ucd.ie
ETHICS COMMITTEE: The study was approved by the University of
Hertfordshire Faculty Of Health And Human Sciences Radiography
And Physiotherapy Ethics Committee.
Research Report Platform Presentation
968 Tuesday 5 June 12:05
VCEC Meeting Rooms 11-12
OUTCOMES OF CYCLING AND/OR ELECTRICAL STIMULATION
FOR CHILDREN WITH SPINAL CORD INJURY
Johnston T, Lauer R, Smith B, Mulcahey M, Betz R; Shriners
Hospitals for Children, Philadelphia, PA, USA
PURPOSE: Determine the effects of cycling and/or electrical
stimulation on the musculoskeletal, respiratory, and cardiovascular
systems of children with spinal cord injury (SCI). RELEVANCE:
Children with SCI are at risk for secondary complications. Cycling
with functional electrical stimulation (FES) has led to improvements
in adults with SCI, but no studies have examined these effects
in children or have compared the effects of FES cycling to those
of passive cycling or electrical stimulation alone. PARTICIPANTS:
Seventeen subjects, ages 9.1 ±2.4 years, with American Spinal Injury
Association A or B SCI of 5.2 ±2.3 years duration participated.
Fifteen subjects sustained an SCI due to motor vehicle accidents,
one sustained an intrauterine SCI, and one subject’s SCI resulted
from chemotherapy. METHODS: Subjects were randomly assigned
to one of three interventions: functional electrical stimulation (FES)
cycling, passive cycling (PC), and electrically stimulated exercise
(ES). Children exercised one hour three times per week for 6
months at home. Data collected included stimulated quadriceps and
hamstrings strength, hip and knee bone mineral density (BMD),
lipid profiles, and heart rate (HR) and oxygen consumption (VO2/kg)
during arm ergometry. ANALYSIS: 2 x 2 ANOVAs (group x time) were
performed. RESULTS: Differences (p < 0.05) were seen between
groups over time for BMD at Ward’s triangle (hip) and the distal
femur with the FES groups having increases of 65.1 ±100% and
16.3 ±24.4% respectively. The PC group had increases at Ward’s
triangle (45.4 ±104.4%). The ES group had decreases at both
locations. Similar trends were seen at the femoral neck, overall hip,
and tibia with the FES group having increases in all areas, and
BMD in the PC group increasing only around the hip. There were no
significant differences between groups over time for other variables;
however trends were present. Stimulated strength improved in all
groups for the quadriceps by 126.3 ±88.6% (FES), 34.8 ±89.5%
(PC), and 49.6 ±87.1% (ES) and for the hamstrings by 45 ±49%
(FES), 52.2 ±44% (PC), and 16.4 ±27.8% (ES). All groups showed
decreases in triglyceride levels (FES: −15.7 ±22.2%, PC: −12.2
±10.2%, ES: −4.9 ±48.2%), but there were no changes in other
lipid measures. During arm ergometry, the FES group’s peak VO2/kg
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
groups (FES: −7.5 ±8.6%, PC: −4.5 ±21.9%, ES: −8.5 ±16.6%),
and resting HR declined in the FES (−11.2 ±10.8%) and PC
(−3.6 ±19.3%) groups, but not in the ES group (3.2 ±10.5%).
CONCLUSIONS: The FES group showed trends for having the
greatest overall changes; however improvements were seen in
the PC and ES groups, indicating that all 3 interventions may
provide benefits to children with SCI. IMPLICATIONS: Cycling and/or
electrical stimulation can improve health outcomes in children with
SCI and may lead to longer term musculoskeletal, respiratory, and
cardiovascular benefits. KEYWORDS: Spinal cord injury, pediatrics,
cycling. FUNDING ACKNOWLEDGEMENTS: Shriners Hospitals for
Children, Grant #8540. CONTACT: tjohnston@shrinenet.org
ETHICS COMMITTEE: Temple University Institutional Review Board
WCPT 2007, Research Reports
Research Report Platform Presentation
3132 Tuesday 5 June 12:05
VCEC Meeting Room 16
RISK FACTORS OF FRACTURES AMONG OLDER PERSONS IN
A FINNISH MUNICIPALITY – A POPULATION-BASED 12-YEAR
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,
Finland; 2 Härkätie Health Centre, Lieto, Finland; 3 Department
of Biostatistics, University of Turku, Turku Finland; 4 Pori Health
Centre, Pori, Finland; 5 Satakunta Central Hospital, Pori, Finland;
6 Unit of Family Medicine, Turku University Hospital, Turku, Finland
PURPOSE: The purpose of this study was to analyse gender
specific risk factors of fractures among persons 65 years or older
during the follow-up of 6 and 12 years. RELEVANCE: Long-term
risk factors of fractures should been identified and screened in
physiotherapy practice in order to reduce falls and fractures among
older persons. PARTICIPANTS: 1177 subjects aged 65 years or
older (482 men, 695 women), mean age 73 years (range 65-97),
living in the municipality of Lieto, located in South-Western Finland.
METHODS: A true population-based cohort study started in October
1990. Information about fractures among 1177 participants was
collected individually from health care registers during 1991-2002.
The mean follow-up period was 8.5 years. ANALYSIS: Subjects
having sustained at least one fracture during 6 or 12 year follow-
up period were compared with subject with no fractures at the
same follow-up period. Risk factors of fractures were analyzed using
Poisson regression model. All analyses were done separately for men
and women. RESULTS: In multivariate Poisson regression analyses
the independent risk factors among women during six years of
follow-up were weak hand grip strength (Relative Risk (RR) 2.2,
95% confidence intervals (95% CI) 1.2-4.0) low BMI (body mass
index) (RR 2.1, 95% CI: 1.3-3.4), poor cognitive ability (RR 2.4,
95% CI: 1.1-5.7), and in a chest radiogram observed compression
fracture in one or more thoracic vertebras (RR 2.3, 95% CI: 1.4-
3.8). In 12 years of follow-up the risk factors were weak hand grip
strength (RR 2.2, 95% CI: 1.4-3.4), low BMI (RR 2.0, 95% CI: 1.3-
2.8), and in the chest radiogram observed compression fracture
in one or more thoracic vertebras at base line (RR 2.0, 95% CI:
1.4-3.0). Among men a high amount of depressive symptoms (RR
3.6, 95% CI: 1.7-7.6), (RR 2.0, 95% CI: 1.2-3.4), and in the chest
radiogram observed compression fracture in one or more thoracic
vertebras (RR 4.1, 95% CI: 1.8-9.6), (RR 3.4, 95% CI: 1.8-6.2) were
related to the risk of sustaining at least one fracture during both
six and 12 years of follow-ups, respectively. CONCLUSIONS: The
Risk factors of sustaining fractures among persons 65 years or older
varied by gender. In the chest radiogram observed compression
fracture in one or more thoracic vertebras at base line was an
independent risk factor in both genders. IMPLICATIONS: This
new information about predictive, independent, and gender specific
risk factors provides new possibilities in prevention of falls and
fractures in clinical everyday work. More education for physiotherapist
and all health care professionals is needed. KEYWORDS: Risk
factors, fractures, older people. FUNDING ACKNOWLEDGEMENTS:
The baseline study was supported by The Academy of Finland,
The Yrjö Jahnsson Foundation, and The Finnish Anti-Tuberculosis
Association. The follow-up study of fractures was supported by The
La Carita Foundation, The Finnish Cultural Foundation; The Regional
Fund of Varsinais-Suomi – The Laina and Aarne Alitalo, The Juho
Vainio Foundation, grants from Satakunta Hospital District and Lieto
Health Centre, and the scholarship fund of the Ageing, Wellbeing and
Technology graduate school. CONTACT: maarit.piirtola@utu.fi
ETHICS COMMITTEE: The Joint Ethics Committee of the Turku
University and Central Hospital and the Finnish Ministry of Social
Affairs and Health.
Platform Presentations, Tuesday 5 June
Research Report Platform Presentation
2734 Tuesday 5 June 12:05
VCEC Meeting Room 17
A SINGLE CASE STUDY IN THE IMPLEMENTATION OF A
BEHAVIOURAL MODIFICATION MANUAL IN A CARDIAC
REHABILITATION CENTRE
Hopkins-Rosseel D; School of Rehabilitation Therapy, Faculty of
Health Sciences, Queen’s University, Kingston, Ontario, Canada
PURPOSE: To pilot a behavioural modification manual (BMM)
developed for use in cardiac rehabilitation (CR) with a focus on
enhancing the adoption of healthy exercise behaviours using a single
case study. RELEVANCE: The effectiveness of adopting exercise
regimes depends on the individual being able to initiate and maintain
the change over time yet, we may be limiting our effectiveness by
not evaluating individual’s readiness for change, their ability to make
change or continue that change over time. In the Transtheoretical
Model Model of Behaviour Change (TTM), or ‘Stages of Change’
(SOC), Prochaska and DiClemente (DiClemente, 82, 85, 90, 91;
Prochaska, 79, 82, 83, 85, 87, 88, 91, 92, 94, 97) proposed 5 SOC:
pre-contemplation, contemplation, action, maintenance and relapse.
An additional stage, preparation, was proposed in 1991. Subsequent
research lead to the development and validation of questionnaires
to measure and document patient’s their (1) stage of change, (2)
processes of change, (3) decisional balance and (4) degree of self-
efficacy. DESCRIPTION: A BMM in CR was developed based on the
TTM to enhance patient outcomes. The BMM includes an introduction
to the SOC model, the questionnaires and sections addressing
behaviours linked to cardiovascular risk: (i) smoking, (ii) nutrition,
(iii) exercise and (iv) stress. There is also a clinician instructional
component. A 58 year old female with known coronary artery disease
and one month post-myocardial infarction (MI), who was admitted to
an ambulatory multidisciplinary CR centre was recruited to the trial.
This patient was selected due to the patient’s history of a previous MI
with unsuccessful rehabilitation, no co-morbidities and an extensive
risk factor profile. She was a never smoker. The patient provided
her informed consent. The subject went through the 1st section of
the manual with the PT and then completed the questionnaires with
exercise as the primary outcome. The exercise section was used as
the primary intervention and the BMM was revisited monthly over 4
months. EVALUATION: The subject was in the contemplation SOC
on admission, rated ‘dramatic relief’ and ‘self-reevaluation’ as her
primary processes of change, demonstrated a precarious decisional
balance [DB] (cons 22: pros 15) and low self-efficacy [SE] (36 of
a possible 90). The subject was compliant (attendance at exercise
sessions 2x/week, education sessions 1x/week and counseling
sessions 1x/month). She also documented her daily walk in her
logbook but was sporadic at completing and recording her weekly
independent exercise session. BMI decreased from 31.6 to 29.1
kg/m2 and waist circumference decreased by 4.1 cm. At discharge
she rated her SOC as ‘action’, her DB was 10: 16 and her SE had
increased to 59. CONCLUSIONS: The BMM was user friendly and
its application with this subject appeared to improve her outcomes in
cardiac rehabilitation compared to her previous attempt. Although the
subject did move successfully forward, the measures suggested her
status would remain precarious until she entered the maintenance
stage, reported lower temptation and a higher SE. IMPLICATIONS:
The use of BMM with objective outcome measures may enhance
rehabilitation outcomes. Future study should randomize individuals
entering cardiac rehabilitation into a group using the manual and
a matched control group using usual interventions. KEYWORDS:
Behavioural modification, stages of change, rehabilitation practice
model. FUNDING ACKNOWLEDGEMENTS: Not applicable.
ETHICS COMMITTEE: Queen’s University Research Ethics Board
S337
Research Report Platform Presentation
3179 Tuesday 5 June 12:05
VCEC Meeting Room 18
MAPPING THE STROKE IMPACT SCALE TO THE INTERNA-
TIONAL CLASSIFICATION OF FUNCTIONING, DISABILITY AND
HEALTH: USING A STANDARDIZED PROTOCOL
Moriello C1 , Mayo N1 , Stolee P2 , Byrne K3 , Cieza A4 ; 1 School
of Physical and Occupational Therapy, McGill University,
Montreal, Quebec, Canada; 2 Lawson health Research Institute,
St. Joseph’s Health Care London Ontario Canada; 3 Rehabilitation
Sciences, University of Western Ontario, London Ontario Canada;
4 Department of Physical Medicine and Rehabilitation, University
of Munich, Germany
PURPOSE: The purpose of this study was to create coded functional
status indicators for the items of the SIS-16 using the ICF as a coding
framework. The specific aim is to describe the mapping protocol.
RELEVANCE: Electronic Health Records (EHR) are able to provide
a substantial amount of data for research in the clinical, population
and health related services. However, there is some valuable
information missing, such as a patients’ functional status (such as
the ability to perform activities of daily living). This information would
have great value for care planning and outcome measurement,
and in planning for service needs, but these data are typically
not being captured electronically in this new technological era.
PARTICIPANTS: Nineteen professionals from various disciplines.
METHODS: All participants received a training package prior to
this mapping exercise. It included a Power Point presentation that
explains the terminology of the ICF along with rules for mapping,
an article describing the rules for mapping existing items to the
ICF coding system, and the SIS-16 questionnaire. They were then
asked to assign alphanumeric codes to each item of the SIS-16
questionnaire. A Delphi technique was used to obtain consensus. In
addition, cognitive debriefing sessions were conducted with persons
with a stroke living in the community. The purpose of the sessions
was to determine the meaning of the chosen items to the individual.
ANALYSIS: The percentage of agreement was calculated for all
suggested codes. A percentage of agreement of greater than or
equal to 70% was selected a priori as a threshold that needed
to be met in order for a code to be endorsed. RESULTS: There
were 7 items that reached a 4 digit level consensus with agreement
ranging from 70 to 100%. At the 3 digit level, consensus was
reached for 5 items with agreement ranging from 89 to 100%. A
total of 3 items did not reach consensus therefore these items do
not have functional status indicators. Cognitive debriefing sessions
demonstrated some inconsistency between interpretation among
different respondents and the developers of the questionnaire. Also
uncovered was gaps in the ICF relating to common constructs in
physical therapy. For example, balance is not represented in the
ICF, but equilibrium is coded under dizziness. CONCLUSIONS:
There exists a degree of conceptual ambiguity between terminology
commonly used in physical therapy and its outcome measures and
the ICF. Communication is facilitated by having a common language
and the ICF framework should be adopted. On a practical level it
makes more sense to develop a measure based on the ICF. This
would reduce ambiguity in terminology. Items should then also be
written in a manner that the respondents will interpret the items as
they are defined by the ICF. IMPLICATIONS: This demonstrates the
added benefit of using the ICF to map existing measures, its value
for the electronic health era and also to use as a foundation to the
future developed measures. KEYWORDS: electronic health records;
mapping; ICF; SIS-16. FUNDING ACKNOWLEDGEMENTS: CIHR.
S338
Research Report Platform Presentation
3098 Tuesday 5 June 12:05
VCEC Meeting Rooms 19-20
WHAT IS THE BEST CLINICAL TEST FOR IDENTIFYING SLAP
LESIONS OF THE SHOULDER? RESULTS OF A SYSTEMATIC
REVIEW
Walton D, Sadi J; The University of Western Ontario
PURPOSE: To identify the best clinical test for identifying SLAP
lesions of the shoulder, based on critical evaluation of available
evidence using pre-defined criteria. RELEVANCE: SLAP lesions
are difficult to manage conservatively. Arthroscopic repair is the
management approach of choice. Gold standard evaluation, including
MR arthrography and arthroscopic investigation are not always
feasible. Clinicians would benefit from the ability to screen for these
conditions prior to referral for more invasive work-up. There are a host
of tests described in the literature, many of which report diagnostic
accuracy which is not repeated in subsequent investigations. A
new critical appraisal of this literature is needed. PARTICIPANTS:
N/A METHODS: Key databases were searched and articles that
fit our inclusion criteria were retained for evaluation. Articles were
graded based on the presence of 4 criteria for methodologic
validity, diagnostic accuracy, risk of flaring an irritable condition, and
difficulty in learning the technique and interpreting the results of the
test. ANALYSIS: N/A RESULTS: A total of 12 published articles
describing 14 different tests for SLAP lesions were retained for review.
As expected, the findings of high sensitivity and specificity reported
in the initial development report of many tests were not repeated
by subsequent investigations. Critical review reveals methodologic
problems in many articles. The Resisted Supination/External Rotation
test received the highest grade in this review. CONCLUSIONS:
Clinicians should be prepared to critically evaluate reports of
new clinical tests as we discovered many methodologic limitations
in currently-available literature. The Resisted Supination/External
Rotation test appears to be the best available clinical test for
identifying SLAP lesions, although this test has yet to be investigated
in groups other than the initial validation report. IMPLICATIONS:
The Resisted Supination/External Rotation test appears to be a
useful screening tool for identification of patients who would benefit
from more invasive diagnostic exploration. KEYWORDS: SLAP,
systematic review, clinical test. FUNDING ACKNOWLEDGEMENTS:
The authors received no funding in support of this project. CONTACT:
dwalton5@uwo.ca
Research Report Platform Presentation
1094 Tuesday 5 June 12:45
PP Crystal Pavilion B & C
THE INFLUENCE OF EXAMINER EXPERIENCE ON ACCURACY
AND INTERPRETATION OF THE CERVICAL FLEXION-ROTATION
TEST IN CERVICOGENIC HEADACHE EVALUATION
Hall T1 , Robinson K1 , Fujinawa O2 , Akasaka K3 ; 1 Curtin University,
Perth, Western Australia; 2 Saitama Prefectural University, Saitama,
Japan; 3 Saitama Medical University College, Saitama, Japan
PURPOSE: The cervical flexion-rotation test (FRT) is used to
identify C1/2 segmental dysfunction in cervicogenic headache
(CGH). Previous research has provided preliminary evidence of
agreement, sensitivity and specificity for this test for experienced
examiners, but no studies have investigated these characteristics
for inexperienced/naive testers. Therefore the purpose of this study
was to determine whether inexperienced examiners have the same
accuracy and agreement, when using the FRT, as experienced
examiners. A secondary objective was to establish the accuracy of
the FRT at identifying C1/2 dysfunction in a mixed sample, with CGH
arising from varied cervical symptomatic segments. RELEVANCE:
CGH is a common condition frequently managed by physiotherapy. A
novel exercise approach has been developed by Mulligan to manage
CGH in subjects with identified FRT dysfunction. This approach
WCPT 2007, Research Reports
is routinely taught on short post-graduate Mulligan Concept and
other courses. It is therefore important that physiotherapists using
this approach must be able to accurately identify the presence
and degree of FRT dysfunction. PARTICIPANTS: This study was
staged in two parts. In the first, two experienced examiners
independently evaluated 20 subjects with CGH of C1/2 origin, 10
asymptomatic subjects and 10 CGH subjects not of C1/2 origin, for
FRT dysfunction and agreement determined. CGH was based on
published guidelines for headache classification. Cervical segmental
level of involvement was based on manual diagnosis. In the second
part, two inexperienced and one experienced examiners evaluated
the FRT in 12 CGH and 12 asymptomatic subjects and agreement
determined. Subjects were a sample of convenience. METHODS:
Ethical approval was granted for this study. The rights of individuals
were respected at all times and all subjects provided written informed
consent. An index of headache severity and demographic data
was determined by questionnaire. FRT range was measured to
the left and right using a goniometer placed on the apex of
the skull. Examiners were blind to each other and independently
measured FRT range and were required to classify the FRT as
positive if there was a greater than 10 degree reduction in range.
ANALYSIS: ANOVA and planned orthogonal comparisons were
used to analyze FRT range. Bland-Altman and linear regression
plots were produced for each comparison between examiners.
Sensitivity, specificity and agreement of the FRT were analyzed
using cross tabulation and a receiver operating curve. RESULTS:
Mean sensitivity and specificity of the FRT was 90% and 88%
with 92% agreement for experienced examiners (p < 0.001). Overall
diagnostic accuracy was 89% (p < 0.001) and kappa 0.85. For
inexperienced examiners, FRT range was significantly greater than
for experienced examiners, but sensitivity, specificity, agreement and
kappa values were all within acceptable levels for clinical tests.
Accuracy of the FRT is not diminished in CGH diagnosis when the
sample comprises mixed levels of symptomatic cervical segments.
CONCLUSIONS: The FRT can be used accurately and reliably by
experienced and inexperienced examiners and is a useful aid in CGH
evaluation. IMPLICATIONS: This study should give inexperienced
examiners increased confidence in their ability to diagnose FRT
dysfunction. KEYWORDS: Headache, manual diagnosis. FUNDING
ACKNOWLEDGEMENTS: This study was unfunded. CONTACT:
halltm@netspace.net.au
ETHICS COMMITTEE: Curtin University Human Research Ethics
Committee
Research Report Platform Presentation
1962 Tuesday 5 June 12:45
VCEC Meeting Rooms 11-12
DISTINCTION BETWEEN PARESIS AND DEXTERITY: A
CLINICAL CHALLENGE IN SCI
Wirth B1,2 , van Hedel H1 , Curt A3 ; 1 Spinal Cord Injury Center,
Balgrist University Hospital, Zurich, Switzerland; 2 Swiss Federal
Institute of Technology, Zurich, Switzerland; 3 ICORD, University
of British Columbia, Vancouver, Canada
PURPOSE: Motor performance after a lesion of the central nervous
system can be affected by both muscle weakness (paresis) and
dexterity (the ability for coordinating muscle activity to meet
environmental demands).The aims of this study were (1) to develop
a simple foot motor test that gives deeper insight into motor recovery
after incomplete spinal cord injury (iSCI) (by being applicable from the
acute stage after iSCI throughout rehabilitation and by distinguishing
between paresis and impaired dexterity) and (2) to link its results to
ambulatory capacity. RELEVANCE: At present, motor assessments
after iSCI are limited to isometric muscle tests and gait tests.
However, in addition to isometric muscle strength, dynamic muscle
performance is of particular importance for safe locomotion and
walking tests are of limited value in monitoring the early stage of
recovery after iSCI. Regarding new treatment strategies in SCI,
Platform Presentations, Tuesday 5 June
there is a need for precise assessment of motor recovery after
iSCI. PARTICIPANTS: For the first study, 16 in- and outpatients
(5 females; mainly ASIA C and D; mean age 53.6±17.0 years)
with iSCI were recruited at an SCI center in Zurich, Switzerland.
16 healthy subjects (mean age 51.9±14.4 years) were matched for
gender and age. Gait capacity was tested in 20 iSCI patients (6
females; ASIA C and D; mean age 55.8±14.3 years). METHODS:
The subjects had to perform auditory-paced repetitive ankle dorsi-
and plantarflexion movements (0.8 to 3.2 Hz at intervals of 0.4
Hz) in supine position as accurately in timing and with the largest
range of motion (ROM) possible. Ankle movements were measured
by an electric goniometer. Walking speed was assessed by a 10
meter walk test at preferred and maximal speed. ANALYSIS: ROM
and peak velocity of dorsi- and plantarflexion was determined per
movement cycle and averaged for each frequency. Accuracy of timing
was calculated by determining the duration of each movement cycle.
The average was then converted to a frequency and compared to
the target frequency. RESULTS: 1. The iSCI subjects were able
to follow the target frequency with high accuracy (up to 1.6 Hz,
healthy subjects to 2.4 Hz). The difference in accuracy between
the two subject groups was not significant prior to 3.2 Hz. However,
ROM and peak velocity for dorsi- and plantarflexion were significantly
reduced at all frequencies in the patient group. 2. The peak
velocity in dorsiflexion at 2.4 Hz (=frequency, where absolute peak
velocity was reached on average) of the more affected leg highly
correlated to maximal (Spearman correlation coefficient rS=0.86) and
preferred gait speed (rS=0.85). CONCLUSIONS: Foot dorsal- and
plantarflexion movements allow for distinguishing between paresis
and reduced dexterity. In longitudinal studies, the quantification
of these movement components is thought to give insight into
the mechanisms of motor recovery after iSCI. IMPLICATIONS:
Deeper understanding of the mechanisms underlying motor recovery
after iSCI might contribute to focusing rehabilitation strategies after
iSCI. KEYWORDS: Incomplete spinal cord injury, paresis, dexterity.
FUNDING ACKNOWLEDGEMENTS: This study was supported by
the International Spinal Research Trust (ISRT), Clinical Initiative
Stage II. CONTACT: bwirth@paralab.balgrist.ch
ETHICS COMMITTEE: Kantonale Ethikkommission des Kantons
Zurich, Zurich, Switzerland
Research Report Platform Presentation
1737 Tuesday 5 June 12:45
VCEC Meeting Room 18
EVALUATING TWO IMPLEMENTATION STRATEGIES FOR
WHIPLASH GUIDELINES IN PHYSIOTHERAPY: A CLUSTER
RANDOMISED TRIAL
Rebbeck T; School of Physiotherapy, University of Sydney
PURPOSE: The purpose of this cluster randomised trial was to
evaluate two implementation strategies for whiplash guidelines.
RELEVANCE: This study is relevant to the education and research
tracks of the conference. The clinical guidelines that are implemented
are based on best evidence, as obtained from a systematic review.
Increasingly, clinical guidelines are used as a method to facilitate
evidence based practice, and this study is one of only 3 studies
published on implementing clinical guidelines in physiotherapy.
PARTICIPANTS: 100 physiotherapy clinics in two states of Australia
(NSW and ACT) that had seen at least five whiplash cases in
the previous year were identified from an insurer database. They
were ranked by median cost per whiplash claim by the insurer.
Invitations to participate in the study were sent to 24 physiotherapy
clinics in the highest, and 24 clinics in the lowest quartiles.
Twenty-seven physiotherapy clinics agreed to participate and were
randomised into an implementation group (n=14) or a dissemination
group (n=13). One hundred and three patients presenting to the
physiotherapists with acute whiplash participated (implementation
group n=72, dissemination group n= 31). METHODS: We conducted
a cluster-randomised controlled trial, with physiotherapists the unit
S339
of randomisation. The implementation group underwent education
by opinion leaders about whiplash guidelines and the dissemination
group had the guidelines mailed to them. The primary outcome
was patient disability, measured using the Functional Rating Index,
collected on admission to the trial and at 1.5, 3, 6 and 12 months.
Physiotherapist knowledge about the guidelines was measured using
a custom made questionnaire. Physiotherapist practice and cost of
care were measured by audit of patient notes. ANALYSIS: Patient
outcomes were analysed using an independent t test and adjusted
for the cluster effect using the ACLUSTER software developed by
Pinol and Piaggio (2000). Physiotherapist knowledge and practice
outcomes were analysed using linear regression for continuous
data (eg total questionnaire score and cost of care) adjusted for
the before trial score, Mann Whitney test for ordinal data and Chi
Square test for categorical data. RESULTS: There were no significant
differences between groups for any of the patient outcomes at any
time. The implementation patients had 0.6 (95% CI −7.8 to 6.6)
less disability than the dissemination patients at 12 months. 44%
more physiotherapists in the implementation group reported that
they prescribed the two endorsed treatments of reassurance and
advice to act as usual, and 32% more actually prescribed them.
The cost of care for patients in the implementation group was $255
(95% CI −1505 to 966) less than for patients in the dissemination
group. CONCLUSIONS: Although the active implementation program
increased guideline-consistent practice, patient outcomes and cost
of care were not affected. IMPLICATIONS: Future implementation
strategies for clinical guidelines in physiotherapy may be guided
by our results, given an active implementation strategy including
education successfully changed physiotherapy practice. However, in
order to change patient health outcomes, we suggest implementation
strategies in the future may need to target practitioners whose
baseline practice deviates more substantially from the guidelines,
and suggest that some elements of the guideline content may not
be essential. KEYWORDS: health plan implementation, practice
guidelines, whiplash injuries. FUNDING ACKNOWLEDGEMENTS:
This study was funded by the Motor Accidents Authority of New
South Wales, who also provided administrative assistance. This
organisation, which is the regulator of compulsory third party
insurance companies had no part in the analysis of the data or
reporting of this study. CONTACT: baystphysio@optusnet.com.au
ETHICS COMMITTEE: University of Sydney Human Research Ethics
Committee
Research Report Platform Presentation
1513 Tuesday 5 June 13:05
PP Crystal Pavilion B & C
CERVICAL RANGE OF MOTION IN WHIPLASH
Woodhouse A, Vasseljen O; NTNU – Norwegian University
of Science and Technology, Faculty of Medicine, Dep of Community
Medicine and General Practice, Trondheim, Norway
PURPOSE: The aim of this study was to investigate group differences
in cervical range of motion (ROM) between persons with persistent
whiplash-associated disorders (WAD), persons with chronic non-
traumatic neck pain and asymptomatic volunteers. Primary and
conjunct ranges of motion were measured. RELEVANCE: Evidence
suggests that cervical ROM can be an indicator of physical
impairment in the cervical spine. Cervical ROM has also been
found capable of discriminating between asymptomatic persons
and persons with persistent WAD. There is however inconclusive
evidence on differences between persons with persistent WAD and
persons with persistent non-traumatic neck pain. In the diagnosis
and treatment of persons with persistent WAD there is still a need to
explore ROM in this group PARTICIPANTS: The study participants
were divided into three groups: A “WAD group” of 56 persons with
persistent WAD (22 men, 34 women, mean age 38.0 years), a
“neck group” of 53 persons with chronic non-traumatic neck pain
(19 men, 34 women, mean age 43.9 years) and a control group
S340
of 57 asymptomatic volunteers (29 men, 28 women, mean age
38.2 years). METHODS: Three dimensional cervical motion ranges
were measured using a 3Space Fastrak™ device (Polhemus, Inc,
Colchester, Vermont, USA). All measurements were done in a
seated position with shoulders fixed to a backrest. Movements were
assessed in the full range of the three primary motion planes. Three
repetitions of each movement were performed. ANALYSIS: Mean
values of ROM and conjunct motion for each subject were computed
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
all primary motion planes was significantly different between the
three groups, sagittal plane being most affected. Conjunct motions
were significantly different between groups in some motion planes.
CONCLUSIONS: Cervical ROM differentiated between the three
groups in all planes. IMPLICATIONS: The relevance of Cervical ROM
and conjunct motion in the diagnosis and treatment of WAD should
be acknowledged. KEYWORDS: WAD, neck pain, Fastrak, Cervical
Range of Motion. FUNDING ACKNOWLEDGEMENTS: The project
received financial support from The Norwegian Fund for Postgraduate
Training in Physiotherapy. CONTACT: astrid.woodhouse@ntnu.no
ETHICS COMMITTEE: Regional ethichs committe in Trondheim,
Norway.
Research Report Platform Presentation
2220 Tuesday 5 June 13:05
VCEC Meeting Rooms 11-12
RELIABILITY OF ASSESSMENT TOOLS TO MEASURE
UNSUPPORTED SITTING BALANCE IN PEOPLE WITH SPINAL
CORD INJURIES
Boswell-Ruys C1 , Sturnieks D1 , Lord S1 , Harvey L2 , Sherrington C1 ,
Middleton J2 ; 1 Prince of Wales Medical Research Institute and
University of New South Wales, Sydney, Australia; 2 Rehabilitation
Studies Unit and University of Sydney, Sydney, Australia
PURPOSE: The ability to maintain balance in sitting is an important
determinant of independence in people with spinal cord injuries (SCI).
However, there are as yet no standardised measures of seated
balance. The aim of this study was to develop simple and reliable
measurements of unsupported sitting balance in people with SCI.
RELEVANCE: Physiotherapists spend a large percentage of reha-
bilitation time training seated balance, yet the lack of measurement
tools leaves therapists unsure of the effectiveness of their treatment.
PARTICIPANTS: 30 people with SCI participated in this study. Sub-
jects were recruited from the community and the local hospital. Each
subject’s level of injury was between C6 and L1 and the classification
varied from complete (AISA A) to incomplete (AISA B, C or D).
METHODS: Subjects performed a battery of tests, which were modi-
fications of balance tests used in other populations. Each subject was
assessed on two different occasions to determine the test-retest relia-
bility. These included a test of fast alternating arm reaching; timed un-
supported sitting; a maximal torso leaning test; a test of co-ordinated
stability; a seated upper body/arm reach test; and the donning/doffing
of a T-shirt. ANALYSIS: Intraclass correlation coeffients (ICC3,1 ) were
calculated for each outcome measure. The Mann Whitney U test was
applied to detect differences in chronicity and injury level. RESULTS:
All the tests showed good to excellent reliability scores (ICC3,1
0.719 to 0.912). The most repeatable tests were donning a T-shirt
(ICC3,1 0.912) and the test of unsupported maximal torso leaning
(ICC3,1 0.904). The fast alternating reach and T-shirt tests appeared
to discriminate between subject injury level (p = 0.005 and 0.003
respectively). The torso leaning, co-ordinated stability and seated
reach tests appeared to discriminate chronicity (p = 0.002, 0.008 and
0.002 respectively). CONCLUSIONS: The tests were simple, quick
to administer, and reliable. The battery of tests will be utilised in
a randomised controlled trial to evaluate the effectiveness of sitting
balance training in the SCI population. IMPLICATIONS: The tests
WCPT 2007, Research Reports
would be appropriate for research and clinical use in the assessment
of unsupported sitting balance in people with SCI. KEYWORDS:
SCI, Balance, Measurement. FUNDING ACKNOWLEDGEMENTS:
Supported by the NSW Premier’s Spinal Cord Injury Grant Program
and the National Health and Medical Research Council of Australia.
ETHICS COMMITTEE: Royal Rehabilitation Centre Sydney Ethics
Committee and South East Health Human Research Ethics Commit-
tee
Research Report Platform Presentation
1976 Tuesday 5 June 13:05
VCEC Meeting Room 18
THE DEVELOPMENT AND EVALUATION OF A MULTIFACETED
IMPLEMENTATION STRATEGY TO IMPLEMENT THE DUTCH
GUIDELINES FOR PHYSICAL THERAPY IN PARKINSON’S
DISEASE
Munneke M1 , Keus S2 , Nijkrake M1 , Kwakkel G3 , Bloem B1 ;
1 Radboud University Nijmegen Medical Centre, Netherlands;
2 Leiden University Medical Center, Netherlands; 3 VU Medical
Center, Amsterdam, Netherlands
PURPOSE: To develop a multifaceted implementation strategy in
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,
physical therapy is often prescribed. In the Netherlands more than
60% of PD patients are referred to an physiotherapist. In 2004
an evidence-based clinical practice guideline for physical therapy
in PD was distributed to all physical therapists in the Netherlands
(available via www.kngf.nl and www.cebp.nl). However, distribution
hardly ever results in implementation. Therefore, we developed an
implementation strategy and evaluated this strategy. DESCRIPTION:
The implementation strategy consists of six steps: 1) selection of
therapists who applied to participate in a small PD expert network;
2) a 4.5 day, competence oriented basic course in covering PD in
general, and correct use of the guideline for physical therapy in
PD; 3) a web-based learning management system which facilitates
continuous education (e.g. completing tasks, sharing knowledge,
exchanging experiences) combined with feedback from coaches;
4) two-monthly seminars in which PD related topics will be discussed;
5) a decision supporting, web-based electronic patient record which
guides the therapist through the guideline; 6) involvement of referring
physicians. EVALUATION: The multifaceted implementation strategy
has started in eight regions in the Netherlands. Willingness to enrol in
a PD network was high. Forty-three therapists are selected to enroll
in the PD expert network. These therapists are continuous educated
through the PD basic course, the web-based learning management
system, and the electronic patient record. To evaluate the effective-
ness of the implementation strategy, we have started a large cluster
Randomised trial, the ParkNet Trial. Sixteen clusters (departments
of neurology of general hospitals), localized around three university
medical centers, are randomly allocated to an experimental group
(network care lusters) or a usual care group (unchanged care). In the
network care clusters, the implementation strategy is implemented.
We intend to include at least 800 eligible patients in the 16 clusters.
All medical records of participating centres (n=3403) are screened
and more than 700 patients enrolled already in our study. All patients
will be followed for six months. Primary outcome measures are a
patient preference outcome scale for limitations in activities, a Dutch
validated version of the Dutch Parkinson’s Disease Questionnaire-
39 (PDQ-39) Mobility domain, and costs. CONCLUSIONS: A
multifaceted implementation strategy aimed at implementation of the
Dutch guidelines of Physical Therapy in Parkinson’s Disease has
been developed and will be evaluated within a cluster randomised
trial. IMPLICATIONS: If our multifaced implementation strategy
proves to be effective it can be used for the implementation of other
guidelines in order to improve the quality of Physical Therapy Care.
KEYWORDS: Guidelines; Parkinson’s Disease; Implementation.
Platform Presentations, Tuesday 5 June
FUNDING ACKNOWLEDGEMENTS: The ParkNet trial is financial
supported by the Netherlands Organisation for Health Research and
Development (ZonMW). CONTACT: m.munneke@neuro.umcn.nl
ETHICS COMMITTEE: The ethics commitee of the UMC st Radboud,
Nijmegen, the Netherlands
Research Report Platform Presentation
3244 Tuesday 5 June 13:25
PP Crystal Pavilion A
HERITABILITY OF LOW BACK PAIN AND THE ROLE OF DISC
DEGENERATION
Battié M1 , Videman T, Levalahti E, Gill K, Kaprio J; 1 Department
of Physical Therapy, University of Alberta, Canada
PURPOSE: Twin studies suggest that both disc degeneration and
back pain have a genetic component. We were interested in
estimating the heritability of low back pain in men and examining
whether genetic influences on back pain are mediated through
genetic influences on disc degeneration. RELEVANCE: Understand-
ing possible conditions underlying back pain are critical for the
development of rational treatment interventions. PARTICIPANTS:
Subjects included 147 monozygotic and 153 dizygotic male twin pairs
(N=600 subjects) from the population-based Finnish Twin Cohort.
METHODS: All subjects underwent lumbar magnetic resonance
imaging and completed an extensive interview, including back pain
history and exposure to suspected risk factors. Disc height narrowing
was the degenerative finding most associated with pain history, and
was used to index disc degeneration in the models. ANALYSIS:
We conducted a classic twin study with multivariate quantitative
genetic models to estimate the degree to which genetic (or
environmental) effects on back pain were correlated with genetic (or
environmental) effects on disc degeneration. RESULTS: Statistically
significant genetic correlations were found for disc height narrowing
and different definitions of back pain, such as duration of the
worst back pain episode (rg=0.46) and hospitalization for back
problems (rg=0.49), as well as disability in the previous year from
back pain (rg=0.33). The heritability estimates for these back pain
variables ranged from 30% to 46%. There also were statistically
significant, but weaker environmental correlations for disc height
narrowing with back symptoms over the prior year. CONCLUSIONS:
A substantial minority of the genetic influences on pain was due
to the same genetic influences affecting disc degeneration. This
suggests that disc degeneration is one pathway through which genes
influence back pain. IMPLICATIONS: These results add to our
understanding of genetic influences on low back pain and possible
mechanisms through which genes and environment influence
symptoms. KEYWORDS: low back pain, disc degeneration, genetics.
FUNDING ACKNOWLEDGEMENTS: Funding was received from
the Alberta Foundation for Medical Research, the NIH, the Finnish
Academy and the Canada Research Chairs Program.
ETHICS COMMITTEE: The study was approved by the University of
Alberta Health Ethics Review Board.
Research Report Platform Presentation
1689 Tuesday 5 June 13:25
PP Crystal Pavilion B & C
FUNCTIONAL SELF-EFFICACY MEDIATES THE RELATION
BETWEEN FEAR OF MOVEMENT AND OUTCOME IN PATIENTS
WITH CHRONIC NECK PAIN
Woby S1,2 , Urmston M1,2 , Thompson D1,2 ; 1 Department of
Physiotherapy, North Manchester General Hospital, Manchester,
United KIngdom; 2 Centre for Rehabilitation Science, University
of Manchester, Manchester, United Kingdom
PURPOSE: There is a paucity of data relating to whether self efficacy
and fear of movement predict outcome in patients with chronic
neck pain (CNP). Consequently, the purpose of this study was to
S341
determine whether self-efficacy and fear of movement were related
to outcome in patients with CNP. Furthermore, the study explored
the extent to which self-efficacy mediated the relation between fear of
movement and outcome. RELEVANCE: Physical therapists are often
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
contribute to the disability levels of patients with CNP. If these factors
contribute to disability then strategies that explicitly target these
cognitive factors could be utilised during treatment. PARTICIPANTS:
Data were collected from 64 patients with non-specific chronic neck
pain who had been referred to a physical therapy department. All of
the patients exhibited an elevated fear of movement (TSK > 39). Fifty-
six percent were female, the mean age was 43.3 years (SD=14.3)
and the mean duration of symptoms was 3.6 years (SD=6.5). Thirty-
seven percent reported that their pain had started following a motor
vehicle accident, 18% were not working because of their neck pain,
and 32% were pursuing medico-legal compensation. METHODS:
Prior to treatment patients completed the Neck Disability Index
along with the Tampa Scale for Kinesiophobia and the Chronic
Pain Self-Efficacy Scale. ANALYSIS: Multi-step linear regression
analysis (Baron & Kenny, J Pers Soc Psychol 1986; 51:1173-82)
was performed to determine whether self-efficacy mediated the
relation between fear of movement and outcome. In Analysis 1,
age, sex, pain duration and fear of movement were the independent
variables and total NDI score was the dependent variable. In Analysis
2, self-efficacy was entered as the dependent variable and the
independent variables were the same as those entered in Analysis
1. In Analysis 3, total NDI score was the dependent variable but
self-efficacy was added to the set of independent variables. For
a mediational effect to exist, fear of movement should significantly
contribute to the prediction of outcome in Analysis 1 and 2, but
not in Analysis 3 after the introduction of self-efficacy. RESULTS: In
Analysis 1, fear of movement predicted outcome (b = 0.32; P < 0.01).
In analysis 2, fear of movement predicted self-efficacy (b = −0.42;
P < 0.01). In the third analysis, total NDI score was entered as
the dependent variable (same as Analysis 1) and self-efficacy was
entered as an additional independent variable. The model explained
25% of the variance in outcome. Following the introduction of self-
efficacy, fear of movement no longer predicted outcome (b = 0.15;
P > 0.05) whereas self-efficacy emerged as a strong predictor (b
= −0.42; P < 0.01). CONCLUSIONS: Functional self-efficacy and
fear of movement were related to outcome in patients with CNP.
Furthermore, functional self-efficacy mediated the relation between
fear of movement and outcome. IMPLICATIONS: Physical therapists
should employ techniques that reduce fear of movement and
increase functional self-efficacy when treating patients with CNP.
KEYWORDS: Fear of Movement, Self-Efficacy, Neck Pain. FUNDING
ACKNOWLEDGEMENTS: This study was funded by Pennine Acute
NHS Trust. CONTACT: steve.woby@pat.nhs.uk
ETHICS COMMITTEE: North Manchester Local Research Ethics
Committee
Research Report Platform Presentation
3011 Tuesday 5 June 13:25
VCEC Meeting Rooms 11-12
DEVELOPMENT OF A SITTING BALANCE SCALE FOR
PATIENTS WITH SPINAL CORD INJURIES
Eksteen C1 , Bührs D2 , Van der Bon L, Maritz L, Motsi V,
Tieleman E; 1 University of Pretoria South Africa; 2 Netcare
Rehabilitation Hospital (S I T Lab)
PURPOSE: The need for an objective outcomes measure to
quantify patients with spinal cord injuries’ (SCI) balance (stability)
in sitting on a low plinth as well as in their wheelchairs was
identified during consultation sessions on the recommendation of
suitable seating equipment. Such an objective outcomes measure
specifically for patients with SCI could not be found in the literature.
S342
This study therefore focused on the development of an objective
outcomes measure for quantifying the patient’s siting balance.
RELEVANCE: A balance scale for SCI patients in sitting would
provide physiotherapists (rehabilitation therapists) with an objective
tool to quantify a patient’s progress during rehabilitation, give
feedback to health care providers, patients’ care-givers and health
care funders about the patient’s progress. PARTICIPANTS: Six
participants with complete C5-L2 spinal cord injuries were recruited
from a private spinal unit. The participants ranged from one week to
fifteen (15) months post injury. All the subjects were male, between
17 and 38 years of age: mean age being 28.17 years (SD = 6.91).
None of the participants had pressure sores and their spasticity did
not prevent them from performing the activities of the balance scale.
All of the subjects were permanent wheelchair users. An expert
panel consisting of 5 members and a special interest in neurological
and spinal rehabilitation, were recruited. Each of the members had
ten or more years of clinical experience. METHODS: A descriptive,
analytical exploratory research methodology was implemented. All
participants signed an informed consent form and the study was
approved by the Ethics Committee of the University of Pretoria.
The study was conducted in four phases. (1) Conceptualization and
development of a concept balance scale; (2) Testing the balance
scale on patients while being video-recorded during the performance
of the activities of the balance scale. The procedure was repeated
twice but participants were differently clothed differently during the
second time to give the impression of being tested on the scale
on different occasions; (3) Evaluation of the balance scale as an
evidence based outcomes measuring tool by a panel of expert
physiotherapists in the rehabilitation of patients with SCI. (4) Phase
4: Analysis and categorization of the comments of the expert panel.
ANALYSIS: Coding and categorisation of the comments made by
the expert panel members. Intraclass Correlation Coefficients (ICC)
was used to determine the inter and intrarater reliability of the
numerical values given to each patient’s performance of the activities.
RESULTS: Intrarater as well as interrater reliability of the panel
members varied between excellent (a score of 1) and poor (a score of
0.12). On the whole the intra and interrater reliability of the assesment
of activities in sitting in the wheelchair were better than in sitting
on the low plinth. Comments of the expert panel were implemented
to enhance the user-friendliness of balance scale. CONCLUSIONS:
The final balance scale is a valuable outcomes measure to assess
a patients with SCI’s balance in sitting. It should be refined through
testing in a variety of clinical environments. IMPLICATIONS: The
balance scale contribute towards evidence based rehabilitation
of patients with SCI. KEYWORDS: Balance scale, Spinal Cord
Injury, Outcomes measure. FUNDING ACKNOWLEDGEMENTS:
Unfunded. CONTACT: carina.eksteen@up.ac.za
ETHICS COMMITTEE: Ethics Committee of the University of Pretoria
Research Report Platform Presentation
3186 Tuesday 5 June 13:25
VCEC Meeting Room 18
EVALUATION OF A MULTIFACETED IMPLEMENTATION
STRATEGY FOR PHYSIOTHERAPY GUIDELINES IN
PARKINSON’S DISEASE: THE PARKNET-PILOT
Nijkrake M1 , Keus S2 , Lanson S1 , Fijen A1 , Braspenning J1 ,
Hendriks E3 , Bloem B1 , Oostendorp R1 , Munneke M1 ; 1 Radboud
University Nijmegen Medical Centre, Nijmegen, The Netherlands;
2 Leiden University Medical Centre, Leiden, The Netherlands;
3 Maastricht University, Maastricht, the Netherlands
PURPOSE: To evaluate a multifaceted implementation strategy (the
ParkNet program) which aims to improve the application of the
Dutch guidelines for physical therapy (PT) in Parkinson’s Disease
(PD). RELEVANCE: In 2004 an evidence-based clinical practice
guideline for PT in PD is distributed to all physiotherapists in the
Netherlands (www.cebp.nl). However, distribution hardly ever results
in implementation. A multifaceted strategy is needed to facilitate
WCPT 2007, Research Reports
guideline implementation and to improve quality of physiotherapeutic
care in PD. PARTICIPANTS: Questionnaires were sent to 18
physiotherapists who participate in the ParkNet program (ParkNet
therapists), and to 86 physiotherapists who do not participate in the
program. Only questionnaires of physiotherapists who had treated
at least one PD patients during the preceding six months were
included in the analysis. METHODS: The ParkNet implementation
strategy consists of six steps: 1) selection of therapists who applied
to participate in a small PD expert network; 2) a 4.5 day basic course
in covering PD in general, and correct use of the guideline for Physical
Therapy in PD; 3) a web-based learning management system
which facilitates continuous education (e.g. completing tasks, sharing
knowledge, exchanging experiences) combined with feedback from
coaches; 4) two-monthly seminars in which PD related topics are
be discussed, or skills are trained; 5) a decision supporting, web-
based electronic patient record which guides the therapist through
the guideline; 6) involvement of referring physicians. A questionnaire
was developed to evaluate the quality of physiotherapeutic care in
PD. The questionnaire was based on fifteen recommendations of
the evidence-based guideline physiotherapy in PD. These fifteen
recommendations were selected by an expert-panel for being most
crucial to the quality of PT care provided to PD patients. For the
selection a Delphi technique was applied. The recommendations
were transformed into guideline driven quality indicators. As part
of the questionnaire, physiotherapists were asked to rate on a five-
point scale how frequently they followed these recommendations of
the guideline. ANALYSIS: Descriptive statistics and non-parametric
tests for two independent groups were carried out to compare
ParkNet therapists with non-ParkNet therapists. For the level of
significance p < 0.05 was applied. A recommendation was considered
to be sufficiently implemented if at least 70% of therapists followed
that recommendation frequently. RESULTS: Of the 45 returned
questionnaires, 22 met the inclusion criteria (14 ‘ParkNet’; 8 ‘non-
ParkNet’). ParkNet therapists were significantly more familiar with the
guideline and used the guideline significantly more when they were
faced with PD patients with difficult problems. Furthermore, ParkNet
therapists more frequently followed recommendations of the guideline
in comparison to non-ParkNet therapists. These differences were
significant for eight of the 15 recommendations. ParkNet therapists
had sufficiently implemented 14 of the 15 recommendations, while
non-ParkNet therapists only had implemented five recommendations.
CONCLUSIONS: Our results indicate that ParkNet program is
a feasible and promising, multifaceted implementation strategy.
This strategy might therefore be used to enhance the quality of
physiotherapy in PD. IMPLICATIONS: The ParkNet program will be
evaluated in a large cluster randomised trial (the ParkNet Trial).
In this trial also costs, and the eventual effects for PD patients
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
Development (ZonMW).
Research Report Platform Presentation
2719 Tuesday 5 June 14:00
PP Crystal Pavilion A
CONSTRUCT VALIDITY OF THE COMPREHENSIVE
PROFESSIONAL BEHAVIOURS DEVELOPMENT LOG: A
SELF-ADMINISTERED INSTRUMENT TO INFORM ENTRY-TO-
PRACTICE AND CONTINUING PROFESSIONAL COMPETENCY
Lucy S, Bartlett D, Bisbee L, Conti-Becker A; School of Physical
Therapy, The University of Western Ontario, London ON, Canada
PURPOSE: A self-administered Comprehensive Professional Be-
haviours Development Log (CPBDL), with 9 key professional
behaviours, was developed and validated through a Delphi process
to refine the specific behavioural criteria for each of the identified key
behaviours. To gain a fuller understanding of the CPBDL validity, we
Platform Presentations, Tuesday 5 June
examined the convergent validity of the CPBDL and the Physical
Therapist Clinical Performance Instrument (CPI). RELEVANCE:
Clinical reasoning and a complex array of professional behaviours
have been increasingly recognized as key attributes for both entry-
to-practice and continuing competency, as has reflection. Explicit
formative self-evaluation of professional behaviours is an important
strategy for fostering further development and continued professional
growth. PARTICIPANTS: A cohort of forty-four students, 33 women
and 11 men, mean (SD) program admission age 24.0 (3.0) y,
enrolled in our entry-level physical therapy professional Master’s
program provided data. METHODS: The CPBDL requires students
to reflect on and indicate the consistency of performance (‘not at
all’, ‘sometimes’, ‘always’) of specific criteria for the key behaviours
of accountability, adherence to legal and ethical codes of practice,
evidence-based practice, client-centered practice, communication,
critical thinking, sensitive/respectful practice, lifelong learning and
professional image. For this study, the CPBDL was completed in
the final academic term, following completion of senior clinical
placements. Student performance was evaluated during each clinical
placement with the CPI, an instrument designed to evaluate clinical
performance relative to entry-level competency in 24 areas along
a continuum from ‘novice’ to ‘entry-level’, using a visual analogue
scale. Each CPI performance and CPBDL professional behaviour
score was normalized to yield a score between 0 and 100.
ANALYSIS: Selected CPI clinical performance scores matched
with the 9 CPBDL professional behaviours were compared using
paired sample t-tests. A Bonferroni correction for multiple paired
comparisons (p0.006) was applied. RESULTS: The CPI and
CPBDL scores were all high (>92), with tight 95% confidence
intervals, and not significantly different for adherence to legal and
ethical codes, client-centered practice, sensitive/respectful practice
and communication. Conversely, student self-evaluations (CPBDL
scores) of accountability (CPBDL 90.1; CPI 97.0), critical thinking
(CPBDL 87.5; CPI 96.1), life long learning (CPBDL 85.6; CPI
96.7), professional image (CPBDL 78.2; CPI 96.8) and evidence-
based practice (CPDBL 87.9; CPI 94.2) were consistently lower
(p0.004) than the Clinical Instructor evaluated CPI performance
scores. CONCLUSIONS: These results provided support in part
for the convergent validity of the CPBDL (4 key behaviours) and
the CPI. Unlike the CPI, 5 CPBDL scores did not demonstrate
a ‘ceiling effect’, likely reflecting the differing respective foci on
entry-level versus continuing professional competency. Limiting a
broader understanding of the CPBDL validity was its 3-level scaling.
IMPLICATIONS: The CPBDL has been modified to 6-level scaling in
support of future Rasch Analysis to clarify the typical professionalism
developmental order, and enhance the instrument’s intended usage
to provide formative feedback regarding individual development.
KEYWORDS: professional behaviours, development. FUNDING
ACKNOWLEDGEMENTS: Supported by The University of Western
Ontario, School of Physical Therapy. CONTACT: deblucy@uwo.ca
Research Report Platform Presentation
773 Tuesday 5 June 14:00
PP Crystal Pavilion B & C
TUTOR EXPERIENCES OF DEVELOPING AN
INTERPROFESSIONAL LEARNING (IPL) PROGRAMME
IN HIGHER EDUCATION (HE):RECOGNISING A PARALLEL
PROCESS IN TUTORS AND STUDENTS
Smith S1 , Kate K1 ; 1 Leeds Metropolitan University,Leeds,UK;
2 Leeds Metropolitan University,Leeds, UK
PURPOSE: This exploratory study aimed to investigate the inter-
professional experiences of tutors at Leeds Metropolitan University
working together to develop a new IPL programme for pre-
registration health and social care students.This new IPL programme
is assessed and integrated into the health and social care curricula
RELEVANCE: A major drive in the UK and internationally to educate
physiotherapists and other health and social care profesisonals
S343
together aims to prepare students for the reality of being effective
team workers in practice. Previous research has recognised the
importance of preparing tutors for interprofessional education (IPE)
and described how tutors of IPL can be effective role models for
their students. PARTICIPANTS: 12 Faculty of Health tutors, working
in the IPL programme, were invited to volunteer for this study. Tutors
were from the pre-registration physiotherapy, nursing, occupational
therapy, speech therapy, dietetics and social work programmes.
METHODS: A qualitative approach utilised individual semi structured
taped interviews to explore the tutors’ experiences of working
together to plan the new programme. Both researchers carried
out the interviews. ANALYSIS: Transcribed interviews underwent a
thematic content analysis.Categories and themes were developed
using the phrase as the unit of analysis. Member checking of
the transcripts was used to check for accuracy RESULTS: Four
key themes were identified: Communication issues (bilingualism),
professionally tribalistic behaviour, workplace geography and critical
reflection. Participants described difficulties understanding other
tutors’ profession-specific language and difficulties relinquishing
“power” by having to “give up” their profession specific module
content to the IPL programme. Participants also addressed difficulties
in working interprofessionally when staff were located in different
buildings. Tutors discussed how reflecting informally on their own IP
practice helped them understand the parallel process they needed to
engender in the students. Participants mentioned the lack of reflective
frameworks on which to structure their own critical reflection. Tutors
recognised the negotiation and bargaining that occurs in thier
IPL planning meetings reflected the reality of IP working which
students will have to face in future practice. CONCLUSIONS: The
new programme encourages tutors to view IPL not as an “add
on” but as part of their core work.Tutors recognised that skills
they used in IP meetings were the very skills they needed to
facilitate in their students. Tutors were encouraged to challenge
other tutors who use profession specific jargon and encourage
development of a shared plain language.If tutors can understand
and internalise the challenges of working interprofessionally they
are in an optimal position themselves to support students and
be effective role models. Current and future work concentrates on
i) Generating a tutor training pack founded on this study’s findings
ii) Developing a new model of critical reflection that provides a
framework for students and tutors to reflect on their IP experiences.
There was recognition that the small sample limits the generalisbility
of findings. Issues of bias because the interviewers were not
independent were reflected upon. IMPLICATIONS: Pre registration
physiotherapists need to be prepared for the realities of practice
both at home and abroad. Effective physiotherapy practice is not
just uniprofessional practice. Multiprofessional tutors with insight into
the challenges of IP working can catalyse this process in all their
students KEYWORDS: Tutors; Interprofessional education; Interpro-
fessional learning. FUNDING ACKNOWLEDGEMENTS: Unfunded.
CONTACT: s.v.smith@leedsmet.ac.uk
ETHICS COMMITTEE: Faculty of Health Research Ethics Sub
Committee
Research Report Platform Presentation
975 Tuesday 5 June 14:00
VCEC Ballroom A
COMPARISON OF EVIDENCE BASED AND NON-
STANDARDISED PHYSIOTHERAPY FOLLOWING AUTOLOGOUS
BLOOD INJECTION FOR THE TREATMENT OF PATELLA
TENDINOSIS
Robertson C1 , Walter J2 , James S3 , Connell D3 , Pocock C4 ,
Bell J5 ; 1 Kingston University/St George’s, University of London,
London, UK; 2 Joy Walter Clinic, Wimbledon, London, UK; 3 RNOH
Stanmore, UK; 4 Kingston Hosiptal, Kingston-upon-Thames, UK;
5 Wimbledon Knee Clinic, Wimbledon, London, UK
PURPOSE: To evaluate the effect of an evidence based standardised
physiotherapy programme compared to a non-standardised treatment
S344
package following ultrasound guided autologous blood injection in the
treatment of patellar tendinosis. RELEVANCE: Patellar tendinosis
affects 13-20% of the athletic population, and poor treatment
outcomes are well documented. To date, Young et al.,(2005), have
demonstrated the most effective physiotherapy protocol, and Bahr
et al., (2006) suggests this is equal to open patellar tenotomy.
Autologous blood has previously been documented as a treatment
for lateral epicondylitis in humans, and rabbit patella tendons.
No published evidence exists for the use of autologous blood
with human patella tendons, and hence the outcomes of post-
injection physiotherapy programmes are unknown. PARTICIPANTS:
41 subjects, 3 with bilateral knee symptoms, 24 men, mean age
(range) 34.5 (17-54) years, with clinically diagnosed patella tendi-
nosis confirmed by sonographic examination agreed to participate.
Mean (SD) duration of symptoms 12.9 (9.4) months. All subjects
reported unsuccessful previous physiotherapy. All subjects gave
informed consent for their data to be collected and used to present
the results of this treatment. METHODS: All subjects received 2
treatments (4 weeks apart) of ultrasound guided dry needling and
injection of autologous blood into the site of patellar tendinosis.
After the second injection, 22 subjects received an evidenced based
standardised physiotherapy package. The programme comprised of;
twice daily, 5X30 second quadriceps, hamstring and calf stretching,
(Cook et al., 2004), daily 3x15 reps decline eccentric loading
with incrementally increased loading, (Purdam et al., 2004), and
activity modification, (Visnes et al., 2005). Physiotherapy continued
until return to sport. 19 subjects chose to be treated at other
sites for geographical convenience and received a non-standardised
programme, (general exercise and electrotherapy techniques). Pre
and post treatment Victorian Institute of Sport Assessment scores,
(VISA), were collected on all subjects, (administered by a researcher,
independent of the radiologist and physiotherapist). VISA is a self-
reported score, ranging from 0-100, (100 represents full pain-free
function). ANALYSIS: Data were normally distributed. Differences in
VISA scores between standardised and non-standardised treatment
groups were compared using un-paired t tests. RESULTS: Mean
difference (SD) in VISA score for the standardised physiotherapy
group, 40.1 (16.9), mean difference (SD) for non-standadised group,
28.4 (14.3), difference between groups 11.9 (2.17 to 21.3) p = 0.01.
The mean follow-up period was (SD) 14.8 (4.9) months. Two subjects
from the standardised group, one from the non-standardised group
proceeded to surgical decompression. There were no complications
reported by any subject. CONCLUSIONS: Autologous blood injection
combined with an evidence based standardised physiotherapy
protocol incorporating stretching and eccentric decline loading is
an effective treatment for patellar tendinosis. IMPLICATIONS: The
findings of this study suggest that our package of evidence based
standardised physiotherapy may have additional benefits to that of
non-standardised physiotherapy with patients post autologous blood
injection for patellar tendinosis. However, a limitation of our study
is that the location of physiotherapy packages differed between
groups and our subjects were not randomly assigned to the treatment
protocols. Further work is planned for a large randomised controlled
trial in this area. KEYWORDS: Patellar tendinosis, evidence
based, autologous blood. FUNDING ACKNOWLEDGEMENTS:
none. CONTACT: c.robertson@hscs.sgul.ac.uk
WCPT 2007, Research Reports
Research Report Platform Presentation
1279 Tuesday 5 June 14:00
VCEC Meeting Rooms 8&15
THE PROGRESSIVE ISOINERTIAL LIFTING EVALUATION
(PILE): RELIABILITY IN PATIENTS WITH LOW BACK PAIN
Lygren H1 , Dragesund T2 , Joensen J3 , Ask T4 , Moe-Nilssen R5 ;
1 Department of physiotherapy, Bergen University College, and
Department of Physical Therapy, Haukeland Univesity Hospital,
Bergen, Norway; 2 Department of Physiotherapy Science,
Department of Public Health and Primary Health Care, University
of Bergen, Bergen, Norway; 3 Department of physiotherapy,
Bergen University College, Bergen, Norway; 4 Department of
Physical Therapy, Haukeland Univesity Hospital, Bergen, Norway;
5 Department of Physiotherapy Science, Department of Public Health
and Primary Health Care, University of Bergen, Bergen, Norway
PURPOSE: Tests of functional abilities are used for the clinical
assessment of patients with low back pain (LBP). Therefore, such
tests should be validated relative to the clinical populations in which
the tests are intended to be used. Progressive Isoinertial Lifting
Evaluation (PILE) is a commonly used isoinertial lifting test, and
was developed to evaluate the effect of treatment as well as to
diagnose and classify low back pain. Satisfactory test-retest reliability
has been found in a sample of 10 healthy men. However, test-
retest reliability for clinical populations needs to be established. We
therefore wanted to investigate test-retest reliability of PILE applied
to patients with LBP. RELEVANCE: Different lifting tests are among
the function tests used in physical therapy practice. Lifting is a
function at the activity level, and is part of many job operations and
activities of daily life. Studies show that patients with chronic back
pain very often have reduced lifting capacity. PARTICIPANTS: A total
of 31 patients (17 women and 14 men) with long-lasting low back
pain participated in the study. The patients were tested twice at an
interval of 2 days and at the same time of the day. METHODS: The
patients were tested and retested at an interval of 2 days and at
the same time of the day. Sex, age, weight, height, and profession
were registered. The heaviest load in kilos, which the patient was
able to lift 4 times, was used as outcome measure ANALYSIS: To
estimate the degree of agreement, we used an ICC (1,1) model. A
systematic change from the first to the second testing was shown by
a paired t test with a chosen level of significance of 0.05. Absolute
agreement was calculated. From the within subject standard deviation
(Sw), we calculated the error of measurement and the smallest
detectable difference between 2 measurements RESULTS: ICC was
0.91. The error of measurement indicates that the true result in
95% of cases will be within ±4.5 kg from the measured value,
while the difference between 2 measurements in 95% of cases will
be less than 6.4 kg. CONCLUSIONS: Relative test-retest reliability
was high assessed by ICC, but absolute measurement variability
reported as the smallest detectable difference has relevance for the
interpretation of clinical test results and should also be considered.
IMPLICATIONS: Measurement variability shown in this study has
relevance for the interpretation of clinical test results, and indicates
that a difference between 2 measurements for the same person
should be more than approximately 6 kg for a woman and 7
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: hly@hib.no
ETHICS COMMITTEE: The study was approval by Re-
gional Committees for Medical Research Ethics in West-Norway
(http://www.etikkom.no/REK).
Platform Presentations, Tuesday 5 June
Research Report Platform Presentation
1161 Tuesday 5 June 14:00
VCEC Meeting Rooms 11-12
A PROSPECTIVE,RANDOMIZED TRIAL OF IMMEDIATE
PHYSIOTHERAPY FOLLOWING LUMBAR MICRO-
DISCECTOMY:A PILOT STUDY
Newsome R1−3 , Cole A1 , Chiverton N1 ; 1 Orthopaedic Spinal Unit
Northern General Hospital Sheffield Teaching Hospitals NHS Trust
United Kingdom; 2 Physiotherapy Department, Northern General
Hospital Sheffield Teaching Hospitals NHS Trust United Kingdom;
3 Faculty of Health and Wellbeing Sheffield Hallam University United
Kingdom
PURPOSE: To investigate whether immediate physiotherapy fol-
lowing lumbar micro-discectomy enabled patients to become in-
dependently mobile more rapidly with no increased risk of com-
plications. RELEVANCE: Studies have demonstrated the efficacy
of rehabilitation following lumbar micro-discectomy although none
have looked at physiotherapy commencing within two hours post-
operatively.While there are reports of day case micro-discectomy
none of these discusses rehabilitation or physical intervention
following this. PARTICIPANTS: Thirty patients in total were recruited
from one NHS hospital within the orthopaedic surgical spinal
unit.Inclusion criteria were first time single surgical level lumbar
micro-discectomy patients who had not responded to conservative
treatment and MRI revealed a disc prolapse consistent with
symptoms. Exclusion criteria consisted of previous discectomy, more
than one surgically indicated level and emergency cauda equina
syndrome. METHODS: The study was designed as a single blind
quasi-experimental trial.Thirty patients were randomized either to an
immediate group commencing physiotherapy within two hours post-
operatively or a control group receiving physiotherapy exercises the
day after surgery. Outcome measures included the time taken for
the patient to become independently mobile post-surgery,Oswestry
Disability,VAS back and leg and McGill pain scores.These were
collected pre-operatively, post-operatively at four weeks and three
months.The two surgeons involved were blinded to group allocation
as were the physiotherapists collecting post-operative data.Patients
were also blinded to allocation although this would become apparent
following surgery. ANALYSIS: The data was analysed using the
Statistical Package for the Social Sciences. The Mann Whitney U
test was used to compare independent mobility between the groups
as the results did not follow a normal distribution curve owing to
working hours and times of operation. Mann Whitney U test was
used to analyse the disability and pain scores. RESULTS: The
results indicated significantly reduced time to independent mobility
(p = 0.009) and return to work (p = 0.002) in the immediate group.
In this study there was a trend towards lower pain and disability
scores in the immediate group at four weeks but not statistically
significant. At three months there was no difference between
the groups. CONCLUSIONS: Immediate physiotherapy following
first time single level lumbar micro-discectomy enables patients
to become independently mobile more rapidly and return to work
sooner.Immediate physiotherapy may enable patients to experience
earlier discharge with no detriment to their recovery with associated
cost benefits to healthcare.In this study there was no increased risk in
re-prolapse,but future work in this area would require a larger sample
size to significantly determine this is the case.A larger study would be
required to detect significant differences in pain and disability scores
between the groups following this pilot. IMPLICATIONS: Current
physiotherapy practice should change for patients undergoing first
time lumbar micro-discectomy, beginning specific exercises within
two hours of the operation and becoming independently mobile the
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
S345
would be required. KEYWORDS: discectomy, immediate, physiother-
apy. FUNDING ACKNOWLEDGEMENTS: Unfunded. CONTACT:
Ruth.Newsome@sth.nhs.uk
ETHICS COMMITTEE: South Sheffield NHS Local Research Ethics
Committee,
Research Report Platform Presentation
1053 Tuesday 5 June 14:00
VCEC Meeting Room 16
ADEQUATE HEART RATE INTENSITIES DURING GAIT TRAINING
IMPROVES WALKING ABILITY IN NON-AMBULATORY PATIENTS
AFTER STROKE
Mehrholz J1,2 , Werner C3 , Hesse S3 , Pohl M1 ; 1 Department of Early
Rehabilitation, Klinik Bavaria, Kreischa, Germany; 2 Department
of Public Health, Technical University, Dresden, Germany;
3 Department of Neurological Rehabilitation, Klinik Berlin, Germany
PURPOSE: The purpose of our study was to evaluate the relationship
between heart rate intensity during two different gait training
strategies and walking abilities of patients after stroke. RELEVANCE:
Stroke and cardiovascular disease are closely associated and
limited exercise capacity is likely to immobilize stroke patients in
their ability to carry out routine functional tasks and extended
activities of daily living. However, recently it was demonstrated
that during rehabilitation of patients after stroke the intensity of
routine physiotherapy did not appear to elicit adequate metabolic
stress to induce any cardio-vascular training effect. PARTICIPANTS:
We included non-ambulatory patients within six weeks after first
ischaemic or hemorrhagic supratentorial stroke, aged between 18
to 79 years, a duration of illness less than 60 days. METHODS:
The local ethical committee of Saxony, Germany (EK-MPG-4/2002),
approved the present study. Patients received five times a week for
four weeks either 20 minutes of repetitive locomotor training (RLT)
and 25 minutes physiotherapy (PT), or 45 minutes PT without RLT.
We calculated the rates of patients achieving a heart rate intensity of
15 minutes within the individual target zone (HRtargetzone) during
gait training sessions (HRresponder). Additionally, we assessed
the rate of independent walking (defined as Functional Ambulation
Category (FAC)>3) and the rate of independent ability to perform
activities of daily life (defined as a Barthel-Index Score 75) at study
end, at six month, and at three years after study end. ANALYSIS:
We used t-tests for independent variables and Fishers exact tests
to determine statistical differences between groups. Alpha was set
as 0.05 for all comparisons. RESULTS: 30 patients were included
in each study group and analyzed as intended to treat. Patients in
RLT-PT-group exercised longer in HRtargetzone than in PT-group
(16.1±11.8 minutes versus 5.3±5.6 minutes, p < 0.001). Rates of
HRresponder of both groups were associated with higher rates of
independent walking after study end, at six month, and at three years
after study end (Fishers exact test, p= 0.014, p = 0.012 and p = 0.017,
respectively), but not with independency in activities of daily life
(p = 0.175, p = 0.111 and p = 0.081, respectively). CONCLUSIONS:
A repetitive locomotor training approach may lead to higher cardiac
intensities without overexertion during gait training. Adequate heart
rate intensities during the inpatient physiotherapy gait training of non-
ambulatory patients after stroke may partly results in sustainable
independent walking. IMPLICATIONS: The emphasis physiotherapy
should not lay alone on motor rehabilitation goals. KEYWORDS:
Walking – Stroke – Training. FUNDING ACKNOWLEDGEMENTS:
None declared.
ETHICS COMMITTEE: The local ethical committee of Saxony, Ger-
many (Landesärztekammer Sachsen, EK-MPG-4/2002), approved
the present study.
S346
Research Report Platform Presentation
1233 Tuesday 5 June 14:00
VCEC Meeting Room 17
TEMPOROSPATIAL GAIT PARAMETERS UNDERLYING PHYSIO-
THERAPISTS SCORING OF THE 4-ITEM DYNAMIC GAIT INDEX
IN PERSONS WITH AND WITHOUT VESTIBULAR DISORDERS
Whitney S1,2,6 , Marchetti G2,3 , Phillip B4,5 , Vance J5 , Morris L6 ;
1 University of Pittsburgh, Department of Physical Therapy, Pittsburgh,
PA, USA; 2 University of Pittsburgh, Department of Otolaryngology,
Pittsburgh, PA, USA; 3 Duquesne University, Department of Physical
Therapy, Pittsburgh, PA, USA; 4 Lebanon Valley College, Annville,
PA, USA; 5 Lancaster General Hospital, Lancaster, PA, USA;
6 Centers for Rehab Services, Pittsburgh, PA, USA
PURPOSE: The purpose of this study was to describe the
relationship between temporal and spatial gait characteristics and
the ordinal clinician ratings of patients and controls performing the 4-
item Dynamic Gait Index (DGI). RELEVANCE: Persons with balance
and vestibular disorders often report difficulty walking. The 4-item
DGI walking test consists of 4 walking skills. Clinicians provide an
ordinal score to quantify walking ability plus the impact of head and
body movements on walking, yet little is known about how these
scores relate to underlying spatial and temporal gait characteristics.
PARTICIPANTS: Forty seven subjects (mean age: 59.2 years, s.d.
18.5, range 24-90) participated in a descriptive cross sectional
study (26 control subjects and 21 persons with balance and/or
vestibular dysfunction). METHODS: Three trials of each of the 4
gait items (level walking, walking with changes in gait speed, and
walking with head up/down and and walking with head right/left)
were administered to subjects as they ambulated on a 13.5 meter
instrumented walkway (GAITRite). Three to five phyisotherapists
scored each subject on the 4-item DGI. Temporal and spatial gait
characteristics were measured using GAITRite software (Version
3.4). Step length variability (coefficient of variation), gait velocity,
stance width variability, and the gait stability ratio (steps per meter)
were calculated. ANALYSIS: Descriptive statistics were utilized to
describe subject demographics (age, gender, and disease status).
The median clinician rating was used to identify subjects as having
either normal, mild, moderate or severe impairment for each 4-
item DGI task. Analysis of variance was performed to compare gait
parameters (velocity, gait stability ratio, step length and stance width
variability) between normal, mild, moderate and severely impaired
subject groups. A Type I error rate of p < 0.05 was used for all
comparisons. RESULTS: Significant velocity and gait stability ratio
differences across the ordinal scores were noted for all of the 4-
item DGI gait tasks (p < 0.001). Step length variability differences
across the ordinal scores were noted for each of the 4 walking
tasks (p < 0.01). Stance width variability was also significant (p < 0.02)
for walking with head turns to the right and left. CONCLUSIONS:
Physiotherapists’ ratings of dynamic gait are underscored by changes
in velocity, increased variation in step length, and in the gait stability
ratio as measured by the GAITRite. Additionally, ratings of ambulating
with horizontal head turns was associated with an increase in
stance width variation. Phyiotherapists observations of impairments
of dynamic gait, as measured by the 4-item DGI, appear valid when
compared to temporal and spatial gait measures. IMPLICATIONS:
This study further validates the 4-item DGI as a time effective,
inexpensive, clinically feasible tool for use in clinical settings. The
responsiveness of this measure to changes in disease status requires
additional study. These findings may have implications for the
design of impairment specific interventions for persons with balance
and vestibular disorders. KEYWORDS: gait; vestibular; balance.
FUNDING ACKNOWLEDGEMENTS: This project was supported in
part by NIH grants DC 05384 (slw), Lebanon Valley College (pjb),
and Lancaster General Hospital (jv). CONTACT: whitney@pitt.edu
ETHICS COMMITTEE: University of Pittsburgh Biomedical Review
Board, Lancaster General Hospital, and the Lebanon Valley College
WCPT 2007, Research Reports
Research Report Platform Presentation
1325 Tuesday 5 June 14:00
VCEC Meeting Room 18
CHANGES IN QUALITY OF FINE MOTOR PERFORMANCE IN
CHILDREN AGED 6-12 YEARS
Watter P, Burns Y, Purcell C, Morton C, Pompei J, Nicholson V;
The University of Queensland, Australia
PURPOSE: This study aimed to measure changes in quality of
hand performance in children aged 6-12 years using a clinical
measure of movement quality. Gender and preferred/non-preferred
hand differences were also explored. RELEVANCE: Children with
poor fine motor performance often have immature or clumsy hand
skills, which require the quality of performance to be evaluated.
This study used simple clinical criteria to assess children’s quality
of hand movement, and evaluated its change between 6 and 12
years of age. This knowledge will provide a basis for comparison
when assessing children with motor impairment, and evaluating
intervention outcomes. PARTICIPANTS: A sample of convenience,
508 children (294 girls, 214 boys) was recruited from schools
representing private and public sectors, city/ suburban, and higher/
lower socioeconomic areas within the greater Brisbane area,
Australia. Children were included if they: were 6 −12 yeas old
+/−3months, participated in a standard curriculum, were well at
testing, and provided consent. Children were excluded if they: had a
diagnosis affecting performance, sensory loss, or a history of severe
sprain/ fracture. METHODS: Children performed three randomized
three tasks for 10 seconds, using preferred and non-preferred
hands, namely: finger drumming, index finger tapping, sequential
finger/thumb opposition. They used standard positions, instructions
and rests. Synkinesis and quality of movement were rated using set
criteria. Quantitative findings were reported elsewhere. ANALYSIS:
Kruskall-Wallis tests evaluated changes in rating with age and gender
and Wilcoxon Signed Rank tests compared differences between
hands. Reliability was evaluated using Cronbach’s alpha, and p was
set at 0.05. RESULTS: Synkinesis scores were highly reliable (r =
0.78-0.89). Quality of movement was more variable. Best results were
for quality of drumming and opposition in the right hand (r = 0.72, 0.5
respectively) and index finger tapping in the left hand (r = 0.7). Trends
to improvement with increasing age need to be carefully considered.
Quality of performance significantly improved with increased age in all
tasks (chi squares = 12.3-80.2, p’s = 0.0001-0.05), as did synkinesis
(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,
p= 0.034), and control of index finger tapping in preferred and non-
preferred hands reaching significance (chi squares = 7.57, 5.82,
p’s =0.006, 0.016 respectively).Gender exerted a significant effect
on synkinesis for most tasks, with girls again better than boys
(chi squares = 5.83-14.2, p’s = 0.016-0.0001). Preferred hand had
significantly better performance quality and synkinesis than non-
preferred hand for all tasks except opposition (Z’s = −2.8- −6.9,
p’s = 0.0001- 0.0005). CONCLUSIONS: Quality of performance
varied although synkinesis was consistent. Quality and synkinesis
improved with age, and girls tended to outperform boys. Preferred
hands generally outperformed non-preferred hands IMPLICATIONS:
Qualitative aspects of fine motor performance provide insight into
movement difficulties.The study provides knowledge about motor
performance in typical children, informing our ability to more
adequately assess children with impairments, and to optimally direct
intervention programs. KEYWORDS: Paediatrics; fine motor skill;
quality of movement. FUNDING ACKNOWLEDGEMENTS: Financial
Markets Foundation for CHildren. CONTACT: p.watter@uq.edu.au
ETHICS COMMITTEE: Medical Research Ethics committee of The
University of Queensland
Platform Presentations, Tuesday 5 June
Research Report Platform Presentation
1467 Tuesday 5 June 14:20
VCEC Ballroom A
A COMPARISON OF HIP STRENGTH AND FUNCTION
IN PATIENTS WITH UNILATERAL AND BILATERAL
PATELLOFEMORAL PAIN SYNDROME AND HEALTHY
CONTROLS
Huang J1,2 , Yang C1 , Guo L3 , Yu T4 , Liang C2 ; 1 Department
of Physical Therapy, Tzu-Chi College of Technology, Hua-Lien,
Taiwan; 2 Department of Physical Medicine & Rehabilitation, Tzu-Chi
General Hospital, Hua-Lien, Taiwan; 3 Faculty of Sports Medicine,
School of Medicine, Kaohsiung Medical University, Kaohsiung,
Taiwan; 4 Department of Orthopedics, Tzu-Chi General Hospital,
Hua-Lien, Taiwan
PURPOSE: Patellofemoral joint pain (PFP) is one of the most
common orthopedic complaints among adolescents and young
adults, with particularly high incidence rate (>25%) in athletes.
Despite the wealth of literature focused on the knee joints, recent
evidence has reported weaker hip strength in young women athletes,
especially in the hip abductors and external rotators. It is postulated
that this could be a contributing factor for PFP. The purpose of this
study is to examine whether hip weakness is present in individuals
with PFP, and its relationship between functional scores, pain (VAS)
and hip strength. RELEVANCE: The research results can provide
inofrmation of hip strngth in individuals with chronic patellofemoral
pain syndrome and the relationship of proximal joint strength and
functions. PARTICIPANTS: A total of 65 participants volunteered to
recruit in this study. 24 subjects with unilateral PFP and 17 with
bilateral PFP were assessed based on a standardized screening
examination referred by an orthopedic physician. 24 age and body
mass index (BMI) matched healthy subjects were selected as the
control group. METHODS: A hand-held dynamometer (Lafayette
Manual Muscle Testing System, USA) was used to examine the
isometric strength of abduction, adduction, extension, flexion, internal
and external rotations in randomized order. A functional assessment
tool (Kujala) was used to measure the self-reported functional status
in injured subjects. ANALYSIS: One-way ANOVA and multivariate
paired comparison were used to test any significant difference
between sides and groups. Pearson’s correlation coefficient was
used to examine the association between functional status, pain and
hip strength. RESULTS: Significant less hip flexor (p = 0.027) and
abductor strength (p = 0.002) on the affected side were found in the
unilateral group compared to their non-injured sides. For the bilateral
group, significantly less bilateral abductor (dominant p = 0.0004; non-
dominant p = 0.002) and internal rotator strength (dominant p = 0.025;
non-dominant p = 0.033) were found compared to that of the control
group. Decrease of hip strength in unilateral and bilateral PFP were
poorly associated with functional status and were not significant.
Pain had a negative and moderate association with functional status
in unilateral (r= −0.511, p = 0.011) and bilateral groups (r= −0.497,
p = 0.042). CONCLUSIONS: Subjects with bilateral PFP showed
bilateral deficits in abductor and internal rotator strength compared
to healthy controls, whereas unilateral flexor and abductor strength
was found in individuals with unilateral PFP. IMPLICATIONS: It is
necessary to consider examination of hip strength and possible
treatment strategies for proximal hip muscle strength in individuals
with unilateral and bilateral PFP. KEYWORDS: Patellofemoral pain,
Muscle Strength, Function. FUNDING ACKNOWLEDGEMENTS:
Thanks for the internal grant(TZH93-21)support from Tzu-Chi
General Hospital and Tzu-Chi Foundation, TAIWAN. CONTACT:
r.chyang@tccn.edu.tw
ETHICS COMMITTEE: Ethical Clearance from the Ethical Committee
of Tzu-Chi Hospital adn Tzu-Chi Unversity
S347
Research Report Platform Presentation
1445 Tuesday 5 June 14:20
VCEC Meeting Rooms 8&15
COMPARISON OF THREE RELIABILITY ESTIMATION
STRATEGIES: AN EXAMPLE USING THREE COBB ANGLE
MEASURES IN ADOLESCENT WITH IDIOPATHIC SCOLIOSIS
Parent E, Allen S, Hill D, Raso J; Glenrose Rehabilitation Hospital,
Edmonton, Canada
PURPOSE: (1) To compare measurement error estimates obtained
using three reliability assessment strategies for three Cobb angle
measurements methods in persons with adolescent idiopathic
scoliosis (AIS). (2) To discuss the advantages and inconveniences of
each reliability assessment strategy. RELEVANCE: The assessment
of reliability for outcome measures is essential for evidence-based
physiotherapy. Cobb angles measurements were used to illustrate
the pros and cons of three accepted reliability assessment strategies
to help physiotherapists select the most appropriate strategy for
their research needs. Cobb angles are routinely measured to make
relative (comparing between subjects) and absolute (comparing
to a threshold) decisions in managing scoliosis. While manual
measurements are prone to evaluator errors, semi-automatic pro-
cedures could improve reliability. PARTICIPANTS: Radiographs from
22 adolescents with AIS, treated conservatively, with Cobb angles
between 20º and 50º, were selected from our database for this study.
METHODS: Cobb angles were measured on the postero-anterior
radiographs by two raters on three occasions using manual, semi-
automated (evaluator identifying endplates corners) and “automated”
(identifying four vertebrae) methods. Raters evaluated images at least
2 days apart and were blind to the subject’s identity, their previous
measures and those from the other rater. The semi-automated
method is usually offered as part of commercial digital X-Ray analysis
software. The “automated” method software uses active shape
models to determine in the radiograph the orientation of the endplates
at the curve end-points by referring to a training set of digitized
images representative of curves treated conservatively (47 images).
ANALYSIS: Reliability and measurement errors were assessed using
95% confidence intervals for intraclass correlations, generalizability
theory (G-Theory)coefficients and Bland and Altman’s limits of
agreement. RESULTS: Corresponding intra- and inter-evaluator error
estimates obtained using all three reliability assessment strategies
were not found to differ significantly. The reliability of the manual
and semi-automated methods were not found to differ significantly
and were significantly more reliable than the automated method.
G-theory was the most flexible strategy allowing estimation of
coefficients for measurements situations involving more than one
source of error. Using G-Theory, for relative decisions, repeated
measurements obtained using interchangeable evaluators and/or
occasions using either the manual or the semi-automated method
are expected to be within ±7.1º 95% of the time. In contrast, for
absolute clinical decisions with respect to a set threshold, Cobb
measurements would fall within ±10.0º 95% of the time. G-theory
also allows quantification of the proportions of error attributable to
differences between method, evaluators and occasion. These were
40.4%, 7.3% and 5.6%, respectively. CONCLUSIONS: G-theory is
the most flexible assessment strategy. The Bland and Altman strategy
with its associated plots is useful in understanding where the error
lies in the range of measurement. However,both the Bland and
Altman strategy and intraclass correlations are tedious to use with
multiple sources of error. Automation of Cobb angle measurement
using active shape model, although it showed high intra- and inter-
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
S348
ACKNOWLEDGEMENTS: Edmonton Orthopaedic Research Com-
mittee. CONTACT: eparent@ualberta.ca
ETHICS COMMITTEE: Health Research Panel – Health Research
Ethics Board of the University of Alberta, Capital Health, and the
Caritas Health Group.
Research Report Platform Presentation
1205 Tuesday 5 June 14:20
VCEC Meeting Rooms 11-12
COMPARATIVE STUDY BETWEEN CHEMICAL AND MECHAN-
ICAL TREATMENT OF LUMBOSACRAL RADICULOPATHY
Ali M1 , Balbaa A2 , Elhafez S1 ; 1 Department of Biomechanics,
Faculty of Physical Therapy, Cairo University, Egypt; 2 Department of
Physical Therapy for Musculoskeletal Disorders, Faculty of Physical
Therapy, Cairo University, Egypt
PURPOSE: This study was designed to compare the chemical,
mechanical and their combination in treatment of sciatica in subjects
with lumbar disc prolapse. RELEVANCE: This may establish the
best treatment or combination of treatments in relieving the radicular
pain in lumbar radiculopathy. PARTICIPANTS: Thirty subjects with
unilateral L5 discogenic sciatica and radicular symptoms of pain,
numbness and/or weakness were randomly selected and examined.
Their age ranged from 25-45 years. METHODS: The subjects
were divided randomly into 3 groups of 10. Group (A) received
medications only in the form of NSAID, neurotonics and muscle
relaxant for 2 weeks. Group (B) received positional treatment in the
form of exercise based on Optimal Spinal Posture (OSP) 3 sessions
per week for 2 weeks. The OSP was determined by conducting
the kinsiologic H-reflex of the soleus muscle. Group (C) received
both treatment protocols of group A and B for 2 weeks. Each
subject had pre and post treatment evaluation of pain level using
Visual Analogue Scale (VAS), and functional activity level using
Oswestry scale and Stanford score. ANALYSIS: Statistical analysis
of the pre and post test using two ways ANOVA was performed
using Statgraphics software with multiple range tests to examine
the differences between the three studied groups. RESULTS: The
statistical analysis of this study indicated that the pain level reduced
significantly (p < 0.05) in group C compared to the other groups.
Group B showed significant improvement in the pain level compared
to that of group A. Similarly, the Stanford scale improved significantly
(p < 0.05) in group C compared to that of group A and group B.
Regarding the Oswestry scale, the results revealed that there was no
significant difference (p > 0.05) in the functional performance of group
A and group B. On the other hand, the functional performance of
group C improved significantly (p < 0.05) compared to that of groups
A and B. CONCLUSIONS: Combining both chemical and mechanical
intervention in the form of medications and positional treatment based
on OSP as an exercise program has a significant improvement
in the level of pain and the functional performance in subjects
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
prolapse. KEYWORDS: Sciatica, H-Reflex, Medications. FUNDING
ACKNOWLEDGEMENTS: Self. CONTACT: dr3mpt@yahoo.com
ETHICS COMMITTEE: EGYPTIAN PHYSICAL THERAPY SYNDI-
CATE
WCPT 2007, Research Reports
Research Report Platform Presentation
1175 Tuesday 5 June 14:20
VCEC Meeting Room 16
DOES CLINIC MEASURED GAIT SPEED DIFFER FROM GAIT
SPEED MEASURED IN THE COMMUNITY IN PEOPLE WITH
STROKE
Taylor D1 , Stretton C2 , Mudge S3 , Garrett N4 ; 1 Physical
Rehabilitation Research Centre, AUT University, Auckland, New
Zealand; 2 School of Physiotherapy, AUT University, Auckland, New
Zealand; 3 Neuro Rehab Results, Auckland, New Zealand; 4 Faculty
of Health and Environmental Sciences, AUT University, Auckland,
New Zealand
PURPOSE: To compare the extent to which gait speed measured
in the clinic setting differs from that measured in the community.
RELEVANCE: Community walking ability is often assumed from
clinical gait measures, such as the 10m walk test. It is important
to determine if tests taken in a clinic setting predict performance in
a real life setting. PARTICIPANTS: Twenty-eight people with chronic
stroke who regularly accessed the community were divided into 2
groups based on gait velocity as measured in the clinic (<0.8m/s
and 0.8m/s). METHODS: Participants completed the 10m walk test
at a self-selected speed in a clinic setting. Each participant then
completed a 300m community based walking circuit. Gait velocity
was measured at certain points in the circuit. The same circuit
and sampling points were used for all participants. The community
based circuit was situated in a local shopping mall. ANALYSIS:
Spearman’s rank correlation coefficients were used to deternine the
correlation between the clinic based gait velocity and the community
based gait velocity. A linear mixed model was used to examine the
difference scores between each of the community conditions and the
baseline clinic gait velocity. RESULTS: Spearman’s rank correlation
coefficients indicated that there was a strong correlation between
the total time taken to walk the 300m community based circuit and
the clinic based velocity (r = −0.88, p < 0.0001. A linear mixed model
with repeate dmeasures analysis revealed significant interaction
between the 2 groups on community based conditions [F(4,26) = 4.49,
p = 0.0068] and significant differences across community conditions
[F(4,26) = 7.12, p = 0.0005]. CONCLUSIONS: The clinic based 10m
walk test is able to predict walking velocity in a community setting
in people with chronic stroke who score 0.8m/s or faster on the
clinic based test. For those who score less than 0.8m/s in the
clinic test gait velocity in the community may be overestimated.
IMPLICATIONS: Clinic based 10m walk tests provides a useful
indicator of gait velocity in the community for people with chronic
stroke who score 0.8m/s or higher. For those who score less
than 0.8m/s the clinic based test may underestimate community
performance. KEYWORDS: Gait velocity; 10m walk test; community
ambulation; stroke. FUNDING ACKNOWLEDGEMENTS: Faculty of
Health and Environmental Sciences Contestable Grant.
ETHICS COMMITTEE: AUT Ethics Committee
Research Report Platform Presentation
1488 Tuesday 5 June 14:20
VCEC Meeting Room 17
GAIT PARAMETERS DURING WALKING WITH A FOUR-POINT
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
Platform Presentations, Tuesday 5 June
efficiency of gait and reduce fear of falling they could have important
benefits for the patient’s independence and quality of life. Since it
is the patient who will use the aid in question, their opinion of its
benefit would seem an important point to consider. PARTICIPANTS:
Eleven in-patients with a first cerebrovascular insult, able to walk 10
metres holding a handrail without therapeutic support, who had no
walking difficulties before their stroke and who were unfamiliar with
any of the aids being tested. METHODS: The patient’s neurological
deficit, functional independence and motor recovery were evaluated
after recruitment. They were then tested over three consecutive days,
each day with a different walking aid. The order in which the walking
aids were tested was randomized. The test session included a walk
on a seven-metre gait analysis walkway system (GaitRite® ) and a 6-
minute walking test. At the end of the test, patients were asked to rate
(VAS) how the aid had helped their walking overall. ANALYSIS: We
carried out descriptive analysis and applied non-parametric statistics
to determine whether there was a significant difference between
the effects of the three walking aids. (Friedman test, Wilcoxon).
RESULTS: Patient walked a greater distance (p = 0.011), improved
the duration of single support on the paretic leg (p = 0.022) and
decreased the duration of stance (% of Gait cycle) on the non-paretic
side (p= 0.028) when using the simple cane with ergonomic handgrip
compared to the Nordic stick. No significant differences were found
between the 4-point cane and the other walking aids. Analysis
of the patient’s subjective ranking revealed significant differences
between the different types of aid (Friedman: p = 0.003). Patients
found both the simple cane and the 4-point cane to be significantly
more beneficial than the Nordic stick (p = 0.01; 0.026 respectively)
Furthermore the simple cane was ranked as the most beneficial aid
by 7 of the 11 patients. CONCLUSIONS: The patient’s subjective
preference shows a relationship with some of the temporo-spatial
gait parameters. Subjective appreciation could therefore be a relevant
criterion to be taken into consideration for the selection of the most
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
walking stick at an early stage of rehabilitation. Physical therapists
should question their criteria for choosing the most appropriate
aid for each patient and consider both objective parameters and
patients’ preference. KEYWORDS: walking aids, stroke, hemiparesis,
gait parameters. FUNDING ACKNOWLEDGEMENTS: No funding.
CONTACT: lara.allet@hcuge.ch
ETHICS COMMITTEE: Univesrity Hospital of Geneva
Research Report Platform Presentation
1475 Tuesday 5 June 14:20
VCEC Meeting Room 18
NONLINEAR ANALYSIS OF SPONTANEOUS MOVEMENTS IN
INFANTS WITH BRAIN INJURIES
Ohgi S, Mizuike C, Shigemori K; School of Rehabilitation Sciences,
Seirei Christopher University
PURPOSE: The purpose of this study was to examine the
development of spontaneous movements with kinematic analysis in
infants with brain injuries using nonlinear analysis. RELEVANCE:
Assessment of the quality of infants’ spontaneous can thus provide
insight on the functional integrity of the neonate’s central nervous
system. However, a major impediment has been the lack of an
analytical system to evaluate the complex movements over time.
Recently, nonlinear analysis techniques have been applied in several
studies to the analysis of motor development. PARTICIPANTS:
This study was approved by the Ethics Committee of the Seirei
Christopher University. Participants were 7 healthy premature infants
and 7 brain injured premature infants, at 1 month of corrected age.
METHODS: A tri-axial accelerometer (Motion Recorder MVP-A304Ac
DigiTrac, Micro Stone Co. LTD. Japan) was used to measure limb
acceleration in three-dimensional space. Monitor weighted 4 g and
S349
dimensions were W20 x D12.5 x H7.5mm. Acceleration signals were
recorded from the right wrist, when the infant was in active alert
state, lying in supine. The recording time was 200 seconds, based
on recommendations for the characteristics of this accelerometer.
The acceleration signal was sampled at a rate of 200Hz (1/0.005 sec)
and stored in the system memory. ANALYSIS: The acceleration time-
series data were analyzed by linear and nonlinear analyses using the
package TISEAN. We utilized the following tools; 1) Power spectrum
analysis, 2) Estimation of the optimal embedding dimension using
the false nearest neighbor (FNN) method, 3) Test for the nonlinearity
using the method of surrogate data, 4) Estimation of the Maximal
Lyapunov exponent. RESULTS: The power spectrum analysis
appeared to be largely a linear random process in both healthy and
brain injured infants. Results of nonlinear analysis provided evidence
that the spontaneous movements have a nonlinear chaotic dynamics
characteristic in both infants. This result indicates evidence that
chaotic dynamic process generate an important role for acquisition of
movements during development. The characteristics of spontaneous
movements in brain injured infants showed significantly larger dimen-
sionality, and more unstable and unpredictable behavior than healthy
infants. CONCLUSIONS: Motor behavioral development proceeds in
a nonlinear manner, consistent with dynamical chaotic processes.
Brain injured infants might have problems of the processes of self-
organization as a function of the coordination of these subsystem
based on nonlinear dynamic. IMPLICATIONS: Applications of
nonlinear analysis to analyze the infants’ motor-behavior have led to
recent advances in resolution of developmental processes in infants
with motor learning difficulties as well as in understanding neuromotor
development. KEYWORDS: spontaneous movements, nonlinear
analysis, brain injured infants. FUNDING ACKNOWLEDGEMENTS:
This work was unfunded. CONTACT: shohei-o@seirei.ac.jp
ETHICS COMMITTEE: Ethics Committee of the Seirei Christopher
University
Research Report Platform Presentation
1572 Tuesday 5 June 14:40
PP Crystal Pavilion A
LEARNING PHYSIOTHERAPY IN CLINICAL PLACEMENT –
STUDENTS’ DESCRIPTIONS OF HOW AND WHY THEY LEARN
Vaagstoel U1 , Skoien A2 ; 1 Bergen University College; 2 Bergen
University College
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
the students’ learning process. RELEVANCE: Clinical placements
are an essential component of the bachelor program in physiotherapy.
It is regarded as crucial for the acquisition of theoretical knowledge,
practical skills, and for the development of clinical judgement
and reasoning. Student activities in these periods consist of
assessment and management of different clinical tasks including
patient demonstrations for supervisors, teachers and fellow students.
Although most students evaluate their clinical placement as important
for personal and professional development, relatively little is known
about the “how and why” learning takes place. Knowledge about
“how and why” may aid the physical therapy institution to customize
the placement period for the individual student in collaboration with
clinical tutors to enhance the learning process. PARTICIPANTS: The
sample consisted of a) the first five 3rd grade students with completed
clinical placements, who following a general invitation volunteered to
take part in the study, and b) interns selected from a random list
contacted by telephone. The first five who gave a positive response
were included. None of the students had a close relationship to the
project leader. METHODS: Data were collected by semi structured
interviews. The interview guide was developed for this study and com-
prised the following themes: Descriptions of a learning situation from
the clinical placement period. Factors related to supervision. Factors
related to the students own role. Factors related to fellow students’
S350
role. Existing professional knowledge and experience. Organization
of the clinical placement situation. Working environment. ANALYSIS:
The interviews were taped and transcribed, and further divided into
meaning units and analysed according to procedures accepted in
the field of phenomenography. Data clustered into 4 main categories
related to the student, the tutor, the task, and aspects related to the
working environment. RESULTS: The main findings can be summa-
rized as follows: 1) Student related aspects: Being an active learner
throughout the placement period. 2) Tutor related aspects: A tutor
with capability to guide the student towards mastering and building of
confidence. 3) Task related aspects: Patient demonstrations involving
tutor and fellow students were reported as important. 4) Working envi-
ronment: the feeling of being included was central. CONCLUSIONS:
The students focused on how challenges and demands and
subsequent mastering were important aspects in making them active
learners. Tutors capable of giving direct, specific feedback close in
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
order to promote the learning process. IMPLICATIONS: For students
the importance of being an active learner will be focused during
classes and during clinical placement. Knowledge gained through
this project is important for further cooperation with supervisors in the
clinical field. KEYWORDS: Physiotherapy education, clinical place-
ment, student perspective, qualitative research, phenomenography.
FUNDING ACKNOWLEDGEMENTS: No economical funding was
received. The project was made possible by allocation of resources
from Bergen University College, Faculty of Health and Social
sciences, Department of Physiotherapy. CONTACT: uva@hib.no
Research Report Platform Presentation
1978 Tuesday 5 June 14:40
VCEC Ballroom A
EFFECTS OF LEG-PRESS EXERCISE ON MORPHOLOGY OF
VASTUS MEDIALIS OBLIQUUS, PAIN, AND FUNCTION IN
PATIENTS WITH PATELLOFEMORAL PAIN SYNDROME
Song C1 , Yen T1 , Wei T1 , Lin Y2 , Jan M1 ; 1 School and Graduate
Institute of Physical Therapy, College of Medicine, National Taiwan
University, Taipei, Taiwan; 2 Department of Orthopaedics, West
Garden Hospital, Taipei, Taiwan
PURPOSE: Patellofemoral pain syndrome (PFPS) is a common knee
disorder characterized by anterior or retropatellar pain associated
with activities which load the patellofemoral joint. VMO-specific train-
ing is a well-accepted clinical treatment for PFPS. What remained to
be determined is whether hip adductors enhance VMO contraction as
VMO is anatomically originated from hip adductors. The purpose of
this study was to investigate the effects of a new VMO strengthening
exercise which combines hip adduction with knee extension. We
applied ultrasonography to examine the changes in VMO morphology
as a measure to quantify the effects of the new exercise, a traditional
knee extension exercise, and a control (no exercise) condition.
RELEVANCE: This study provides evidence-based practice about
the management of PFPS. PARTICIPANTS: 62 PFPS patients with
age under 55 were recruited for the study. METHODS: Patients were
randomly assigned to one of the three protocols (new, traditional,
and control). Muscle morphology of VMO (including cross-sectional
area on patella-base level, and volume under patella-base level), 10
cm-VAS of usual pain (VAS-U), worst pain (VAS-W), activity pain
(VAS-activity), and Lysholm Scale scores were measured before and
after 8-wk leg press exercise training or control periods. ANALYSIS:
Two-way mixed ANOVAs were used for main comparative analyses
between baseline and final outcome measurements among three
groups. Post-hoc test with Bonferroni correction was performed.
RESULTS: Significant improvements of VMO CSA, volume, VAS-
U, VAS-W, VAS-activity, and Lysholm Scale scores were observed
after 8-wk training in both exercise groups (p < 0.005), but not
WCPT 2007, Research Reports
in the control group. Both exercise groups improved more than
the control groups (p<0.005), except for the VMO cross-sectional
area (CSA) and volume (p = 0.011–0.042), and for the VAS-activity
between the hip adduction combined with knee extension exercise
and control groups (p = 0.016). However, no differences were found
between two exercise groups. CONCLUSIONS: Immediate and
similar effects of VMO hypertrophy, pain reduction, and functional
ability improvement was observed, followed by two exercise trainings.
IMPLICATIONS: Clinical practices may consider the application of
leg-press exercise alone with knee extension since additional equip-
ments are not required. KEYWORDS: Patellofemoral pain, vastus
medialis obliquus, exercise. FUNDING ACKNOWLEDGEMENTS:
National Science Council of Taiwan (NSC95-2314-B-002-217-MY2).
CONTACT: mhjan@ntu.edu.tw
ETHICS COMMITTEE: Ethics committee of National Taiwan
University Hospital
Research Report Platform Presentation
1274 Tuesday 5 June 14:40
VCEC Exhibit Hall A
DOES THE CLINICAL IMPRESSION OF EXTENDED SCOPE
PHYSIOTHERAPISTS MATCH THE FINDINGS ON MRI SCANS
IN PEOPLE WITH LOW BACK PAIN.?
Mercer C1 , Smith T2 ; 1 Worthing & Southlands Hospital NHS Trust,
Worthing, England; 2 Brighton & Sussex University Hospital NHS
Trust, Haywards Heath England
PURPOSE: The main aim of this retrospective analysis was to
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
developed their role as first contact clinicians in the management of
patients with musculoskeletal conditions in the UK. These extended
scope roles have expanded to include the requesting of MRI
scans as well as other diagnostic imaging. Whilst there is growing
evidence that these models of care are cost effective, safe and
effective at reducing waiting times, there is a paucity of evidence
evaluating the ability of these practitioners to request appropriate
MRI scans. PARTICIPANTS: Five Extended Scope Physiotherapist
working in musculoskeletal spinal clinics. All of the physiotherapists
were senior clinicians and had been working in the spinal clinics
for a minimum of two years. MRI scan requests made over a
nine month period between January and September 2005 were
included in the study. METHODS: A retrospective analysis of 123
MRI scan requests was undertaken. These requests were made by
five Extended Scope Physiotherapists working in two NHS trusts. The
study evaluated the clinical impression documented on the MRI scan
request form and compared this with the MRI scan report issued
by a consultant radiologist. Sensitivity, specificity and diagnostic
accuracy values were calculated for spinal stenosis and lumbar
spine disc prolapse at the L3/4, L4/5, and L5/S1 levels. ANALYSIS:
Descriptive statistical analysis, using recognised formulae was used
to calculate the sensitivity, specificity and diagnostic accuracy. Sec-
ondary analysis of patients presenting with suspected serious spinal
pathology was also undertaken. RESULTS: L3/4 sensitivity 100%,
specificity 98%, accuracy 100%; L4/5 sensitivity 89%, specificity
96%, accuracy 94%; L5/S1 sensitivity 93%, specificity 85%, accuracy
89%; Stenosis sensitivity 93%, specificity 98%, accuracy 97%.
CONCLUSIONS: The findings of this study suggest that clinical
impression of Extended scope physiotherapists accurately reflects
the findings on MRI scans. IMPLICATIONS: The findings of this study
support the continued development of extended scope physiotherapy
roles in musculoskeletal spinal clinics. This audit suggests that
physiotherapists in these roles have the appropriate clinical skills to
requests MRI imaging. Further research is required to evaluate other
areas of extended scope practice. KEYWORDS: MRI, Lumbar Spine,
Extended Scope. FUNDING ACKNOWLEDGEMENTS: Unfunded.
CONTACT: christopher.mercer@wash.nhs.uk
Platform Presentations, Tuesday 5 June
Research Report Platform Presentation
1602 Tuesday 5 June 14:40
VCEC Meeting Rooms 8&15
RELIABILITY OF THE SWEDISH VERSION OF THE SHOULDER
RATING QUESTIONNAIRE, SRQ-S
Dahlgren G1 , Hjalmarsson U2 , Lundin-Olsson L1 ; 1 Physiotherapy,
Department of Community Medicine and Rehabilitation, Umeå
University, SE-901 87 Umeå, Sweden; 2 The Orthopaedic clinic,
University Hospital of Umeå, SE-901 85 Sweden
PURPOSE: The purpose of this study was to evaluate the test-
retest reliability of the Swedish version of the Shoulder Rating
Questionnaire – SRQ-S, a self-administered questionnaire for
shoulder function. RELEVANCE: There is a need for a useful
valid and reliable method for assessing shoulder function. A short
questionnaire with the patient’s own subjective evaluation can be
cost-effective and easy to use in both the clinical setting and in
research. PARTICIPANTS: 51 patients at the waiting list for shoulder
surgery at an Orthopaedic Clinic in Sweden were asked to participate
and 38 completed the study. They all had 1) a clinical stable shoulder
disorder and 2) pain duration of more than 6 months. The group
consisted of 24 males (mean 48.3 years, range 20-62) and 14
females (mean 42.3, range 21-59), 55% were working, 21% were
on sick-list, 13% had disability pension, 8% were students, 3%
were retired. They had the following registered diagnoses; rupture
(n=12), impingement/rotatorcuffsyndrom/subacromial conflict (n=12),
glenohumeral instability (n=10), other shoulder disorders (n=9). Five
of the patients had two diagnoses in the shoulder. METHODS: The
SRQ comprises 21 questions, divided into six scored and weighted
domains concerning health, pain, daily activities, recreational and
athletic activities, work, satisfaction and a non-graded domain for the
patient to score the two most important areas of improvement. The
first five domains are included in the total score, ranging from 17
(worst possible) to 100 (healthy) points. SRQ was translated and back
translated from English to Swedish according to an established inter-
national guidelines. The questionnaire was sent home to the subjects
twice. After they had filled in and returned the first questionnaire, the
second questionnaire was sent. Mean interval of days between the
questionnaires was 6 days (range 2-19). ANALYSIS: Agreement of
the total score and the score for each domain was analysed with Intra
Class Correlation, ICC. Agreement on each question was analysed
with Weighted Kappa. RESULTS: The agreement of the total score
was excellent (ICC=0.97). All domains, except ‘recreational and
athletic activities‘, also showed an excellent agreement (ICC 0.88-
0.97). Individual questions resulted in a very high weighted Kappa
value for seven of the questions (0.81-1.0), a substantial value
(0.61-0.80) for eleven questions and moderate values (0.41-0.60)
for three questions. CONCLUSIONS: The SRQ-S seems to be a
tool for self rated shoulder function. However, more studies are
required to further investigate the psychometric properties in groups
of patients with different shoulder diagnosis. IMPLICATIONS: SRQ-
S is a questionnaire for shoulder function which can be used in the
clinical setting and in research. KEYWORDS: Assessment, question-
naire, shoulder. FUNDING ACKNOWLEDGEMENTS: Minnesfonden,
Swedish Association of Registered Physiotherapists, Stockholm.
CONTACT: gunilla.dahlgren@physiother.umu.se
ETHICS COMMITTEE: The study was approved by the ethical
committee, Umeå University
S351
Research Report Platform Presentation
2890 Tuesday 5 June 14:40
VCEC Meeting Rooms 11-12
PHYSIOTHERAPIST AND PATIENT PERSPECTIVES ON MAN-
AGEMENT OF LOW BACK PAIN IN AN ARAB, ISLAMIC CONTEXT
Naser M1 , Dawson L2 , Trew M3 , Louw G4 ; 1 Al Azhar University,
Gaza; 2 University of Brighton, UK; 3 University of Brighton, UK;
4 University of Brighton
PURPOSE: The purpose of the study was to explore the views
and experiences of physiotherapists and patients with low back pain
about the physiotherapy management of non-specific low back pain
in the Gaza Strip. RELEVANCE: Physiotherapists face a significant
challenge in the management of low back pain, because the cause
of pain often cannot be determined. There is an evidence that culture
plays an important role in the management of non-specific low back
pain, and physiotherapists develop thier treatments according to their
understandings of the origin of low back pain. Patient participation in
the management of low back pain has been proved to be important
for improving function and preventing resulting disability. There is
also evidence that physiotherapist-patient agreement on treatment
of non-specific low back pain is important for better outcomes of
physiotherapy. PARTICIPANTS: The study used two focus groups of
physiotherapists and two focus groups of patients with low back pain.
Each group included 6-8 individuals of the same gender. METHODS:
A qualitative approach was used to explore the experiences of
physiotherapists and low back pain sufferers about the current
physiotherapy for low back pain and its implications in the Gaza
Strip. Data were collected by means of focus group interviews,
facilitated by the researcher and a colleage of the same gender
of each focus group, after undertaking a pilot study involving two
focus groups. Focus groups were audio-taped and transcribed. Field
notes were kept by the researcher in order to identify any potential
bias in data analysis. ANALYSIS: A thematic content approach to
data analysis was used. The researcher invited two participants and
one physiotherapist to verify the accuracy of the data transcribed
and a translator to translate the transcripts from Arabic into English
language. A physiotherapist familiar with qualitative research and
data obtained was invited to vertify categories and themes generated
from the data. RESULTS: Eight themes emerged from analysis of
the physiotherapist focus groups and four themes emerged from
patient focus groups analysis. Findings of the study showed a
gap between the needs of patients and physiotherapy approaches
provided in the management of patients with non-specific low back
pain. The findings identified socio-cultural, professional and economic
factors as barriers to effective physiotherapy. CONCLUSIONS:
Physiotherapists and patients showed dissatisfaction with phys-
iotherapy provided for non-specific low back pain in the Gaza
Strip. There is lack of autonomy of physiotherapists that has
resulted in lack of physiotherapist-patient and physiotherapist-
doctor communications. Patients were treated using the biomedical
approach, ignoring the psychosocial factors that could affect the
outcomes of treatment. The findings of the study showed deficits
in physiotherapy education and scope of physiotherapy practice in
the Gaza Strip. IMPLICATIONS: The findings of the study have clear
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.
CONTACT: l.dawson@bton.ac.uk
ETHICS COMMITTEE: School of Health Professions Ethics Commit-
tee. University of Brighton, UK and the Palestinian Ministry of Health
S352
Research Report Platform Presentation
1632 Tuesday 5 June 14:40
VCEC Meeting Room 16
INNOVATIVE, EFFICACIOUS INTERVENTION AND
MEASUREMENT FOR DYSCOORDINATED GAIT COMPONENTS
Daly J1,2 , Brenner I2 , Rogers J2 , McCabe J2 , Fredrickson E2 ,
Roenigk K2 ; 1 Department of Neurology, Case Western Reserve
University School of Medicine; 2 Stroke Motor Control and Motor
Learning Laboratory, LSC VA Medical Center, Cleveland Ohio
PURPOSE: Utilize theoretical models to develop an innovative
intervention to restore persistent, dyscoordinated gait movement
components in stroke survivors. RELEVANCE: There is a dearth
of studies regarding restoration of coordinated gait movement
components for stroke survivors. To develop the intervention, we
utilized two models: 1) World Health Organization, disability model,
(International Classification of Function and Disability(ICF)) to inform
the breadth of intervention, which was an array of impairments
thought to underlie dyscoordinated gait in stroke survivors; and 2)
The Central Nervous System Activity-Dependent Plasticity Model and
its associated assumptions (CNS Plasticity) to develop the nature of
the intervention, including close-to-normal motor practice, intensity
of practice, and attention to practice. PARTICIPANTS: Forty-one
stroke survivors (>6 mo) were enrolled, with persistent swing and
stance phase deficits (attrition=3). METHODS: In a randomized,
controlled trial, participants were randomized to: 1) gait training
with functional neuromuscular stimulation (FNS) using intramuscular
(IM) electrodes (FNS-IM); or 2) gait training without FNS. Both
groups had the following identical treatment: 1.5hrs/day, 5days/wk,
for 12wks, including 0.5hr coordination exercise, 0.5hr body weight
supported treadmill training, and 0.5hr over-ground gait training.
However, the FNS-IM group used FNS-IM for all aspects of treatment;
the No-FNS group did not. IM electrodes were provided for the
FNS-IM group for ankle, knee, and hip muscles. Primary outcome
measure was consistency of intralimb hip/knee coordination (H/K
ACC; 30 strides, volitional over-ground walking, no FNS-IM for
testing, no brace, usual aid (cane/no cane)). Consistent hip/knee
coordination is necessary for safe execution of swing and stance.
H/K ACC was proven valid, reliable, and capable of discriminating
improvement in gait deficits of stroke survivors (in press, prior work).
H/K ACC was derived from kinematic gait data obtained using a
VICON 370 motion-capture system (blinded team member). The
qualitative secondary measure was participant report of functional
and life role participation milestones achieved after treatment (e.g.,
meal preparation, gardening). ANALYSIS: The following analyses
were performed: 1) Baseline group comparison; Mann Whitney
Test; 2) within groups, pre-/post-treatment comparisons; Wilcoxon
Signed Ranks Test, for small sample not meeting all assumptions for
parametric analysis; 3) non-parametric regression model, with time-
since-stroke (independent variable) and H/K ACC gain (dependent
variable); 4) the functional and life role participation milestones
were tallied for each group. RESULTS: At baseline, there was
no significant difference between groups, according to H/K ACC
(p = 0.37). There was no significant pre-/post-treatment difference for
No-FNS (p = 0.573). There was a statistically significant pre-/post-
treatment improvement for FNS-IM (p = 0.027). Time-since-stroke
was not a significant predictor of H/K ACC gains [F(1,37) = 1.105;
p = 0.30]. The FNS-IM group reported a five times greater number
of milestones for function and life role participation versus the No-
FNS group. CONCLUSIONS: FNS-IM produced a significant gain in
a measure of movement coordination during walking, H/K ACC; and
No-FNS did not. IMPLICATIONS: The study illustrates the potential
usefulness of theoretical models in developing efficacious gait
training. The results showed that otherwise persistent dyscoordinated
gait components were improved in response to targeting an adequate
number of impairments (ICF Model) that were addressed in a
manner fulfilling the principles of motor learning accompanying
the CNS Plasticity Model. KEYWORDS: gait, stroke, coordination,
coordinated gait components. FUNDING ACKNOWLEDGEMENTS:
WCPT 2007, Research Reports
This research was supported by the Department of Veterans Affairs,
Office of Rehabilitation Research and Development, Grants B2226R
and B3102R. CONTACT: jjd17@case.edu
ETHICS COMMITTEE: Louis Stokes Cleveland Department of
Veterans Affairs Medical Center, Internal Review Board
Research Report Platform Presentation
2030 Tuesday 5 June 14:40
VCEC Meeting Room 17
DEVELOPMENTAL TRENDS IN TEMPORAL AND SPATIAL
PARAMETERS RECORDED BY THE GAITRITE IN CHILDREN
4-14 YEARS
Alderson L1,2 , Watson T1 , Eleanor M2,3 ; 1 University of
Hertfordshire, Hatfield, UK; 2 Physiotherapy Department, Great
Ormond Street Hospital, London, UK; 3 Institute of Child Health,
University College London, UK
PURPOSE: Temporal and spatial measurements of gait in children
have the potential to quantify important clinical changes associated
with recovery or therapy. However, measurements in the clinical
environment rely on a clear understanding of normal developmental
gait changes during growth. Recent advances in electronic walkways
such as the GAITRite provide an accessible way for physiotherapists
to measure gait in a clinical setting. The purpose of this study
was to investigate developmental trends in velocity, cadence, step
length, and single and double support in children between 4-14
years. RELEVANCE: There are currently no widely used, acceptable
and accurate measures of gait in a paediatric clinical setting. While
there is some normative data in children from sophisticated gait
laboratory equipment, normative paediatric data for the GAITRite
walkway is sparse. PARTICIPANTS: 137 children aged 4-14 years
with no neurological or musculoskeletal conditions were recruited
from local schools (59% boys). The first ten children in each school
year group who returned signed parental consent were included.
METHODS: The children walked across the GAITRite walkway
(5mx1m) three times at each of three speeds: preferred, fast and
slow. One practice trial was permitted. Preferred speed was always
recorded first to ensure children had established a reference speed.
Footfalls were automatically recorded by GAITRite software and
edited following the prescribed protocol in the handbook. ANALYSIS:
Gender and left-right differences were assessed using t-tests and
paired t-tests respectively. Children were stratified into five age
groups (4-5yrs n=29; 6-7yrs n=22; 8-9yrs n=32; 10-11yrs n=28;
12-14yrs n=26). A one-way ANOVA was used to explore age
group effects on velocity, step length, cadence, single and double
support. Planned contrasts were completed to evaluate differences
between specific age groups. RESULTS: Velocity and step length
increased significantly with age (p < 0.001) at all three speeds.
Cadence reduced significantly with age at preferred and fast speeds
only (p < 0.001); with the most significant changes occurring in the
youngest three groups (4-9 years) at preferred speed, and the
oldest three groups (8-14 years) at fast speed. Double and single
support (percent of gait cycle) showed no significant age effects
except for left single support at slow speed (p = 0.05), which was
significantly shorter than the right (p = 0.05). There were no significant
gender differences. CONCLUSIONS: The increase in velocity and
step length can be explained by an increase in leg length with
growth. However both cadence and normalised velocity (divided by
leg length) decrease with age, demonstrating that walking in older
children is made more efficient by an increase in stride length
and fewer steps per minute. This study shows that between 8-11
years cadence approaches adult norms with inter-subject variation
continuing to reduce up to 14 years. Walking speeds had different
effects on both cadence and single support, which reinforces the
importance of using more than one speed in gait assessment.
IMPLICATIONS: This study demonstrates that the GAITRite is an
accurate yet relatively inexpensive way to measure temporal and
spatial gait changes associated with development. Understanding
Platform Presentations, Tuesday 5 June
these changes will facilitate the assessment of therapeutic efficacy
and natural recovery in children with walking and balance difficulties.
KEYWORDS: Walking, Measurement, Child development. FUNDING
ACKNOWLEDGEMENTS: This study was completed as part of a
PhD, which was funded by the Health Foundation and Great Ormond
Street Hospital. CONTACT: alderl@gosh.nhs.uk
ETHICS COMMITTEE: Barnet and Enfield Research and Ethics
Committee, London
Research Report Platform Presentation
2081 Tuesday 5 June 14:40
VCEC Meeting Room 18
MOTOR COORDINATION DIFFICULTIES IN 6-YEAR-OLD
CHILDREN WITH SEVERE BEHAVIOURAL AND EMOTIONAL
PROBLEMS
Iversen S1 , Knivsberg A2 , Ellertsen B2 ,
Nødland M3 ,
Både
Larsen T4 ; 1 Section of Physiotherapy Science, Department of Public
Health and Pirmary Health Care, University of Bergen, Norway;
2 National Centre for Reading Education and Research, University of
Stavanger, Norway; 3 Madlavoll Scool, Stavanger, Norway; 4 Municipal
Physio- and Occupational Therapy Services, Bamble, Norway
PURPOSE: The main purpose was to evaluate incidence, severity
and types of motor coordination difficulties in 6-year-old children
with persistent behavioural and emotional problems. A secondary
aim was to compare motor profiles on the Movement Assessment
Battery for Children (M-ABC) with specific types of behavioural and
emotional problems as assessed with Teacher’s Report Form (TRF).
RELEVANCE: Children with developmental problems and disorders
represent a complex, variable and vulnerable group, and recent
research highlights comorbidity as a rule rather than the exception.
Traditionally children with severe behaviour and emotional problems
are assessed within psychiatric settings, and comorbid motor
coordination difficulties may easily be overlooked. It is important to
investigate incidence and types of motor problems in this group as
additional motor coordination difficulties could increase an already
substantial risk for social inclusion. PARTICIPANTS: 29 6-year-old
children (4 girls, 25 boys, mean age 6.35 years) enrolled in a high-
risk programme at a city school in Norway were compared to 29 age
and gender matched controls (mean age 6.17 years). The children
in the high-risk group had been carefully selected by the municipal
school psychology services,and the main criteria for inclusion in the
programme were persisting behavioural and emotional problems. The
control group was randomly drawn from a total sample of 83 first
grade children from two first grade groups in typical all-inclusive
schools in a middle-sized Norwegian town. METHODS: The children
were assessed with Teacher’s Report Form (TRF), and the Movement
Assessment Battery for Children (M-ABC). For children who obtained
M-ABC scores at or below the 15th centile, their teachers observed
and graded chosen target skills over period of two weeks. ANALYSIS:
Non-parametric, two-tailed Mann-Whitney U-tests and Spearman
rho correlations were applied. The teacher observations of target
skills were graded into three categories: Age-expected perfomance,
borderline performance or definite difficulties. RESULTS: 62.1% in
the high-risk group and 20.7% in the control group showed borderline
or definite motor coordination difficulties at or below the 15th centile.
In the high-risk group 55.2% fulfilled the criteria of the DSM-IV
for developmental coordination disorder, compared to 3.4% of the
controls. The high-risk group showed a mixed profile, with significant
difficulties within all sub-areas of the M-ABC compared to controls.
Investigation of motor profiles for children in the high-risk group
with specific types of behavioural and emotional problems showed
a significant relationship between attention problems and manual
dexterity difficulties, and continuous, precise movements stood out
as particularly difficult. CONCLUSIONS: The majority of the children
with persistent behavioural and emotional problems showed fine-
as well as gross motor difficulties assessed with the M-ABC.They
also struggled at the functional levels of activity and participation.
S353
The combination of severe behavioural and emotional problems and
motor coordinations difficulties could increase an already substantial
risk of social exclusion. IMPLICATIONS: Parents and professionals
should be aware of the possibility of motor coordination difficulties
in young children with severe behavioural and emotional problems.
Physical therapists can provide valuable assistance to this vulnerable
group of children. KEYWORDS: Children with behavioural and emo-
tional problems, developmental coordination disorder, comorbidity.
FUNDING ACKNOWLEDGEMENTS: Foundation for Education and
Research in Physiotherapy, Norway. CONTACT: syiverse@online.no
ETHICS COMMITTEE: The Regional Comitee of Medical Research
Etichs -region West
Research Report Platform Presentation
2388 Tuesday 5 June 15:00
PP Crystal Pavilion A
’ITS JUST NOT BLACK AND WHITE’. STUDENTS’ PERCEPTIONS
OF LEARNING CLINICAL SKILLS IN THEIR FIRST CLINICAL
PLACEMENT: LESSONS FOR EDUCATORS
Delany C1 , Bragge P, Remedios L; 1 The University of Melbourne,
Melbourne, Australia
PURPOSE: For undergraduate physiotherapy students, the first
major experience of interacting with and treating patients represents
a key transition period where theoretical concepts are put into
practical clinical contexts. At the University of Melbourne School of
Physiotherapy, third year undergraduate students attend three six-
week blocks of supervised clinical placements as their first major
clinical placement. Students’ perception of their first clinical education
experience has received little attention in physiotherapy clinical
education. The purpose of this study was to examine the experiences
of a group of third year undergraduate physiotherapy students
over the period of their first three blocks of clinical placements.
RELEVANCE: Using clinical settings for the provision of clinical
education for increasing numbers of graduating physiotherapists
is expensive in terms of both cost and resources. Like clinical
practice, clinical education must increasingly be both efficient and
based on evidence of effectiveness. Measures to potentially increase
effectiveness in clinical education include having an understanding
of the factors that shape students’ learning and an ability to identify
constraints to their full engagement with the obligations of clinical
learning. PARTICIPANTS: Thirty students (40% of the total student
group) participated in focus groups held at the end of each of their
three six week clinical placements in two major teaching hospitals.
METHODS: Within the focus groups, students were encouraged
to relate their experiences of learning clinical skills and how their
experiences changed with different clinical placements. In addition,
clinical educators from the same hospitals also participated in
separate focus groups, which recorded their experiences of teaching
third year undergraduate students. All focus groups were recorded
and transcribed. ANALYSIS: Both student and educator focus group
transcriptions were analysed using qualitative methods of content and
thematic analysis. This study reports primarily on student focus group
data. The transcripts were coded for recurring themes, compared
both within and between focus group transcriptions and a conceptual
analysis of students’ experience of their clinical placements was
developed. RESULTS: Students identified the process of clinical
reasoning, or making and justifying clinical decisions for patients
in clinical contexts, as both exciting and enlightening, but also a
challenging and, at times uncertain task. For students, learning
clinical skills involved being able to accommodate tensions between
displaying commonsense with patients and applying appropriate
theoretical knowledge, and tensions between expectations of
confidence/self motivation to learn, and the reality of learning
by mistakes being corrected. In addition to learning theoretical
and practical clinical skills, over the three clinical blocks, students
identified their learning needs to be empowerment to question, ways
to build self-confidence, and skills to deal with uncertainty and
S354
conflict management. CONCLUSIONS: Students’ initial experiences
of learning clinical skills within a hospital setting involve an ability
to link the certainty of theoretical knowledge with the uncertainty
inherent in the educator/student and patient/student relationship, all
within the complex context of a busy public hospital. IMPLICATIONS:
There is a need in physiotherapy clinical education to develop
curriculum that incorporate methods of teaching in the ‘grey areas’
of uncertainty, relationships, communication and value conflict.
KEYWORDS: clinical education, student experience, uncertainty.
FUNDING ACKNOWLEDGEMENTS: Victorian Government, Depart-
ment of Human Services. CONTACT: c.delany@unimelb.edu.au
ETHICS COMMITTEE: The University of Melbourne Human
Research Ethics Committee.
Research Report Platform Presentation
2246 Tuesday 5 June 15:00
VCEC Ballroom A
MORPHOLOGY OF THE VASTUS MEDIALIS OBLIQUUS IN
PATIENTS WITH PATELLOFEMORAL PAIN SYNDROME AND
HEALTHY YOUNG ADULTS –A SONOGRAPHIC STUDY
Mao H, Jan M; School and Graduate Institute of Physical Therapy,
College of Medicine, National Taiwan University, Taipei, ROC
PURPOSE: To determine if there are significant differences in several
morphologic parameters of the vastus medialis obliquus(VMO)
between patients with patellofemoral pain sydrome(PFPS) and
healthy controls under 50. RELEVANCE: Previous studies reveal
that the vastus medialis obliquus is an important dynamic medial
stabilizer of the patellar. Insufficiency of the VMO leads to lateral
shift of the patella, increases the patellofemoral contact force, and
results in patellofemoral pain. However, an in vitro study conducted by
Hubbard JK. et al. claimed that there were no significant relationship
between several morphologic characteristics of the VMO and the
extent of patellofemoral joint deterioration. We consider that the
condition might be different in vivo, so we chose ultrasonogrphy
as the measurement tool to examine the morphology of the VMO
in PFPS patients and healthy controls. PARTICIPANTS: Thirty-
one patients and 31 healthy controls were recruited for the study.
The patients were all less than 50 y/o and diagnosed with PFPS,
excluding any other coexisting knee disorders, among which 26 were
women and 5 were men. Twenty of the patients were bilaterally
affected, thus data of both knees were taken. The control group
was carefully matched to the patients by age, gender, BMI, and
dominant leg. METHODS: The HDI 5000 ultrasonography machine
was used to evaluate morphologic parameters of the VMO, including
the percent of patella attachment, fiber angle, the volume attached
to the patella, and the change of shape of the VMO. ANALYSIS:
Descriptive statistics was used to display the basic data of the PFPS
and control groups. An independent T-test was calculated to evaluate
the morphologic parameters of the VMO.(a<0.05)Wilcoxon Signed
Ranks Test was performed to analyze the data of the affected and
unaffected side in unilateral affected patients.(a<0.05) RESULTS:
Fifty-one data were collected in each of the two groups and were
perfectly matched by age, gender, BMI, and dominant leg. The only
parameter that revealed significant difference was the percent of
patella attachment (p < 0.05). The mean percentage of the PFPS
group was 40.61%, while that of the healthy group was 46.46%
(±7.6%). The actual length of the VMO attachment on the patella
was 2.07cm (±0.63cm) in the PFPS group and 2.43cm (±0.48cm) in
the healthy group, revealing a 0.4 cm difference. On the other hand,
comparing the affected and non-affected side of the 14 unilateral
affected PFPS patients, all parameters failed to reveal significant
difference. CONCLUSIONS: The only parameter which revealed
significant difference between the two groups is the percent of
VMO attachment (p < 0.05). IMPLICATIONS: Training programs for
PFPS patients usually include strength training of the VMO muscle,
but the only morphological parameter which revealed significant
difference in our study, the percent of VMO attachment, was not
WCPT 2007, Research Reports
capable of being trained. For those PFPS patients who have a
proximally inserted VMO, strength training might not be effective
and surgery might be a better choice for treatment. KEYWORDS:
Patellofemoral pain syndrome, vastus medialis obliquus, ultrasonog-
raphy, the percent of VMO attachment, VMO volume attached to
the patella. FUNDING ACKNOWLEDGEMENTS: None. CONTACT:
hsinyumao@hotmail.com
ETHICS COMMITTEE: National Institute of Health, FDA
Research Report Platform Presentation
1904 Tuesday 5 June 15:00
VCEC Exhibit Hall A
THE ROLES OF CLINICAL SPECIALISTS AND ADVANCED
PRACTITIONERS IN PHYSICAL THERAPY: RESULTS OF A
SURVEY IN ONTARIO, CANADA
Yardley D, Gordon R, Freeburn R, So C, Beauchamp D, Landry M,
Switzer-McIntyre S, Evans C, Brooks D; Department of Physical
Therapy, University of Toronto, Toronto, Canada
PURPOSE: As in most jurisdictions, the roles and responsibilities
of health professionals are in a state of flux. Ongoing trends
towards innovative approaches in the delivery of cost-effective, quality
services present opportunities for the expansion of roles of the
physical therapist (PT), including the Clinical Specialist (CS) and
Advanced Practitioner (AP) models. The literature regarding CS and
AP roles in physical therapy is relatively limited. This study examined
the perceptions of PTs and employers of physical therapists (EPTs)
in Ontario, Canada. A secondary purpose was to examine the role
professional associations and academic institutions may have in
implementing specialized roles. RELEVANCE: As health systems
reform continues, the roles and responsibilities of all health care
professionals are being re-examined. In Canada, roles occupied by
PTs continue to develop and evolve with system reform. Based on
these ongoing changes a common understanding of scope of practice
may enhance service utilization and provide better health outcomes.
PARTICIPANTS: A random sample of 500 PTs and 500 EPTs was
chosen from two databases. The PT database was derived from
a list provided by the Canadian Physiotherapy Association (CPA),
comprised of the contact information of registered PTs practicing in
the Province of Ontario. The PTs had to be members of the Ontario
Physiotherapy Association (OPA) and registered with the College
of Physiotherapists of Ontario. The EPT list was obtained from a
database established through the University of Toronto. To be eligible,
EPTs had to employ at least one registered PT, or be a registered
PT working as a sole practitioner. METHODS: A cross-sectional
mail survey was conducted. Two questionnaires were developed,
one for PTs and one for EPTs. Upon ethics approval from the
Research Ethics Board of the University of Toronto the questionnaires
were mailed out. A Modified Dillman Approach was used throughout
the survey. ANALYSIS: A descriptive analysis was performed, and
frequency distributions were used to interpret the responses provided
in the completed questionnaires. RESULTS: Response rates were
60% for PTs and 53% for EPTs. Both groups had substantial interest
in pursuing CS and AP roles. The primary motivation behind the
pursuit of specialized roles was to improve clinical reasoning skills in
order to more effectively service clients (81% for CS and 71% for AP).
Responders supported the involvement of both academic institutions
(60% for CS and 70% for AP) and professional associations (61%
for CS and 57% for AP) in the development of formalized programs.
Of interest, 33% of PT respondents already considered themselves
CSs, and 8% considered themselves APs, despite not being formally
recognized by the profession. CONCLUSIONS: PTs and EPTs are
supportive of specialization within the physical therapy profession.
Future research should explore the specific benefits CS and AP roles
have on multiple stakeholders including clients, providers and the
health care system in Canada. IMPLICATIONS: Promotion of CS
and AP roles within and outside the physical therapy profession may
develop an extended career trajectory to support PTs in this changing
Platform Presentations, Tuesday 5 June
health care system. KEYWORDS: practitioner, specialist, special-
ization. FUNDING ACKNOWLEDGEMENTS: Ontario Physiotherapy
Association Central Toronto District Student Research Grant; Dina
Brooks holds a New Investigator Award from the Canadian Institute
of Health Research (CIHR). CONTACT: dina.brooks@utoronto.ca
ETHICS COMMITTEE: Research Ethics Board of the University of
Toronto
Research Report Platform Presentation
2272 Tuesday 5 June 15:00
VCEC Meeting Rooms 8&15
SELF-PERCEIVED QUALITY OF LIFE FOR ADOLESCENTS IN
TAIWAN
Wang H1,2 , Lo S3 , Lee S4 , Teng Y5 , Shih C6 , Lin J1,2 ; 1 Kaohsiung
Medical University, Kaohsiung city, Taiwan; 2 Department of
Rehabilitation, Kaohsiung Medical University Hospital, Taiwan;
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;
5 Department of Occupational Therapy, Chung Shan Medical
University; 6 Department of Physical therapy, Tzu Chi College of
Technology
PURPOSE: The study purpose was to describe the current self-
perceived quality of life (QoL) of healthy school adolescents in
Taiwan. Specific objectives were to examine the association between
QoL and gender, age, and area of habitation. RELEVANCE: A better
understanding of the QoL of adolescents is of special relevance in
clinical health care, because QoL in this period forms the basis for
health and QoL in adulthood. One way of measuring and interpreting
QoL data is to identify the QoL levels in different life domains
and also from both the objective and subjective perspective on
QoL. Another interpretation of QoL outcome is to appreciate the
variations of QoL which depend on certain determinants. From the
results of previoius studies, age, gender and living environment
are potential determinants that may influence the wellbeing of
adolescents. PARTICIPANTS: A total of 1477 adolescents (53.2%
boys), aged 10–18 years (mean 14.0±2.4) participated in the study.
They were recruited by convenience sampling from primary and high
schools in the north, middle, south and east of Taiwan. METHODS:
The Comprehensive Quality of Life Scale Student Version, a
multidimensional self-reported measure of objective and subjective
QoL, was used. Both the objective and subjective subscales consist
of seven domains; these are Material Wellbeing, Health, Productivity,
Intimacy, Safety, Place in Community and Emotional Wellbeing.The
QoL scores were calculated as a percentage of the maximum score
(%SM), which represents the highest positive QoL. Each participant
completed the ComQoL-S questionnaire by themselves in their
school classroom. ANALYSIS: In addition to descriptive statistics,
one-way analysis of variance (ANOVA) followed by Duncan’s post
hoc analysis was used to test any significant differences in objective
and subjective QoL scores between gender, the three age groups
and the residential regions. RESULTS: The findings showed that
the overall objective and subjective QoL scores were 62.2%SM and
67.9%SM, respectively. In the objective subscale, the adolescents
reported the highest scores (85.2%) in the Health domain whereas
the Emotion domain was the lowest (49.5%). For subjective subscale,
the highest score was in the Intimacy domain (71.7%) while the
lowest score (59.9%) was in the Productivity domain. Boys scored
significantly lower than girls in several objective domains. Lower QoL
scores were found in older age groups. Besides, lower objective
score was found in participants living in the east country. In contrast,
participants residing in the middle country reported significantly lower
subjective QoL scores. CONCLUSIONS: This study demonstrated
the multidimensional aspects of QoL among school adolescents in
Taiwan; different extents of variations in self-perceived QoL were
observed in different genders, age groups, and resident areas.
Future research should analyze longitudinal change of QoL in
S355
Taiwanese adolescents by using a larger randomized sampling.
IMPLICATIONS: The investigation into QoL of adolescents is worthy,
considering the high potential and flexibility of adolescent lifestyle.
Adolescence is a critical age for resisting many preventable health
problems and impairments, and continuing healthy development. In
addition, a disease free sample population is useful for serving
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
from the National Science Council (NSC 94-2314-B-037-019, NSC
94-2314-B-037-044). CONTACT: hywang@cc.kmu.edu.tw
ETHICS COMMITTEE: The study was approved by the Institutional
Review Board of Kaohsiung Medical University
Research Report Platform Presentation
1773 Tuesday 5 June 15:00
VCEC Meeting Rooms 11-12
CAN PRACTITIONERS’ BEHAVIOUR TOWARDS BACK PAIN
BE CHANGED? A RANDOMISED CONTROLLED TRIAL WITH
PHYSIOTHERAPISTS, OSTEOPATHS AND CHIROPRACTORS
Evans D1 , Foster N2 , Vogel S3 , Breen A4 , Pincus T5 , Underwood M6 ;
1 School of Health and Rehabilitation, Keele University, Staffordshire,
UK; 2 Primary Care Musculoskeletal Research Centre, Keele
University, Staffordshire, UK; 3 Research Centre, British School of
Osteopathy, London, UK; 4 The Institute for Musculoskeletal Research
and Clinical Implementation, Bournemouth, UK; 5 Department of
Psychology, Royal Holloway University of London, London, UK;
6 Centre for Health Sciences, Bart’s and The London, London, UK
PURPOSE: To test the effectiveness of a directly-posted, contextu-
alised, printed educational package, containing recommendations for
the evidence-based management of acute low back pain (LBP), on
changing practitioners’ reported behaviour (practice), as measured
using three key quality indicators (advice to patients about activity,
work and bed rest). RELEVANCE: The three professional groups
of chiropractic, osteopathy and musculoskeletal physiotherapy are
involved in the management of 15-20% of all people with LBP
in the UK. Exploratory and descriptive research suggests that the
management of non specific LBP by a significant proportion of
each of these groups does not follow best available evidence.
PARTICIPANTS: Simple random samples were drawn from UK
professional registers for each group, and practitioners (n = 3604)
were invited by post to participate. The trial was powered to
detect a 10% shift between proportions of guideline consistent
and guideline inconsistent reported behaviour, based on the key
quality indicators. The unit of randomisation and analysis throughout
the trial was the individual practitioner. METHODS: A pragmatic
randomised trial tested the effectiveness of a directly posted,
printed educational package versus a no intervention control. Health
care practitioners were invited to participate via postal invitation.
Consenting respondents were randomised into one of two groups,
avoiding inclusion of practitioners who worked together at the
same practice address. Intervention packages were sent to those
practitioners randomised to the intervention group. Postal follow up
questionnaires were sent 6 months later. ANALYSIS: Responses to
each of the three key quality indicators (activity, work and bed rest)
were dichotomised into either being consistent with recent guidelines
or not consistent. An intention to treat approach was taken in the
primary analysis, and multiple logistic regression models were used,
which were adjusted for baseline measures of the outcome variable
as covariates. In addition, sensitivity analyses were performed to test
the stability of the models. RESULTS: 1758 consenting practitioners
were recruited into the trial, 876 randomised to the intervention group
and 882 to the control group. Overall response to the 6 month follow-
up was 1557/1758 (88.6%). Changes in reported practice behaviour
at 6 months on the key quality indicators (odds ratios and 95%
confidence intervals) were: Activity: OR = 1.29 (1.04, 1.61); Work OR
S356
= 1.27 (1.0, 1.59); Bed-rest: OR = 1.29 (0.96, 1.73). CONCLUSIONS:
These results demonstrate that directly-posted, printed educational
material can make a small, but statistically significant change
in the reported practice behaviour of these practitioner groups.
Given the likely limited effectiveness of educational interventions
targeting individual health care practitioners, combing organisational
interventions with educational approaches may be more effective.
IMPLICATIONS: Used in isolation, printed educational material is
likely to produce only very small changes in practice. Given the low
unit cost, printed material should still play a part in implementation
strategies, but should not be used alone. KEYWORDS: Clinical
guidelines, printed educational material, randomised controlled
trial. FUNDING ACKNOWLEDGEMENTS: The School of Health
and Rehabilitation, Keele University, The Osteopathic Educational
Foundation, the General Osteopathic Council, the Anglo-European
College of Chiropractic and the British Chiropractic Association.
Nadine Foster is funded by a Primary Care Career Scientist
award from the Department of Health and NHS R&D. CONTACT:
d.w.evans@shar.keele.ac.uk
ETHICS COMMITTEE: London Multi-Centre Research Ethics
Committee
Research Report Platform Presentation
1695 Tuesday 5 June 15:00
VCEC Meeting Room 16
GAIT ASSESSMENT AND INTERVENTION TOOL (G.A.I.T.) FOR
MEASURMENT OF COORDINATED GAIT COMPONENTS
Daly J1,2 , Nethery J2 , McCabe J2 , Rogers J2 , Brenner I2 , Gansen J2 ;
1 Department of Neurology, Case Western Reserve University School
of Medicine, Cleveland, Ohio, USA; 2 Stroke Motor Control and Motor
Learning Laboratory, LS VA Medical Center, Cleveland, Ohio, USA
PURPOSE: develop a measure of coordinated gait components that
is comprehensive, reliable, inexpensive, and capable of discriminating
gains in response to training targeted to correct dyscoordinated gait.
RELEVANCE: The Gait Assessment and Intervention Tool (G.A.I.T.)
was developed for use by clinicians, educators, and researchers to
assess the presence/absence of coordinated movements composing
normal walking. The rationale is that available gait measures do
not meet all the following requirements: practicality; inexpensive;
comprehensive; a homogenous scale excluding confusion between
compensatory strategies and gait deficits; and capability to dis-
criminate gains in coordinated gait movements in response to
interventions. PARTICIPANTS: Six therapists with 5–35yrs of neuro-
rehabilitation experience developed and tested the G.A.I.T. Thirty-one
stroke survivor participants with persistent (>12 months) stance and
swing phase deficits were enrolled (attrition=3) to test G.A.I.T. validity,
reliability, and discriminability of treatment response. METHODS:
Coordinated gait components were defined as movement excursions
of the hip, knee, and ankle joints, torso and arms that occur in
particular combinations, sequences, speeds, and timings during
normal gait. The first draft of the G.A.I.T. measure was created
by two therapists who compiled and organized gait component
items from existing gait measures and generated new items for
completeness. Four additional therapists evaluated the first draft and
provided feedback for accuracy, clarity and completeness, followed
by three rounds of evaluation, feedback, and revision, after which
all therapists approved the G.A.I.T. Participants with stroke were
randomized to either: 1) gait training with functional neuromuscular
stimulation (FNS) using intramuscular (IM) electrodes (FNS-IM);
or 2) gait training without FNS. Both groups had the following
identical treatment: 1.5hrs/day, 5days/wk, for 12wks, including 0.5hr
coordination exercise, 0.5hr body weight supported treadmill training,
and 0.5hr over-ground gait training. However, the FNS-IM group used
FNS-IM for all aspects of treatment; the No-FNS group did not.
IM electrodes were provided for the FNS-IM group for ankle, knee,
and hip muscles. Video gait records were made before and after
treatment (no brace; volitional over-ground walking; usual device:
WCPT 2007, Research Reports
cane/no cane). ANALYSIS: 1) G.A.I.T. inter-rater reliability; IntraClass
Correlation Coefficient (ICC); two raters, 10 participants; 2) G.A.I.T.
intra-rater reliability (ICC); 10 participants, one rater, two time periods;
3) capability to discriminate treatment response using within-groups
pre-/post-treatment comparison for both groups (Wilcoxon Signed
Ranks Test; blinded examiner). RESULTS: The G.A.I.T. is a 27-item
comprehensive measure of swing and stance phase components.
The G.A.I.T. had good intra- and inter-rater reliability (p > 0.85).
The G.A.I.T. exhibited good capability to discriminate response to
treatment. Both the No FNS and FNS-IM groups had significant pre-
/post-treatment change, respectively (p < 0.003). CONCLUSIONS:
The G.A.I.T was reliable and capable of discriminating gains in
coordinated gait components in response to the gait training targeted
to improve the coordinated movements of gait for those with
persistent deficits. IMPLICATIONS: With the emergence of innovative
gait training methods, it is important to develop measures that are
capable of comprehensively and accurately measuring response
to treatment. In order to develop an evidence-based practice,
it is critical that measures are developed that can discriminate
efficacious response to treatment. KEYWORDS: stroke, CVA,
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.
CONTACT: jjd17@case.edu
ETHICS COMMITTEE: Louis Stokes Cleveland VA Medical Center,
Internal Review Board
Research Report Platform Presentation
2070 Tuesday 5 June 15:00
VCEC Meeting Room 17
SINE WAVE ANALYSIS OF WALKING PATTERNS IN CHILDREN
DEMONSTRATES CHANGES WITH MATURITY OF GAIT
Alderson L1,2 , Watson T1 , Main E2,3 ; 1 University of Hertfordshire,
Hatfield, UK; 2 Physiotherapy Department, Great Ormond Street
Hospital, London, UK; 3 Institute of Child Health, University College
London, UK
PURPOSE: Walking on even surfaces generates a regular pattern
of weight shift. As the body moves forward the Centre of Pressure
(COP) follows a sinusoidal pattern, which has potential to describe
both normal and abnormal gait. The GAITRite walkway provides raw
COP data and preliminary results from a novel analysis of this data
(comparing the regularity of the COP walking pattern to a normal
sine-wave), show promise for clinical applications. In preparation
for using this technique in children with balance difficulties and
irregular walking patterns, this study aimed to describe changes
during growth using a) the characteristics of the sine-wave during
gait, and b) the variation between the predicted sine-wave for each
child and actual COP data. RELEVANCE: There are few appropriate
clinical outcome measures that provide quantitative information about
dynamic walking balance in children. Temporal and spatial (TS)
outcomes like velocity or step length do not provide sufficient
depth of information to describe control of movement when children
have walking and balance difficulties. PARTICIPANTS: 137 children
aged 4-14yrs with no neurological or musculoskeletal conditions
were recruited from local schools. The first ten children in each
year group who returned signed parental consent were included.
METHODS: The children walked across the walkway (5m x 1m)
three times at each of three speeds: preferred, fast and slow.
Linear regression was used to find the best fit sine-wave for each
speed. The wavelength (represented by two step lengths) was used
to fit the model, and the amplitude (step width) and the gradient
(direction of line of progression) for each walk were computed.
The fit of the sine-wave (%) and the residual error (cm) were
calculated to provide absolute and relative measures of variation.
ANALYSIS: Children were stratified into five age groups 4-5yrs;
6-7yrs; 8-9yrs; 10-11yrs; 12-14yrs. A one-way ANOVA was used
Platform Presentations, Tuesday 5 June
to explore age group effects. Planned contrasts were completed
to evaluate differences between specific age groups. RESULTS:
The fit of the model, and residual error both had significant age
effects at all speeds (p  0.01). The fit increased with age from 80
to 90%, and residual error decreased from 3 to 1.5cm. Both had
greatest differences between 4-9 years. The wavelength showed a
significant increase with age (p  0.02). The amplitude had significant
increase with age at slow speed only (p < 0.001). The effect of
age on gradient was not significant. CONCLUSIONS: Regression
analysis was successfully used to fit a sine-wave to the GAITRite
COP data. This demonstrates that during development, wavelength
(step length) increases, and the fit of a sine-wave model improves
with a reduced error. This unique application of a sine-wave analysis
suggests children reduce variability of their walking as they grow,
improving efficiency. This analysis has enormous potential to detect
subtle changes in the regularity of the walking pattern in children
of different ages and further work incorporating clinical populations
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
enables clinicians to describe the uniformity of the walking pattern.
KEYWORDS: Walking, Centre of Pressure, Sine-wave analysis.
FUNDING ACKNOWLEDGEMENTS: This study was completed as
part of a PhD project that was funded by the Health Foundation and
Great Ormond Street Hospital. CONTACT: alderl@gosh.nhs.uk
ETHICS COMMITTEE: Barnet and Enfield Research and Ethics
Committee, London, UK.
Research Report Platform Presentation
2221 Tuesday 5 June 15:00
VCEC Meeting Room 18
GOAL ATTAINMENT SCALING AS AN OUTCOME MEASURE IN
AUSTRALIAN CHILDREN WITH MINOR MOTOR DIFFICULTIES
Klepper K, Burns Y, Watter P; The University of Quensland, Australia
PURPOSE: A study evaluating a family centred physiotherapy
intervention for children with minor motor difficulties used several
outcome measures, including Goal Attainment Scaling (GAS). The
study examined changes after intervention and after a following
period of no-intervention. RELEVANCE: In a school aged population,
children with minor motor difficulties represent a large group requiring
physiotherapy services. Use of a quantitative but individualized
outcome measure such as GAS allows change to be measured
after physiotherapy intervention in this client group. PARTICIPANTS:
Seventeen children aged 7 years 6 months-10 years 6 months
attending a community based child development unit for motor
coordination difficulties provided a sample of convenience, and were
included if they: were male or female; had no physiotherapy or
occupational therapy in the prior 12m; scored <15th percentile on
Movement Assessment Battery for Children and provided signed
consent. Children were excluded if they had: Intellectual Impairment;
a specific sensory or neurological disorder. METHODS: Children
were randomized to 1 of 2 groups and a cross-over study design
implemented. One group received intervention, while the other
received no intervention, providing a baseline for comparison. After
3months, the non-intervention group received intervention. Goal
Attainment Scaling was used at the commencement and conclusion
of intervention for both groups. Goals were set by the family,
child and therapist in consultation, and intervention was provided
over a 10 week period. Both groups were followed for a further
3months after cessation of intervention and reassessed to evaluate
maintenance of any gains made during the intervention period.
ANALYSIS: Distribution of scores was evaluated for normality.
Repeated Measures Analysis of Variance was used to evaluate
changes between assessments for each group, and p was set
at  0.05. Power was calculated for all analyses. RESULTS:
Significant improvement in GAS scores after intervention was
found for both groups [F(1,8) = 378.7, p = 0.0001 and F(1,7) = 241.3,
S357
p = 0.0001]. No significant difference was found between GAS
scores at conclusion of intervention and the end of the 3months
follow up period of no-intervention. CONCLUSIONS: This study
suggests that GAS is a useful measure of quantitative child and
family specific goals demonstrating improvement with physiotherapy
intervention, in children with minor motor difficulties. Improvements
made during intervention were maintained unchanged after a
further 3 months period of non-intervention. IMPLICATIONS: This
tool can be used as a quantitative and individualized outcome
measure to evaluate change with intervention in this large client
group, providing evidence to support the efficacy of physiotherapy
intervention. KEYWORDS: Paediatrics; Goal Attainment Scaling;
Intervention. FUNDING ACKNOWLEDGEMENTS: NA. CONTACT:
y.burns@shrs.uq.edu.au
ETHICS COMMITTEE: Medical Research Ethics Committee of
The University of Queensland, and Royal Children’s Hospital Ethics
Committee
Research Report Platform Presentation
2594 Tuesday 5 June 15:20
VCEC Ballroom A
A SURVEY OF CURRENT PHYSICAL THERAPY MANAGEMENT
OF PATELLOFEMORAL PAIN SYNDROME (PFPS)IN THE
GREATER TORONTO AREA
Couperthwaite S, Palinkas V, Sagur S, Tsai M, Zheng J, Laprade J;
Department of Physical Therapy, Faculty of Medicine, University
of Toronto, Canada
PURPOSE: This study aimed to determine the current management
of Patellofemoral Pain Syndrome (PFPS) by Physical Therapists
(PTs) in the Greater Toronto Area (GTA), compare current PT
treatment to best available evidence in the literature and identify
gaps in the knowledge and information needs of PTs with respect
to this syndrome. RELEVANCE: PFPS is a common lower extremity
disorder that affects 20-25% of the general population which is
commonly managed by conservative means in Physical Therapy.
Despite vast amounts of clinical research relating to PFPS, the
management has been a challenge mainly due to the inconsistency in
the literature regarding the definition, terminology and pathogenesis.
Additionally, there is a paucity of randomized controlled trials (RCTs)
with strong methodological design making it difficult for clinicians
to manage their patients based on scientific research. Therefore,
there is a need for further investigation on the nature of PTs clinical
practice of PFPS and to what extent it matches the evidence.
PARTICIPANTS: A random sample of 800 PTs, 400 from Metro and
100 from each of the remaining GTA regions was selected from the
College of Physiotherapist of Ontario database. The inclusion criteria
included fluency in English, an active PT with a caseload of less than
50% paediatrics and practicing ten or more hours in an outpatient
orthopaedic setting. METHODS: A questionnaire comprised of 20
items related to the definition, assessment, treatment and outcome
measurement of PFPS was mailed out to selected therapists. The
therapists were also asked to comment on their information needs.
Articles were evaluated and deemed best available evidence when
scoring 3/5 via the Jadad Scoring tool. ANALYSIS: Responses
to open-ended questions or to categories labelled “other” were
systematically grouped and coded based on a content analysis. Two
designated investigators were responsible for coding and entering
data. Data were summarized as the mean +/− SD or median and
range for continuous measures and as frequencies and respective
percentages for categorical variables. RESULTS: Eighty-four articles
pertaining to the treatment of PFPS were scored with fourteen
deemed the best available evidence. Best interventions included
acupuncture, SI manipulation, electrical muscle stimulation of the
VMO and a multimodal treatment approach. Four hundred fifty-
one questionnaires were returned, of which, 105 met the inclusion
criteria. Females comprised 69% of the respondents. No consensus
on a working definition of PFPS or essential assessment tests and
S358
objective findings was reported. The highest reported interventions
were patellar taping (91%), patellar mobilization (81%), VMO
strengthening (80%), ultrasound (61%), foot orthotics (60%). Eighty
PTs stated using a combination of exercise, tape and stretching. Only
42% of the therapists reported using outcome measures with the
LEFS(30%), VAS (19%) and PSS (1%) being most common. Clinical
experience was identified by 70% of the therapist as being most
influential in managing PFPS. CONCLUSIONS: Many of the varied
assessment and treatment techniques reported are currently not
supported in the literature suggesting a mismatch between current
practice and the literature. IMPLICATIONS: Further research and
dissemination of current clinical knowledge and practice is required
in order to provide leading edge treatment to clients with PFPS.
KEYWORDS: patellofemoral pain syndrome, survey, treatment,
assessment, management. FUNDING ACKNOWLEDGEMENTS:
None. CONTACT: judi.laprade@utoronto.ca
ETHICS COMMITTEE: University of Toronto Research Ethics Board
Research Report Platform Presentation
2375 Tuesday 5 June 15:20
VCEC Meeting Rooms 8&15
INTRA-EXAMINER RELIABILITY OF SENSORY NERVE
CONDUCTION MEASUREMENTS
Ven A1,2 , Van Hees J3 , Stappaerts K1 ; 1 Department of
Rehabilitation Sciences, Faculty of Kinesiology and Rehabilitation
Sciences, Catholic University of Leuven, Leuven, Belgium;
2 Physiotherapy Ghent, Artevelde University College – Ghent
University, Gent, Belgium; 3 Department of Neurosciences and
Psychiatry, University Hospital Gasthuisberg, Leuven, Belgium
PURPOSE: To investigate the intra-examiner reliability of consecutive
sensory nerve action potential (SNAP) amplitude measurements with
short time intervals. RELEVANCE: With this research, the influence
of measurement variability versus intra-subject variability on sensory
nerve conduction has been clarified, which is highly important when
performing serial testing on patients or in research. PARTICIPANTS:
63 healthy volunteers (11 men, 52 women, age between 19–25 years,
BMI between 16.11–24.83 kg/m2) participated. Exclusion criteria
were diabetes, neuropathy, radicular syndrome, peripheral nerve
damage, sensory disturbance in upper extremities and peripheral
edema. METHODS: Height and weight were measured. A constant
ambient temperature (mean, 18.2 ºC), combined with light clothing,
minimized skin sympathetic reflex activity and resulting SNAP
amplitude fluctuations. The skin was thoroughly scrubbed and
cleaned (impedance <20 kW). Stimulating electrodes were attached
to the wrist radial to the flexor carpi radialis tendon; the cathode
was 140 mm distal to the active recording electrode, and the
anode more distal. The ground electrode was positioned midway.
The recording electrodes were handheld on the location where the
highest SNAP amplitude could be obtained; the active electrode
40 mm distal to the elbow fold, and the reference electrode more
proximal. Stimuli were supramaximal, and 5–10 responses were
averaged. A SNAP was measured (1a) (between the negative peak
and the preceding positive peak). All electrodes were removed;
skin and electrodes cleaned. Conductive gel reapplied, and all
electrodes were immediately repositioned. Again a SNAP was
measured (1b). Following an interval of 90 minutes, during which
all subjects were submitted to the same passive protocol, all
electrodes were repositioned and a SNAP was measured (2a). All
electrodes were removed; skin and electrodes cleaned. Conductive
gel reapplied, and all electrodes were immediately repositioned.
Again a SNAP was measured (2b). ANALYSIS: Bland-Altman plots
were constructed to visualize differences between two amplitude
measurements against the mean of the measurements, situating
the obtained data and the accepted limits of association for the
population. Intraclass correlation coefficients (ICC) were calculated,
with a standard error (SE). All analyses were performed with the SAS-
statistical package. RESULTS: Visualised in Bland-Altman plots,
WCPT 2007, Research Reports
mean difference between test-retest equals 0.0 mV (1a, 1b) and (2a,
2b), and 95% of the test-retest differences are located between
−1.5 mV and 1.4 mV (1a, 1b) and between −0.9 mV and 0.9 mV (2a,
2b). ICC between test-retest without interval is 0.996 with SE of
0.001 (1a, 1b), and 0.998 with SE of 0.000 (2a, 2b); and with interval
0.926 with SE of 0.018 (1a, 2a), and 0.919 with SE of 0.019 (1b,
2b). Mean SNAP values are 20.2 mV (1a), 20.2 mV (1b), 21.1 mV
(2a), and 21.0 mV (2b). CONCLUSIONS: This study demonstrates
that a single tester can obtain reliable amplitude measurements
of sensory nerve action potentials utilizing surface recording
electrodes. IMPLICATIONS: To perform and report reliability studies
an appropriate research design and correct terminology is important.
Minimal time interval should be used to study measurement
variability, larger time intervals between test and retest to study
intra-subject variability, provided measurement variability is proved
to be very low. KEYWORDS: reliability, intra-subject variability, nerve
conduction. FUNDING ACKNOWLEDGEMENTS: The work was
unfunded. CONTACT: antoon.ven@arteveldehs.be
ETHICS COMMITTEE: Committee of the Faculty of the University
Research Report Platform Presentation
2339 Tuesday 5 June 15:20
VCEC Meeting Rooms 11-12
ATTITUDES TO BACK PAIN AMONGST MUSCULOSKELETAL
PRACTITIONERS: A COMPARISON OF UK PROFESSIONAL
GROUPS AND PRACTICE SETTINGS USING THE ABS-MP
Vogel S1 , Pincus T2 , Foster N3 , Santos R2 , Breen A4 ,
Underwood M5 ; 1 Research Centre, British School of Osteopathy,
London, UK; 2 Department of Psychology, Royal Holloway
University of London, London, UK; 3 Primary Care Musculoskeletal
Research Centre, Keele University, Staffordshire, UK; 4 Department
of Psychology, Royal Holloway University of London, London,
UK; 5 The Institute for Musculoskeletal Research and Clinical
Implementation, Bournemouth, UK; 6 Centre for Health Sciences,
Bart’s and The London, London, UK
PURPOSE: To investigate differences between the attitudes to low
back pain (LBP) in three professional groups in the UK: chiropractors,
osteopaths and musculoskeletal physiotherapists. Secondarily, the
study explored differences in attitudes between National Health
Service (NHS) physiotherapists and those in private practice.
RELEVANCE: Chiropractors, osteopaths and musculoskeletal phys-
iotherapists play key roles in the management of low back pain
in the UK. There is some evidence that practitioners’ beliefs
affect treatment recommendations, however no studies examine
chiropractors’, osteopaths’ and musculoskeletal physiotherapists’
attitudes to LBP. PARTICIPANTS: A random sample of practitioners
was drawn from the chiropractic (n = 300) and osteopathic (n
= 300) statutory UK registers. Physiotherapists listed as “muscu-
loskeletal” were drawn randomly from the Chartered Society of
Physiotherapy register (n = 300). METHODS: A cross-sectional
postal survey was sent to 900 practitioners, with one postal follow
up to non responders. The questionnaire instrument was the
recently developed and validated Attitudes to Back Pain Scale –
musculoskeletal practitioners (ABS-mp). The ABS-mp contains two
sections (Personal Interaction and Treatment Orientation). The
overall response rate was 61%. ANALYSIS: Multivariate analyses of
variance (ANOVA) were performed to investigate group differences
across subscales and between settings using effect size (Cohen’s d).
To assess the relationship between demographic variables and ABS-
mp subscales correlation coefficients were computed. RESULTS:
465 responses were used in the final analyses: 132 chiropractors,
159 osteopaths and 174 musculoskeletal physiotherapists. All three
professional groups endorse a psychosocial approach to treatment.
Re-activation is seen across the professions as an important
treatment goal. There were some significant differences between
the groups: Physiotherapists endorsed limiting the number of
treatment sessions more than osteopaths and osteopaths more than
Platform Presentations, Tuesday 5 June
chiropractors (large effect size). Physiotherapists felt more connected
to a net-work of care (moderate effect), and endorsed items
supporting a biomedical approach less than chiropractors (large
effect). Comparisons between NHS-based physiotherapists and
those who worked in private practice showed significant differences in
willingness to limit treatment sessions and in advice about restricting
activities. These findings were not affected by gender, clinical
environment or geographical location. CONCLUSIONS: The ABS-
mp is a sensitive tool, which allows comparison of subtle differences
between professional groups who share many attitudes. The findings
that all three groups endorse psychological exploration with patients
and support re-activation as a major treatment goal are in line with
current guidelines. The difference observed on the endorsement of
limiting treatment sessions might reflect practical or professional
considerations and warrants further investigation. The tendency
towards limiting sessions was found in private, as well as NHS-based
physiotherapists, and cannot be explained by this factor alone. Future
research should explore the relationship between reported attitudes,
clinical decisions, and outcome in patients. IMPLICATIONS: The
relationship between attitudes and beliefs in clinicians, their clinical
choices and the process of care (including multiple outcomes) is
poorly understood. The findings suggest that both similarities and
differences exist between the three professional groups, and help pin-
point areas for future research. KEYWORDS: Professional attitudes,
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
Health and NHS R&D. CONTACT: s.vogel@bso.ac.uk
ETHICS COMMITTEE: Worksop Multi Region Ethics Committee
Research Report Platform Presentation
2194 Tuesday 5 June 15:20
VCEC Meeting Room 16
FES NEUROPROSTHESIS VERSUS AN ANKLE FOOT
ORTHOSIS: THE EFFECT ON GAIT STABILITY AND SYMMETRY
Weingarden H1,2 , J2−4 ; 1 Sheba
Hausdorff Medical Center
Department of Neurological Rehabilitation; 2 Sackler School of
Medicine,Tel-Aviv University, Tel-Aviv, Israel; 3 Movement Disorders
Unit, Neurology Department, Tel-Aviv Sourasky Medical Center, Tel-
Aviv, Israel; 4 Division on Aging, Harvard Medical School, Boston, MA
PURPOSE: To compare the effects of an FES neuroprosthesis
(NESS L300TM ), versus an Ankle Foot Orthosis (AFO), on gait
stability and symmetry in patients with foot drop. RELEVANCE:
Gait rehabilitation is a cornerstone of physical therapy practice.
PARTICIPANTS: 15 patients (age: 52.2±3.6 yrs) with chronic
hemiparesis (5.9±1.5 yrs) whose walking was impaired by foot drop
and regularly used an AFO. 12 patients were post stroke and 3 patient
were post traumatic brain injury. METHODS: After providing written
informed consent, approved by the Human Studies Committee,
Lowenstein Rehabilitation Hospital, the FES neuroprosthesis was
applied individually for each patient. There was a four week
adaptation period during which participants increased their daily use
of the neuroprosthesis; while using the AFO for the rest of the day.
Gait was then assessed in a 6 minute walk while wearing force-
sensitive insoles, alternately using the neuroprosthesis and the AFO
in a randomized order. An additional gait assessment was conducted
after using the neuroprosthesis for a further four weeks. Stride time
(inverse of cadence) was determined, as were gait symmetry index
and swing time variability, both markers of gait stability and fall
risk. ANALYSIS: Paired t-tests were used for each parameter to
compare the AFO and neuroprosthetic effects after four and eight
weeks. RESULTS: After the four week adaptation period, the FES
neuroprosthesis and the AFO affected gait similarly (p > 0.05). After
eight weeks of walking with the neuroprosthesis, gait was significantly
improved relative to the AFO. Stride time, a measure of the walking
pace, improved from 1.48±0.21 sec while walking with the AFO to
1.41±0.16 sec with the neuroprosthesis (p < 0.02).The single limb
S359
support (SLS)of the paretic leg (swing time of the non paretic leg)
became more consistent. The coefficient of variation (CV) of the SLS
decreased from 5.3±1.6% while walking with AFO to 4.3±1.4% while
walking with the neuroprosthesis (p = 0.01). The gait symmetry index
improved by 15%, from 0.20±0.09 with the AFO to 0.17±0.08 with
the neuroprosthesis (p < 0.05). All of the participants preferred the
neuroprosthesis to the AFO for daily ambulation. CONCLUSIONS:
After initial adaptation, the neuroprosthetic effect on gait was similar
to an AFO, but was significantly better after eight weeks. The results
thus indicate that the use of an FES neuroprosthesis (NESS L300TM )
is likely to enhance gait performance in comparison to walking
with an AFO. The neuroprosthesis improved walking pace, with gait
becoming less variable and more consistent. These findings suggest
enhanced “automaticity of gait”, and a reduction in the risk of falls.
The ongoing improvement at 8 weeks further suggests that continued
use may lead to further normalization of gait. IMPLICATIONS: These
findings suggest that compared to an AFO, an appropriate dynamic
FES neuroprosthesis may yield better balance control and symmetry
during walking, and thus more effectively manage foot drop due to
stroke or traumatic brain injury. KEYWORDS: Neuroprosthesis, AFO,
Gait. FUNDING ACKNOWLEDGEMENTS: Equipment provided by
NESS, Ltd., Raanana, Israel.
ETHICS COMMITTEE: Human Studies Committee, Lowenstein
Rehabilitation Hospital
Research Report Platform Presentation
2623 Tuesday 5 June 15:20
VCEC Meeting Room 17
MUSCLE CO-CONTRACTION DURING WALKING:
COMPARISONS BETWEEN YOUNG AND ELDERLY WOMEN
Dias J, Alencar M, Arantes P, Kirkwood R, Dias R; Physical
Therapy Department, Federal University of Minas Gerais, Belo
Horizonte, Brazil
PURPOSE: The objective of this study was to compare co-
contraction levels between young and elderly women with regard
to the vastus lateralis and biceps femoris (VL-BF) and the tibialis
anterior and gastrocnemius (TA-GAS) muscles, 200 ms before and
after initial contact (IC) during gait. Comparisons of gait velocity,
knee and ankle angles at IC and work for body mass (W/BM) were
also analyzed. RELEVANCE: An investigation into the presence
of co-contractions as a possible strategy adopted by the elderly
during this initial contact phase and its correlations with kinematics
alterations in gait and muscle performance, may contribute to a better
understanding of the mechanisms of dynamic joint stabilization.
This evidence may also contribute with important information to the
existing body of knowledge and assist in the elaboration of more
efficient strategies for gait training. PARTICIPANTS: Forty women
participated in this study: 20 young (20-27 yrs; 22.5±2.21 yrs)
and 20 elderly (65-79 yrs; 71±4.23 yrs). The volunteers had to
meet the following criteria: live independently in the community, be
capable of walking without an assistance device and be sedentary
in accordance with the classification of the American College of
Sports Medicine (ACSM). This study was approved by the Federal
University Ethics Committee-number 2004/579. METHODS: Muscle
co-contraction was assessed through surface electromyography and
kinematics parameters during gait. Gait velocity and knee and ankle
joint angles at initial contact were obtained by motion analysis
system. Work normalized by body mass was obtained through
concentric contractions using isokinetic dynamometry. ANALYSIS:
Distribution of data was tested by the Shapiro-Wilk and Lilliefors
tests and the homogeneity of variance was tested by the Cochran
and Bartlett tests. ANOVA with posterior average comparisons
(Student-t test) was performed to compare groups regarding to
variables of co-contraction levels, gait velocity, knee and ankle joint
angles at initial contact and W/BM. The observed co-contraction
levels, kinematics parameters and muscle performance in each
group were analyzed by Pearson correlation test. The level of
S360
significance was set at 5%. RESULTS: The elderly women co-
contracted VL-BF and TA-GAS more than the young women both
before and after IC (p0.0005). Gait velocity and W/BM were
lower for older women (p0.0003). No differences were observed
with regard to joint angles (p0.493). For the younger group,
moderate correlations were only observed between TA-GAS co-
contractions before IC and dorsiflexor W/BM (r = 0.504; p = 0.024)
and plantar flexors W/BM (r = 0.602; p = 0.005. CONCLUSIONS:
Elderly women showed higher levels of co-contraction of the VL-
BF and TA-GAS during the initial contact phase of the gait when
compared with young women. This increase in co-contraction may
be a strategy the elderly adopt to ensure dynamic joint stability and
be better prepared for potentially unstable situations during gait.
However, the possible factors associated to this phenomenon are
not yet completely known and require future studies to elucidate
this issue. IMPLICATIONS: It is likely that these adaptations are
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
might be beneficial to enhance these adaptations. KEYWORDS:
elderly, young, co-contraction. FUNDING ACKNOWLEDGEMENTS:
Financial support: CNPq – Brazilian Funding Research Agency.
CONTACT: jmdd@ufmg.br
ETHICS COMMITTEE: Federal University Ethics Committee-number
2004/579.
Research Report Platform Presentation
2235 Tuesday 5 June 15:20
VCEC Meeting Room 18
THE MOVEMENT PATTERNS OF RISING FROM A SUPINE
POSITION TO AN ERECT STANCE IN HEALTHY CHILDREN: A
THREE-YEAR LONGITUDINAL STUDY
Nakano C1 , Shiba Y2 , Sakamoto M2 , Sato H2 , Mihara N3 ;
1 Graduate school of medical science, Kitasato University; 2 Kitasato
University, School of Allied Health Sciences; 3 Tsukuba Memorial
Hospital, Rehabilitation Center, Ibaraki, Japan
PURPOSE: The ability to rise from a supine position to an erect
stance is a significant part of physical independence, and is an
important step toward the development of functional capabilities in
early childhood. Previous studies on children’s rising from such a
position concentrated on cross-sectional analysis, in which various
types of movement patterns (MPs) were shown to develop according
to age, though the development of physical functions depended
on each child. Therefore, as the purpose of this study was to
demonstrate the MP changes in a child’s ability to rise from such
a position, a longitudinal study was used so as to explain sequential
development. RELEVANCE: Such a longitudinal study as this can
reveal normal MP development in this action in early childhood.
PARTICIPANTS: This involved 17 healthy children belonging to the
youngest year at kindergarten (mean age ±SD = 3y 9mo ±4mo),
who were then followed, on a yearly basis, over a three-year period
between 2003 and 2005. METHODS: In 2003, children in the
youngest year at kindergarten were regarded as the baseline (mean
age ±SD = 3y 9mo ±4mo). In 2004, they had their first follow-up
(mean age ±SD = 4y 9mo ±4mo), with their second one in 2005,
at which time they were then (mean age ±SD = 5y 9mo ±4mo).
They were videotaped with 2 cameras simultaneously from both the
frontal and sagittal planes, while rising from a supine position, and
MPs were classified according to VanSant’s descriptions of the action
of three bodily movements: the upper extremity region (UE); the axial
region (AX); and the lower extremity region (LE). These three were
then categorized in four to five steps. ANALYSIS: The MP change of
these three regions in every child was investigated over a three-year
period, and the incidence was calculated, based on each different
change. RESULTS: 9 of the 17 (52.9%) children in the UE and 6
of the 17 (35.3%) in the AX, showed the same MPs over the three-
year period. However, in the LE, the MP changes varied depending
WCPT 2007, Research Reports
on the child. In both the UE and AX, such changes only occurred
between the baseline and the first follow-up, but none after that. In
the UE, the most common MP change was from a push-and-reach
to a bilateral push (both hands, placed on the ground beside the
pelvis), to an asymmetrical push-and-reach pattern. In the AX, the
children tended to rise with less body rotation. CONCLUSIONS: This
study demonstrated that the greatest MP change occurred between
3 and 4 years old, and one common feature of such change was
found in the UE and AX, though the MP change in the LE varied
among the children. IMPLICATIONS: These results suggested that it
is important for the physiotherapist to observe the MPs in the UE
and AX in order to evaluate the development of the child, rising
from a supine position. KEYWORDS: longitudinal study, healthy
children, rising from a supine position to an erect stance. FUNDING
ACKNOWLEDGEMENTS: NA. CONTACT: mm06037b@st.kitasato-
u.ac.jp
Research Report Platform Presentation
3157 Tuesday 5 June 15:40
PP Crystal Pavilion A
AN EXPLORATION OF CLINICAL INSTRUCTORS’ EXPERIENCES
AND PERCEPTIONS OF THE PHYSICAL THERAPIST CLINICAL
PERFORMANCE INSTRUMENT
Creaser G; Mount Saint Vincent University, Halifax, Nova Scotia,
Canada
PURPOSE: The purpose of this study was to explore the shared
experiences of physiotherapist clinical instructors using the Physical
Therapist Clinical Performance Instrument and their perceptions
of its relevance to their clinical practice and student evaluation.
RELEVANCE: Education and evaluation of physiotherapy students’
clinical performance is carried out under the guidance of physio-
therapist clinical instructors (CIs) who have had varying amounts
of preparation for their roles. CIs observe students’ behaviour
within the complex context of patient care and interpret their
performance as it relates to defined evaluation criteria. The CPI
was developed as an evaluation tool that would be widely accepted
and applicable to a broad range of clinical environments. There
is a need to study how CIs use the CPI and if they consider it
to be useful for clinical evaluation. PARTICIPANTS: A purposeful
sample of 16 CIs from three tertiary healthcare centres affiliated
with Dalhousie University, Halifax, Nova Scotia, participated. The
CIs provided care for adults or children on either inpatient or
outpatient services in acute-care or rehabilitation settings. The CIs
had a mean of 15.5 years of clinical experience and they had
instructed a mean of 4.6 students. METHODS: The study was
undertaken using a qualitative methodology. Each clinical instructor
participated in one of three focus groups. All discussions were
audiotaped and verbatim transcipts constituted the data for the
study. ANALYSIS: Each transcript was thoroughly reviewed and
word/phrase lists were compiled, compared and colour coded.
Topics were clustered and broad headings initially identified were
regrouped resulting in four emergent themes. Five themes were
identified in the final analysis: CPI for summative evaluation, CPI
for formative evaluation, Training to use the CPI, Shared learning,
and Practicality of the CPI. RESULTS: The CIs described factors
that influenced their perceptions of the value of the CPI and
their application of it. The strength of the CPI was considered
its use as a tool to promote dialogue and learning. Its use for
summative evaluation was perceived to be problematic due to
inconsistent application across clinical instructors. Training to use
the CPI was useful and was considered a positive influence on
CIs’ understanding of the instrument. The language, relevance of
the performance criteria, and excessive overall length of the CPI
were considered to have a negative impact on its practicality.
CONCLUSIONS: This exploratory study cannot be generalized to
all clinical instructors but it indicated challenges and the potential
impact that inconsistent understanding of the CPI can have on
Platform Presentations, Tuesday 5 June
the clinical evaluation. The evaluation of physiotherapist students’
performance in the context of patient care delivery is complex and
CIs’ understanding and application of the CPI should not be left to
chance. IMPLICATIONS: Further study is required to determine the
impact that training has on CIs’ application and satisfaction with the
CPI. Inconsistent application of the CPI could erode students’ and
CIs’ confidence in clinical evaluation as a fair and consistent process.
KEYWORDS: CPI, clinical education, physiotherapy. FUNDING
ACKNOWLEDGEMENTS: This research was not funded by an
external agency. CONTACT: gail.creaser@dal.ca
ETHICS COMMITTEE: University Research Ethics Board of Mount
Saint Vincent University.
Research Report Platform Presentation
2919 Tuesday 5 June 15:40
VCEC Exhibit Hall A
DIAGNOSTIC ULTRASOUND ASSESSMENT OF SCIATIC NERVE
MOVEMENT DURING NEURAL MOBILISATION
Hing W1 , Ellis R1 , Allen S2 ; 1 Physical Rehabilitation Research
Centre, Auckland University of Technology, New Zealand; 2 Horizon
Scanning, Auckland University of Technology, New Zealand
PURPOSE: The aim of this project is to assess movement
of the sciatic nerve, using real-time ultrasound imaging during
neural mobilisation techniques. The study assesses whether sciatic
nerve movement occurs during neural mobilisation. RELEVANCE:
Peripheral nerves must be able to dynamically move in relation
to their surrounding tissues for efficient function. Pathological
adherence or compression of peripheral nerves may impact on their
ability to effectively move in respect to surrounding tissues, which may
result in neural damage and dysfunction. A ‘slider’ is a neurodynamic
technique designed to promote movement of peripheral nerves.
Essentially tension is taken up from one end of the nerve trunk
whilst it is simultaneously released from the opposite end. This
sequence is then reversed allowing longitudinal sliding to occur. In
pathological situations where nerve movement may be reduced, it
would potentially be helpful to quantify movement loss or restriction
and also to allow comparison of relative neural movement pre-
and post-intervention. Objective measurement of nerve movement
using real-time ultrasound, may be extremely useful clinically. There
are numerous studies which have measured longitudinal nerve
movement, of upper limb nerves using real-time ultrasound. As for
the sciatic nerve, there appears to be no ultrasound studies that
make any quantifiable analysis or measurement. PARTICIPANTS:
Subjects (n=15) who met the inclusion criteria were seated in a
custom built standardised rig, specifically designed to maintain the
subject in a slump position. METHODS: Ultrasound images from
a Philips HD11 ultrasound machine using a linear array probe
(5-12 MHz, 55mm) were collected. Two standardised positions
of a) the mid-point of the posterior thigh (mid-thigh nerve bed)
and b) at the level of the popliteal crease were visualised. At
each of these positions recordings within the transverse plane and
the longitudinal plane were collected. The video loops were then
converted to digital format using conversion software. For the purpose
of this study, a neurodynamic ‘slider’ was utilised in order to allow
movement of the sciatic nerve. ANALYSIS: A method of frame-
by-frame cross-correlation analysis (Dilley et al. 2001) was utilised
to determine and measure the relative in-vivo nerve movement
between successive frames in the sequence of ultrasound images.
RESULTS: Transverse movement of (mean±SD) 4.42±0.89mm
vertical and 7.29±2.33mm horizontal was measured at the popliteal
crease compared with 0.69±0.31mm vertical and 0.83±0.43mm
horizontal measured at the mid-thigh nerve bed location. Longitudinal
nerve movement measured 0.87±0.09mm at the popliteal crease
compared to 2.18±0.59mm at mid-thigh nerve bed. CONCLUSIONS:
In line with the ‘convergence theory,’ a greater degree of transverse
movement (versus longitudinal movement) was measured at the
popliteal crease location while the opposite was observed at the
S361
mid-thigh nerve bed. This research confirms that varying degrees
of transverse and longitudinal movement do occur and supports
the suggestion that neural mobilisation can be effective in the
treatment of altered neurodynamics. IMPLICATIONS: This research
may validate the claim that its effectiveness is due to movement
of peripheral nerves in relation to surrounding tissues. Therefore,
if the hypothesis of this project is accepted, then there may be a
wider implication for ultrasound imaging of neural mobilisation in
pathological populations. KEYWORDS: diagnostic ultrasound, neu-
ral, mobilisation. FUNDING ACKNOWLEDGEMENTS: New Zealand
Society of Physiotherapy and the Auckland University of Technology.
CONTACT: wayne.hing@aut.ac.nz
ETHICS COMMITTEE: AUTEC – Auckland University of Technology
Ethics Committee
Research Report Platform Presentation
1478 Tuesday 5 June 15:40
VCEC Meeting Rooms 11-12
EXTENDED SCOPE PRACTITIONERS’ MANAGEMENT OF
LUMBAR SPINAL STENOSIS
Browne J1,2 , Roberts L1 ; 1 School of Health Professions and
Rehabilitation Sciences, University of Southampton, Southampton,
UK; 2 Therapy Department, Royal Cornwall Hospital, Truro,
Cornwall, UK
PURPOSE: Lumbar spinal stenosis (LSS) refers to narrowing of the
spinal canal, nerve root or intervertebral canal resulting in variable
signs and symptoms. Extended Scope Practitioners (ESPs) often
assess and manage patients with LSS in clinics, however clinical
guidelines and clear evidence of how best to manage these patients
is yet to evolve. The aim of this research is to identify factors that
affect clinical decision-making in ESP clinics. RELEVANCE: LSS is
the most common diagnosis associated with lumbar spinal surgery
in adults over 65 years old and its management remains a focus
for debate. Initially the prognosis of LSS was believed to be poor in
the absence of laminectomy, recommended for patients with “severe
symptoms” and conservative treatment was limited to patients with
minimal symptoms, elderly patients with co-existing illnesses, or
who contraindicated surgery. Over time, it has been shown that
long-term outcomes following surgery can produce disappointing
results, and that many patients do well without surgery. Patients with
moderate symptoms fall into a “grey zone” in which the appropriate
treatment is not obvious and clinical decisions are based on multiple
factors. However, there are no reported randomised-controlled trials
in the literature comparing surgical and non-surgical management.
Therefore the predictors of outcome, relative risks, efficacy and cost
of surgical versus non-surgical management are difficult to discern.
PARTICIPANTS: The target population included all ESPs in the
United Kingdom (UK), defined as “clinical physiotherapy specialists
in any recognised speciality with an extended scope of practice”
registered in the ESP Occupational Interest Group (OIG) and
working in clinics with patients who have spinal conditions (n=288).
METHODS: This quantitative study used a postal questionnaire
design and two clinical vignettes. Reminders were sent at one and
four weeks. Data were analysed using the Statistical Package for the
Social Sciences (SPSS 11.0). ANALYSIS: Multivariate descriptions
of service characteristics were attained through cross tabulations.
Possible associations between the characteristics were established
using Pearson’s chi-squared and Somers’d test. Open questions were
analysed by thematic and content analyses. RESULTS: Of the 288
questionnaires were sent out, 226 were returned (response rate
78.5%). Of the returned questionnaires, 134 were ESPs working
in clinics with patients who have spinal conditions. The main
factors found to affect clinical decision-making were: accessibility
to resources (including MRI and surgeons); patient choice; and
severity of symptoms. CONCLUSIONS: The results indicated that
there was a lack of consensus amongst ESPs in the UK as to the
most appropriate management of patients who have suspected LSS.
S362
Referral patterns vary considerably throughout the UK and there
are currently no national guidelines or protocols, which are followed
in clinic to help standardise the management of these patients.
IMPLICATIONS: This lack of consensus for management has a cost
and waiting time impact for the National Health Service. The natural
history of LSS does not appear to be one of inevitable deterioration,
challenging the need for routine further investigations. Further
research is needed to develop and implement clinical guidelines
for patients with LSS. KEYWORDS: stenosis, conservative, sur-
gical. FUNDING ACKNOWLEDGEMENTS: Unfunded. CONTACT:
janine.browne@rcht.cornwall.nhs.uk
ETHICS COMMITTEE: South West Multi Research Ethics Comittee
Research Report Platform Presentation
2662 Tuesday 5 June 15:40
VCEC Meeting Room 16
EFFECT OF THE TUNING OF ANKLE FOOT ORTHOSES-
FOOTWEAR COMBINATION (AFO-FC) ON GAIT OF A
HEMIPLEGIC PATIENT- A CASE STUDY
Jagadamma K1 , Coutts F1 , Owen E2 , Herman J3 , Yirrell J4 , van
der Linden M1 ; 1 Queen Margaret University College, Edinburgh,
UK; 2 Child Development Centre, Bangor, UK; 3 Anderson Gait
Analysis Laboratory, Edinburgh, UK; 4 Royal Hospital for Sick
Children, Edinburgh, UK
PURPOSE: Ankle Foot Orthoses (AFO’s) are commonly prescribed
for patients with hemiplegia to control ankle joint motion. It has
been suggested that the optimal alignment can be gained by
tuning the AFO -footwear combination (AFO-FC) using wedges
and rockers to realign the Ground Reaction Force vector (GRF)
relative to the joint centres minimizing abnormal joint moments1,2 .
RELEVANCE: Although some studies have provided evidence
regarding the importance of the alignment of AFOs, tuning of
the AFO-FC by optimising the alignment of the shank and GRF
is not common in clinical practice. Objective data is needed to
establish the effects of tuning AFO-FCs on the gait of patients
with hemiplegia. PARTICIPANTS: This single case study involved a
61 year old female with left hemiplegia; generalised hypertonicity,
short gastronemius, and reduced muscle power on the left side.
She presented with constant pain and swelling in the left knee
caused by excessive hyperextension but was ambulant with one
stick. METHODS: Data collection was part of routine clinical gait
analysis and the subject agreed the use of the data for research
purposes. Gait analysis (Vicon 612 with two AMTI force plates)
was performed on three occasions; baseline (with untuned AFO
prescription), immediately after tuning and 3 months after tuning.
In tuning, wedges were attached to the heel of the shoe until the
Shank to Vertical Angle (SVA) of the AFO-FC, in standing, was
approximately 12º inclined. The SVA was further adjusted to optimise
joint kinematics at midstance and orientation of the GRF relative
to the knee and hip joints. The optimum SVA for midstance tuning
was 14º inclined. A rocker was added to tune terminal stance. Gait
analysis was repeated for the finalised AFO-FC and reassessment
was carried out after three months. ANALYSIS: Comparisons were
made between the walking speed and the graphs showing knee
flexion-extension movement and flexion extension moments of the
knee joint in all the three sessions. RESULTS: While the walking
speed decreased from 0.95 m/s with the original AFO-FC to 0.81
m/s with the tuned AFO-FC on the same day, it increased to 1.03
m/s after using the tuned AFO-FC for three months. Knee flexion
during early stance increased and hyperextension during mid stance
decreased by the use of tuned AFO-FC in comparison with the
original prescription. The knee extension moment during stance
phase decreased towards normal. CONCLUSIONS: Reduction of
the knee hyperextension and the excessive knee extension moment
throughout stance can be attributed to the realignment of GRF
through modification of SVA and the addition of a rocker sole.
Reduction in hyperextension has led to significant decrease in knee
WCPT 2007, Research Reports
pain and swelling. The patient adapted well to the tuned AFO and
stated that tuning has been “a life changing experience” for her.
IMPLICATIONS: The effects of tuning of AFO-FC are evident from
this case study. Future randomized controlled studies are required
to generalise these results. References: 1. Owen E (2002) Gait &
Posture 16: Supp 1, S132-S133. 2. Owen E (2005) Gait & Posture
22S: S36-S37. KEYWORDS: Hemiplegia, Ankle Foot Orthoses,
Tuning. FUNDING ACKNOWLEDGEMENTS: The first author of this
study is funded by Queen Margaret University College, Edinburgh in
the form of scholarship. CONTACT: kjagadamma@qmuc.ac.uk
Research Report Platform Presentation
3114 Tuesday 5 June 15:40
VCEC Meeting Room 17
DO ANATOMICAL MEASURES EXPLAIN GENDER
DIFFERENCES IN HIP AND PELVIS MOTION DURING GAIT?
Chumanov E1 , Wall-Scheffler C2 , Heiderscheit B3 ; 1 University
of Wisconsin – Madison Department of Mechanical Engineering;
2 Department of Zoology; 3 Department of Orthopedics and
Rehabilitation
PURPOSE: The purpose of this study was to determine if
gender differences in pelvis and hip kinematics during walking and
running on a range of inclines correlate to anatomical measures.
RELEVANCE: Patellofemoral pain and iliotibial band syndrome are
common running related injuries, particularly in females. Abnormal
non-sagittal hip and pelvis motion has been observed among females
and suggested as the cause of the injury-rate disparity between
genders. It is reasonable that these differences in pelvis and thigh
motion may be related to the gender-specific morphology of the
pelvis and thigh. It is therefore important to consider how anatomical
differences between gender could influence the pelvis and hip
kinematics. PARTICIPANTS: Twenty-six healthy athletes (10 females
and 16 males), 18–31 yr old, participated in this study. METHODS:
An optical motion analysis system was used to collect the kinematic
trajectories of 40 reflective markers while subjects walked (1.2, 1.5,
and 1.8 m/s) and ran (1.8, 2.7, and 3.6 m/s) at inclines of 0, 10,
and 15%. A circumduction motion of the thigh on both the right and
left side was performed to estimate the location of the functional hip
joint center. A three-dimensional 14 segment, 29 degree of freedom
musculoskeletal model (SIMM) was used to compute hip and pelvis
angles throughout the motion. ANALYSIS: The effects of gender
on peak joint angles and angular excursions (internal hip rotation,
lateral pelvic tilt) were determined using repeated measures ANOVA.
Anthropometric measures (height, mass, BMI, leg length, thigh
length, trochanteric breadth, iliac breadth, and distance between
functional hip joint centers) were compared between genders using
an independent t-test. Pearson’s r coefficients and forward stepwise
regression analysis were used to determine the relationship between
the anthropometric measures and kinematic variables. RESULTS:
Females displayed significantly greater lateral pelvic tilt excursion
(1.5-5.8º; p < 0.001) compared to males across all walking speeds
and inclines. They also displayed significantly greater peak internal
hip rotation (1.6-4.3º; p < 0.05) across walking and running and
at all surface inclinations. Significant differences between genders
were present for all anthropometric measures (p < 0.05). However,
no significant correlations (r = 0.00-0.50) were observed between
the anthropometric measures and the pelvis and hip motions.
CONCLUSIONS: Healthy female athletes exhibited greater lateral
pelvic tilt during walking and greater internal hip rotation during both
walking and running compared to males. However, these kinematic
distinctions do not appear to be related to the anthropometric
differences between genders. IMPLICATIONS: Healthy subjects
exhibited gender related differences in the pelvis and hip kinematics
during walking and running, suggesting the need for gender specific
criteria to be applied during the clinical evaluation of individuals
with running related injuries. Furthermore, anatomical differences
alone do not explain the discrepancies in pelvis and hip kinematics
Platform Presentations, Tuesday 5 June
between genders. KEYWORDS: running injury, patellofemoral pain,
anthropometry. FUNDING ACKNOWLEDGEMENTS: NSF Fellow-
ship (E.Chumanov); University of Wisconsin graduate and medical
schools. CONTACT: easchmerr@wisc.edu
ETHICS COMMITTEE: University of Wisconsin – Madison Health
Sciences Institutional Review Board
Research Report Platform Presentation
2476 Tuesday 5 June 15:40
VCEC Meeting Room 18
MOTOR COORDINATION DIFFICULTIES IN A MUNICIPALITY
GROUP AND IN A CLINICAL SAMPLE OF POOR READERS
Iversen S1 , Berg K2 , Ellertsen B3 , Tønnesen F3 ; 1 Section of
Physiotherapy Science, Department of Public Health and Primary
Health Care, University of Bergen, Norway; 2 Department of
Physiotherapy, Faculty of Health and Sosial Sciences, Bergen
University College, Norway; 3 The Reading Centre, University of
Stavanger, Norway
PURPOSE: We wanted to investigate incidence, severity and types
of motor problems in two different groups of children with reading
difficulties compared to a control group of children with good reading
abilities. RELEVANCE: Research regarding motor coordination
difficulties and dyslexia is somewhat conflicting. Further research
from different angels is warranted. As a member of a multidisciplinary
team, physiotherapist can offer children with such problems help
to improve their motor performance. PARTICIPANTS: A group of
children with severe dyslexia (CD), a teacher selected municipality
sample (MUN) comprising the 5% poorest readers, and a control
group (CON) consisting of the 5% best readers, participated. The CD
group, 20 children, mean age 11.1 years, were all the children who
over a period of 14 month, were referred to a regional Competence
Centre due to severe reading problems and received a diagnosis
of dyslexia at the centre. The MUN group, 17 children, mean age
10.6 years, and CON group, 22 children, mean age 10.5 years, were
randomly selected from each of the teachers identified 5% poorest
readers and 5% best readers in school grade 6 in a Norwegian
municipality. The MUN group satisfied psychometric criteria for a
diagnosis of specific reading problems. METHODS: A quantitative
approach was used. The participants were assessed applying a
norm-based, standardized measure by Henderson and Sugden 1992
(The Movement Assessment Battery for Children). ANALYSIS: The
three groups were compared with regard to total motor impairment
scores as well as within the sub-areas of manual dexterity, ball-
skills and balance. Overall group comparisons were analysed using
one-way ANOVA. Chi-square was used to analyse frequency tables.
Significance level was set at p = 0.005. RESULTS: Shown by one-
way ANOVA, there was an overall significant difference between the
three groups on the total M-ABC impairment score [F(2,58) = 6.23,
p = 0.004], in manual dexterity [F(2,58) = 9.18, p < 0.001] and in
balance [F(2,58) = 3.54, p = 0.036], but not in ball skills. More than
50% of the children in both groups of poor readers showed definite
motor difficulties at or below the 5th percentile. Children in both
groups showed difficulties within manual dexterity in particular and
the ability to perform continuous, precise fine-motor movements was
severely affected (sub-test manual dexterity 3). For this sub-test Chi-
square analysis of the frequency table of CD versus CON yielded
c2 (1,42) = 22.51, p < 0.001, and for MUN versus CON c2 (1,39) = 7.97,
p < 0.001. CONCLUSIONS: The high incidence of motor coordination
problems in the two groups of poor readers indicates that all
children with reading difficulties should be screened for possible
motor difficulties. Further research is needed with regard to various
types of fine motor function in children with reading difficulties,
and in order to clarify functional consequences of motor difficulties
at activity and participations levels. IMPLICATIONS: The diversity
and complexity of developmental disorders point to the importance
of providing a multidisciplinary assessment and intervention within
a broad dynamic developmental framework. KEYWORDS: DCD,
S363
dyslexia, motor function. FUNDING ACKNOWLEDGEMENTS: The
study was supported by Foundation for Education and Research in
Physiotherapy, Norway. CONTACT: karin.berg@hib.no
ETHICS COMMITTEE: Approved by regional devision of National
Committee for Research Ethics in Norway.
Research Report Platform Presentation
2274 Tuesday 5 June 16:15
PP Crystal Pavilion B & C
FACTORS ASSOCIATED WITH MANUAL FORCES APPLIED
DURING CERVICAL MOBILIZATION
Snodgrass S1 , Rivett D1 , Robertson V2 , Stojanovski E3 ; 1 Discipline
of Physiotherapy, School of Health Sciences, The University of
Newcastle, Australia; 2 School of Health Sciences, The University of
Newcastle and North Sydney Central Coast Health, NSW, Australia;
3 School of Mathematics and Physical Sciences, The University
of Newcastle, Australia
PURPOSE: To investigate associations between manually applied
cervical mobilization forces and characteristics of therapists and
mobilized subjects. RELEVANCE: Optimizing manual treatment
to the cervical spine necessitates evaluation of the application
of commonly used techniques. PARTICIPANTS: 116 physical
therapists practicing in outpatient musculoskeletal clinics primarily
in NSW Australia and 35 asymptomatic volunteers. METHODS:
Each therapist applied a central and a unilateral postero-anterior
(PA) mobilization technique to the spinous and articular processes
(one right and one left) of both C2 and C7 of a single volunteer.
Maitland mobilization grades I through IV were applied at each pre-
marked location in randomized order. Therapists repeated all four
mobilization grades at a single location on the same volunteer after 20
minutes. Manual forces were measured in three directions using an
instrumented treatment table fitted with seven bi-axial load cells. Prior
to mobilization, spinal stiffness at both C2 and C7 was measured with
a device that applied five cycles of standardized mechanical force at
1 Hz to the spinous process while recording force and displacement.
Age, gender, height and weight of both therapists and mobilized
subjects were documented. Other therapist characteristics recorded
included years of experience, training, frequency of performing
cervical mobilizations, work setting, history and frequency of thumb
pain, change in technique due to thumb pain, current symptoms
in the upper limbs due to previous injuries, and understanding
of the mobilization grades. Three parameters of applied force
were examined: peak force (average peak of oscillations, N), force
amplitude (average difference between minimum and subsequent
maximum forces for each oscillation, N), and oscillation frequency
(rate of force application, Hz). ANALYSIS: One-way anovas with
Bonferroni post-hoc tests were used to examine differences between
mobilization grades and techniques. Regressions were used to deter-
mine associations between force parameters and characteristics of
therapists and mobilized subjects. Directions of force were analyzed
separately. RESULTS: Therapists applied different forces for different
techniques and grades, greater force at C7 than C2, and greater
mediolateral force for unilateral techniques (all significant at the 0.001
level). Oscillation frequency did not differ between techniques, but
between grades I and IV and grades II and III (p < 0.005 for each
pair of grade comparisons). Characteristics associated with force
parameters varied with technique and grade. Gender of therapist
and mobilized subject were associated with vertical peak force
(p < 0.001 for most techniques and grades); mobilized subject height
and weight were associated with caudad-cephalad peak forces and
force amplitudes for C7 techniques (p  0.001 for grades II-IV); and
frequency of thumb pain, change in technique due to thumb pain, and
therapist understanding of the mobilization grades were associated
with oscillation frequency for all techniques and grades (p < 0.001).
CONCLUSIONS: Factors associated with cervical mobilization forces
vary depending on the technique and grade applied. IMPLICATIONS:
These results describe characteristics of therapists and mobilized
S364
subjects associated with manual cervical mobilization forces. Rec-
ognizing these associations may optimize therapists’ application
of manual cervical treatments, and impact on future research
and training programs for cervical mobilization. KEYWORDS:
musculoskeletal manipulations, cervical vertebrae, physical therapy
modalities. FUNDING ACKNOWLEDGEMENTS: This work was
supported by a University of Newcastle Early Career Researcher
Grant. CONTACT: Suzanne.Snodgrass@newcastle.edu.au
ETHICS COMMITTEE: The University of Newcastle Human Re-
search Ethics Committee, and ethics committees of Hunter New
England Health and Central Coast Health
Research Report Platform Presentation
2247 Tuesday 5 June 16:15
VCEC Ballroom A
WOMEN LIVING WITH A SPINAL CORD INJURY: PERCEPTIONS
ABOUT THEIR CHANGED BODIES
Chau L, Hegedus L, Praamsma M, Smith K, Tsukada M, Yoshida K;
University of Toronto
PURPOSE: The purpose of this study is to illuminate narratives
of women living with a spinal cord injury (SCI) with regards to (1)
learning how to live with a changed body and (2) exploring the factors
that influence how they feel towards their new bodies. RELEVANCE:
A SCI produces immediate physical impairments resulting in a
changed body, which refers not only to physical modifications, but
also to changes in emotional and social experiences. Through
its focus on enhancing the body, physical therapy can help to
promote a positive view of the self within the changed body. To
date, research surrounding the social-psychological aspects of SCI
rehab has been very limited and there is a lack of focus on the
specific concerns of women. More research about lived experiences
is needed to better understand the role that physical therapy plays
in the development of body image and self-concept of women post-
SCI. PARTICIPANTS: This secondary study extracted data for all
15 female participants from a primary study sample of 80 adults
living with a SCI. The primary study was conducted by Dr. Karen
Yoshida and Dr. Rebecca Renwick (2004). Participants, aged 27
to 59 years, included 7 with paraplegia and 8 with quadriplegia.
METHODS: A qualitative secondary analysis of semi-structured
face-to-face interviews was conducted. Coded segments of the
interviews from the primary study were analyzed and compared to
identify broader conceptual concepts concerning body image and
self concept in women with spinal cord injury. These concepts were
then integrated into an initial framework that attempts to describe the
relationships between these concepts, and the factors that contribute
to them. ANALYSIS: A modified grounded theory method was used,
focusing on memoing and integrating codes. RESULTS: Findings
derived a middle-range framework illustrating a fluid three-phase
progression of attitudes towards living with a changed body that
generally moves from (1) discomfort, (2) moving towards comfort,
(3) comfort. Discomfort, in this analysis, refers to a sense of
uneasiness related to one’s changed body and the associated loss
of control over bodily functions, privacy, and treatment approach.
The second stage, moving towards comfort, is characterized by
strategies progressing from social isolation to representing oneself in
a positive light through appearance and behaviour. Finally, comfort
is fulfilled by educating others about visible disabilities and by
surrounding oneself with an accepting environment. The framework’s
dual-directionality reflects the continual shift in comfort experienced
by the participants. CONCLUSIONS: Physical therapy can potentially
influence the process of women gaining comfort with their changed
bodies following SCI. The proposed framework provides a basis
for future research into the recovery process following SCI. Future
prospective studies should investigate the significance of gender,
ethnicity, and spinal level of injury. IMPLICATIONS: This framework
and participants’ narratives yielded recommendations for enhancing
the role of physical therapy in the SCI rehab process. These
WCPT 2007, Research Reports
recommendations include offering improved privacy, individualized
treatment, educational sessions, and providing opportunities for peer
support and rehab outings. KEYWORDS: spinal cord injury, women,
body image. FUNDING ACKNOWLEDGEMENTS: The original study
was supported by the Ontario Neurotrauma Foundation.
ETHICS COMMITTEE: The Health Sciences II Research Ethics
Board at the University of Toronto
Research Report Platform Presentation
748 Tuesday 5 June 16:15
VCEC Meeting Rooms 1-3
DELISTING PUBLICLY-FUNDED COMMUNITY-BASED
PHYSICAL THERAPY SERVICES IN ONTARIO, CANADA: A
12-MONTH FOLLOW-UP STUDY
Paul J1 , Park L1 , Ryter E1 , Miller W1 , Ahmed S1 , Landry M2 ,
Cott C2 ; 1 Department of Physical Therapy at the University of
Toronto, Toronto, Canada; 2 Department of Physical Therapy at
the University of Toronto, and The Arthritis Community Research
and Evaluation Unit, Toronto, Canada
PURPOSE: Publicly-funded community-based physical therapy (PT)
services in Ontario were partially delisted in April 2005. This study
is a 12-month follow up to previous studies that assessed short-term
consequences of the delisting. This follow up aimed to assess the
long-term consequences of the policy decision from the perspectives
of both PT providers and clients in Ontario. RELEVANCE: Reduc-
ing expenditures on publicly-funded health services has become
necessary as health care costs are increasing. Examining the
consequences of the delisting provides substantiation of its impact on
both clients and the PT profession, which may help direct future policy
decisions. PARTICIPANTS: Sixteen provider participants (89%) were
recruited from the 18 providers who participated in a previous
provider study regarding the delisting and who agreed to be
contacted for follow up. These providers worked in one of four practice
categories: (1) publicly-funded, community-based clinics (termed
Designated Physiotherapy Centres), (2) privately-funded clinics, (3)
hospitals, or (4) home care under contract with Community Care
Access Centres. Sixty-four client participants (65%) were recruited
from the 98 clients who participated in a previous client study
regarding the delisting and who agreed to be contacted for follow up.
These clients had been accessing publicly-funded, community-based
PT services prior to the delisting. METHODS: At 12 months following
the partial delisting, provider and client participants completed
a 10 minute telephone interview that included both quantitative
and qualitative components. ANALYSIS: Quantitative data from
participant interviews were systematically analyzed using descriptive
statistics. Qualitative data from provider interviews were entered into
a data analysis software package, and major themes derived from
the data were subsequently analyzed. RESULTS: At 12 months
follow up, 28 of 37 (76%) client participants considered ineligible for
publicly-funded, community-based PT, reported increased difficulty
accessing PT services. Several of these clients also expressed health
concerns. A decrease in demand for PT was reported by providers at
Designated Physiotherapy Centres, whereas most providers in other
settings reported no change resulting from the delisting. Providers
reported that clients were increasingly using other publicly-funded
health care services after the partial delisting. Lastly, there were
mixed perceptions regarding the impact of the delisting on the PT
profession in Ontario. CONCLUSIONS: Long-term consequences of
the delisting were not significantly different from short-term effects
identified two weeks after the policy implementation. Follow-up
results indicate that clients requiring PT services in publicly-funded,
community-based settings are unable to access services elsewhere.
Further research is required to assess the cost-effectiveness of
shifting fiduciary health care responsibility away from the provincial
government and moving it towards private and third-party payers.
Research into innovative resource allocation methods is needed to
sustain public health care systems. IMPLICATIONS: Documentation
Platform Presentations, Tuesday 5 June
and dissemination of these results will help inform the PT profession
in Ontario, as well as stakeholders in other jurisdictions who may
face similar policy changes. Failure to remodel health policy to
meet emerging demands may ultimately shift the Canadian health
care paradigm away from equal access. KEYWORDS: Delisting,
Health Policy, Public Funding. FUNDING ACKNOWLEDGEMENTS:
Medicare to Home and Community (M-THAC) Research Unit at the
University of Toronto, Ontario Physiotherapy Association, Ontario
Physiotherapy Association – Hamilton District, Ontario Physiotherapy
Association – Central Toronto District, Physiotherapy Association
of British Columbia, Alberta Physiotherapy Association, Toronto
Rehabilitation Institute and the Arthritis Community Research and
Evaluation Unit.
ETHICS COMMITTEE: The University of Toronto Health Sciences II
Research Ethics BoardThe University Health Network
Research Report Platform Presentation
1812 Tuesday 5 June 16:15
VCEC Meeting Rooms 11-12
PRESCRIBING CYCLE TRAINING INTENSITY FROM THE
SIX-MINUTE WALK TEST (6MWT) FOR PATIENTS WITH
CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD)
Zainuldin M1 , Knoke D1 , Mackey M1 ,Luxton N1 ,Alison J1,2 ;
1 Discipline of Physiotherapy, The University of Sydney, Sydney,
Australia; 2 Department of Physiotherapy, Royal Prince Alfred
Hospital, Sydney, Australia
PURPOSE: Cycle training intensity for patients with COPD is
normally based on an incremental cycle test (ICT). Such tests are
expensive and not readily available to clinicians. Previous research
has shown that the peak oxygen consumption (VO2peak ) for ICT
and 6MWT is equivalent. A regression equation relating distance
walked on the 6MWT and peak work rate (Wpeak ) on the ICT has
been reported. The aim of this pilot study was to prescribe cycle
training intensity from the 6MWT (using the regression equation) and
determine whether this resulted in a level of exercise (measured by
VO2 ) known to produce physiological training effects in people with
COPD. RELEVANCE: This study provides a quantitative method for
more precise, individualised prescription of cycle training intensity
from a simple 6MWT in patients with COPD. PARTICIPANTS: 12
participants with stable COPD and mild to severe lung disease were
recruited from referrals to pulmonary rehabilitation. Subjects with co-
morbidities limiting exercise performance were excluded. The mean
±SD age was 66 ±9 years; percent predicted forced expiratory
volume in one second (FEV1 %pred) 49±19%; ratio of FEV1 to
forced vital capacity (FEV1 /FVC) 0.47±0.13. Based on FEV1 %pred,
five participants had severe lung disease, three moderate and four
mild. METHODS: This study was a prospective, repeated measures
design. Two 6MWTs were performed. The better 6MWT was then
used to calculate Wpeak for cycle exercise from the regression
equation. After 30 minutes rest, subjects performed ten minutes
of constant-load cycle exercise at 60% of the calculated Wpeak .
During all exercise, cardiorespiratory and metabolic data (Cosmed
K4b2), dyspnea and rate of perceived exertion (RPE) were recorded.
ANALYSIS: The VO2 measured at the end of cycle exercise was
compared to VO2peak of the 6MWT (VO2bike /VO2walk ). Pearson’s
correlation coefficient was calculated for the relationship between
VO2bike and VO2walk . An ANOVA, with Bonferroni correction, was
performed to determine whether VO2bike /VO2walk was affected by
disease severity. RESULTS: VO2bike was significantly correlated with
VO2walk (r = 0.701, p = 0.01).The mean ±SD VO2bike /VO2walk was 82
±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
S365
COPD. However, the regression equation may be more applicable to
participants with mild to moderate lung disease as some participants
with severe disease had difficulty completing the constant-load cycle
exercise. Future research with a larger sample size, particularly
those with severe disease, is required. IMPLICATIONS: The ability
of clinicians to more precisely prescribe cycle training intensity from
a simple, reliable and inexpensive 6MWT will enhance effective,
individualised exercise prescription for patients with COPD referred to
pulmonary rehabilitation. KEYWORDS: COPD, six-minute walk test,
cycle training prescription. FUNDING ACKNOWLEDGEMENTS: The
University of Sydney. CONTACT: j.alison@fhs.usyd.edu.au
ETHICS COMMITTEE: 1) Sydney South West Area Health Service;
2) The University of Sydney
Research Report Platform Presentation
542 Tuesday 5 June 16:15
VCEC Meeting Room 16
EXERCISE MOTIVES OF OLDER ADULTS
Thow M1 , Rafferty D1 , Carson M1 , Chandler C; 1 Glasgow
Caledonian University
PURPOSE: There is a predicted increase in the number of older
people that will make up the world wide population. It will be
important that this population maintain good health to minimise
the impact on health services. There is compelling evidence of
the physiological and psychosocial benefits of habitual exercise for
older people. These benefits will only be achieved with adherence
to exercise participation. The motives that affect adherence to
exercise are less well known in this population. The aim of this
study was to investigate the exercise motives of older women.
RELEVANCE: The understanding of exercise motives of older people
will inform practictioners and health professionals on strategies to
encourage exercise participation and adherence. PARTICIPANTS: A
convienience sample of 51 women, mean age 71 (SD±7.9) years of
age, was recruited from an over-50’s exercise class. The women had
been attending a weekly exercise class for more than three months.
METHODS: The 51 subjects completed a validated questionnaire.
The instrument used was the Exercise Motivations Inventory (EMI-
2) (Markland & Ingledew 1997). The questionnaire comprises 51
questions that address five characteristics of participation: personal,
interpersonal, health, appearance and fitness. The responses are
on a Likert scale of 0-5. ANALYSIS: The mean and SD for each
category was established. RESULTS: The highest scores were for
nimbleness 4.2 SD±0.9, ill health avoidance 4.3 SD±0.9, positive
health 4.2 SD ±1.0,affiliation 3.0 SD±1.4, revitalisation 3.4 SD±1.4,
enjoyment 2.9 SD ±1.2. The lowest scores were for competition
0.5 SD±0.7 and social recognition 0.5 SD ±0.5. CONCLUSIONS:
The maintenance of good health and avoidance of illness are
strong motivators. In addition, agility and feeling good are important
for the older women. Lastly, enjoyment and social contact are
highly. IMPLICATIONS: Physiotherapists should be aware of the
motivators for older exercisers. The identification of reliable predictors
of exercise and motivation will help physiotherapists effectively
intervene and improve the pattern of physical activity in older adults.
In addition, awareness of motivational factors can provide a basis
for motivational interviewing and behaviour change to enhance
adherence in this ever growing population. KEYWORDS: Older
adults, exercise, motivation. FUNDING ACKNOWLEDGEMENTS:
None. CONTACT: M.thow@gcal.ac.uk
ETHICS COMMITTEE: The School of Health and Social Care
Glasgow Caledonian University
S366
Research Report Platform Presentation
1097 Tuesday 5 June 16:15
VCEC Meeting Room 17
FUNCTION-CENTERED TREATMENT INCREASES WORK
DAYS IN PATIENTS WITH NON-ACUTE NON-SPECIFIC LOW
BACK PAIN: ONE-YEAR RESULTS FROM A RANDOMIZED
CONTROLLED TRIAL
Kool J1 , Bachmann S1 , Oesch P1 , Knuesel O1 , Ambergen T2 ,
van den Brandt P3 , de Bie R3 ; 1 Department of Rheumatology,
Rehabilitation Centre Valens, Valens, Switzerland; 2 Department
of Methodology and Statistics, University of Maastricht, Maastricht,
the Netherlands; 3 Department of Epidemiology, University of
Maastricht, Maastricht, the Netherlands
PURPOSE: To compare the effect of function-centered (FCT)
and pain-centered treatment (PCT) on the number of work days,
permanent disability, and the unemployment rate. RELEVANCE:
Days lost from work are responsible for the major costs related to
low back pain (LBP). FCT was developed for patients with multiple
nationalities working in Switzerland. Most of these patients have
limited knowledge of the Swiss national language; many are at risk of
developing permanent LBP disability. Multidisciplinary rehabilitation
is effective compared with usual care. It is unknown whether FCT is
superior to PCT in this population. PARTICIPANTS: Eligible were
patients between 20 and 55 years with non-acute (duration  6
weeks) non-specific LBP,  6 weeks of sick leave in the previous 6
months. Written informed consent was available in German, Italian,
Serbo-Croatian, Albanian, Turkish, French, Spanish and Portuguese.
We excluded patients with co-morbidity and patients who did not
understand German or Italian sufficiently to cooperate with the initial
assessment. METHODS: Randomized controlled trial with one-year
follow-up. FCT was 4 hrs/day during 3 weeks and emphasised
activity in spite of pain using work simulation, strength, endurance
and cardiovascular training. PCT was 2.5 hrs/day during 3 weeks
and emphasised pain reduction and included passive and active
mobilisation, stretching, strength training and a mini back-school. We
collected work days with questionnaires sent to the employers and
physicians responsible for work certificates. The study was approved
by the ethical committee of St.Gallen. ANALYSIS: Intention-to-treat
analysis. We analyzed between group comparisons of work days with
negative-binomial logistic hurdle regression. RESULTS: We included
174 patients, 79% male, age 42, previous sick leave 6 months.
The one-year follow-up completeness of work days was 96%. After
one year, the FCT group had more work days (118, 95% CI=89-
147) than the PCT group (74, 95% CI=50-98, p = 0.011). The OR of
returning to work in the FCT/PCT group was 2.1 (95% CI=1.1-3.6).
There was a negative effect for litigation, longer sick leave before
treatment, and South-East European nationality without interaction
with treatment. The differences in unemployment rates and in the
numbers of patients receiving compensation for permanent disability
were not significant but the study was underpowered for these
outcomes. CONCLUSIONS: FCT is more effective than PCT for
increasing work days. IMPLICATIONS: Function-centred treatment
is effective in patients from multiple countries with limited knowledge
of the Swiss national language. FCT should be generally used
instead of the still predominantly applied PCT. We currently perform
a three-year cost-effectiveness analysis of FCT. KEYWORDS:
Randomized controlled trial, low back pain, occupational diseases,
sick leave, vocational rehabilitation, exercise therapy, outcome
assessment, predictive factors. FUNDING ACKNOWLEDGEMENTS:
This randomized controlled trial was supported by grant 00.00437
from the Swiss Federal Office of Health. CONTACT: j.kool@klinik-
valens.ch
ETHICS COMMITTEE: St Gallen, Switzerland
WCPT 2007, Research Reports
Research Report Platform Presentation
2902 Tuesday 5 June 16:15
VCEC Meeting Room 18
A WEB-BASED SURVEY OF 14-16 YEAR OLDS: THE
RELATIONSHIPS BETWEEN BACK PAIN AND LIFESTYLE
Candy E1,2 , Stephenson R1 , Jerosch-Herold C1 ; 1 University of
East Anglia, Norwich, Norfolk. UK; 2 Gwent Healthcare NHS Trust,
Gwent, Wales,UK
PURPOSE: The purpose of this Web based survey was to define
the prevalence of back pain in 14-16 year olds and identify
potential lifestyle factors associated with back pain. RELEVANCE:
By the age of 15 the prevalence of back pain is equal to that in
adulthood. Previous surveys have established links between back
pain and gender, sport, psychological stress and sitting. The links
between lifestyle and back pain in young people require further
exploration if effective preventative measures are to be introduced.
PARTICIPANTS: An Internet survey of school students aged from
14-16 in a predominantly rural county in Eastern England UK was
undertaken (potential population of 17,640 children). METHODS:
The Local Education Authority gave permission to approach all 38
state schools. The 9 independent schools were contacted directly.
A contact teacher was established in each participating school to
provide links between the researcher and the children. Presentations
were given to all eligible students to explain the nature of the study.
The contact teacher distributed the URL to the students. The survey
was completed between November 2004 and May 2005. ANALYSIS:
Data was downloaded directly into the survey design program and
transferred into Excel for organisation and coding. SPSS was used
for analysis. Logistic regression was used to observe relationships
and trends in the data. RESULTS: Seventeen schools agreed to take
part (population of 6,507 children). An overall student response rate
of 8% (492 children) was achieved; but 5 schools failed to return any
responses. 69% (341 children) reported back pain, of these 26% (90
children) reported some functional limitation. Significantly more girls
reported back pain (60%; 206 girls) than did boys (40%; 135 boys)
with an odds ratio (OR) of 1. 68 (95% CI 1.13 to 2.53, p = 0.01).
Those who carried their school bags all day (73%, 358 children)
were significantly more likely to reported back pain (OR=2.83, 95% CI
1.36 to 5.98, p = 0.01). A family history of back pain was reported
by 64% (316 children), and was also significantly associated with
back pain (OR= 2.01, 95% CI 1.36 to 3.01, p  0.001). There were
no significant associations in this group between the intensity of back
pain, mood, sport and sitting duration. CONCLUSIONS: Accepting
that the low response rate may incorporate survey bias towards
back pain, the survey offers further evidence of a high prevalence
of back pain in school children which may be linked to gender, bag
carrying and family history. IMPLICATIONS: Further exploration of
these factors should be undertaken to establish the nature of the
relationships. KEYWORDS: Web survey, Back pain, Young People.
FUNDING ACKNOWLEDGEMENTS: This study was supported
by funding from the Chartered Society of Physiotherapy Eastern
Board and Backcare (registered charity no: 256751). CONTACT:
elizabeth.candy@gwent.wales.nhs.uk
ETHICS COMMITTEE: East Suffolk Local Research Ethics Commit-
tee
Research Report Platform Presentation
1381 Tuesday 5 June 16:15
VCEC Meeting Rooms 19-20
FACTORS THAT IMPACT INCONTINENT WOMEN’S
PARTICIPATION TO A PELVIC FLOOR MUSCLE EXERCISE
CLASS AND A HOME PROGRAM
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)
Platform Presentations, Tuesday 5 June
in weekly pelvic floor muscle (PFM) exercise classes; completion of
a 12-week exercise class program; and daily home PFM exercises
throughout the program. Data were collected as part of a feasibility
study looking at the use of a PFM exercise class program to treat
older women with UI. RELEVANCE: Supervised PFM exercises
alone or in combination with bladder retraining is the first-line
treatment for stress UI and mixed UI. Both interventions can
be delivered either in one-on-one therapy or class therapy by
physiotherapists. Since they have proven effective, it is assumed
that they can be applied to both younger and older UI women, but
this assumption has not been formally tested for women of over
60 suffering from UI and following a PFM exercise class program.
PARTICIPANTS: A total of 27 community-dwelling older women
aged 70.77±7.75 years with signs and symptoms of stress UI or
mixed UI, participated in the study. They were recruited from three
UI clinics in Montreal and participated in 12 PFM weekly exercise
classes in groups of six to eight. METHODS: A cross-sectional
qualitative study using focus group methodology was conducted.
There were four different focus groups with six to eight subjects at
the end of the 12-week PFM exercise class program. Subjects were
asked what made them participate or not in weekly PFM exercise
classes; complete or not the 12-week exercise class program and
do or not do daily home PFM exercises throughout the duration
of the program. Open discussion of the participant’s perceptions
was facilitated by the moderator. Subjects who withdrew from the
study were contacted to solicitude the same information. Data
was collected, revised and compiled using a tape-based abridged
transcript method. ANALYSIS: Data was analyzed with a long-
table approach described by Kruger and Casey. RESULTS: For
participation in weekly PFM exercise classes, the facilitators were, in
order of importance; the desire to reduce UI; a sense of responsibility
towards the study; close supervision by the physiotherapist and
group support. Impedimenta were: illness, medical appointments and
planned social activities. For the completion of a 12-week exercise
class program, the facilitators were the perceived severity of UI and
the desire to avoid surgery; follow the doctor’s recommendations,
help in UI research and avoid the waiting list for other treatment.
Impedimenta were illness and conflict with social activities. For the
home PFM exercises, facilitators were the desire to reduce UI and to
make exercises part of a daily routine. Impedimenta were: a busy
schedule, the length of the home exercise program and illness.
CONCLUSIONS: Two major themes emerged: individual factors
(motivation, responsibility) and situational factors (home exercise
program length, class schedule, and illness) CONCLUSIONS: Two
major themes emerged: individual factors (motivation, responsablilty)
and situational factors (home exercise program lenght, class
schedule, illness). IMPLICATIONS: To be successful, a PFM
exercise class program must target modifiable factors to insure
older women’s optimal participation. KEYWORDS: physiotherapy;
urinary incontinence; pelvic floor muscle; exercise class; focus group;
older women. FUNDING ACKNOWLEDGEMENTS: This project was
funded by the Incontinence Axis of the Quebec Network for Research
on Aging, Quebec Fund for Health Research.
ETHICS COMMITTEE: Ethics commitees: CSSS-IUGS of Sher-
brooke, Laval health and social services center and Sir Mortimor
B. Davis Jewish General Hospital
S367
Research Report Platform Presentation
1010 Tuesday 5 June 16:35
PP Crystal Pavilion A
THE INTEGRATION OF REHABILITATION INTO PRIMARY
HEALTH CARE: RESULTS OF A RANDOMIZED TRIAL
Richardson J1 , Letts L1, , Chan D2,3 , Stratford P1 , Baptiste S1 ,
Edwards M1 , Coman L1 , Price D2,3 , Hilts L3,4 , Law M1 ; 1 School
of Rehabilitation Science, McMaster University, Hamilton, Ontario,
Canada; 2 Dept of Family Medicine, McMaster University, Hamilton,
Ontario, Canada; 3 Stonechurch Family Health Centre,McMaster
University, Hamilton, Ontario, Canada; 4 School of Nursing,
McMaster University, Hamilton, Ontario
PURPOSE: The objectives were to determine whether adults with
a chronic illness receiving care in a Primary Care(PC)setting as
a result of a rehabilitation intervention, compared with adults in
the PC setting who do not receive the intervention:1.show greater
improvement in health status 2.have fewer hospital admissions and
emergency room visits 3.show greater improvement in physical
functional status,and decreased falls 4.show greater satisfaction.
RELEVANCE: The future of Primary Care lies in its ability to meet
the needs of persons who are chronically ill (Anderson & Wagner,
2003).Persons with chronic illness, especially older persons who
are most at risk for functional decline, are currently not receiving
effective management(Grumbach & Bodenheimer, 2002).This project
introduced Physical Therapy and Occupational Therapy into a PC set-
ting to address this need. PARTICIPANTS: Adults 44 years or older
with one or more chronic conditions who had 4 or more physician
visits in the previous year were selected from the Stonechurch family
practice database and invited to participate. Mean age was 64 years,
56% 46-64 years, 63% were women. METHODS: Blind assessors
(PTs and OTs) assessed patients in their homes on four occasions.
The outcomes used were the SF-36, the Late-Life Function and
Disability Index,ER visits and hospitalizations and caregiver strain
index. Semi-structured qualitative interviews were undertaken with
patients and staff. Rehabilitation services offered through the project
involved:screening and prioritizing individuals in both the intervention
and the control groups at risk for functional decline,a recent fall
and the probability of hospitalization; assessment by a PT or an
OT for persons in the intervention group to establish treatment
goals;home, clinic or community visits; group or individual interven-
tion directed at chronic disease self-management(CDSMP) based
on the CDSMP from Stanford and adapted to focus on rehabilitation-
related strategies;collaborative goal setting; an Activity and Wellness
Group that provides opportunities to explore healthy lifestyles PT
Individual services included individualized exercise programs using
motor learning principles, modalities, acupuncture, manual therapy;
consultation regarding mobility devices and funding, home safety and
falls prevention and posture and positioning.A website I Am Able
Website (www.iamable.ca)was developed with information regarding
rehabilitation and community resources. ANALYSIS: An analysis of
covariance was used to analyze the continuous variables, logistic
regression for dichotomous variables and Mann-Whitney U-test for
ordinal variables. RESULTS: The intervention group had fewer
planned hospital days,adjusted difference=0.60 p < 0.01, a cost
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
S368
therapists. KEYWORDS: primary care, randomized controlled trial,
physical therapy. FUNDING ACKNOWLEDGEMENTS: This study
was funded through the primary health care transition fund through
the Ministry of Health. CONTACT: jrichard@mcmaster.ca
ETHICS COMMITTEE: Hamilton Health Sciences/McMaster Univer-
sity Ethics Board
Research Report Platform Presentation
2289 Tuesday 5 June 16:35
PP Crystal Pavilion B & C
ARE PSYCHOLOGICAL FACTORS PROGNOSTIC INDICATORS
OF OUTCOME IN PATIENTS WITH SUB-ACUTE NECK PAIN?
Pool J1 , Ostelo R1,2 , Knol D1,3 , Bouter L1 , De Vet R1 ; 1 EMGO
institute VU University medical centre Amsterdam; 2 Department
of Allied Health Care Research, Amsterdam School for Allied
Health Care Education; 3 Department of Clinical Epidemiology and
Biostatistics, VU Medical Center, Amsterdam
PURPOSE: Our aim was to identify psychological factors that are
prognostic indicators of the short and long term outcome of patients
with sub-acute neck pain in terms of perceived recovery, pain
and functional disability. RELEVANCE: An increasing amount of
attention is being paid to psychological factors in the development
and maintenance of pain and disability. Furthermore, psychological
and social factors are possibly involved in the transition from
acute to chronic neck pain. PARTICIPANTS: This prospective study
was conducted within the framework of a randomised clinical
trial comparing two types of conservative therapy in 146 patients
with non-specific sub-acute neck pain. METHODS: At baseline,
146 patients completed a questionnaire containing questions about
potential prognostic indicators such as: gender, age, history of
neck complaints, severity of the pain. Furthermore, the 4 dimension
psychological symptomatology questionnaire (4DSQ) was used to
measure: somatisation, distress, depression and fear, and the
Pain Coping and Cognition List PCCL was used to measure:
catastrophysing, coping, and internal and external pain control. Fear
of movement was measured with the Tampa Scale for Kinesiophobia
(TSK), the level of chronicity was assessed with the Graded Chronic
pain Scale (GCPS). The patients preference or non-preference for
therapy, manual therapy, physical therapy, and general practitioner
attitude towards neck pain were assessed with the Pain Beliefs and
Attitude Scale. Three primary outcome measurements were defined
and measured at 12 and 52 weeks. 1)perceived recovery on a 7-
point ordinal rating scale. 2)The severity of neck pain was scored
on an 11-point Numerical Rating Scale (NRS). 3)The Neck Disability
Index (NDI) was used to measure functional status. ANALYSIS: The
relationship between each potential prognostic indicator and outcome
was evaluated, adjusting for the randomly allocated intervention. As
the interventions were performed by a number of therapists, we
took patients clusters under therapists into account in the analysis.
Therefore a multilevel analysis was performed, with two levels:
patients and therapists. RESULTS: The short and long term results
for the three outcomes were very diverse. Furthermore, the explained
variance in the short term ranged from 16% to 30%, and from 6% to
34% in the long term. This can be considered to be low, and applies
that it is difficult to predict the course of neck pain. The sub-scales of
the used questionnaires, i.e. the Pain Coping and Cognition List, and
the 4 Dimensions of Psychological Symptomatology Questionnaire,
did not contributed significantly to all of the multilevel models. Only
the factor ‘fear of movement’ (Tampa scale) was consistently and
significantly present in the univariable analysis for all outcomes at
both follow-up measurements, and also for the short term outcome
pain and disability in the multivariable analysis. CONCLUSIONS: We
conclude that we were unable to identify a core set of prognostic
psychological factors that predict the short and long term outcome
of sub-acute neck pain. Further prognostic research is needed
to achieve more consistent results. IMPLICATIONS: In clinical
practice it is thought that psychological factors are important in
WCPT 2007, Research Reports
the transition to chronic pain, but it is still difficult to underpin this
seemingly evident statement with scientific evidence. KEYWORDS:
neck pain, prognostic indicators, psychological factors. FUNDING
ACKNOWLEDGEMENTS: None. CONTACT: j.pool@vumc.nl
ETHICS COMMITTEE: VU University ethical committee
Research Report Platform Presentation
2659 Tuesday 5 June 16:35
VCEC Ballroom A
TRAINING SKILLED WALKING: A NEW APPROACH FOR
INCOMPLETE SPINAL CORD INJURY
Musselman K1 , Roy F2 , Norton J2,3 , Gorassini M2,3 , Fouad K1 ,
Misiaszek J4 , Yang J3,5 ; 1 Faculty of Rehabilitation Medicine;
2 Department of Biomedical Engineering; 3 Centre for Neuroscience;
4 Department of Occupational Therapy; 5 Department of Physical
Therapy, University of Alberta, Edmonton, Canada
PURPOSE: To design and test the effectiveness of a program to
enhance walking skills for individuals with incomplete spinal cord
injury (iSCI). Walking in the home and community is an important
goal for clients with iSCI. Body weight-supported treadmill training
(BWSTT) helps some of these individuals regain the ability to
walk. Walking in the community, however, requires a variety of
walking skills. For example, community walking entails negotiating
curbs, doors and uneven terrain. Would intensive training of a
variety of relevant walking skills enable individuals with iSCI to
walk in the community to a greater extent than BWSTT? To
address this question, we first designed a new method (skill
training) that is intensive, variable and relevant to daily walking.
The aim of skill training is to challenge the nervous system
to solve motor problems in walking, and consequently, maximize
the use of spared descending pathways and spinal circuits to
promote plasticity for optimal performance (Raineteau et al. 2002,
Ballerman & Fouad 2006). Secondly, we compared clinical and
neurophysiological outcomes of BWSTT and skill training in a pilot
group of persons with iSCI. RELEVANCE: Gait training is an
integral part of the rehabilitation of many clients with neurological
deficits. Developing increasingly efficacious methods will benefit
physical therapy practice. PARTICIPANTS: Seven individuals with
iSCI have participated to date (2 in the development phase and 5
in the randomized-controlled trial (RCT)). METHODS: Skill training
incorporates 3 principles: 1) practice walking skills important for daily
life (Musselman & Yang 2005) to ensure training is task-specific, 2)
practice these skills in a variety of environments to train the nervous
system to adapt, and 3) train intensively (5x/week). To assess the
feasibility of the new method, 2 individuals with iSCI, who had
completed BWSTT, participated in skill training for 3 months. Their
feedback was used to further refine the program. Subsequently, a
RCT was initiated to compare walking gains made through BWSTT
and skill training. All subjects complete 3 months of BWSTT, followed
by either 3 months of skill training or another 3 months of BWSTT.
Walking ability and participation are assessed using standardized
measures (i.e., 6 minute walk, speed, modified Emory Functional
Ambulation Profile (mEFAP, which is a measure of skilled walking)).
Two neurophysiological measures, transcranial magnetic stimulation
(Thomas & Gorassini 2005) and inter-muscular coherence (Norton &
Gorassini 2006), are used to estimate the strength of descending
connections from the motor cortex. Outcomes are assessed monthly
during training, and 3, 6 and 12 months post-training. ANALYSIS:
The Wilcoxon Signed Rank Test is used to compare outcomes of
BWSTT and skill training (p < 0.05). RESULTS: Preliminary findings
show that walking speed and endurance improved with both types of
training. Greater gains on the mEFAP were seen with skill training,
especially in the obstacles and stairs subscales. Neurophysiological
measures showed strengthening of descending connections from
the motor cortex with training. CONCLUSIONS: Preliminary findings
suggest that the new method of skill training effectively trains many
of the skills needed for community ambulation. IMPLICATIONS: Skill
Platform Presentations, Tuesday 5 June
training can be easily incorporated into a treatment plan for clients
with ISCI. KEYWORDS: training community walking. FUNDING
ACKNOWLEDGEMENTS: Christopher Reeve Foundation, Canadian
Institutes of Health Research, Alberta Heritage Foundation for
Medical Research, Neuroscience Canada, Killam Trust. CONTACT:
kristin.musselman@ualberta.ca
ETHICS COMMITTEE: Health Research Ethics Board of the
University of Alberta and Capital Health, Edmonton
Research Report Platform Presentation
2407 Tuesday 5 June 16:35
VCEC Meeting Rooms 11-12
MECHANISMS OF IMPROVED PHYSICAL PERFORMANCE
AFTER TRAINING WITH AND WITHOUT OXYGEN IN PATIENTS
WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE
Janaudis-Ferreira T1 , Henriksson-Larsén K2 ,
Lundgren R3 ,
Wadell K1,3 ; 1 Dep of Community Medicine and Rehabilitation,
Physiotherapy, Umeå University, Umeå, Sweden; 2 Dept of Surgical
and Perioperative Sciences, Sports Medicine, Umeå University,
Umeå, Sweden; 3 Dept of Respiratory Medicine and Allergy,
University Hospital, Umeå, Sweden
PURPOSE: The aim of this study was to investigate whether
the increased exercise performance in patients with COPD after
training with or without oxygen supplementation is due to central or
peripheral adaptations. RELEVANCE: Previous studies have come
to different conclusions regarding additional benefits of supplemental
oxygen during training. It is of great importance to put focus on
the physiologic effects of different methods to enhance physical
performance in patients with COPD. PARTICIPANTS: Twenty-two
patients with moderate to severe COPD. METHODS: The patients
were randomised to interval training on a treadmill with or without
oxygen (single blind design), three times per week for eight
weeks. They performed two six minute walking tests with different
instructions, one standardised (6MWD) and one modified (they were
stopped if they desaturated below 90%) (mod-6MWD)), before and
after the training period. ANALYSIS: Non- parametric tests were
applied and the results are presented as median, minimum, and
maximum values. Wilcoxon matched-pairs signed ranks test was
used to compare differences within groups and Mann-Whitney U-
test was used to compare differences between groups. To account
for the risk of mass significance the level of significance was set
to p < 0.01. RESULTS: The group training with air (AG) increased
distance walked in both tests and walking speed in 6MWD. The
group training with oxygen (OG) increased the distance walked and
walking speed after training in 6MWD. No changes in lactate levels
during test were found in the AG after compared to before training
in either of the tests. The OG had larger increase in lactate levels
after compared to before training in the 6MWD but not in the mod-
6MWD. The total time during which the patients desaturated below
90% did not change in AG in any of the tests after compared to
before the training period, though there was a trend towards longer
time of desaturation for the OG in the 6MWD. The AG rated lower
perceived exertion in 6MWD after training. There were no significant
differences between groups regarding changes after training in either
of the tests. CONCLUSIONS: Our data suggests that training without
supplemental oxygen might provide both central and peripheral
adaptations while training with supplemental oxygen mainly seems
to contribute to central adaptations. Patients in the OG tended to
have higher levels of lactate and longer periods of desaturation in
tests after training. This indicates an increased anaerobic metabolism
which is not considered to be a beneficial training effect for these
patients, since it might limit their exercise performance. The AG on
the other hand improved distance walked with no concurrent increase
of lactate or increased time of desaturation. IMPLICATIONS: These
results implies that the effects of supplemental oxygen during
training needs further investigation and should not be applied
routinely until more studies have been conducted. KEYWORDS:
S369
COPD, exercise training, supplemental oxygen, 6MWD. FUNDING
ACKNOWLEDGEMENTS: Funding for the study was gratefully
received from The Swedish Heart and Lung Foundation. CONTACT:
karin.wadell@sjukgym.uu.se
ETHICS COMMITTEE: The Research Ethics Committee of Umeå
University, Sweden.
Research Report Platform Presentation
1992 Tuesday 5 June 16:35
VCEC Meeting Room 16
WHAT INFLUENCES ACTIVITY LEVEL AND EFFECTS ACTIVITY
LEVEL CHANGE IN WOMEN AGED 40 TO 80 YEARS?
Nitz J, LowChoy N; The University of Queensland
PURPOSE: Higher levels of physical activity are encouraged for
optimal health and to reduce fall’s risk with ageing. The purpose of
this study was to report habitual physical activity level in community
living women aged 40-80years and document the change in level of
activity and the factors effecting this change over a 5-year period.
RELEVANCE: It is predicted that by 2031, 25% of the population
in Australia will be aged over 65years. Currently the incidence of
falls is 1 in 3 per year among people in this age group. The
cost of fall related injury is growing in accordance with population
increase. A higher level of habitual activity has been identified as
reducing the risk of a fall. Therefore the factors influencing level
of activity in women and the effect of a change in this level of
activity needs elucidation. This information is relevant in order to
inform strategic planners regarding approaches that might be most
effective in raising activity level in younger women to preempt decline
in physiological processes that contribute to increased fall’s risk. This
is an important approach to reducing the cost of fall related injuries
in older women since current interventions for those over 65 are only
serving to stabilize costs and not reduce them. PARTICIPANTS: 463
women completed our longitudinal observational study of balance
and postural stability as one part of a large multimodal assessment of
ageing. METHODS: Assessment recorded self-reported age, activity
level, fall history, number of co-morbidities and measured BMI and
balance. ANALYSIS: ANOVAs were used to estimate the effect of
activity level at baseline on activity change over the 5-year period.
The effect on change in activity level from falls, BMI, change in
number of co-morbidities during the study period and age and
stability at base line also was determined. RESULTS: Activity level
at baseline significantly affected change in activity level over 5 years
(P < 0.000). This change was negatively affected by age (P = 0.045)
and BMI (P < 0.000). Initial activity level had a positive effect if
subjects participated only in household chores or self paced activity
once or twice weekly (P < 0.001). This picture of change was most
evident in the cohort of women in their 40s. Women undertaking
more strenuous activity one or more times per week tended to reduce
their level of activity over the study period. There was no influence
from stability, history of falling or number of co-morbidities on change
in activity level. CONCLUSIONS: Younger less active women were
more likely to increase their activity level during the study period.
This finding shows that sedentary younger women are more likely
to be receptive to a lifestyle change that includes an increase in
activity level compared to older women or those with a higher BMI.
Being unsteady or having already fallen did not stimulate change.
IMPLICATIONS: Physiotherapists should be working with strategic
planners to suggest a variety of activities that have proven efficacy
regarding maintenance of balance to encourage increased levels of
activity in women from before the menopause if cost of fall related
injuries is to be controlled. KEYWORDS: women, activity level.
FUNDING ACKNOWLEDGEMENTS: Royal Brisbane and Women’s
Hospital Foundation, Australasian Menopause Society. CONTACT:
n.lowchoy@shrs.uq.edu.au
ETHICS COMMITTEE: The Medical Research Ethics Committee of
the University of Queensland and the Royal Brisbane and Women’s
Hospital Research ethics Committee.
S370
Research Report Platform Presentation
1222 Tuesday 5 June 16:35
VCEC Meeting Room 17
EFFECT OF FREQUENCY OF STABILIZATION EXERCISES ON
PLASMA SEROTONIN LEVELS IN PARTICIPANTS WITH SUB
CLINICAL CHRONIC LOW BACK PAIN
Sokunbi O1 , Moore A1 , Watt P2 ; 1 Clinical Research Centre
for Health Professions, University of Brighton, Eastbourne, UK;
2 Department of Sport and Exercise Science, Chelsea School,
University of Brighton, Eastbourne, UK
PURPOSE: To investigate the effects of frequency of application
of stabilization exercises on plasma serotonin levels and low back
pain outcome measures in participants with chronic low back
pain. RELEVANCE: It is not clear, if with the use of stabilisation
exercises; endogenous pain neurotransmitters can play a role in
the analgesic and treatment outcomes for low back pain patient.
Furthermore, it is not clear what dosage of the exercise might be
sufficient to ensure that the patient is achieving optimal benefit in
terms of reduction of chronicity and disability caused by low back
disorder. PARTICIPANTS: Eighty four participants, 50 females and
34 males were recruited to participate in this study. They were
participants with non specific mechanical chronic low back pain.
Only those who agreed not to undergo any other specific therapeutic
intervention (sub-clinical) during the time this study were recruited.
METHODS: Participants were randomly allocated to the control (no
exercise) or the exercise treatment groups in which they carried
out stabilization exercises at different frequencies i.e. once weekly,
twice weekly and three times weekly. Outcome measures used
in the RCT were plasma serotonin level measured with Enzyme-
linked radioimmunoassay technique,pain intensity measured with
Numeric rating scale, Functional disability measured with Roland-
Moris Disability Questionnaires and Quality of life measured with
Nottingham Health Profile. Data were collected at baseline, after
six weeks of intervention and at 18 week follow up assessments.
ANALYSIS: Data obtained from the measurement of dependent
variables did not show symmetrical distribution. Thus, they were
presented as median with accompanying semi-interquartile range,
Kruskall-Wallis test and Wilcoxon test were used to analyse between
group and within group differences respectively. RESULTS: The
results of the RCT showed that spinal stabilization exercises
produced a significant increase in plasma serotonin level by 17.8%
at all stages of data collection in all the exercise groups. All
the participants in the treatment groups experienced significant
reduction by more than 50% in pain and functional disability and
improvement by more than 50% in quality of life scores after six
weeks of treatment (P < 0.05). The extent of reduction in pain
and functional disability scores and improvement in quality of
life showed a clear trend in favour of the three times weekly
exercise group at 18 week follow up assessments(P < 0.05). A
linear regression analysis showed significant correlation between the
changes in plasma serotonin and each of pain, functional disability
and quality of life scores(r2 values ranged from 0.42 to 0.67,
P < 0.05). CONCLUSIONS: The results of this study indicated that an
increase plasma serotonin level gained with the use of stabilisation
exercise could have a role to play in the outcome of treatment
with this type of exercises. IMPLICATIONS: The cost effectiveness
of undergoing 18 sessions of treatment (x3 weekly for 6 weeks)
with stabilization exercises for an optimal therapeutic benefit may
warrant further investigation. KEYWORDS: Back Pain, Stabilization
exercise, Serotonin. FUNDING ACKNOWLEDGEMENTS: This study
was funded by The Association of Commonwealth Universities.
CONTACT: o.g.sokunbi@brighton.ac.uk
ETHICS COMMITTEE: University of Brighton Research Ethics
Committee
WCPT 2007, Research Reports
Research Report Platform Presentation
1740 Tuesday 5 June 16:35
VCEC Meeting Room 18
A BEHAVIORAL APPROACH USING MESSAGE BANNERS AND
POSTERS: PROMOTING STAIR USE IN JAPAN
Nomura T1 , Yoshimoto Y2 , Akezaki Y2 , Tomita Y2 , Hamakubo T2 ,
Fujiwara R2 , Higashi T2 , Sato A3 ; 1 Department of Physical
Therapy, School of Comprehensive Rehabilitation, Osaka Prefecture
University; 2 Graduate School of Human Life Science, Kochi
Women’s University; 3 Faculty of Human Life and Environmental
Science, Department of Health Science, Kochi Women’s University
PURPOSE: It has been proven that appropriate exercise lowers
the risk of chronic disease, but continuing regular exercise remains
difficult for most people. Stair climbing is frequently available
to most population groups, and it provides a useful model for
lifestyle exercise intervention. The main goal of this study was to
evaluate the effectiveness of using message banners and posters
in order to encourage the use of stairs instead of escalators at a
department store and a train station in Japan. RELEVANCE: These
data can be utilized to develop new approaches to enable such
individuals as diabetic or obese patients to increase their chances
to perform meaningful exercise on a daily basis. PARTICIPANTS:
The general public. METHODS: In study 1, the use of an escalator
and adjacent stairs was monitored at a department store from
11:00 to 13:00, 3 days a week, from November through January.
In study 2, the use of an escalator and adjacent stairs was
monitored at a commuter train station from 7:30 to 9:30, on
consecutive weekdays days, excluding weekends, from July through
September. ANALYSIS: All participants were coded for gender
and age in both studies, and the presence of hand bags in
one study 1. In addition, the temperature, humidity and weather
environmental factors in study 2 regarding observations before
and after each observation period. In both studies, a 2-week
baseline period was followed by a 4-week intervention period
using motivating messages written on banners and posters which
encouraged the use of stairs. The follow-up data were also
collected for 1 and 2 weeks after the removal of the banners
2 and 3 weeks later. To investigate the effects when using or
not using such banners, the intervention and follow-up periods
were compared to the baseline period using both the chi-square
and logistic regression analysis: a logistic regression analysis was
used for escalator/stair use as a dichotomous outcome variable.
RESULTS: In study 1, a total of 9,834 escalator/stair-choice
observations were made. The percentage of people who used the
stairs increased significantly from 46.0% to 51.1% during the 3-
4 week intervention period (p < 0.001). When the banners were
removed, the percentage still remained higher than at baseline.
The odds ratio for baseline vs intervention (3-4 weeks) of the
banner, gender, age and presence of hand bag were 1.249,
0.951, 2.071, 0.874. In study 2, a total of 43,241 escalator/
stair-choice observations were made. The percentage of people
who used the stairs increased significantly from 3.58% to 5.80%
during the 3-4 week intervention (p < 0.001). The odds ratio for
baseline vs intervention (3-4 weeks) with the banner, gender, age,
temperature, humidity and weather were 1.483, 0.581, 2.930, 0.996,
0.989, 1.100. CONCLUSIONS: This above described intervention
method was therefore found to effectively encourage physical
activity among the general public. As one method with wide
applications for encouraging meaningful exercise for an unspecified
number of individuals in the general public, this intervention
method was therefore considered to be successful. IMPLICATIONS:
education. KEYWORDS: exercise, daily physical activity, behavioral
approch. FUNDING ACKNOWLEDGEMENTS: The authors thank
Prof. Hiroyuki Nakamura (Department of Environmental Medicine,
Kochi Medical College) and the management personnel at the
experimental sites (a department store in Kochi City and a train
station in Himeji City) for their valuable assistance in conducting this
Platform Presentations, Tuesday 5 June
intervention study. The authors also thank the observers. CONTACT:
nomurata@rehab.osakafu-u.ac.jp
ETHICS COMMITTEE: Graduate school committee, Kochi Women’s
University
Research Report Platform Presentation
1484 Tuesday 5 June 16:35
VCEC Meeting Rooms 19-20
CAN 3D ULTRASOUND BE USED IN MEASUREMENT OF THE
SIZE OF LEVATOR HIATUS AND PELVIC FLOOR MUSCLE
THICKNESS?
Braekken I1,2 , Majida M3 , Marie E3 , Umek W4 , Dietz H5 , Bø K1 ;
1 Norwegian School of Sport Sciences, Oslo, Norway; 2 Hans &
Olaf Physiotherapy, Oslo, Norway; 3 Akershus University hospital,
Akershus, Norway; 4 University of Vienna, Vienna, Austria;
5 University of Sydney, Sydney, Australia
PURPOSE: The aim of the present study was to evaluate test
retest and intra-tester reliability of the determination of thickness
of the pelvic floor muscles and dimensions of levator hiatus using
3D translabial ultrasound. RELEVANCE: Pelvic floor muscle training
(PFMT) may increase physiological cross sectional area of the
pelvic floor muscles and decrease the size of levator hiatus. Three
dimensional (3D) ultrasound may be capable of measuring these
parameters. Ultrasound has the advantage of allowing multiplanar
real-time imaging, which is almost impossible using current MRI
technology. Few studies have evaluated intra-tester reliability of
measurement of the morphology of these muscles. This has to be
established in order to evaluate the mechanical effects of PFMT.
This is a test retest study to evaluate the reliability of sonographic
biometric measures of pelvic floor muscle anatomy. DESCRIPTION:
17 healthy female volunteers (mean age 47.9 years; range 29-71,
mean parity 1.8; range 0-4) were examined twice, using a “GE
Voluson 730 Expert system”. The intervals between the two tests
varied between 7 to 35 days (mean 15.9 days). 3D static volumes
were recorded at rest in dorsal lithotomy position, with an empty
bladder. Analyses were done offline on a PC using the software
“4DView” (GE Healthcare). Hiatal dimensions were measured in the
axial plane. The plane of minimal hiatal dimensions was identified as
the minimal distance between the posterior aspect of the symphysis
pubis and the anterior border of the back sling of the pubovisceral
muscle. The thickness of the m. puborectalis was measured in two
different locations in the axial plane of maximal muscle thickness.
Test retest was analysed using the intra-class correlation coefficient
(ICC, repeated measures) with 95% confidence intervals (CI), and by
coefficient of variation (CV). ICC values under 0.20 were considered
poor, 0.21-0.40 fair, 0.41-0.60 moderate, 0.61-0.80 good, and 0.81-
1.00 very good. EVALUATION: ICC values for transverse and
anterio- posterior hiatal dimensions were 0.72 and 0.61, and CV
was 5.5 and 5.7%. Area of levator hiatus showed ICC value 0.56
and CV was 8.8%. Cross sectional area for the pubovisceral muscle
was measured with ICC values 0.59 and 0.70 on the left side
and 0.13 to 0.36 on the right side. All the CV values were below
16.5% for measurements of thickness. CONCLUSIONS: Transverse
and anterio- posterior hiatal diameters demonstrated good reliability,
and hiatal area demonstrated moderate reliability. Measurement of
m. puborectalis thickness was less reliable, especially on the right
side. However the coefficient of variation was under 16.5% for all
parameters. IMPLICATIONS: 3D translabial ultrasound can be used
in clinical trials evaluating changes in anatomical parameters after
PFMT. KEYWORDS: Reliability, ultrasound, pelvic floor muscles.
FUNDING ACKNOWLEDGEMENTS: This project has been financed
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.
S371
Research Report Platform Presentation
1450 Tuesday 5 June 16:55
PP Crystal Pavilion A
A QUALITATIVE EVALUATION OF THE PHYSIOTHERAPY
SERVICE FOR HOMELESS PEOPLE IN GLASGOW, SCOTLAND
Hislop J1,2 , Smith J3 ; 1 Queen Margaret University College,
Edinburgh; 2 Glasgow Caledonian University, Glasgow; 3 Greater
Glasgow Primary Care NHS Trust, Glasgow
PURPOSE: The purpose of this study was to explore homeless
peoples’ views and experiences of a specialist physiotherapy service
for homeless people in Glasgow, Scotland. RELEVANCE: Evidence
suggests that homelessness increases the risk of poor health
and makes access to appropriate healthcare difficult. Benefits of
specialist health services for homeless people have been identified
and can improve access to appropriate healthcare. In Glasgow,
a specialist physiotherapy service has existed since 1996. The
aim of this study was to evaluate the physiotherapy service from
the perspective of homeless people. This would allow for the
development of a service which is responsive to the needs of the
population it serves. PARTICIPANTS: A sample of convenience of
twelve homeless people (11 males, 1 female, mean age: 47±13.6
years) was recruited from a homeless drop-in centre in Glasgow.
METHODS: Ethical approval to carry out this study was granted from
Greater Glasgow Primary Care NHS Trust ethics committee. Using a
qualitative approach, 1-hour semi-structured interviews and a focus
group were conducted with 12 homeless people. Five participants
had experience of the specialist physiotherapy service, 7 had not.
Interviews were conducted within a private room, were audio-
taped and transcribed verbatim. ANALYSIS: Using an interpretive
phenomenological approach to data analysis, recurrent themes were
identified from interview transcripts. Member checking of identified
themes was undertaken. RESULTS: The findings revealed that
participants who had used the physiotherapy service were positive
about this and valued the one-to-one contact they had with their
physiotherapist. The fact that the physiotherapist came to them in
their hostel or at a drop-in clinic meant that it was easily accessible.
Despite the availability of direct access to the service none of the
participants had initiated a self-referral and instead relied on a
support or hostel worker for this. Participants felt that physiotherapy
was for people who had sustained serious injuries, such as car
accidents or for people with sports injuries. As a result physiotherapy
was not felt to be relevant to them and their problems. While good
health was valued, poor health was often tolerated as an expected
consequence of homelessness. CONCLUSIONS: Homeless people
in this study were positive about their experiences of the specialist
physiotherapy service. However there was limited awareness of what
physiotherapy might offer and this could reduce participants’ self-
referring to the physiotherapy service. A strength of this study was
that it allowed individuals to voice their opinions of the physiotherapy
service. A weakness is that the sample comprised of self-selecting
participants. Further research on how to support homeless people
to access physiotherapy services is needed. IMPLICATIONS: The
study revealed a need to raise awareness about physiotherapy and
the services available amongst homeless people and those who work
closely with them. Homeless people experience difficulties accessing
appropriate and timely healthcare and may require support to do
so. KEYWORDS: Homelessness, access, service users. FUNDING
ACKNOWLEDGEMENTS: Greater Glasgow Primary Care Trust,
‘Involving People’ grant scheme. CONTACT: jhislop@qmuc.ac.uk
ETHICS COMMITTEE: Greater Glasgow Primary Care NHS
Trust ethics committee, Glasgow, Scotland; Glasgow Caledonian
University Research Ethics committee, Glasgow, Scotland
S372
Research Report Platform Presentation
2963 Tuesday 5 June 16:55
PP Crystal Pavilion B & C
A NOVEL METHOD OF NECK-COORDINATION EXERCISE –
EFFECTS ON SENSORIMOTOR FUNCTIONS AND SELF
REPORTED HEALTH AND FUNCTIONING
Röijezon U1−3 , Björklund M1,2 , Djupsjöbacka M1 ; 1 Centre for
Musculoskeletal Research, University of Gavle, Box 7629, S- 907
12 Umeå, Sweden; 2 Alfta Research Fundation, Alfta Rehab Centre,
Box 94, 82222 Alfta, Sweden; 3 Dept of Community Medicine and
Rehabilitation, Physiotherapy, Umea University, SE-901 87 Umeå,
Sweden
PURPOSE: To evaluate the efficacy of a novel method for neck-
coordination exercise in chronic neck pain persons. RELEVANCE:
Neck pain is often associated with changes in sensorimotor functions,
such as reduced proprioceptive acuity, disturbed coordination of the
cervical muscles, and increased postural sway. In line with this,
there is a growing body of evidence supporting the efficacy of
exercises targeting different aspects of sensorimotor function, e.g.,
training aimed at improving proprioception and muscle coordination.
It is important to further develop this type of exercises. Hence
we have designed a devise and method for a specific exercise to
improve sensorimotor control, which may improve motor functions
like stabilising and moving the neck as well as postural control.
PARTICIPANTS: Fourteen persons, mean age 35 years (10 females)
with non-traumatic neck pain (mean duration 19 months) participated
in the study. METHODS: The study was designed as an uncontrolled
clinical trial. A newly developed device was used for the neck-
coordination exercise. The device consisted of a plate (28 cm in
diameter) with a rim, and was fixed on top of the persons’ head.
The person was seated and provided with visual feedback of the
device via mirrors during the exercise. The task was to move a metal
ball from a starting position to the centre of the plate by controlled
movements of the head. The person performed the exercise at
eight occasions (2-3 times a week), each session lasting 10-15
minutes. Tests of sensorimotor functions -postural sway in quiet
stance and cervical rotation, including repositioning, movement time
and and smoothness of movements (i.e., movement jerkiness)- were
performed prior to and after the exercise intervention. A follow up
with questionnaires: (Short Form 36 (SF-36), Neck Disability Index
(NDI), Disability of Arm, Shoulder and Hand (DASH), Self Efficacy
Scale (SES) and Tampa Score of Kinesiophobia (TSK)) was done
after six months. ANALYSIS: Data were analysed with paired t-test.
RESULTS: The analysis revealed a significant reduction in postural
sway, and movement time and jerkiness of cervical rotation after the
training. No effect on cervical repositioning was detected. At the six
months follow up, significant improvements were seen in three of
the eight scales in SF-36 (physical functioning, vitality and social
functioning), as well as on NDI, DASH and TSK. CONCLUSIONS:
The improvements in sensorimotor function outcomes suggest a
transfer effect from the exercise to more general, non-task specific
motor functions. The improvements in the questionnaire scores at six
months follow up may indicate a long term beneficial effect. Future
work should include a randomized controlled trial as well studies of
the mechanisms behind the exercise effects. IMPLICATIONS: The
present method may be effective in improving the motor control of
the cervical spine as well as postural control in neck pain patients.
KEYWORDS: Neck pain; coordination; postural control. FUNDING
ACKNOWLEDGEMENTS: Alfta Research Foundation and University
of Gävle. CONTACT: ulrik.roijezon@alftarehab.se
ETHICS COMMITTEE: By the ethic committee of the Faculty of
Medicine at Uppsala University
WCPT 2007, Research Reports
Research Report Platform Presentation
1077 Tuesday 5 June 16:55
VCEC Meeting Rooms 1-3
DIRECT ACCESS TO PHYSICAL THERAPY IN THE
NETHERLANDS: RESULTS ONE YEAR AFTER INTRODUCTION
Leemrijse C, Swinkels I, Veenhof C, De Bakker D; Netherlands
Institute for Health Services Research
PURPOSE: In the Netherlands, patients have direct access to
physical therapy since January 2006. One of the reasons for
introducing direct access was the increasing pressure on the
access of primary health care and the growing workload of general
practitioners. The aim of the present study was to investigate how
many patients and for which health problems, make use of direct
access to physical therapy. Furthermore, it was examined how
many physical therapy contacts self referred patients have, and
whether this policy measure leads to an increasing demand for
physical therapy. RELEVANCE: Direct access implies a recognition
of the professional expertise of the physical therapists. National
representative figures are indispensable in order to evaluate the
effects of this policy measure for both physical therapy practice and
patients. PARTICIPANTS: Data will be used of all patients who
visited the physical therapy practices participating in the National
Information Service for Allied Health Care (in Dutch: LiPZ) in 2006
(approximately 12,000). METHODS: Data were collected within the
National Information Service for Allied Health Care (LiPZ). LiPZ
is a nationally representative electronic registration network, based
on physical therapists’ electronic medical records, in which about
100 physical therapists working in 40 private practices all over
the country participate. These therapists monthly provide data on
patients, referrals, health problems and treatments. In June 2007,
data from 2006 will be complete. ANALYSIS: Data were analysed
with descriptive statistics. In order to test for differences in categorical
data, such as education level, Chi-square tests were used, while
differences in continuous data, such as age, were analysed with t-
tests. RESULTS: Preliminary results from January through June 2006
revealed that nearly 25% of the patients visited the physiotherapist
without a referral. These direct access patients were more likely to
be male, younger, higher educated, suffering from symptoms of the
spine and were more often treated before by a physical therapist
(34.8% versus 18.3%). Furthermore, patients with health problems
existing for shorter than one month, made more use of direct access
as compared to patients with longer existing problems (34.5 versus
18.4%). The total number of patients visiting the physical therapist
had not changed. In June 2007, updated results will be presented,
together with results about the number of physical therapy contacts.
CONCLUSIONS: The proportion of patients visiting the physical
therapists without referral exceeds expectations. Furthermore, a
specific group of patients uses direct access. As the volume of
the physical therapists’ patient population has not grown and the
demographics of the patient population did not change, it seems
that the demand for physical therapy as yet remains the same.
IMPLICATIONS: Direct access makes the profession of physical
therapists more challenging and increases their independence within
the health care system. If physical therapists would like to further
enlarge the effect of direct access on their daily practice, they should
focus on specific groups of patients, for example patients who are
less known with physical therapy. Further research is needed to
monitor the costs-effectiveness of direct access and to evaluate
the satisfaction of the physical therapists’ patients. KEYWORDS:
Patients characteristics, policy. FUNDING ACKNOWLEDGEMENTS:
LiPZ is financed by the Dutch Ministry of Health, Welfare and Sports.
C.Leemrijse@nivel.nl.
Platform Presentations, Tuesday 5 June
Research Report Platform Presentation
2758 Tuesday 5 June 16:55
VCEC Meeting Rooms 11-12
OUTCOMES OF PROGRESSIVE RESISTANCE EXERCISE
FOR PEOPLE WITH CHRONIC OBSTRUCTIVE PULMONARY
DISEASE (COPD)
O’Shea S1,2 , Taylor N1 , Paratz J3 ; 1 School of Physiotherapy, La Trobe
University, Melbourne, Australia; 2 Community Rehabilitation Centre,
Wodonga Regional Health Service, Wodonga, Australia; 3 School
of Physiotherapy, University of Queensland, Brisbane, Australia
PURPOSE: To examine the effectiveness and efficacy of a
predominantly home-based 12 week progressive resistance exercise
(PRE) program on measures of impairment, activity, and participation
for people with COPD. Longer term outcomes were also examined
12 weeks after the intervention concluded. RELEVANCE: Skeletal
muscle weakness is common in people with COPD and associated
with reduced exercise tolerance, higher health care utilisation, and
poorer prognosis. Whilst improvements in muscle strength have been
demonstrated after PRE, it is unclear how increases in muscle
strength influence functional performance or long-term outcomes.
In addition, the feasibility of PRE programs conducted at home or
with equipment other than weight machines is not known in this
population. PARTICIPANTS: Fifty-four people (33 women, mean
age = 67.7 ±8.6 years) with moderately severe COPD (mean
FEV1%predicted = 51 ±23%) were recruited from four hospitals.
Inclusion criteria required no pulmonary rehabilitation in the previous
12 months. Participants were excluded if they had unstable medical
conditions. METHODS: A single-blind randomised controlled trial in
conjunction with qualitative interviews was undertaken. Participants
were randomly allocated into a PRE (n = 27) or no-intervention
group (n = 27). The PRE group completed three sessions per week
(one supervised, two home-based) for 12 weeks. Six exercises were
performed at an intensity of three sets of 8–12 repetition maximum,
progressed against graduated elasticised resistance bands. Major
outcomes included muscle strength, six-minute walk distance,
grocery-shelving task, Chronic Respiratory Disease Questionnaire,
and Patient-Specific Functional Scale. Measures were assessed
at baseline, post-intervention (12 weeks) and 12 weeks after the
intervention (24 weeks). The PRE group were invited to participate
in interviews regarding the outcomes of training at 12 and 24 weeks.
ANALYSIS: Two-way ANOVA for repeated measures, with and
without intention-to-treat analysis, were used to examine changes
occurring between 0–12 and 0–24 weeks. Interview data were audio-
taped, transcribed, and then coded by two independent researchers.
RESULTS: The PRE program was completed by 15 out of 27
participants. Participants completing PRE demonstrated improved
muscle strength (27–46%), dyspnoea, and fatigue levels at 12
weeks when compared with no-intervention, but the benefits had
dissipated by 24 weeks. No differences were detected between
groups for measures of activity or participation, or when all outcomes
were examined using intention-to-treat analysis. People with COPD
perceived physical, psychological, and social benefits after PRE,
which had a positive effect on activity performance. The perceived
physical benefits of PRE were not prominent at 24 weeks, but feelings
of increased confidence and control persisted. CONCLUSIONS:
When performed consistently, predominantly home-based PRE can
improve muscle strength, dyspnoea, fatigue, and perceptions of
control during activity for people with COPD. The physical outcomes
of short-term PRE decline after training stops, but psychological
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,
S373
USA. 2. Postgraduate Support Grants – School of Physiotherapy
and Faculty of Health Sciences, La Trobe University. CONTACT:
simoshe@optusnet.com.au
ETHICS COMMITTEE: La Trobe University; The Alfred Hospital;
Wodonga Regional Health Service; Northeast Health Wangaratta;
Wagga Wagga Base Hospital
Research Report Platform Presentation
2027 Tuesday 5 June 16:55
VCEC Meeting Room 16
THE EFFECTS OF THE SQUAT TRAINING MACHINE FOR
PHYSICAL FUNCTIONING IN FRAIL ELDERLY PEOPLE: A
RANDOMIZED CONTROLLED TRIAL
Kato H1,4 , Shimada H2 , Iriyama W3 , Niino N4 , Obuchi S2 ,
Suzuki T2 ; 1 Faculty of Health Science, School of Physical Therapy,
Gunma-PAZ College; 2 Tokyo Metropolitan Institute of Gerontology;
3 School of Technology for Social Medicine; 4 Department of
Gerontology, Graduate School of Obirin University
PURPOSE: The purpose of this study was to determine effects
of machine squat training on frail elderly people utilizing day care
program. RELEVANCE: A relationship putatively exists between
lower extremity strength and falls, balance, and activities of daily living
(ADL). Development of convenient and effective training machines
and knowledge of their effects are necessary for frail elderly people
using community care services. PARTICIPANTS: Subjects were
72 community-dwelling elderly people (mean age: 81.3±7.9 years)
who were using a day-care facility. METHODS: The subjects were
separated randomly into a training group (n=36) and a control group
(n=36). The training group performed squat training using a machine
at a frequency of 1–2 days per week for 12 weeks. Training was
performed by staff who had been educated by a physical therapist.
The control group did not change their exercise or other activities for
the intervention period. Physical function tests such as maximal knee
extension strength, grip power, Timed Up and Go Test, Functional
Reach Test, and Chair Stand Test were measured at pre-training and
post-training. ANALYSIS: Baseline measurements were compared
between the training group and control group using independent
Student’s t-test. Repeated measures ANOVA was used to investigate
the effect of the training. RESULTS: At post intervention, 22
subjects received no measurements (Squat training group n = 11,
Control group n = 11). No significant differences were found in any
measurements at baseline between the squat training group and
control group. Compared to the control group, the training group
showed significant improvement in maximal knee extension strength,
grip power, and the Chair Stand Test. However, the Timed Up and
Go Test, Functional Reach Test showed no significant differences.
CONCLUSIONS: Results showed that squat training with a machine
by day-care staff can improve muscle strength in elderly people.
However, improvements were apparent only in muscle strength. We
should perform squat training along with other interventions such as
walking and balance exercise. IMPLICATIONS: Squat training using
a machine was effective to improve lower-extremity muscle strength.
It can be used supplementarily with physical therapy or community
care. KEYWORDS: randomized controlled trial, elderly people, squat
training. FUNDING ACKNOWLEDGEMENTS: This study was funded
by a grant from OGA Co., Tokyo, Japan. CONTACT: katou@paz.ac.jp
ETHICS COMMITTEE: My work was apporoved by the ethics
committee in Tokyo Metropolotan Institute of Gerontology.
S374
Research Report Platform Presentation
2074 Tuesday 5 June 16:55
VCEC Meeting Room 17
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,
Aberdeen, UK; 2 University of Aberdeen, Aberdeen, UK
PURPOSE: The purpose of this study was to explore the perceptions
of people who had received physiotherapy for chronic low back
pain (CLBP). RELEVANCE: Guidelines suggest that physiotherapy
for CLBP should be patient-centered, should optimise function
and encourage self-management. Exploring the perceptions of
people who have received physiotherapy for CLBP will help to
understand the extent to which this is being achieved in practice
and allow their views to be considered in future service redesign.
PARTICIPANTS: Twenty-five people aged between 18 and 65 who
had attended outpatient physiotherapy for the treatment of non-
specific CLBP were recruited by mail. They were purposively sampled
for geographical location of physiotherapy treatment, number of
sessions attended, management style, age and gender. METHODS:
Semi-structured interviews were conducted with all participants. The
interviews were designed to explore expectations of and satisfaction
with physiotherapy, participants’ perceptions of patient-centered
physiotherapy, the importance of function to people with CLBP,
and participants’ perceptions of long-term management. ANALYSIS:
Data was analysed using the framework method, resulting in
both descriptive and explanatory accounts of the data. RESULTS:
Participants had expected exercises or hands-on treatment, long
sessions with the physiotherapist, and a diagnosis to be made.
They had expected pain-relief to be achieved, although some
participants had expected increased knowledge on self-management
strategies or for improvements in function to be the outcome.
There were varied levels of satisfaction within the sample, and a
complex relationship emerged between satisfaction and treatment
outcome. The participants considered patient-centered physiotherapy
to be a complex combination of five key factors (information
giving, organisation, individualised treatment, the physiotherapist,
and decision-making) underpinned by effective communication.
Function was of great importance to the participants. All freely
discussed functional limitations, many had functional treatment goals
and some measured treatment effect in terms of functional ability.
However, participants commonly felt that their functional limitations
were not addressed in physiotherapy. The participants commonly
did not feel that physiotherapy had empowered them to manage
their CLBP. The perceived need for follow-up and future access to
physiotherapy was a strong theme, with several methods suggested
for supporting people with CLBP in the longer-term. CONCLUSIONS:
This study has provided some insight into several aspects of the
physiotherapy experience from the point of view of those with CLBP.
A larger study will be required in order to generalise the findings.
Nonetheless, the findings will help physiotherapists in understanding
the needs of this client group and they have highlighted several areas
to focus future research on. IMPLICATIONS: Physiotherapists should
encourage realistic expectations of physiotherapy to be adopted by
people with CLBP. Physiotherapists need to be aware of the factors
that people with CLBP consider important in relation to patient-
centred physiotherapy. Physiotherapists should address and evaluate
functional limitations of those presenting with CLBP and should
explore methods of supporting this client group in the long-term
management of their chronic condition. Enhancement is required
in both under and postgraduate education in the fields of commu-
nication skills, patient-centredness and self-management education
strategies. KEYWORDS: Expectations, patient-centred, long-term
management. FUNDING ACKNOWLEDGEMENTS: This project was
supported by the Nursing, Midwifery and Allied Health Professions
Research Training Scheme (Scotland), funded by NHS Education for
WCPT 2007, Research Reports
Scotland (NES), the Scottish Executive Health Department and the
Health Foundation. CONTACT: kandm@cooper931.fsnet.co.uk
ETHICS COMMITTEE: NHS Grampian Research ethics Committee
Research Report Platform Presentation
2801 Tuesday 5 June 16:55
VCEC Meeting Room 18
PHYSICAL ACTIVITY AMONG HIGH SCHOOL STUDENTS –
OUTCOME OF FIRST SOUTH AFRICAN YOUTH RISK
BEHAVIOUR SURVEY
Amosun D1 , Reddy P2 , Kambaran N3 , Omardien R3 ; 1 School
of Health & Rehabilitation Sciences, Faculty of Health Sciences,
University of Cape Town, Cape Town, South Africa; 2 National
Health Promotion Research & Development Group, Medical
Research Council, Cape Town, South Africa; 3 ARCH Actuarial
Consulting, Cape Town, South Africa
PURPOSE: The first Youth Risk Behaviour Survey in South Africa
sought to obtain representative data on self-reported prevalence of
health risk behaviours that contribute to intentional and unintentional
injury; tobacco use; alcohol and drug abuse; sexual behaviours;
physical inactivity; and dietary behaviors. Though physical inactivity
is a major contributory factor to chronic diseases of lifestyle in South
Africa, there is no reliable database on the status of involvement
of youths in physical activity. RELEVANCE: Physical inactivity is
a known major risk factor for cardiovascular disease, type 2-
diabetes, and some musculoskeletal disorders. Physiotherapists
play major roles in prevention as experts in exercise prescription.
PARTICIPANTS: This cross-sectional prevalence study targeted
students in grades 8-11 in public schools in the nine provinces.
The sampling frame was the database from the School Information
Services Directorate, National Department of Education. Using a two-
stage cluster sample design to ensure nationally and provincially
representative data, 206 schools were eligible to participate in
the survey, and 364 classes with 14,766 students, were randomly
selected. However, 10,699 students (54.0% females, 46.0% males)
in 345 classes from 188 schools submitted completed questionnaires.
METHODS: Adapting the Youth Risk Behaviour Survey of the
Centers for Disease Control, a questionnaire was developed in
English, and pre-tested for face and construct validity. Thereafter,
the questionnaire was translated and back-translated into the
remaining 10 official languages in preparation for the pilot study.
Ethical approval was obtained from the South African Medical
Association. Informed consent was also obtained from the National
Department of Education, School Principals, parents and learners.
Participating students completed the self-administered questionnaire
in the classroom under the supervision of trained research assistants.
The section of the questionnaire relating to physical activity
sought information on participation in vigorous physical activity,
moderate physical activity, and insufficient physical activity in the
seven days preceding the survey; reasons for abstaining from
participation; and types of activities carried out during physical
education classes. ANALYSIS: Epi-Info 2002 was used to analyse
the data. Weighted prevalence rates and 95% confidence intervals
were computed. Differences between prevalence estimates were
considered statistically significant at the level of p < 0.05 if the 95%
confidence intervals did not overlap. RESULTS: Data of 10,699
students (54.0% females, 46.0% males) revealed that majority
of respondents were aged 14-18 years. About 38.0% of the
respondents did not participate in sufficient physical activity or
abstained completely, while the remaining students participated in
either vigorous physical activity, moderate physical activity or a
combination of both. Among those who abstained from participation,
25.9% reported an unwillingness to participate. Out of 10,313
students, 29.0% did not have physical education classes at school.
CONCLUSIONS: Though the promotion of physical activity and
healthy lifestyle is a national priority of the government of South
Africa, the survey suggests the need to pay attention to an
Platform Presentations, Tuesday 5 June
appreciable proportion of high school students who do not participate
sufficiently in physical activity. IMPLICATIONS: Physiotherapists in
South Africa should become actively involved in the development
of appropriate intervention programs to enhance physically active
lifestyles. KEYWORDS: Physical activity, Youth Risk Behaviour Sur-
vey. FUNDING ACKNOWLEDGEMENTS: The National Department
of Health, South Africa. The Centres for Diseases Control, USA
(technical and financial assistance). The Medical Research Council,
South Africa. CONTACT: damosun@uctgsh1.uct.ac.za
ETHICS COMMITTEE: The South African Medical Association
Research Report Platform Presentation
2211 Tuesday 5 June 16:55
VCEC Meeting Rooms 19-20
THE SPECIAL SPECIALIST: EXPLORING HOW HEALTH
PROFESSIONALS FACILITATE UNDERSTANDING AND
ADHERENCE TO CONSERVATIVE TREATMENT FOR WOMEN
WITH URINARY INCONTINENCE
Dean S1 , Hay-Smith J; 1 Rehabilitation Teaching and Research
Unit, University of Otago, Wellington, New Zealand
PURPOSE: To explore women’s and health professionals’ percep-
tions regarding conservative treatment of urinary incontinence (UI);
identify shared (coherent) or mismatched views about this treatment,
and discuss the implications of establishing coherent perceptions
for facilitating understanding and long-term treatment adherence.
RELEVANCE: Systematic review of randomised trials shows that
individual components of conservative treatment (e.g. pelvic floor
muscle training) and conservative treatment as a whole, are effective
for women with symptoms of stress, urge and mixed UI. However, ad-
herence to such programmes can be problematic because treatment
has to be continued to be effective. Through exploring experiences
of health professionals and patients this study identifies ways to
promote treatment adherence. PARTICIPANTS: Six women over 40
years of age referred for conservative treatment of stress or urge UI
symptoms, and four physiotherapists / two continence advisors who
provided treatment. Women with any physical or psychological co-
morbidity that rendered usual conservative treatment inappropriate
were excluded. METHODS: This qualitative study comprised in-
depth audio-taped interviews. Participants were interviewed twice:
at the start and end of treatment. Transcribed interview data were
explored using Interpretative Phenomenological Analysis (IPA). This
qualitative approach has explored individual experiences of health
related issues, and of rehabilitation adherence. ANALYSIS: Three
levels of analysis occurred: 1) content analysis whereby repeated
reading and line by line notation of key words or sentences that gave
insight into participants’ experiences produced emergent themes;
2) a re-iterative process developed the themes, ensuring in-depth
and detailed case by case analysis afforded by small participant
numbers (and characteristic of this methodology) could occur; 3)
robust verification procedures refined the themes. In IPA verification
occurs in stages: 1) a researcher, who was independent from data
gathering, commented on the themes; 2) discussion occurred with
regard to final themes and interpretation and 3) agreement was
made on the extent to which raw data represented themes and
interpretations. Participants had opportunity to comment upon their
transcripts, pseudonyms ensured anonymity. RESULTS: Will focus
on three themes emerging from the analysis: ‘the special specialist’
refers to how health professionals perceive their role in this highly
personal service including how they attempt to be like a personal
trainer for motivating and supporting patients in doing their treatment;
‘seeking and regaining control’ relates to patients concerns about
seeking help for an essentially private ‘inside’ problem yet the lack
of control and bothersomeness of leakage showing on the ‘outside’
and in public acts to facilitate seeking help and adherence to
treatment in order to regain control on the inside and outside;
‘expectations of outcome’ reveal differences in perceptions between
patients and health professionals regarding the timeline to obtaining
S375
any observable benefit from adhering to treatment, with patients
unprepared for long-term commitment. CONCLUSIONS: Exploring
experiences of undertaking and prescribing conservative treatment
for UI reveals the importance of specialised health professional
roles for understanding and facilitating adherence. IMPLICATIONS:
Overcoming barriers to help-seeking and doing exercises long-term
is difficult, suggesting potential for cognitive-behavioural approaches
to be used in future clinical research trials for rehabilitation of
UI. KEYWORDS: Incontinence, exercise, adherence. FUNDING
ACKNOWLEDGEMENTS: This study was funded by a University of
Otago Research Grant. CONTACT: sarah.dean@otago.ac.nz
ETHICS COMMITTEE: This study received ethical approval from the
National Ethics Committee of New Zealand.
Research Report Platform Presentation
2975 Tuesday 5 June 17:15
PP Crystal Pavilion B & C
CERVICAL SPINE MOBILISATION: ADJUSTMENT OF DOSE IN
RELATION TO EXPERIENCE AND PATIENT
Shirley D, Langshaw M, Refshauge K; School of Physiotherapy,
The University of Sydney
PURPOSE: The purpose of this study was to quantify the forces
used in the different grades of cervical spine mobilisation, identify
differences in techniques applied by novice and experienced phys-
iotherapists, and to determine the effect of patient characteristics on
the dosage applied. RELEVANCE: Cervical spine mobilisations are
commonly used by physiotherapists to assess and treat cervical spine
pain. Although cervical spine mobilisation is used widely in clinical
practice the forces used in mobilisation have not been quantified, the
effect of therapist experience has not been described and the effect
of different patient characteristics on treatment dose has not been
explored. The accurate acquisition of this fundamental information
is an essential step towards a more comprehensive understanding
of cervical spine mobilisation. PARTICIPANTS: Three groups of
participants were recruited for this study. A group of 4 subjects was
selected as patient models to represent varied spinal stimuli. There
were also 2 therapist groups; the first consisted of 9 novice therapists
who were physiotherapy students and the second was a group 9
experienced physiotherapists who were practicing clinicians and/or
physiotherapy academics. METHODS: All of the therapists applied
mobilisations to each patient model that was lying on an instrumented
treatment plinth. The custom built, instrumented plinth was equipped
with load cells to measure the magnitude and amplitude of force,
as well as the frequency of oscillation applied during mobilisation.
Therapists were asked to apply 4 grades of mobilisation and find end
of range, in random order. This study was approved by the University
of Sydney Human Research Ethics Committee. ANALYSIS: Data
was analysed with SPSS 12 for Windows. Descriptive statistics
were used to characterise mobilisation doses in terms of force,
amplitude and frequency. Comparisons of mobilisation variables
between therapists and novices were made using 2 way repeated
measures ANOVA. The average force, frequency and amplitude
applied by experienced therapists and novices to the 4 different
patient models were also compared using 2 way repeated measures
ANOVA. RESULTS: The characteristics of forces (magnitude, ampli-
tude and frequency) applied by experienced physiotherapists were
significantly different from those applied by novices for all 4 grades
of mobilisation. Specifically, novices applied significantly greater
forces, amplitudes and frequencies than the experienced therapists
during lower mobilisation grades. In addition, patient characteristics
influenced the force magnitude and amplitude, but not the frequency
of mobilisation techniques. CONCLUSIONS: This study provides
valuable information on quantifying mobilisation doses of the cervical
spine. There are differences in mobilisation dose between novices
and experienced physiotherapists. Although patient model influenced
mobilisation dose the interaction of patient model characteristics and
therapist characteristics in determining mobilisation doses requires
S376
further investigation. IMPLICATIONS: The differences in dosage of
forces applied during mobilisation between experienced and novice
therapists suggest that when teaching manual therapy techniques
novices require guidance in the selection of the magnitude of force,
amplitude and frequency they apply during the lower grades of
mobilisation. Also guidance is required to determine the appropriate
mobilisation doses according to the characteristics of individual
patients. KEYWORDS: cervical spine mobilisation, experience,
doasge. FUNDING ACKNOWLEDGEMENTS: This project was not
funded. CONTACT: d.shirley@fhs.usyd.edu.au
ETHICS COMMITTEE: The University of Sydney Human Ethics
Committee
Research Report Platform Presentation
3183 Tuesday 5 June 17:15
VCEC Ballroom A
EFFECT OF A PUSH-RIM ACTIVATED POWER ASSIST
WHEELCHAIR ON SHOULDER MUSCULAR DEMAND DURING
MANUAL WHEELCHAIR PROPULSION IN PERSONS WITH
TETRAPLEGIA
Lighthall Haubert L, Requejo P, Mulroy S, Newsam C, Gronely J,
Perry J; Pathokinesiology Service at Rancho Los Amigos National
Rehabilitation Center, Downey, United States
PURPOSE: Determine whether use of a Push-Rim Activated Power
Assist Wheelchair (PAPAW) reduces shoulder muscular demands of
manual wheelchair (WC) propulsion in individuals with tetraplegia.
RELEVANCE: Shoulder pain is prevalent in spinal cord injury and
impaired upper extremity function in those with tetraplegia addi-
tionally impedes manual WC propulsion. PARTICIPANTS: Thirteen
males with complete tetraplegia (C6=5, C7=9) were recruited from
outpatient clinics at Rancho Los Amigos National Rehabilitation
Center. METHODS: Subjects pushed a standard WC and PAPAW
on an ergometer at a self-selected matched free velocity during
level and simulated graded (4% or 8%) propulsion. Indwelling wire
electrodes recorded muscle activity from 4 push-phase muscles
(anterior deltoid (ADELT), pectoralis major (PEC), infraspinatus
(INFRA), supraspinatus (SUPRA)). EMG intensity was normalized
to maximal voluntary isometric contraction (MVC). Propulsion
velocity was calculated from Vicon motion marker trajectories of
the wheel. Anterior/posterior trajectory of the lateral epicondyle
marker determined push cycle. Median EMG intensity and duration
were calculated for each 1% of the push cycle. ANALYSIS:
Data were analyzed utilizing SPSS 11.0 software. Shapiro-Wilke
statistic determined data normality. Velocity data were normally
distributed, thus paired t-test compared group means. EMG data
were not normally distributed, therefore, medians were compared
using Wilcoxon Signed Ranks test. A significance level of 0.05
was selected. RESULTS: Free velocity during level propulsion was
similar between PAPAW (61.5+/−20.7 meters/minute) and standard
WC (59.9 +/−20.8 meters/minute (p = 0.44). PAWPAW velocity during
inclined propulsion (42.9 meters/minute) was significantly faster
than standard WC (31.0 meters/minute) (p = 0.01). Median EMG
intensity during PAPAW level propulsion was significantly reduced
for 3 of 4 muscles (AD level: 0% vs. 18.5% MVC; PEC level: 9.3%
vs. 42.5% MVC; INFRA level: 5.8% vs. 11.3% MVC; PAPAW vs.
standard, respectively (p < 0.05)), and similar for SUPRA (SUPRA
level: 12.8% vs. 13.3% MVC, (p = 0.12), respectively). Median EMG
intensity during PAPAW graded propulsion was significantly reduced
for all muscles (AD graded: 10.8% vs. 48.5% MVC; PEC graded:
16.5%vs. 65.5%; INFRA graded: 10.5% vs. 37.3% MVC; SUPRA
graded: 16.5% vs. 40.8% MVC, respectively (p < 0.05)). Duration
of EMG activity during PAPAW level and graded propulsion was
significantly reduced for all muscles, except SUPRA (ADELT level:
0% vs. 28% propulsion cycle (PC); ADELT graded: 27% vs. 62%
PC; PEC level: 15% vs. 44.0% PC; PEC graded: 45.5% vs. 71.5%
PC; INFRA level: 18.0% vs. 29.5%PC; INFRA graded: 27.5% vs.
57.5% PC; SUPRA level: 42%vs. 48.5% PC; SUPRA graded: 33.5%
WCPT 2007, Research Reports
vs. 39%PC, respectively, (p > 0.05)). CONCLUSIONS: Compared
to standard manual WC propulsion, PAPAW substantially reduces
shoulder muscular demand during free level and graded propulsion,
as demonstrated by reduction in median intensity and duration of
EMG activity of the primary push phase muscles. The decrease
during the graded condition occurred despite significantly greater
velocity during PAPAW propulsion (38% increase). IMPLICATIONS:
Individuals with spinal cord injury and impaired upper extremity
function and/or shoulder pain are often hesitant to transition to
a power WC owing to reduced portability and maneuverability,
reduction in physical activity, and increased appearance of disability
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
#37098. CONTACT: lhaubert@larei.org
ETHICS COMMITTEE: IRB at Rancho Los Amigos National
Rehabilitation Center and Los Amigos Research and Education
Institute
Research Report Platform Presentation
2772 Tuesday 5 June 17:15
VCEC Meeting Rooms 11-12
FACTORS INFLUENCING ADHERENCE TO PROGRESSIVE
RESISTANCE EXERCISE FOR PEOPLE WITH CHRONIC
OBSTRUCTIVE PULMONARY DISEASE (COPD)
O’Shea S1,2 , Taylor N1, , Paratz J3 ; 1 School of Physiotherapy, La
Trobe University, Melbourne, Australia; 2 Community Rehabilitation
Centre, Wodonga Regional Health Service, Wodonga, Australia;
3 School of Physiotherapy, University of Queensland, Brisbane,
Australia
PURPOSE: To explore factors influencing short and longer term
adherence of people with COPD to a program of predominantly
home-based progressive resistance exercise (PRE). RELEVANCE:
Exercise is an important treatment modality for people with COPD.
However, the benefits of exercise interventions have been shown
to diminish over time. High levels of non-adherence to health care
interventions such as exercise have been reported for people with
chronic health conditions. Yet, the factors influencing adherence to
exercise for people with COPD have been examined infrequently.
Physiotherapists play a key role in prescribing and implementing
exercise programs during pulmonary rehabilitation; therefore, un-
derstanding the factors influencing the ability and willingness of
people with COPD to perform exercise is necessary for maximising
the effectiveness of training interventions. PARTICIPANTS: People
with COPD enrolled in a trial of PRE were invited to participate in
two semi-structured qualitative interviews exploring factors affecting
program adherence. At the conclusion of the 12 week intervention,
22 people (mean age = 66.7 ±6.8 years, mean FEV1%predicted =
51 ±25%) completed an interview, with 19 participants returning at
24 weeks for a second interview. All participants provided written
informed consent. METHODS: Ethics approval was granted prior
to the investigation. All interview participants were enrolled in
a 12 week PRE program, where training was undertaken three
times per week (one supervised, two home-based). Six exercises
were performed against graduated elasticised resistance (three
sets at 8–12 repetitions maximum). A log-book was provided
to record details of all training sessions. At the conclusion of
the intervention participants were advised to keep their training
equipment, but ongoing exercise was a personal choice. Interview
one explored facilitators and barriers to exercise during the 12
week PRE intervention, whereas interview two examined factors
influencing ongoing performance of the training program between
12 and 24 weeks. All interviews were audio-taped with permission
of participants, and transcribed verbatim. ANALYSIS: Interview
data were coded independently by two researchers. Descriptive
categories and broad themes relating to factors influencing short
Platform Presentations, Tuesday 5 June
and longer term adherence were then developed through discussion.
RESULTS: Short-term PRE adherence (0–12 weeks) was facilitated
by expected outcomes, self-motivation, supervision, and group
support; whereas health and weather factors were the major barriers
to adherence. The major barriers to exercise were unchanged at
24 weeks despite a large decline in exercise adherence. Removal
of environmental support (supervision and group support) at 12
weeks may have contributed to reduced exercise maintenance
between 12–24 weeks. Participants identified group support and
review as the most important strategies for maintaining exercise.
CONCLUSIONS: The provision of external support structures appear
important for helping people with COPD overcome potential exercise
barriers during short and longer term training programs. Therefore,
physiotherapists need to incorporate strategies to facilitate adherence
during exercise program design. IMPLICATIONS: Further investiga-
tion is required regarding effective strategies to maximise exercise
adherence in this population. The findings of this investigation
and the research literature suggest that strategies to improve
adherence may need to be individually tailored and incorporate
cognitive-behavioural techniques. KEYWORDS: COPD, pulmonary
rehabilitation, adherence. FUNDING ACKNOWLEDGEMENTS: 1.
Equipment Grant – Theraband Academy, Hygenic Corporation,
USA. 2. Postgraduate Support Grants – School of Physiotherapy
and Faculty of Health Sciences, La Trobe University. CONTACT:
simoshe@optusnet.com.au
ETHICS COMMITTEE: La Trobe University; The Alfred Hospital;
Wodonga Regional Health Service, Northeast Health Wangaratta;
Wagga Wagga Base Hospital
Research Report Platform Presentation
2376 Tuesday 5 June 17:15
VCEC Meeting Room 16
HIGH-INTENSITY FUNCTIONAL EXERCISE PROGRAM FOR
OLDER PEOPLE DEPENDENT IN ADL: AN RCT EVALUATING
THE EFFECTS ON PHYSICAL FUNCTIONS AND FALLS
Rosendahl E1,2 , Lindelöf N1,2 , Littbrand H1 , Yifter-Lindgren E1 ,
Nordin E1 , Lundin-Olsson L1 , Håglin L3 , Gustafson Y1 , Nyberg L2 ;
1 Umeå University, Department of Community Medicine and
Rehabilitation, Geriatric Medicine and Physiotherapy, Umeå,
Sweden; 2 Luleå University of Technology, Department of Health
Sciences, Physiotherapy Unit, Luleå, Sweden; 3 Umeå University,
Department of Public Health and Clinical Medicine, Family
Medicine, Umeå, Sweden
PURPOSE: To determine if a high-intensity functional exercise
program improves balance, gait ability, and lower-limb strength
in older people dependent in activities of daily living (ADL),
if an intake of protein-enriched energy supplement immediately
after the exercises increases these effects of the training, and
if the exercise program reduces falls. RELEVANCE: Impairments
in physical functions among older people can lead to dramatic
consequences for the individual such as admission to nursing home,
falls and fractures. High-intensity exercise programs are effective to
improve physical functions among older people but knowledge is
limited concerning the effects for older people with severe cognitive or
physical impairments. PARTICIPANTS: 191 older people dependent
in ADL, living in residential care facilities, and with a Mini-Mental State
Examination (MMSE) score of  10 participated in this study (the
FOPANU Study). METHODS: The participants were randomized to
a high-intensity functional weight-bearing exercise program (the HIFE
Program) or a control activity, including 29 sessions over 3 months,
as well as to protein-enriched energy supplement or placebo. Berg
Balance Scale, usual and maximum gait speed, and one-repetition
maximum in lower-limb strength were followed-up at 3 and 6 months
by assessors blinded to group allocation. Fall rate and the proportion
of participants sustaining a fall during the six months following
the intervention were the outcome measures of the fall preventive
effect of the exercise program. ANALYSIS: The intention-to-treat
S377
principle was used. Balance, gait ability, and lower-limb strength: 2 x
2 factorial ANCOVA. Falls: Negative binominal analysis and logistic
regression analysis. RESULTS: At 3 months, the exercise group had
improved significantly in usual gait speed compared with the control
group (mean difference 0.04 m/s, P = 0.02). At 6 months, there
were significant improvements favoring the exercise group for Berg
Balance Scale (1.9 points, P = 0.05), usual gait speed (0.05 m/s, P
= 0.009), and lower-limb strength (10.8 kg, P = 0.03). No interaction
effects were seen between the exercise and nutrition interventions.
When all participants were compared, no statistically significant
differences between groups were found for fall rate (exercise group
3.6 falls per person years and control group 4.6 fall per person years)
or the proportion of participants sustaining a fall (exercise 53% and
control 51%). A subgroup interaction analysis revealed that among
participants who improved their balance during the intervention
period, the exercise group had a lower fall rate than the control
group (exercise 2.7 falls per person years and control 5.9 falls per
person years, incidence rate ratio 0.44, P = 0.03). CONCLUSIONS:
A high-intensity functional exercise program has positive long-term
effects in balance, gait ability, and lower-limb strength for older
people who are dependent in ADL. An intake of protein-enriched
energy supplement immediately after the exercises does not appear
to increase these effects of the training. In addition, the high-intensity
functional exercise program may have an effect in preventing falls
among those who respond to the intervention. IMPLICATIONS:
High-intensity functional exercise can be offered to improve phys-
ical functions among older people who are living in residential
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
Magnus Bergvalls Foundation, the Äldrecentrum Västerbotten, the
Umeå University Foundation for Medical Research, the Gun and
Bertil Stohne Foundation, Erik and Anne-Marie Detlof’s Foundation,
the Loo and Hans Ostermans Foundation, the Borgerskapet in Umeå
Research Foundation, the Swedish Research Council K2002-27VP-
14165-02B, K2002-27VX-14172-02B, K2005-27VX-15357-01A, the
Swedish council for working life and social research, the Ragnhild
and Einar Lundström’s Memorial Foundation, the Dementia Fund,
and Norrmejerier. CONTACT: erik.rosendahl@ltu.se
ETHICS COMMITTEE: The study was approved by the Ethics
Committee of the Medical Faculty of Umeå University (§391/01).
Research Report Platform Presentation
2301 Tuesday 5 June 17:15
VCEC Meeting Room 17
EFFECTIVENESS OF THERAPEUTIC EXERCISE PROGRAMS
IN LOW BACK PAIN. A CONTROLLED, COMPARATIVE FIVE
YEARS FOLLOW-UP STUDY
Mälkiä E1 , Kuukkanen T2 , Kautiainen H3 , Pohjolainen T4 ;
1 Department of Health Sciences, University of Jyväskylä Finland;
2 School of Health and Social Care, Jyväskylä Polytechnic Finland;
3 Rheumatism Foundation Hospital, Heinola Finland; 4 Rehabilitation
unit of ORTON, Invalid Foundation, Helsinki Finland
PURPOSE: Therapeutic exercise has been shown to be beneficial
in decreasing pain and in increasing functioning in chronic low
back pain patients. However, the long lasting follow-up studies are
small in number, and often limited in the number of subjects due
to dropouts. In addition, there is a shortage of real control groups
and the content of physical exercises in most cases. The purpose
of this study was to describe the long-term changes in effectiveness
in low back pain intensity and the Oswestry Index in three study
groups five years after therapeutic exercise programs. RELEVANCE:
There is still great need for guidelines to cope low back pain
in long run in professional practice. PARTICIPANTS: Eighty-five
subjects were reassessed with questionnaire five years after the
initial recruitment for intervention study. METHODS: Interventions
S378
were: three months intensive training group (n=28) with three weekly
exercise sessions and daily home exercises, the home exercise group
(n=29) training once a day and control group (n=28) without exercise
contained in this study protocol. The exercise and physical activities
in follow-up were registered and converted into metabolic equivalents
(Mets). The primary outcome measures composed of questionnaire
of low back pain intensity with CR-10 and Oswestry Index (ODI).
The ethics committee of Jyväskylä Central Hospital approved this
study, and the subjects also gave their signed consents. ANALYSIS:
Differences between non-parametric characteristics were studied
with c2 -tests and between parametric variables with t-tests and
analysis of co-variance (Ancova). The changes in the CR-10 and
the ODI were analysed by the Last Observation Carried Forward
(LOCF). RESULTS: CR-10 and ODI decreased during the first three
months period in all the three study groups. During the follow-ups,
these values of intervention groups remained below the baseline
values. CR-10 was significantly lower in the home exercise group
during the last five years follow-up session compared with the
intensive training or control group. The physical activity had no
association with CR-10 or ODI in follow-up. CONCLUSIONS: This
study indicates that if at the initial phase of low back pain process the
subjects are predisposed to supervised, controlled home exercises,
the positive effects may preserve over years. The role of specific
home exercises remain obscure. IMPLICATIONS: At the beginning of
the low back pain process there is a need for more intensive exercises
under supervision but in the long run the home exercise program
may offer suitable devices to be used if the low back pain recurs
KEYWORDS: follow-up study, low back pain, exercise. FUNDING
ACKNOWLEDGEMENTS: This study was financially support by the
University of Jyväskylä, Jyväskylä University of Applied Sciences,
The Finnish Ministry of Education, the TULES graduate school in
musculoskeletal diseases and Likes Research Center for Sport and
Health Sciences. CONTACT: esko.malkia@sport.jyu.fi
ETHICS COMMITTEE: The ethics committee of Jyväskylä Central
Hospital approved this study, and the subjects also gave their signed
consents.
Research Report Platform Presentation
2876 Tuesday 5 June 17:15
VCEC Meeting Room 18
PERCEPTIONS OF PHYSICAL ACTIVITY AMONG TERTIARY IN-
STITUTION STUDENTS IN RWANDA:A NEED TO ADDRESS NON
COMMUNICABLE DISEASES THROUGH PHYSICAL ACTIVITY
Tumusiime D
PURPOSE: Purpose of this study was to ascertain perceptions
of physical activity, specifically; perceived benefits of, perceived
barriers and perceived helpful cues (motivational factors) to physical
activity among tertiary institution students in Rwanda, and find out
whether there is an influence of the demographic and background
characteristics to the perceptions RELEVANCE: Physical inactivity
or sedentarism, is one of the leading causes of the major non-
communicable diseases, which contribute substantially to the global
burden of diseases, death and disability. The burden of mortality,
morbidity and disability attributable to non-communicable diseases is
currently greatest and continuing to grow in the developing countries.
Some studies indicated that most of people know the benefits of
physical activity, but in countries around the world between 60% and
80% of adults are simply not physically active enough to benefit
their health. It is estimated that by 2020, Non – communicable
diseases in sub-Saharan Africa will constitute almost 50% of the
burden of disease. Most declines in physical activity are during the
transition of the students from high school to College or University
PARTICIPANTS: 500 Tertiary institution students were randomly
sampled from purposively selected departments and classes at each
of the five government educational tertiary institutions in Rwanda
METHODS: A cross-sectional and descriptive study with quantitative
design used a pre-coded self-administered questionnaire with a small
WCPT 2007, Research Reports
number of open-ended questions to collect data from participants.
ANALYSIS: Data were analysed with use of SAS version 8.
Frequencies and percentages for participants’ demographics, mean
score values with standard deviations for each perception variable
were descriptively obtained. Mantel-Haenszel Chi-square (MHC)
with inclusion of False Discovery Rate (FDR) at 5% for multiple
test adjustment, Spearman’s correlation (r) and Kruskal Wallis H
tests were used to identify significant influence of demographic and
background variables on perceptions. RESULTS: A response rate of
85% was obtained. The average age was 26.4 years with SD of 3.8.
Males constituted 63% while females were only 37%. More than 70%
were not participating in physical activity. A decline in physical activity
participation was identified from primary through secondary school
level but tremendous decline was from secondary school level to
tertiary level. Psychological benefits of physical activity were some of
the most important perceived benefits. Most of the important barriers
cited concerned equipments and time constraints to exercising. The
students felt that having a friend to participate with in physical activity
was one of the most important helpful cues. Females perceived
more barriers than males. Students in education as a professional
study course indicated more understanding of physical activity issues
than the rest in other courses. Associations were found between the
previous participation and the current perceptions of physical activity.
Most perceived barriers were negatively associated while perceived
benefits were positively associated with the previous participation
in physical activity. CONCLUSIONS: The findings demonstrate an
influence of the demographic and background characteristics on
perceptions of physical activity among the students. IMPLICATIONS:
Physical activity promoting programs should put factors influencing
physical activity behaviour into consideration during the interventions.
Physical activity programs should be emphasized right from child-
hood. KEYWORDS: Physical activity, Non communicable diseases,
students, perceptions, demographic influence, sedentary lifestyle,
Rwanda. FUNDING ACKNOWLEDGEMENTS: I acknowledge the
efforts made by the Rwandan government through the Ministry
of education for financing my studies. My Supervisor Professor J.
Frantz and participants of this study are all acknowleged. CONTACT:
kabagemad@yahoo.com
ETHICS COMMITTEE: Ethics committe at the University of Western
Cape in South-Africa.
Research Report Platform Presentation
2400 Tuesday 5 June 17:15
VCEC Meeting Rooms 19-20
PELVIC FLOOR MUSCLE ACTIVITY IN DIFFERENT SITTING
POSTURES: COMPARISON OF WOMEN WITH AND WITHOUT
STRESS URINARY INCONTINENCE
Sapsford R1 , Richardson C, Hodges P; 1 The University of
Queensland, Brisbane, Queensland, Australia
PURPOSE: Tonic activity and appropriate strength of the pelvic floor
muscles (PFM) are required for organ support and continence at rest
and during functional activities in all postures. Tonic PFM activity
has been demonstrated in lying, sitting and standing, but spinal
posture varies between those positions and amongst individuals,
and is associated with prolapse. It is not known whether PFM
activity changes with spinal posture (similar to that observed for
the abdominal muscles) thus compromising pelvic support and
continence mechanisms. RELEVANCE: Understanding how the PFM
activity is affected by sitting postures in both continent and incontinent
women may assist in the guidance of treatment of pelvic floor
dysfunction. PARTICIPANTS: Seventeen parous females, with one
or more vaginal deliveries (nine asymptomatic subjects and eight
subjects with untreated symptomatic stress urinary incontinence
(SUI)) were recruited from volunteers and patients. METHODS:
Electromyographic activity (EMG) of the PFM was recorded intra-
vaginally with a Periform probe (Neen Healthcare, UK). EMG was
recorded from five abdominal muscles with surface electrodes.
Platform Presentations, Tuesday 5 June
Muscle activity was recorded in slumped supported sitting (SS)
(n=17), in upright unsupported sitting (UU) (n=17) and in a very
tall unsupported sitting position (VT)(n=13). The shape of the spinal
curves from S2 to C7 was monitored using a flexible ruler in SS
and UU postures ANALYSIS: Raw EMG data (5 s) was analysed for
SS, UU and VT sitting. In the primary analysis EMG was compared
between postures and groups with a repeated measures ANOVA. A
secondary analysis compared EMG between the 3 postures using
a repeated-measures ANOVA for the sub-set of subjects in whom
the position was tested. RESULTS: When subjects adopted the UU
posture the EMG activity of the PFM (P = 0.001) and right obliquus
abdominis internus (OI) (P = 0.04) was greater than during the SS
position. There was also a trend for EMG of all the other oblique
abdominal muscles to increase. Women with SUI had decreased
tonic activity of the PFM in both sitting positions (P = 0.046) compared
with control subjects. This was associated with a trend for increased
activity in rectus abdominis (RA) (P = 0.059) and left OI (P = 0.14)
in SUI. No lumbar lordosis was present in SS. In UU women with
SUI had a lesser depth of lordosis compared with the controls
(p = 0.04). In the VT posture PFM (P < 0.0001) and oblique abdominal
EMG (P < 0.05) was increased in all subjects in comparison with
the SS posture. CONCLUSIONS: More upright sitting postures are
associated with greater tonic activity of the PFM compared with
slumped supported postures, irrespective of continence status, and
this is accompanied by a trend to increased abdominal muscle
activity. However women with SUI had lower levels of tonic PFM
activity and a trend for greater OI and RA activity, irrespective of
position, than continent women. IMPLICATIONS: Tonic PFM activity
is affected by sitting posture. This should be taken into account
during rehabilitation of these muscles and in the development of
programmes for long term maintenance of muscle function. Treatment
for incontinence should involve retraining activity of muscles of
both the pelvic floor and abdominal wall. KEYWORDS: Pelvic floor
muscles, sitting, incontinence. FUNDING ACKNOWLEDGEMENTS:
This study received funding from the National Continence and
Women’s Health Group of the Australian Physiotherapy Association.
CONTACT: rsapsford@ozemail.com.au
ETHICS COMMITTEE: The University of Queensland ethics
committee and the Mater Health Services ethics committee.
Research Report Platform Presentation
2166 Tuesday 5 June 17:35
PP Crystal Pavilion A
PHYSIOTHERAPY AT AN INNER-CITY CLINIC PROVIDES A
POSITIVE CLIENT EXPERIENCE
Mostert K, Maritz L, Gerda S, Cathy P, Liesl G; University of
Pretoria, Pretoria, South Africa
PURPOSE: Adopting the primary health care approach as a
philosophy for health care led to a shift from hospital-centered to
community-based care. What is the experience of clients utilising
community-based physiotherapy services at an inner-city clinic?
RELEVANCE: The experience of customers is the final judge of
the quality of a service. A shortage of research evidence exists
on the impact of community-based services at inner-city clinics,
especially in the South-African context. PARTICIPANTS: A purposive
sample of clients (n=14) utilizing an ongoing physiotherapy group
program, for more than three months at a public inner-city community
clinic, were recruited. The relevant health authority and ethics
committee authorised the study. METHODS: A grounded theory
research design was used. Six individual interviews and two focus
groups (n=5, n=6) were conducted. Each interview started with a
broad open question: “How is physiotherapy for you?”, followed by
probe questions. ANALYSIS: Line-by-line analysis of transcripts was
done. Codes were grouped into broad categories. Similar categories
were grouped into conceptual domains. An independent researcher
re-coded the texts. Where differences occurred, consensus was
reached through discussion. Apart from triangulation of methods and
S379
gathering data over time, triangulation of investigators took place as
five researchers collected and analysed the text. Data saturation
occurred during the last interviews. Results were presented to
participants, who verbally identified with the interpretation as
explained to them. RESULTS: The International Classification of
Functioning (ICF) and the systems theory provided a theoretical
perspective. Input factors (before physiotherapy) included poor
levels of activity and participation due to impairments, as well as
internal factors (poor knowledge of what to expect, anticipating
improvement or cure, uncertainty leading to fear.)Five processes
took place: exercises in a group setting, consultation with clients,
hands-on physiotherapy, health education and home programs. Three
processes were identified as intermediaries between input and
output: comprehensive client assessment, explanation of inportant
concepts by the PT and (s)he acting in an open and reassuring
manner. Clients enjoyed the processes, felt comfortable and complied
with advice.Output factors factors included higher levels of
functioning and participation, more knowledge, understanding and
acceptance about their conditions, more active lifestyles, and self-
responsibility. CONCLUSIONS: Clients at an inner-city clinic reported
that implementation of a community-based physiotherapy program
inter alia improved their level of activity and participation. A follow-
up empirical study could quantify client-satisfaction. IMPLICATIONS:
Evidence from this study would assist in justifying resources allocated
to community physiotherapy to health policy makers and managers.
The findings emphasise the importance of communication skills in
the undergraduate physiotherapy curriculum. Clinicians could note
that clients benefit from a comprehensive program including both
one-on-one and group activities. Health education and counseling
contribute to client satisfaction. KEYWORDS: community based,
client satisfaction. FUNDING ACKNOWLEDGEMENTS: Unfunded.
CONTACT: karien.mostert@up.ac.za
ETHICS COMMITTEE: Ethics Committee of the Faculty of Health
Sciences, University of Pretoria
Research Report Platform Presentation
3246 Tuesday 5 June 17:35
PP Crystal Pavilion B & C
A SYSTEMATIC REVIEW OF THE DOSAGE EFFECTS OF
MANIPULATION AND MOBILIZATION ON MECHANICAL NECK
DISORDERS
Burnie S1,2 , Gross A1 , Goldsmith C1 ; 1 McMaster University;
2 Canadian Memorial Chiropractic College
PURPOSE: The objectives of this review are to determine the optimal
dosage factors (frequency, intensity, etc) for the use of manipulation
and mobilization for neck pain; and whether manipulation and
mobilization improves pain, function, global perceived effect, patient
satisfaction or quality of life outcomes in adults with mechanical neck
disorder (MND). RELEVANCE: Neck pain is one of the most common
musculoskeletal conditions for which people seek help. The use of
manipulation and mobilization for MND is common, however evidence
based dosage recommendations are lacking. PARTICIPANTS:
Randomized trials of manipulation and mobilization in adults suffering
a MND with and without radicular findings or headache were
selected. METHODS: A Cochrane systematic review methodology
was conducted. Computerized searches included Medline, Embase
up to Sept 2006; and Manual Alternative and Natural Therapy,
Cumulative Index to Nursing and Allied Health Literature, Index to
Chiropractic Literature, CCTR up to April 2006. Randomized trials
studying the effects of manipulation and mobilization in adults with
MND were selected. Two independent reviewers extracted data while
three assessed trial quality. ANALYSIS: Standard mean differences
were calculated using random effects model. Meta-analyses and
subgroup analysis were planned but not possible. RESULTS: Five
selected trials of low quality generally differed in study design
methodology, however all used pain as a main outcome measure.
Other outcomes had limited reporting. Thoracic spine manipulation
S380
(1 to 2 sessions) appeared to provide significant improvements
in patients with (sub)acute and chronic mechanical neck pain. No
studies were available to analyze the effects of thoracic spine
mobilizations on neck pain. Although two studies showed a small
clinical advantage to cervical spine manipulation for neck pain
over 1 to 4 sessions, results were not statistically significant. The
combination of neck manipulation and mobilization showed no benefit
over an active control or wait-list control. No studies were available to
analyze the effect of cervical spine mobilizations alone on neck pain.
A dose effect could not be established from these data. Side effects
were inconsistently documented. CONCLUSIONS: The evidence
for manipulation and mobilization dosage recommendations in the
treatment of neck pain is inconclusive. This review of controlled
studies found that evidence exists to support the use of thoracic
spinal manipulation for (sub)acute and chronic MND. Although not
statistically significant, cervical manipulation may have a small clinical
advantage for MND that needs to be explored in larger trials. One
small trials suggests cervical mobilization has no pain reducing effect.
There was insufficient information to provide insight into dosage
effects of any of these treatments. Further studies with strong
methodological design are needed to establish optimal dosage.
IMPLICATIONS: This systematic review highlights the dearth of
evidence available to guide physical therapists on the optimal number
of manipulations and mobilizations required to achieve an optimal
effect for the treatment of MND. KEYWORDS: Systematic review;
Manipulation; Mobilization. FUNDING ACKNOWLEDGEMENTS:
Canadian Institutes of Health Research; Foundation for Chiropractic
Education and Research; Problem Based Research Award, Sunny-
brook Foundation. CONTACT: grossa@mcmaster.ca
Research Report Platform Presentation
2774 Tuesday 5 June 17:35
VCEC Meeting Rooms 11-12
CHEST WALL REHABILITATION: IMPROVING HEALTH-
RELATED QUALITY OF LIFE IN PEOPLE WITH CHRONIC
OBSTRUCTIVE PULMONARY DISEASE
Lucy S, D’Amore Larsen T, Overend T; School of Physical Therapy,
The University of Western Ontario, London ON, Canada
PURPOSE: To investigate the effects of a chest wall stretching
home exercise program on maximal ribcage excursion, health-related
quality of life (HRQL), and pulmonary function in people with chronic
obstructive pulmonary disease (COPD). RELEVANCE: Worldwide,
COPD is the fourth leading cause of death and estimated by
the year 2020 to be fifth among health conditions causing the
highest burden to society. Activity induced dyspnea is a universal
and disabling symptom of COPD, ascribed to an increased work
of breathing, likely due in part to a hyperinflated and rigid chest
wall. Whether chest wall rigidity can be ameliorated and morbidity
decreased in this population poses an important question for
pulmonary rehabilitation. PARTICIPANTS: Twenty-four volunteers
(15 male) of mean (SD) age 71(8.2) y, height 170.8 (33.3) cm,
and body mass index 27.0 (4.6) kg·m−2 , with mild to very severe
(FEV1 14% – 91% % predicted) COPD participated. METHODS:
The study incorporated a single group repeated measures design
consisting of 2 phases; a 4-week non-intervention (baseline) period
over which to evaluate stability/variability of study outcomes and a
4-week intervention period. Maximal rib cage excursion measured
diametrically (antero-posterior, lateral) with chest calipers at the level
of the xiphisternal junction, Chronic Respiratory Questionnaire (CRQ)
scores (dyspnea, emotional function, fatigue, mastery subscales and
total), and pulmonary function assessed by forced spirometry using a
dry-rolling seal spirometer were measured on study intake (week 0),
with repeat evaluations at biweekly intervals (week 2, 4, 6, 8). A chest
wall stretching home exercise program consisting of 5 stretches (trunk
side flexion/elongation, thoracic rotation, neck side flexion, overhead
arm reach and stretching of the anterior chest) was performed over
the final 4 weeks of the study. Three repetitions (15 sec holds) of each
WCPT 2007, Research Reports
of the 5 stretches, were done 3 times daily. Exercise adherence was
encouraged by provision of an exercise log, by viewing and giving
feedback regarding individual exercise performance at the time of
the 6-week testing, and via telephone follow-up on alternate weeks
(5 and 7). ANALYSIS: Data were analyzed using a one-way, repeated
measures analysis of variance. Post hoc pairwise comparisons were
made using the Holm-Sidak method, when the omnibus F statistic
was significant. RESULTS: Ribcage excursion (antero-posterior,
lateral, total) increased (p < 0.01) and fatigue decreased (p < 0.01)
only during the intervention period. On the other hand, dyspnea and
total HRQL demonstrated significant improvements (p < 0.01) both
during the baseline (week 2) and intervention (week 8) periods. CRQ
mastery, high (5/7) on entry, remained unchanged over the study.
Pulmonary function also demonstrated no change. CONCLUSIONS:
These results provided evidence that stretching exercises do increase
ribcage mobility in people with COPD, contributing acutely to
symptomatic relief and improved overall HRQL. However, long-term
exercise compliance and sustainability of the observed acute benefits
remain unknown. IMPLICATIONS: Chest wall stretching may provide
individuals with COPD with an easy, inexpensive, self-administered
technique to improve ribcage stiffness and overall HRQL, and is
further consistent with emerging evidence of the beneficial effects
of self-management strategies in this population KEYWORDS:
ribcage mobility, dyspnea. FUNDING ACKNOWLEDGEMENTS: The
Lung Association, Ontario Respiratory Care Society. CONTACT:
deblucy@uwo.ca
ETHICS COMMITTEE: The University of Western Ontario Research
Ethics Board for Health Sciences Research Involving Human
Subjects (HSREB)
Research Report Platform Presentation
2573 Tuesday 5 June 17:35
VCEC Meeting Room 17
WHAT DO PATIENTS CONSIDER TO BE A CLINICALLY
WORTHWHILE IMPROVEMENT FOR INTERVENTIONS OF LOW
BACK PAIN?
Ferreira M1,2 , Ferreira P1,3 , Herbert R1,4 , Latimer J1 ; 1 School of
Physiotherapy, University of Sydney, Sydney, Australia; 2 Pontificia
Universidade Catolica de Minas Gerais – Depto. Fisioterapia,
Belo Horizonte, Brazil; 3 Universidade Federal de Minas Gerais,
Belo Horizonte, Brazil; 4 Centre for Evidence-Based Physiotherapy,
University of Sydney, Sydney, Australia
PURPOSE: To assess intervention-specific perceptions of minimal
clinically important effects of intervention in patients with non-specific
low back pain. RELEVANCE: Interpreting the clinical significance
of estimates of the effect of interventions provided by randomised
clinical trials and meta-analyses requires consideration of the minimal
clinically important effect. To date, most estimates of minimal
clinically important effects are based on clinicians’ perspectives or
patients’ perceptions of change that are not intervention-specific.
PARTICIPANTS: 77 consecutive patients with non-specific low back
pain participated. METHODS: Before treatment was initiated, five
physiotherapy interventions commonly administered for non-specific
low back pain (exercise, spinal manipulative therapy, ultrasound,
local heat, massage) were described to each patient. Patients were
asked two standardised questions concerning what they considered
to be the minimum change in symptoms that would make each
intervention worthwhile. ANALYSIS: Responses were summarised
with descriptive statistics. ANOVA was performed to investigate
differences in response among the five interventions on continuous
measures of effect. Friedman’s test was performed to analyse differ-
ences in response across interventions of ordinal variables. Multiple
linear regression was used to predict the minimal worthwhile global
perceived change, percentage perceived change and percentage
improvement based on the predictive factors. For each one of the
three outcomes, explanatory variables included in the model were:
past experience with all treatments (total number of sessions across
Platform Presentations, Tuesday 5 June
all interventions), severity of symptoms in the past seven days, age
and duration of symptoms (in weeks). The significance level was
set at 0.05. RESULTS: On average, patients believed that therapy
should make them “much better” to be considered worthwhile. This
corresponded to a mean percentage perceived change in symptoms
of 42% (SD: 23%).There was no significant difference between treat-
ments for global perceived change (p = 0.09), percentage perceived
change (p=1.0), or percentage improvement (p = 0.52) considered
to be worthwhile effects. Of four possible predictive factors (past
experience with treatments, severity of symptoms, age and duration
of symptoms) only severity of symptoms was significantly associated
with perception of worthwhile effects of treatment CONCLUSIONS:
Even though a large variation in responses was observed, on
average patients considered a 42% (SD: 23%) change in symptoms
would make therapy worthwhile. IMPLICATIONS: Researchers and
clinicians interpreting the results of randomised clinical trials and
systematic reviews might be underestimating patients’ expectations.
KEYWORDS: Low back pain, treatment, smallest important effect.
FUNDING ACKNOWLEDGEMENTS: The study was funded by The
Arthritis fundation, Motor Authority Association and the University of
Sydney SESQUI grant. CONTACT: m.ferreira@pucminas.br
ETHICS COMMITTEE: University of Sydney Ethics Committee
Research Report Platform Presentation
1237 Tuesday 5 June 17:35
VCEC Meeting Room 18
THE TELEWALK TRIAL: PHYSICAL ACTIVITY COUNSELING
FOR SEDENTARY OLDER ADULTS
Kolt G1,2 , Schofield G2 , Kerse N3 , Oliver M2 , Garrett N2 ; 1 School
of Biomedical and Health Sciences, University of Western Sydney,
Sydney, Australia; 2 Centre for Physical Activity and Nutrition
Research, Auckland University of Technology, Auckland, New
Zealand; 3 Department of General Practice and Primary Health
Care, University of Auckland, Auckland, New Zealand
PURPOSE: Graded health benefits have been demonstrated for
physical activity in reducing the risk of many non-communicable
diseases. However, a large proportion of the population remains
sedentary. The purpose of the present study was to assess the
effectiveness of a telephone counseling intervention (TeleWalk) on
physical activity and health-related quality of life in low-active older
adults recruited through their primary care physician. RELEVANCE:
Across the world, the population is ageing and physical activity levels
are declining. Physical therapists and other primary care practitioners
should therefore investigate preventative health strategies for the
rising prevalence of non-communicable diseases. PARTICIPANTS:
Participants were 186 (123 females and 63 males) low-active adults
(65 years and older) recruited from their primary care physicians’
patient databases. Inclusion criteria were having participated in
less than 30 minutes of activity on 5 or more days per week for
6 months or longer, and no unstable major health problem that
meant increased activity would be contraindicated. METHODS: A
randomized controlled trial was used to investigate the effectiveness
of the telephone-based counseling intervention aimed to increase
physical activity. Participants were recruited from databases of 3
primary care medical practices in Auckland, New Zealand. Those in
the intervention group took part in 8 telephone counseling sessions
over 12 weeks based on increasing physical activity. Control patients
received usual care. Physical activity (as measured by the Auckland
Heart Study Physical Activity Questionnaire) and quality of life (as
measured by the Short Form-36 Health Survey) were assessed
at baseline, 3 months (end of intervention), and at 6 and 12
months post-baseline as follow-up. ANALYSIS: Differences between
intervention and control groups in change of outcome variables
were analyzed by using repeated measures mixed model with
an unstructured covariance matrix. Models were adjusted for age,
sex, clinic of origin, and baseline effects. A generalized estimating
equation (GEE) for binary data with a logit link function was
S381
used to model the change in meeting physical activity guidelines
from baseline to 12-month follow-up. RESULTS: Moderate leisure
physical activity increased by 86.8 minutes per week more in the
intervention than control group (p = 0.007). More participants in
the intervention group reached 2.5 hours of moderate or vigorous
leisure physical activity per week after 12 months (42% versus
23% respectively, OR 2.9, 95% CI = 1.33-6.32, p = 0.007). No
differences on SF-36 measures were observed between the groups
at 12 months. CONCLUSIONS: Telephone-based physical activity
counseling is effective in increasing physical activity over 12 months
in previously low-active older adults. IMPLICATIONS: Physical
therapists and other primary health care practitioners should be
cognizant of their role in preventative health care strategies for
the ageing population. KEYWORDS: Physical activity, Older adults,
Non-communicable diseases. FUNDING ACKNOWLEDGEMENTS:
National Heart Foundation of New Zealand (Grant Number 1017).
CONTACT: gregory.kolt@aut.ac.nz
ETHICS COMMITTEE: Auckland Ethics Committee
Research Report Platform Presentation
2646 Tuesday 5 June 17:35
VCEC Meeting Rooms 19-20
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
Queensland, St. Lucia, Queensland, Australia, 4072
PURPOSE: The aim of this study was to determine whether the
onset and amplitude of postural activity of the pelvic floor (PF)
and abdominal muscles differs between continent and incontinent
women during rapid arm movements. RELEVANCE: Previous studies
of continent women have shown that PF muscle activity increases
prior to that of deltoid during rapid arm movements. This increased
activity has been argued to be important for the maintenance of
continence and lumbopelvic stability. Although timing of postural PF
muscle activity has not been evaluated in women with stress urinary
incontinence (SUI), activation of the PF muscles is delayed during
coughing. If a similar delay is present during rapid arm movement,
this may have negative consequences for continence and lum-
bopelvic stability. PARTICIPANTS: Sixteen women with stress urinary
incontinence (SUI) and 14 continent women matched for BMI, activity
level and parity volunteered to participate in this study. METHODS:
Electromyographic activity (EMG) of the PF, internal obliquus
abdominis, obliquus externus abdominis, rectus abdominis and
erector spinae muscles were recorded with surface electrodes during
rapid shoulder flexion and extension. ANALYSIS: Onset of trunk and
PF muscle EMG activity relative to onset of deltoid muscle EMG were
detected for each muscle. Data were further analysed by comparison
of root mean square raw (between groups comparisons) and
normalised (postural response comparison) EMG amplitude recorded
150-250 ms before (baseline) and 0-100 ms after (response) the
onset of deltoid EMG. RESULTS: Normalised EMG activity of all
muscles was increased in association with arm movement (all:
p0.001). Unlike the abdominal and erector spinae muscles (all:
p < 0.004), the onset of PF muscle EMG relative to that of deltoid did
not differ with respect to direction of movement (p = 0.70). However,
the onset of postural activity of the PF muscles differed between
continent and incontinent women (p = 0.002). During both shoulder
flexion and extension, the onset of PF muscle activity occurred prior
to that of deltoid for continent women, but after deltoid in women with
SUI. A novel finding was that in many women with SUI, background
PF EMG decreased prior to the PF muscle postural response (flexion:
p = 0.004, and extension: p = 0.024). Unexpectedly, amplitude of
raw PF EMG associated with rapid arm movements was greater
among women with SUI (p = 0.010). CONCLUSIONS: This study has
demonstrated that women with SUI have altered postural activity of
the PF muscles during rapid arm movements that is characterised by
S382
delayed onset of PF muscle activity, an initial decrease in PF EMG
and increased amplitude of PF EMG following activation of deltoid.
IMPLICATIONS: The altered postural response of the PF muscles
in women with SUI appears counterintuitive to the premise that
these muscles are required to maintain continence in a situation of
increased intra-abdominal pressure and stabilise the spine and pelvis
in preparation for movement. As demonstrated during coughing, this
may contribute to the loss of urine commonly experienced during
postural tasks. Furthermore, this finding may help to explain the
association between SUI and back pain that has been identified
in epidemiological studies. KEYWORDS: Electromyography, Postural
control, Back pain. FUNDING ACKNOWLEDGEMENTS: This study
was funded by the National Health and Medical Research Council of
Australia. CONTACT: m.smith@shrs.uq.edu.au
ETHICS COMMITTEE: The University of Queensland Medical
Research Ethics Committee
Poster Displays, Tuesday 5 June
Research Report Poster Display
01-06 Tuesday 5 June 09:00
VCEC Exhibit Hall B & C
METHOD FOR PROGNOSIS OF THE WALKING CAPABILITY
CONCERNING PATIENTS WITH UNILATERAL TRANSTIBIAL
AMPUTATIONS
Ganchev D; National Sports Academy, Bulgaria
PURPOSE: During my long practice as a physical therapist I found
a significant discrepancy between the great desire of the patient to
have a prosthesis and his real functional capacity. The purpose was
to create and apply a method that would give doctors and therapists
a more objective way for prognosticating if the patient would be able
to successfully walk with the prosthesis or not. RELEVANCE: A
certain economical effect was achieved by limiting the experimental
prosthesising of contraindicated patients, and they were protected
from the unnecessary, and sometimes dangerous physical pressure.
PARTICIPANTS: For the period between February and December,
2002, 67 patients with unilateral transtibial amputation, that were
hospitalized for primary prohtesis at the Special Clinic for Prosthe-
sising and Rehabilitation of the Skeleto-Muscular System in Sofia,
were studied. The choice of the patients did not depend on their
sex or diagnosis but they all had to be above 50 years of age.
METHODS: The following indices that are of great importance for the
walking capability with a below-knee prosthesis were traced: stump
length (SL); muscle strength of the extensors of the hip and the
knee (MS); balance abilities (BA); and body weight (BW). ANALYSIS:
From the data obtained by the indices was created a formula
that defines the index of probability of walking (IPW) for men and
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%
of them at the end of the rehabilitation process. CONCLUSIONS:
Patients for whom the IPW is below 25% of the possible result, have
no chance of starting to walk even using two supporting devices.
Experience shows that they should stay in a wheelchair and be
given the appropriate physical therapy and training in self-service.
IMPLICATIONS: The suggested method was successfully used in the
clinical practice of the Special Clinic for Prosthesising – Gorna Banya,
Sofia. The idea was approved by a large group of orthopedists,
prosthesists and physical therapists during my defence of PhD.
KEYWORDS: Transtibial amputation, walking, formula. FUNDING
ACKNOWLEDGEMENTS: During my practical research I had the
moral and professional support of my colleagues – physical therapists
and orthopedists. CONTACT: 1619 Sofia, BULGARIA,Kniajevo, Bial
narzis Str. 3 E-mail: dimigan@mail.bg
ETHICS COMMITTEE: Special scientific council to NATIONAL
SPORTS ACADEMY “Vasil Levsky”, Sofia, BULGARIA
WCPT 2007, Research Reports
Research Report Poster Display
02-14 Tuesday 5 June 09:00
VCEC Exhibit Hall B & C
EFFECTS OF EXERCISE INTENSITY ON SALIVARY LEVEL
OF SECRETORY IMMUNOGLOBULIN A IN PATIENTS WITH
CHRONIC OBSTRUCTIVE PULMONARY DISEASE
Taito S1 , Sekikawa K1 , Kawaguchi K1 , Inamizu T1 , Morita N2 ;
1 Graduate School of Health Sciences, Hiroshima University; 2 Kure
Kyosai Hospital, Tadanoumi Branch
PURPOSE: Upper respiratory tract infection (URTI) is a cause
of acute exacerbation of chronic obstructive pulmonary disease
(COPD). Secretory immunoglobulin A (sIgA), the predominant
immunoglobulin in mucosal secretions of the upper respiratory tract,
is a major effector of resistance against pathogenic microorganisms
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
not appear to change sIgA levels. However, for patients with COPD,
changes in sIgA levels after exercise are unknown. This study aimed
to examine the effect of exercise intensity on salivary levels of sIgA
in patients with COPD. RELEVANCE: This study helps to explain
the effect of exercise intensity in respect to immunity for patients
with COPD. PARTICIPANTS: Five outpatients with COPD (3 males
and 2 females, mean age 76.4 [SD: 2.7] years and mean %FEV1.0
54.9 [SD: 9.0] %). METHODS: Maximum walking speed for each
subject was determined by incremental shuttle walking test (ISWT).
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%
ISWT). Saliva samples were collected before and after exercise.
Salivary sIgA concentrations (mg/ml) were measured by enzyme-
linked immunosorbent assay. ANALYSIS: Salivary sIgA secretion
rates (mg/min), or the total amount of sIgA appearing on the oral
surface per unit time, were calculated by multiplying the salivary
sIgA concentration by saliva flow rate (ml/min) for each subject.
RESULTS: After 40% ISWT, the salivary sIgA secretion rate of
three patients decreased but the other two increased. After 80%
ISWT, the salivary sIgA secretion rate of four patients decreased and
the remaining one increased. CONCLUSIONS: This study suggests
that local immunity of the upper respiratory tract deceased after
low intensity exercise, and that even low intensity exercise may
increase susceptibility to URTI for COPD patients. IMPLICATIONS:
This study is useful for understanding the risk of URTI after exercise
and disease management for patients with COPD. KEYWORDS:
chronic obstructive pulmonary disease, secretory immunoglobulin A,
exercise intensity. FUNDING ACKNOWLEDGEMENTS: This study
was unfunded. CONTACT: shutaitou@hiroshima-u.ac.jp
ETHICS COMMITTEE: The ethics committee of the Hiroshima
University Graduate School of Health Sciences and Kure Kyosai
Hospital, Tadanoumi Branch
Research Report Poster Display
02-18 Tuesday 5 June 09:00
VCEC Exhibit Hall B & C
REPRODUCIBILITY, VALIDITY AND RESPONSIVENESS OF A
GROCERY SHELVING TASK – A MEASURE OF UPPER LIMB
FUNCTION FOR PATIENTS WITH COPD
Hill C1,2 , Denehy L2 , McDonald C3 ; 1 Department of Physiotherapy,
Austin Hospital, Heidelberg, Australia; 2 School of Physiotherapy,
The University of Melbourne, Carlton, Australia; 3 Department
of Respiratory and Sleep Medicine, Austin Hospital, Heidelberg,
Australia
PURPOSE: The aim of this research was to develop an outcome
measure of arm function for patients with chronic obstructive
pulmonary disease (COPD) – the grocery shelving task (GST).
RELEVANCE: Patients with COPD commonly report breathlessness
that limits the performance of routine daily activities requiring
Poster Displays, Tuesday 5 June
unsupported arm activity. The strength of evidence for the use
of upper limb training is not as great as lower limb training in
these patients, contributed to by the lack of a simple, reliable, valid
and responsive outcome measure of arm function. PARTICIPANTS:
59 patients with moderate-severe COPD were recruited from the
pulmonary rehabilitation waiting list at a tertiary teaching hospital.
METHODS: The GST is a timed task that involves standing up from
a chair, bending over, lifting two bags of groceries from the floor and
placing the contents on a shelf set 15 cm above shoulder height.
Repeated measures design was used to determine reproducibility of
the GST over six weeks without intervention in 12 subjects. Pre-post
design was used to investigate the responsiveness of the GST and
the UULEX following a six-week pulmonary rehabilitation program in
47 subjects. In 25 of these subjects, the pattern and magnitude of
cardiorespiratory responses during the GST were compared with the
unsupported upper limb exercise test (UULEX) as the gold standard.
The UULEX is an incremental test performed in sitting, which has
reported reproducibility and validity as an outcome measure of upper
limb work. ANALYSIS: Test-retest reliability was analysed using
intraclass correlation coefficients (ICC). Cardiorespiratory responses
during the two tests were compared using paired t-tests and cor-
relations. Responsiveness pre-post intervention was analysed using
paired t-tests and sensitivity and specificity to responders. RESULTS:
The time taken to perform the GST was highly reproducible over a
six-week period, ICC = 0.98. Moderate to strong correlations were
found between the GST and the UULEX for all peak cardiorespiratory
responses (p < 0.01). Peak VO2 was significantly higher for the
GST (541 versus 481 mL/min), whereas peak VCO2 (489 versus
544 mL/min) and VE (20.0 versus 22.9 L/min) were significantly
higher for the UULEX (p < 0.05). Time taken for the GST improved
following pulmonary rehabilitation by 7.6±9.0% (n = 33, p < 0.05).
The minimum clinically important difference was identified as  5%
improvement. CONCLUSIONS: The GST was found to be a simple,
inexpensive, reproducible, valid and responsive functional outcome
measure that incorporates unsupported arm activity for patients with
COPD. IMPLICATIONS: The availability of the GST as an outcome
will allow future investigation of the clinical significance of upper limb
training for patients with COPD. KEYWORDS: upper limb function;
COPD; outcome measure. FUNDING ACKNOWLEDGEMENTS:
None. CONTACT: catherine.hill@austin.org.au
ETHICS COMMITTEE: Human Research and Ethics Committee at
the Austin Hospital, Heidelberg, Australia.
Research Report Poster Display
02-22 Tuesday 5 June 09:00
VCEC Exhibit Hall B & C
RECOVERY OF INCREASED EXERCISE VENTILATION AND
PULMONARY FUNCTION AFTER CORONARY ARTERY BYPASS
GRAFT SURGERY
Takahashi T, Kumamaru M, Taya M, Miyazawa H, Nishikawa J,
Shitara T, Adachi H, Sakurai S, Oshima S, Taniguchi K; Gunma
Prefectural Cardiovascular Center, Maebashi, Gunma, Japan
PURPOSE: Rapid and shallow breathing and perceived dyspnea are
often observed during exercise in patients underwent cardiac surgery,
in particular, when patients are in recovery stage. These symptoms
associated with reduced exercise tolerance and retarded their phys-
ical reconditioning after cardiac surgery. This study was designed
to determine the relationship between increased ventilation during
exercise and decreased respiratory function such as decreased
respiratory muscle strength and decreased vital capacity after
coronary artery bypass graft surgery (CABG). The specific objective
was to identify the factor which relates to the increased ventilation
during exercise in patients underwent cardiac surgery. RELEVANCE:
An effective evidence-based cardiopulmonary physiotherapy program
after CABG can be found from this research result. PARTICIPANTS:
We investigated 34 patients following CABG in this study. Median
sternotomy were performed in all patients. Patients consisted of
S383
27 male and 7 female with an average age of 64.8±7.1years old.
Exclusion criteria of this study were impaired vision, hearing or
musculoskeletal impairments which might interfere with the ability to
perform the exercise tests, significant pulmonary disease, history of
cerebral vascular disease, clinically unstable condition and resting
percutaneous oxygen saturation less than 90% when breathing
room air. Other exclusion criteria of this study were presence of
cardiac shock and mechanical ventilation for more than 24 hours
after surgery, Written, informed consent was obtained from all
patients prior to testing. METHODS: Once patients reached their
functional capacity to be able to walk without any medical supervision
in the ward after operation, patients were asked to perform the
three tests (Cardiopulmonary exercise test, pulmonary function
test and respiratory muscle strength test), and again performed
these tests after about 2-week supervised exercise training. As
a pulmonary function test, we measured the forced vital capacity
(FVC), the forced expired volume in one second (FEV1) and
slow vital capacity (SVC). Maximal inspiratory pressure (Pi-max)
and maximal expiratory pressure (Pe-max) was also determined.
ANALYSIS: Comparisons of data before and after 2-week supervised
exercise training were performed using a paired t-test. The spearman
rank correlation coefficient was used as a measure of correlation.
A value of p < 0.05 was considered significant. RESULTS: The
FVC, FEV1, SVC, Pi-max, Pe-max, anaerobic threshold and the
slope of minute ventilation (VE) and carbon dioxide output (VCO2)
(VE/VCO2 slope) showed significant improvement after 2-week
aerobic exercise training. However, no relationships were found
between the improvement rate of the VE-VCO2 slope and the
improvement rate of Pi-max, Pe-max, FVC, FEV1 and SVC. Only
end-tidal CO2 pressure (PETCO2) at the respiratory compensation
point significantly and strongly correlated with the VE-VCO2 slope.
CONCLUSIONS: Recovery of pulmonary function such as vital
capacity and respiratory muscle strength did not affect to increased
exercise ventilation after CABG. Improvement of increased exercise
ventilation after CABG may be due to improvement of cardiac
output that represented by improvement of PETCO2 during exercise.
IMPLICATIONS: The purpose of post-operative physiotherapy to
improve respiratory function such as respiratory muscle strength and
vital capacity should be clarified. KEYWORDS: increased exercise
ventilation, cardiac surgery, pulmonary function, cardiac function.
FUNDING ACKNOWLEDGEMENTS: N.A.
ETHICS COMMITTEE: Gunma Cardiovascular Center ethics com-
mittee
Research Report Poster Display
04-10 Tuesday 5 June 09:00
VCEC Exhibit Hall B & C
DIFFERENT TYPES OF COMPETENCE IN PHYSIOTHERAPY
Bredland E
PURPOSE: Professional competence consists of different parts,
often described as propositional knowledge (theoretical), non-
propositional knowledge (professional craft and personal knowledge).
The aim of the present study was to investigate whether a group
of under-graduate students have their strengths at different parts
of the professional competence, and to find out if the two types
of knowledge correlate. RELEVANCE: In order to be a good
physiotherapist it is important to understand, and to be aware of,
one‘s different types of professional strengths. This is important to be
aware of both for the student and for the teacher during the education.
Later on as a physiotherapist it is also important to know where
the professional strengths and weaknesses are. PARTICIPANTS:
The total population (n=98), comprised two final year classes of
students that had qualified at Sør-Trøndelag University College. All
the exams assumed to measure propositional or non-propositional
knowledge were selected, totalling seven for each student. Five of
the exams were written (propositional knowledge) and two were
practical exams (non propositional). Of the two latter, one involved
S384
demonstrating practical physiotherapy on a fellow student, and
in the final exam the students were required to treat an actual
patient. METHODS: A descriptive quantitative approach was taken
to analyse(in SPSS) the data consisting of seven grades for each of
the 98 students. ANALYSIS: Using the data program SPSS, firstly
a comparative analysis of the mean of the two practical exams with
the mean of the two last theoretical exams for each student was
performed. Secondly the final exam (with a patient) was analysed
and compared with the three other exams to determine the relative
ranking of grades. Lastly Spearman‘s correlation test was used to
find correlations between the exams. RESULTS: Preliminary results:
1. Nearly half of the students had a difference of more than one
grade between the practical and the theoretical exams. 2. More than
three-quarters of the students had their final exam as their best or
worst exam of the four. 3. While the theoretical exams correlated
significantly, only very low, non-significant, correlations were found
between the final exam and the theoretical exams. CONCLUSIONS:
There was a significant difference between students‘ propositional
vs non propositional knowledge. The final exam, with a real
patient, emphasizes a different kind of competence from the other
exams. It can be argued that a clinical exam is better suited
to measure non-propositional knowledge compared with any other
exams. IMPLICATIONS: For physiotherapists it is important to know
that as a professional you need to be aware of where you have
your weakness and where you have your strength. For the newly
qualified physiotherapists it is important to be aware of this to
further develop their competencies.A clinical exam with a patient
will highlight a different side of the professional development for the
students. KEYWORDS: Propositional knowledge – non propositional
knowledge, education. FUNDING ACKNOWLEDGEMENTS: No
funding. CONTACT: ebba.l.bredland@hist.no
Research Report Poster Display
08-14 Tuesday 5 June 09:00
VCEC Exhibit Hall B & C
TRANSMISSION OF LIGHT: DOSIMETRY ADJUSTMENT
FOR EFFECTS OF SKIN COLOR, BODY COMPOSITION,
WAVELENGTH AND LIGHT COUPLING TO SKIN
Nussbaum E1,2 , Van Zuylen J3 ; 1 Mount Sinai Hospital, Toronto,
Canada; 2 Department of Physical Therapy, University of Toronto,
Canada; 3 PhotonX Health Corporation, Mississauga, Canada
PURPOSE: To identify factors that influence transmission of light
through human skin. RELEVANCE: There has been no systematic
investigation of factors that affect transmission of therapeutic light.
Failure to adjust radiant exposure to compensate for attenuating
factors might explain some contradictory findings in the laser
literature. PARTICIPANTS: 107 healthy volunteers, 20-85 years.
METHODS: Age, sex, height, and weight were recorded. Age was
categorized as 20-30, 31-40, 41-50, 51-60, 61-70, or>71 years.
Body mass index (BMI) was calculated (kg/cm2 ) and was coded
0 (underweight), 1 (normal), 2 (overweight), and 3 (obese) for
values of <18.5, 18.5-24.9, 25-29.9, and 30, respectively. Skin color
was measured using a spectro-colorimeter and was displayed as a
number from the Pantone® Formula Guide Coated for solid colors.
Color was categorized based on relative light/dark values, Category
I having the least and Category IV the most pigmentation. Skinfold
thickness was measured using digital calipers at standardized sites
over biceps and triceps muscle bellies, and at the anterolateral
waistline. Light was generated at 840nm and 660nm using 23-
diode arrays with surface areas of 7.0cm2 . Transmission through
skinfolds was measured using a power-meter comprising a 1x1-
cm2 light detector. A custom-designed jig was used to hold the
skinfold and to position the detector in the centre of the 7-cm2
illuminated spot. Incident light was taken as the measurement
with zero skinfold thickness. Transmission was measured using
three skin-diode coupling conditions: a) contact with non-painful
pressure, b) contact without pressure, and c) with a 2-mm skin-diode
WCPT 2007, Research Reports
spacing. ANALYSIS: Skin color, BMI, skinfold thickness, skinfold
site, diode coupling, wavelength, age, and gender effects were
analyzed using a mixed effects linear model, after determining that
the data set met the underlying assumptions of the model. Residual
distributions were not normally distributed and all responses were
log-transformed to ensure valid p-values. Significance was set at
p < 0.05. RESULTS: Detected light was expressed as a percentage
of incident light. Transmission using diodes in contact with skin, with
pressure, was 1.5 times of that when using diodes in contact, but
without pressure and was 1.9 times of that using a 2-mm skin-diode
distance (p < 0.0001). Transmission of infrared light was 2.5 times
that of red light (p < 0.0001). Transmission of red light decreased
as skin color darkened stepwise from Category I to IV, by 30%,
35% and 57%, respectively (p < 0.0001). Skin color did not affect
transmission of infrared light. As BMI increased stepwise from 1 to
3, transmission through skinfolds decreased by 49.6% and 45.9%
for red light and by 44% and 43% for infrared light, respectively
(p < 0.0001). There were gender effects on penetration of infrared
light at normal and low BMI values (p < 0.01). CONCLUSIONS: When
using divergent light sources, individual physical characteristics (skin
color, BMI and gender), wavelength and skin-diode coupling must
be taken into account. IMPLICATIONS: This study demonstrates
convincingly that a ‘one dose for all’ approach when applying
light therapy is likely to provide suboptimal treatment for many
patients. Surface radiant exposure should be adjusted to ensure
delivery of effective fluence rates to subcutaneous tissue sites for all
categories of patients. KEYWORDS: laser therapy, light penetration,
physical characteristics. FUNDING ACKNOWLEDGEMENTS: We
gratefully acknowledge support from the 2004 Schnurr Memorial
Fund Research Grant, administered by the Physiotherapy Foundation
of Canada.
ETHICS COMMITTEE: Mount Sinai Hospital Research Ethics Board,
Toronto, Canada
Research Report Poster Display
08-18 Tuesday 5 June 09:00
VCEC Exhibit Hall B & C
HELIUM-NEON LASER IN VIABILITY OF RANDOM SKIN FLAP
IN RATS
Pinfildi C, Prado R, Liebano R, Hochman B, Ferreira L; São Paulo
Federal University – UNIFESP – EPM
PURPOSE: The purpose of this study was to determine the role
of helium-neon laser (He-Ne) random skin flap viability in rats.
RELEVANCE: The LLLT has been used more often in plastic
reconstructive surgery and this study showed that the red laser with
the punctual contact technique on the surface and surrounding the
skin flap can be an excellent technique to increase the vascular
perfusion and the postoperative tissue viability. PARTICIPANTS:
Forty-eight Wistar-EPM rats were used, weighed and divided into
4 groups with 12 rats each METHODS: This study was approved by
Commission of Ethics in Research of São Paulo Federal University
going in the current apt legislation. Forty-eight Wistar-EPM rats were
used, weighed and divided into 4 groups with 12 rats each. The
random skin flap was performed measuring 10 X 4 cm, with a
plastic sheet interposed between the flap and the donor site. The
Group 1 (control) underwent sham irradiation with He-Ne laser. The
Group 2 was submitted to laser irradiation, using the punctual contact
technique on the skin flap surface. The group 3 was submitted to
laser irradiation surrounding the skin flap, and the group 4 was
submitted to laser irradiation both on the skin flap surface and
around it. The experimental groups were submitted to He-Ne laser
irradiation with 3 J/cm2 energy density immediately after the surgery
and for the four subsequent days. The percentage of necrotic area
of the four groups was calculated at the seventh postoperative
day, through a paper template method. ANALYSIS: This study
used an qualitative analysis with the ANOVA (analysis variance)
with a fix factor and the Bonferroni Test to find the differences
Poster Displays, Tuesday 5 June
among the groups. RESULTS: Group 1 reached an average necrotic
area of 48.86%, Group 2–38.67%, Group 3–35.34%, and Group
4–22.61%. After the statistic analysis, results showed that all
experimental groups reached statistically significant values when
compared to the control group, and Group 4 was the best one, when
compared to all groups of this study (p < 0.001). CONCLUSIONS:
The laser He-Ne irradiation was efficient to increase random skin flap
viability in rats IMPLICATIONS: The skin flap is the most frequent
surgical procedure used in the plastic and reconstructive surgery.
The main and most feared complication responsible for failure of
procedures with skin flaps is ischemia. The LLLT can be an important
therapeutic modalities to increase the tissue viability. KEYWORDS:
Low level laser therapy. Skin flap. Necrosis. Rats. Helium-neon laser.
FUNDING ACKNOWLEDGEMENTS: São Paulo Federal University –
UNIFESP/EPM. CONTACT: cepinfildi@hotmail.com
ETHICS COMMITTEE: Commission of Ethics in Research of São
Paulo Federal University
Research Report Poster Display
08-22 Tuesday 5 June 09:00
VCEC Exhibit Hall B & C
EFFECTS OF LOW-POWER LASER THERAPY (ASGA) ON THE
REGENERATION OF SCIATIC NERVE INJURY IN THE RAT
Mello J, Sales N, Alves J, Guilherme J, Lima J; LABMORF/UNISUAM
PURPOSE: Laser irradiation is one of the therapeutic methods
for the recovery of degenerated peripheral nerves. The aim of
the present study was to determine if low-power laser treatment
(LLLT) stimulates the regeneration process of damaged nerves.
RELEVANCE: After total lesions of a peripheral nerve, the neural
ways suffer degeneration or atrophy, including the loss of the central
connections. In partial lesions the reestablishment of lost functions
is possible. The level of recuperation depends of some factors
as, number of axonic injured, effect of edema provoked by the
crushing and finally the maintenance or not of the epineurium.
PARTICIPANTS: Twenty wistar rats were used (weigh 200-250
g). METHODS: anesthetized with ketamina (100 ml/g), and a
standardized crush to the sciatic nerve (SN) was applied to cause
extensive axonal degeneration. After this procedure, low-power
infrared laser irradiation was administered transcutaneously to the
injured sciatic nerve, daily to each of three differents treatment
groups, 4, 8, 12 joules for 15 days. ANALYSIS: The animals were
sacrificed and the SN was dissected with the preservation of the
dorsal root ganglion and the medullar segment corresponding. The
SN slices were stained with hematoxylin and eosin, antigap 43
and the nerves were plated small crystals of DIA in the distal
extremity. RESULTS: In the laser treated rats showed a bigger
remyelinization, increase of the axonal extension after the injury
site, greater speed of axonal growth and increase the number of
axonic for area of section of a peripheral nerve. CONCLUSIONS:
These results suggest that low-power infrared laser irradiation can
relieve the mechanical damage of sciatic nerves and stimulate
the regeneration of peripheral nerves. IMPLICATIONS: This study
is too important for physical therapy practice because the Low-
level laser therapy is a clean, fast and efficient treatment form of
sciatic nerves injury. KEYWORDS: Laser therapy, sciatic nerves,
injury. FUNDING ACKNOWLEDGEMENTS: UNISUAM. CONTACT:
januario@unisuam.edu.br
ETHICS COMMITTEE: UNISUAM ethics committee approved this
study.
S385
Research Report Poster Display
10-02 Tuesday 5 June 09:00
VCEC Exhibit Hall B & C
SEX DIFFERENCES IN QUADRICEPS AND HAMSTRING
MUSCLE TORQUE ACCURACY AND STEADINESS
Bizzini M1,2 , Maffiuletti N1,2 ; 1 Neuromuscular Research Laboratory,
Schulthess Clinic, Zürich, Switzerland; 2 Research Department,
Schulthess Clinic, Zürich, Switzerland
PURPOSE: The purpose of this study was to analyse the effect
of sex, action mode, and contraction intensity on torque control
(accuracy and steadiness) during dynamic contractions of the
quadriceps and hamstring muscles. RELEVANCE: Muscle torque
accuracy and steadiness are typically measured in static (isometric)
conditions. In this study, dynamic contractions were performed,
which imply more complex movement control patterns. Additionally,
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
orthopaedic or neurological problems volunteered to participate in
the study (mean age ± SD: 30.5±4.9 yr; height: 1.75±0.08 m;
mass: 70.1±13.4 kg). METHODS: After a standardized warm-up and
a series of familiarization trials, quadriceps and hamstring muscle
torque accuracy and steadiness were determined using a torque
target-tracking task (±15º/s on an isokinetic device), at two different
contraction intensities (low: 0.5 Nm/kg of body mass; high: 1 Nm/kg
of body mass). Accuracy was quantified as the mean absolute
error relative to the target torque (torque error) and steadiness was
computed as the standard deviation of torque fluctuations divided
by the mean target torque (torque variability). ANALYSIS: A 4-way
ANOVA (sex × action mode × contraction intensity × muscle group)
with repeated measures on the last three factors was performed.
RESULTS: No significant differences between men (−6.65 Nm) and
women (−6.11 Nm) were observed for torque accuracy (P = 0.7).
On the other hand, a tendency toward significance (P = 0.083) was
observed for steadiness, with women showing higher values (2.87)
compared to men (2.53). More interestingly, a significant sex ×
muscle group interaction was observed on steadiness (P < 0.05),
and the post-hoc tests indicated that quadriceps torque variability
was significantly higher in women (3.37) than in men (2.86),
while no sex differences emerged for hamstring muscle (women:
2.36; men: 2.20). CONCLUSIONS: Significant sex differences were
found for quadriceps but not for hamstring torque variability. The
higher steadiness values of the females indicate a more difficult
quadriceps muscle control compared to their male counterparts. This
finding may add an interesting aspect in neuromuscular properties
differences between men and women. Further research is needed
to further study this topic in injured and post-surgical individuals.
IMPLICATIONS: This study shows that healthy women have an
impaired ability to steadily produce submaximal quadriceps forces.
Neuromuscular sex differences are considered one of the key factors
for the higher incidence of knee injuries among females. These data
may add a new aspect in the understanding of the quadriceps and
hamstring muscle sex differences and offer a basis for new training
or treatment strategies. KEYWORDS: quadriceps/hamstring, muscle
torque, accuracy/steadiness. FUNDING ACKNOWLEDGEMENTS:
This study received no funding. CONTACT: mario.bizzini@kws.ch
ETHICS COMMITTEE: This study was approved by the Local
Committee on Human Research (Schulthess Klinik Zürich).
S386
Research Report Poster Display
10-06 Tuesday 5 June 09:00
VCEC Exhibit Hall B & C
THE DIFFERENCE BETWEEN KNEE EXTENSOR STRENGTH
AND POWER WHEN MEASURING AT DIFFERENT VELOCITIES
AFTER PATELLOPLASTIA
Rahko L, Siira P, Laine V; Oulu University Hospital
PURPOSE: The purpose of this study was to determine the
differences between operated and nonoperated limb in isokinetic
knee extensor strength and power three, six and twelve months after
patelloplastia. The second purpose was to find out the differences
between strength and power results in isokinetic measurements at
the velocity 90º/s and 180º/s and that way clarify which velocity would
be more appropriate to strength measurements for patelloplastia
patients. RELEVANCE: The use of the strength and the reliability
of the strength measurements are often reduced because of the
pain or the fear of the pain. More force causes more pressure in
the joint and therefore more pain. In the isokinetic strength test
the faster velocity requires less force to produce the same power,
and the power is the thing used in daily living when jumping or
standing up, for example. Typical power tests, hop tests, require
more skills and fearlessness, and the fear of the pain is often the
reason for the low results. However the patient has better motivation
to do the exercises properly and regularly when the improvements
are clearly established, so a reliable power test is a valuable tool
for the rehabilitation. PARTICIPANTS: Nineteen patients (female 13,
male 6), mean age 27.2 years (range 17- 40) took part in this 1-
year follow-up study. Each of them had undergone Elmslie-Trillat-
patelloplastia. METHODS: The knee extensor strength and the power
was measured by the isokinetic dynamometer at the velocity 90º/s
and 180º/s. ANALYSIS: The Paired- Samples T-test between the
results of the operated and nonoperated limb was used as a statistical
method. RESULTS: The mean extension peak torque at the velocity
90º/s in the operated side was 116±36 Nm (deficit 30%, p < 0.001)
at 3 months, 142±45 Nm (deficit 20%, p < 0.001) at 6 months and
150±51 Nm (deficit 15%, NS) at 12 months. At the velocity 180º/s
that was 95±31 Nm (deficit 29%, p < 0.001), 117±39 Nm (deficit
19%, p < 0.001) and 129±43 Nm (deficit 12%, NS) respectively.
The mean extension power at the velocity 90º/s between the knee
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),
362±129 W (deficit 20%, p < 0.001) and 392±139 W (deficit 12%,
NS) respectively. CONCLUSIONS: The results indicated that the
differences in the knee extensor strength and the power between the
limbs were not anymore significant at 12 months. In the isokinetic
measurements the faster velocity gave the better power results,
probably because the faster velocity reduces the pressure in the joint.
IMPLICATIONS: When measuring 180 deg/s is more appropriate
velocity for patelloplastia patients. KEYWORDS: strength, power,
patelloplastia. FUNDING ACKNOWLEDGEMENTS: None.
Research Report Poster Display
10-10 Tuesday 5 June 09:00
VCEC Exhibit Hall B & C
THE EFFECTS OF HIGH INTENSITY PEDALING TRAINING USING
A BICYCLE ERGOMETER ON LOWER EXTREMITY MUSCLES
Ichihashi N, Ohata K, Ikezoe T, Tsuboyama T; Department of
Physical Therapy, School of Health Sciences, Faculty of Medicine,
Kyoto University, Kyoto, Japan
PURPOSE: The purpose of this study was to investigate the effects
of the 8-week high intensity pedaling training on muscle strength,
cross sectional area of thigh muscles and functional performance.
RELEVANCE: This study evaluates high intensity pedaling training
for the improvement of motor function. PARTICIPANTS: Eleven
WCPT 2007, Research Reports
healthy adults (4 males and 7 females, mean age 22.7±3.3 yr)
participated in this study. None of the subjects had a history of
neurological or orthopedic disorders in their lower extremities or
back. Each subject was informed of the purpose, possible risk,
and benefits of the study prior to giving one’s written consent to
participate. METHODS: Each training session consisted of 4×30 s
bouts at 70% of the maximal load obtained by the maximal power
test with a bicycle ergometer. Thirty seconds of rest were given
between each boat. The subjects maintained pedaling at 90 rpm
for 30s and train for 8 weeks, 3 days per week on the bicycle
ergometer. Muscle strength, cross-sectional area of thigh muscles,
pedaling power and functional performance were measured before
and after the 8 weeks of pedaling training. Maximum muscle strength
tests of hip extensor, hip abductor, knee extensor, knee flexor,
ankle plantar flexor and ankle dorsiflexor were performed using an
isokinetic dynamometer. The cross-sectional area of thigh muscles
was measured by magnetic resonance imaging. Four unilateral
hopping tests (figure-of-8 hop, side hop, up-down hop, and single
hop) and one-legged vertical jump test were used as functional
performance tests in this study. For the first 3 tests, the total time
was recorded with a handheld stopwatch to the nearest 0.01 second,
for the last 2 tests, the distance was recorded to the nearest 0.01 m.
ANALYSIS: Student’s t test for a paired data was used to compare
mean values before and after training. Significance was set at <0.05.
RESULTS: A significant increase in muscle strength was observed in
hip extension, knee extension, knee flexion, ankle plantar flexion and
ankle dorsiflexion, but not in hip abduction. Muscle hypertrophy was
seen in quadriceps, but not in hamstrings. Pedaling power showed
a significant increase during the 8-week training period. Functional
performance improved significantly except in the side hop test.
Improvements in muscle strength and pedaling power gained by the
training resulted in better functional performance. CONCLUSIONS:
High intensity pedaling training is an appropriate exercise for young
healthy subjects to improve both muscle strength in open kinetic
chain and performance in closed kinetic chain. IMPLICATIONS:
High intensity pedaling training should be regarded as a useful
training method. KEYWORDS: Pedaling training, Muscle strength,
Functional perfomance. FUNDING ACKNOWLEDGEMENTS: This
study was unfunded and independently performed. CONTACT:
ichihashi@hs.med.kyoto-u.ac.jp
Research Report Poster Display
11-14 Tuesday 5 June 09:00
VCEC Exhibit Hall B & C
PREVALENCE OF OBESITY IN SCHOOL CHILDREN IN
DURBAN,SOUTH AFRICA
Puckree T, Naidoo P, Pillay P, Naidoo T; University of KwaZulu
Natal, Durban, South Africa
PURPOSE: The primary purpose of this study was to determine the
prevalence of obesity and overweight in school children in Durban,
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.
Physiotherapists can play a vital role in health promotion in children
by determining the extent of the problem and initiating strategies
to curb obesity and its co morbidities PARTICIPANTS: A random
sample of 120 children aged 10 to 12 years of age from a population
of 300 children from 6 schools in the Durban region participated in
the study by fully informed voluntary consent. METHODS: A cross
sectional population based survey with quantitative and qualitative
components was used. A validated questionnaire with open and
closed ended questions captured information on dietary habits,
activity levels and medical history. Body Mass Index was calculated
using measured heights and weights of each child. The scale used
to measure body weight was calibrated prior to use. ANALYSIS:
Calculated Body Mass Index was compared to the Pediatric and
Dietetic formulae to determine percentage of normal, underweight,
Poster Displays, Tuesday 5 June
overweight and obese children. Paired t- tests with a probability of
p < 0.05 was used to determine statistical significance. Qualitative
information was described in categories. RESULTS: 120 children
aged 10-12 years participated. 60% were female, 77% of Indian
origin, and the remining 23% African. Using both the Pediatric
and Dietetic indices, the majority of the children were underweight
(74% and 63% respectively). However while the Pediatric formula
showed only 5% to be overweight, the Dietetic formula showed
that 39% were overweight. CONCLUSIONS: Overweight is a
problem in the study population. Underweight also appears to be
significant. The differences obtained with the Pediatrician and Dietetic
formulas require attention. A deviation from normal weight in the
school children could have implications for physiotherapy in the
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,
over-weight, body mass index. FUNDING ACKNOWLEDGEMENTS:
None. CONTACT: puckreet@ukzn.ac.za
ETHICS COMMITTEE: University of KwaZulu Natal Human Ethics
Committee
Research Report Poster Display
11-22 Tuesday 5 June 09:00
VCEC Exhibit Hall B & C
THE EFFECT OF A HEALTH PROMOTION PROGRAM
CONSISTING OF EASY AND SIMPLE EXERCISES FOR
COMMUNITY LIVING ELDERLY PEOPLE
Nakagawa K1,2 , Inomata N1,2 , Nakazawa R1 , Sakamoto M1 ; 1 Gunma
University Graduate School of Medicine; 2 Kamimoku-Spa. Hospital
PURPOSE: The purpose of this study was to test the efficacy of
a health promotion program consisting of simple exercises among
healthy elderly people in a community. RELEVANCE: As for the
exercise with training machinery, many advantages are obtained, but
have a problem to take a place and a cost. It is important to consider
simple methods and effective exercise to spread exercise intervention
to the elderly people in community. PARTICIPANTS: The participants
were healthy and elderly people (67.6±5.05 years old), who were
picked out from the users of a sports recreation facility. They were
divided into the control group (17 persons) and intervention group (20
persons). METHODS: We carried out physical fitness measurements
and instructed on exercises to participants. The evaluations for
physical fitness were the grip strength, knee extensor strength, sitting
trunk flexion, falling-stick reaction time, one leg stance, Functional
Reach Test (FRT), Timed “Up and Go” Test (TUG), 10-m walking time,
and 6 minutes distance (6MD). We also evaluated activity, social,
and psychological condition with a questionnaire which included
the Tokyo Metropolitan Institute of Gerontology (TMIG) Index of
Competence, Medical Outcomes Study Short-Form 36-Item Health
Survey (SF-36), and Profile of Mood States (POMS). All the exercises
we instructed were those can be easily performed at home. As
resistance exercise, rubber tube and one’s body weight of a subject
were used. Prior to the start of this study, the director and staff of the
sports recreation facility as well as the participants received adequate
explanation and gave their consent, before the measurements and
instruction were carried out. After this study, persons of the control
group were instructed on exercises. ANALYSIS: The Mann-Whitney
test was performed to compare the control and intervention groups
before the intervention, and a Wilcoxon signed-rank test for each
group and for each item was performed for intragroup comparison
before and after the intervention. RESULTS: In the intervention
group, the improvements of leg strength (male; 54.1±13.41%BW
to 63.1±20.01%BW, female; 53.8±15.29%BW to 59.5±18.10%BW),
TUG (female; 6.1±0.91 s to 5.7±0.90 s), 10-m walking time
(male; 5.0±1.64 s to 4.7±1.47 s), 6MD (male; 614.1±137 m to
643.6±140 m), physical function item of SF-36 (42.3±11.44 to
46.7±10.80) and vigor item of POMS (53.4±6.40 to 55.8±5.75)
were significant (P < 0.05). CONCLUSIONS: Exercise instruction in
S387
this study improved not only physical abilities but also in the social
and psychological attitudes of the participants. Intervention with
simple exercise programs had an effect on healthy elderly people
and expected to be highly promising for facilities and communities
equipped with insufficient machines. If this kind of intervention would
be adapted to the elderly who are not very active, redrafting of the
exercise program and more frequent follow-ups by a physiotherapist
were considered to be important. IMPLICATIONS: Physical therapy
practice KEYWORDS: Physical Fitness Measurement, Exercise
Instruction, Home Exercise. FUNDING ACKNOWLEDGEMENTS:
We would like to express our sincere gratitude to users and staff
of Gunma Prefectural Fureai Sports Plaza who cooperated in this
study. CONTACT: mchxq367@ybb.ne.jp
Research Report Poster Display
13-02 Tuesday 5 June 09:00
VCEC Exhibit Hall B & C
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
University, Kyoto, Japan
PURPOSE: Coodinated control of the center of pressure (CoP) and
the center of gravity (CoG) is essential in the motion initiation, and
analyzing this dynamic process provides insights into the postural
control in the patients with motor dysfunction. In patients with hip
osteoarthrosis, asymmetrical motor control caused by hip dysfunction
is often observed in the frontal plane. The purpose of this study was
to clarify the mechanism underlying postural control at the initiation of
lateral step motion in patients with hip osteoarthrosis. RELEVANCE:
This study clarifies relationship between the hip dysfunction and the
postural control, and gives the suggestion on the development of
new evaluation and treatment strategy. PARTICIPANTS: Eighteen
subjects with unilateral hip osteoarthrosis (mean age 59.5 years,
all female, OA group) and 10 healthy controls matched for age and
sex (control group) were investigated. METHODS: The subjects were
instructed to step laterally (10 cm from the stepping foot) as fast as
possible and accurately following a visual cue. The displacements
of the CoP and the CoG in the frontal plane and horizontal ground
reaction force (GRF) were measured using dual force plates during
the initiation phase (from the cue to the foot-off). The order of the
stepping direction was randomized and steps with the affected limb
supporting were included in the analysis for OA group. ANALYSIS:
Non-paired t-test was used in the statistical analysis of all kinetic
variables. RESULTS: The OA and control groups showed a common
pattern in the CoP and the CoG trajectories. During the initiation
phase, the CoP and the CoG were simultaneously shifted to the
stepping side and the supporting side, respectively, followed by a
large shift of the CoP to the supporting side to accelerate the
CoG toward the stepping side. Although there was no difference in
the displacement of the CoG, the displacement of the CoP to the
supporting side was larger in the OA group than in the control group
(p < 0.05). GRF was smaller in the OA group on both sides than
in the control group (p < 0.05). CONCLUSIONS: The patients with
OA appeared to accelerate the CoG to the stepping side by means
of enlarging the distance between CoG and CoP. They probably
adopted compensatory strategy for the insufficient abduction moment
produced by the affected limb. The finding that GRF was smaller
in the patients not only on the supporting side but also on the
stepping side seems to reflect inhibition of the rapid CoG shift
toward the affected side. IMPLICATIONS: These strategies can
possibly lead to bilateral dysfunction in the patients with unilateral
hip osteoarthrosis in the long run. KEYWORDS: postural control,
step, hip osteoarthrosis. FUNDING ACKNOWLEDGEMENTS: This
study was unfunded and independently performed. CONTACT:
tateuchi@hs.med.kyoto-u.ac.jp
S388
Research Report Poster Display
13-06 Tuesday 5 June 09:00
VCEC Exhibit Hall B & C
EXAMINATION OF GAIT SPEED MEASUREMENT AT
HOME-BASED REHABILITATION IN JAPAN: GAIT ABILITY
EVALUATION USING A 1.5 METER WALKING TEST
Makizako H1,2 , Abe T2 , Yoshimatsu T3 , Koguchi R2 , Shimada H4 ,
Kobayashi S5 , Kubo A3 ; 1 Graduate School of Sport Sciences
Waseda University; 2 Itabashi Rehabili Home-Visit Nursing
Station; 3 Department of Rehabilitation, Jiseikaikinen Hospital;
4 Research Team for Promoting Independence of the Elderly, Tokyo
Metropolitan Institute of Gerontology; 5 Department of Rehabilitation,
Jiseikai Tokumaru Hospital
PURPOSE: To investigate the feasibility of functional gait measure-
ment at home-based rehabilitation, 1.5-m, 5-m, and 10-m walking
tests were performed. The 1.5-m walking test’s validity was examined.
RELEVANCE: Evaluating gait ability using a 10 m walking test for
Japanese home-based rehabilitation is difficult. A short distance
walking test must be developed for the home-based physical therapy
field. PARTICIPANTS: Forty inpatients in a rehabilitation ward (18
females and 22 males, mean age 70.4±12.0 years) participated
in this study. Diagnoses were cerebral infarction (n = 27), cerebral
hemorrhage (n = 11), and hip fracture (n = 2). Without assistance
and independently, 22 patients were able to walk, 10 patients
required supervision during walking, and 8 patients required partial
assistance. Patients’ consent to participate was obtained after the
purpose and methods of this study were explained. METHODS:
Subjects walked 10 m at comfortable speed and maximum speed.
The time required and the number of steps was measured when the
subjects passed each line of 1.5 m, 5 m, and 10 m. ANALYSIS:
Walking speed was compared between 1.5 m, 5 m, and 10 m using
one-way analysis of variance. Pearson’s correlation coefficients were
used to confirm the association of the gait speeds for 1.5 m, 5 m,
and 10 m. We calculated quartiles at walking speeds when passing
a 1.5-m line. Significance was inferred for P < 0.05. RESULTS: No
significant differences were found in walking speeds, walking rates,
or step lengths for 1.5 m, 5 m, and 10 m. At a comfortable waking
speed, significant correlations were found between 1.5 m and 5 m (r =
0.94), as well 1.5 m as 10 m (r = 0.92). Regarding maximum walking
speed, significant correlations were found between 1.5 m and 5 m
(r = 0.97), as well as 1.5 m and 10 m (r = 0.94). We classified four
groups by quartiles in 1.5 m comfortable walking speed. The number
of patients who were walking independently in a classified group were
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
or above. CONCLUSIONS: A strong relationship was found between
the 1.5 m walking speed and 10 m walking speed. The 1.5 m walking
speed might be a useful indicator to distinguish between independent
and dependent walking. IMPLICATIONS: Results of this study might
be useful to evaluate gait performance using a 1.5 m walking test for
home-based physical therapy. KEYWORDS: 1.5 meter, gait, home-
based rehabilitation. FUNDING ACKNOWLEDGEMENTS: We are
grateful to all patients and therapists who agreed to participate in
this study. CONTACT: ita-reha.rptm@excite.co.jp
Research Report Poster Display
13-10 Tuesday 5 June 09:00
VCEC Exhibit Hall B & C
INFLUENCE OF VARIOUS METHODS OF DESCENDING STAIRS
ON LOWER EXTREMITY JOINT ANGLES AND MOMENTS
Hasegawa M, Shimatani K, Kanai S, Shimizu M, Oki S, Otsuka A;
Department of Physical Therapy,Prefectural University of Hiroshima
PURPOSE: The purpose of this study was to examine what influence
different methods of descending stairs has on the lower extremity
WCPT 2007, Research Reports
joints, with the consideration of securing safety for senior citizens
and handicapped persons. RELEVANCE: Previous studies reported
on the effectiveness of descending stairs backwards for knee
osteoarthritis. However, handicapped people and senior citizens often
descend stairs sideways, but no reports on this subject were found
in the literature. PARTICIPANTS: Subjects were 11 healthy adult
men. The mean age, height and body weight were 23.3±3.7 years,
169.0±5.1 cm, and 61.4±7.3kg, respectively. The subjects read
and signed the informed consent forms prior to their participation
in the study. METHODS: The angles of the lower limb joints and
moments when descending forward, backwards, sideways with the
swing leg diagonally forward (SF), and sideways with the swing
leg diagonally behind (SB) were measured using a 3-dimensional
motion analysis system combined with two force plates. Ten reflective
markers were attached to anatomical landmarks: the acromion,
greater trochanter, lateral malleolus, and 5th metatarsal head. The
peak angle and moment was selected for each joint. ANALYSIS:
Differences between groups were detected by a one-way analysis
of variance, followed by Fisher’s PLSD post hoc test. For all tests,
values of p < 0.05 were considered statistically significant. RESULTS:
It was found that the hip flexion angle and hip extension moment
in the support leg decreased when descending forward and SF.
On the other hand, the ankle dorsiflexion angle and plantar flexion
moment, and the knee flexion angle and extension moment in
the support leg decreased when descending backwards and SB.
CONCLUSIONS: No difference was found in joint angle and moment
between descending forward and SF. On the other hand, there
is no difference in joint angle and moment between descending
backwards and SB. We suggest that SF may be a good alternative
for descending forward, and SB may be a good alternative for
descending backwards. When descending sideways, the direction of
the swing leg changes the joint angle and moment in the stance
leg. We suggest that descending backwards and SB are suitable
for knee and ankle dysfunctions. Descending forward and SF are
suitable for hip dysfunctions. We confirmed that the difference in
the method of stair descending influences the lower extremity joint
angles and moments, and the methods taught to patients should
be suitable to their situation. IMPLICATIONS: Appropriate methods
of stair descending should be chosen for each patient to avoid
lower extremity joint stress and to increase safety. KEYWORDS:
3-dimensional motion analysis, descending stairs, activities of daily
living. FUNDING ACKNOWLEDGEMENTS: Unfunded. CONTACT:
m-hasegawa@pu-hiroshima.ac.jp
ETHICS COMMITTEE: Prefectural University of Hiroshima
Research Report Poster Display
14-14 Tuesday 5 June 09:00
VCEC Exhibit Hall B & C
INFLUENCE OF LIGHT TOUCH FOR SIDE STEP
Sugi T1 , Ito H2 ; 1 Nishimagi Hospital, Ibaraki, Japan; 2 Ibaraki
Prefectural University of Health Science, Ibaraki, Japan
PURPOSE: Researchers have reported that the amount of swaying
during static standing decreased as a result of light touches. This
study investigated the influence of light touches which don’t result in
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.
PARTICIPANTS: 13 healthy adults (7 males, 6 females)participated.
The age range was 23.7 ±4.0 years old and the height range
was 165.1 ±8.9 cm. METHODS: On the frontal plane, participants
spread their legs widely and stood on a force plate. Each foot
was on a different force plate. The obstacle was between the
legs. Participants brought their right leg closer to their left leg. The
reverse side step was performed with and without their finger tip
touching an object which was made to move synchronizing with the
movement of the finger tip. Right heel displacement was recorded
by 3-D movement analyzing apparatus, vertical (Fz) and lateral (Fy)
Poster Displays, Tuesday 5 June
peak force were measured by using force plate and the movement
time was calculated from the data of the force plate and the 3-
D movement analyzing apparatus. Measurements were made 12
times, with touch and non-touch measurements being taken 6 times
each, according to repeated measures ANOVA. ANALYSIS: The
purpose of the analysis was to examine the difference between
the touch and non-touch responses; a two (touch/non-touch) by
thirteen (subjects) analysis of variance (ANOVA) was conducted with
following data; the peak force of Fz and Fy of the right foot at
the beginning of the task, the time from the start to the right heel
reaching its maximum height during the step over an obstacle (phase-
A), the variability of phase-A between trials within each subjects,
and the variability of the average speed of the right heel from
the right heel off to contact between trials within each subjects.
The above variability characteristics were analyzed since it was
determined that these characteristics can accurately demonstrate the
consistency of the movement trials. RESULTS: When participants
touched the object, Fz and Fy of the right leg were smaller than
the non-touch responses (F(1,128) = 26.72, p < 0.01). Phase-A was
extended by touch (F(1,128) = 11.87, p < 0.01). The variability of phase-
A (F(1,128) = 10.56, p < 0.01) and the average speed of the right heel
moving (F(1,128) = 8.58, p = 0.01) were reduced with touch compared
to non-touch responses. CONCLUSIONS: From start to right heel
reaching maximum height, movement got slowly and smoothly with
touch. The consistency between repeated trials was improved by
touch. It may be considered that light touch could make movement
trials to be consistent. IMPLICATIONS: The results suggest that light
touch which cannot support the body may not only stabilize static
standing but also influence the stability and consistency of dynamic
performance. According to this hypothesis, light touch may be used to
learn or reacquire movement and to assess the ability of movement.
KEYWORDS: Light touch, reverse side step, consistency. FUNDING
ACKNOWLEDGEMENTS: This research was done for part of the
author’s Master’s thesis at the Ibaraki Prefectural University of Health
Science. CONTACT: teru@di.mbn.or.jp
ETHICS COMMITTEE: The Ibaraki Prefectural University of Health
Science Ethics Committee approved the protocol and participants
gave their informed consent.
Research Report Poster Display
14-18 Tuesday 5 June 09:00
VCEC Exhibit Hall B & C
THE EFFECT OF REACHING SPEED ON THE UPPER LIMB
MOTOR STRATEGIES IN PERSONS WITH AND WITHOUT
SHOULDER IMPINGEMENT SYNDROME
Roy J1 , Moffet H1,2 , McFadyen B1,2 ; 1 Center for Interdisciplinary
Research in Rehabilitation and Social Integration; 2 Department
of Rehabilitation, Faculty of Medicine, Laval University
PURPOSE: Repetitive arm movements performed in elevation during
daily activities have been identified as a risk factor for shoulder
impingement (SI) syndrome. The biomechanical demand of these
activities most likely varies with the speed of movement as in
other human movements. The aims of the study are to characterize
the motor strategies during a reaching task at natural and fast
speeds in healthy persons and to compare their performances
to persons with SI. RELEVANCE: A better understanding of the
impact of speed on reaching will help to identify variables that can
be used to assess performances. PARTICIPANTS: Eight healthy
subjects (mean age 45.9 years) and eight subjects with SI (mean
age 46.8 years) were recruited. Subjects with SI were selected
using standardized criteria. METHODS: Participants took part in
one evaluation session. In a seated position, they performed ten
reaching movements toward a target located around 90º of elevation
in the frontal plane at two speeds: natural and as fast as possible.
The kinematics of the shoulder, elbow, wrist, sternoclavicular joint,
neck and trunk were evaluated using the Optotrak system. Muscle
activation of seven shoulder muscles was recorded as well as
S389
temporal parameters. ANALYSIS: Reaching time, joint excursion
and muscle onset latency were calculated. Thereafter, comparison
between conditions in each group was performed using the 95%
confident interval of the mean value of these outcomes at natural
speed. It was decided that important changes in the fast speed
condition occurred when at least 50% of the individual values fell
outside this interval. A similar analysis was done to compare group
performance in each condition using the healthy group as reference.
RESULTS: In both conditions, the healthy subjects reached the target
in less time than the subjects with SI (mean differences: 76ms at fast
speed; 100ms at natural speed). When comparing the two speeds,
healthy subjects had larger wrist and elbow flexion and delayed
recruitment of the middle deltoid during fast reaching compared to
the natural speed condition. In the SI group, the same kinematics
adaptations occurred with speed in addition to an increase of trunk
rotation and an earlier recruitment of lower trapezius during fast
reaching. When comparing the two groups in the natural speed
condition, the SI group had larger trunk and cervical rotation and
sternoclavicular protraction and less elbow flexion compared to the
healthy group. In the fast speed condition, the same differences in
kinematics took place. Moreover, upper and middle trapezius and
anterior and middle deltoid were recruited earlier in the SI group.
CONCLUSIONS: Motor strategies used during fast reaching differed
from the ones used at natural speed in both populations. Subjects
with SI had more involvement of trunk, neck and sternoclavicular
joints during reaching at both speeds and important changes were
found in muscle activation timing at fast speed. IMPLICATIONS:
Reaching speed should be considered when comparing motor
strategies between populations and over time. More changes in motor
strategies were found in the fast speed condition suggesting the
importance of using such a demanding task to highlight the upper
limb impairment. KEYWORDS: Shoulder impingement syndrome;
Motor control; Kinematics. FUNDING ACKNOWLEDGEMENTS: The
study was funded by a grant from the Ordre professionnel de la
physiothérapie du Québec. Jean-Sébastien Roy was supported by
scholarships from the Institut de Recherche en Santé et Sécurité du
travail and the Fonds de recherche en Santé du Québec. CONTACT:
jean-sebastien.roy.1@ulaval.ca
ETHICS COMMITTEE: Ethics Committee of the Quebec Rehabilita-
tion Institute (comité d’éthique de la recherche de l’IRDPQ)
Research Report Poster Display
14-22 Tuesday 5 June 09:00
VCEC Exhibit Hall B & C
INFLUENCE OF SCAPULAR POSITION ON THE PRESSURE
PAIN THRESHOLD OF THE UPPER TRAPEZIUS MUSCLE
Azevedo D1 , Pires T1 , Andrade F1 , McDonnell M2 ; 1 Department of
Physical Therapy, Catholic University of Minas Gerais – PUC-Minas,
Belo Horizonte, MG, Brazil; 2 Program in Physical Therapy,
Washington University School of Medicine, St Louis, MO, USA
PURPOSE: Impairments in scapular alignment may contribute to
excessive stress on cervicoscapular muscles, resulting in pain
complaints. The hypothesis of this study was that a position of
scapular depression would maintain the upper trapezius (UT) in a
lengthened position, increasing stress on this muscle. Thus, people
with non-ideal alignment of scapular depression may have lower
pressure pain threshold (PPT) levels in the UT when compared to
subjects with normal scapular position. The purpose of this study
was to assess the influence of scapular position on the PPT of the
UT in a young healthy population. RELEVANCE: Some physical
therapy strategies for treatment and prevention of musculoskeletal
disorders are based on the relationship between posture and pain.
The knowledge of this relationship could support those strategies.
PARTICIPANTS: 52 physical therapy students (mean age 22.0±1.2
years) of Catholic University of Minas Gerais-PUC-Minas, Brazil,
participated in this study. After a shoulder posture assessment
using skin surface landmarks, subjects were allocated in one of
S390
two groups: depressed scapular position (DS, n=26, 6 men and 20
women), when the superior angle of the scapula and the acromion
were below the spinal process of the second thoracic vertebra
or normal scapular position (NS, n=26, 6 men and 20 women),
when the superior angle of the scapula and acromion were on
the same level or above the second thoracic vertebra. Previous
research has demonstrated that skin surface landmarks are valid
reference points for determining the location of the scapula and
thoracic spine. All subjects signed a consent form to participate in
this study. This study was approved by the Ethics Committee of PUC-
Minas. METHODS: An electronic pressure algometer (J Tech Medical
Industries – USA) was used to measure the PPT of the UT. The
examiner marked the middle point of the UT (midway of a straight line
from spinal process of the second thoracic vertebra to acromion) on
the dominant shoulder. The shoulders and neck of the subject were
than covered by a cloth with a gap which allowed the examiner to
see only the marked point. A second examiner, blinded to the groups,
assessed the PPT on the marked point. The PPT was defined by
the subject when the sensation of pressure changed to pain. The
PPT measurement has demonstrated good intra-rater reliability in
a previous study (ICC=.86, p < 0.05) ANALYSIS: An independent T
test was used to compare PPT mean values between both groups.
A 0.05 significance level was set. RESULTS: There was a significant
difference on PPT mean values between groups. The DS group
(19.0±9.0 N/cm2) demonstrated lower values when compared to
NS group (26.1±9.6 N/cm2, p < 0.01). CONCLUSIONS: Our results
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,
pain and pathology. IMPLICATIONS: Physical therapy strategies
should focus on maintaining an ideal scapular posture to avoid
UT chronic strain. KEYWORDS: scapula, pain, posture. FUNDING
ACKNOWLEDGEMENTS: This study was unfunded. CONTACT:
danielazevedo@pucminas.br
ETHICS COMMITTEE: Ethics Committee of Catholic University of
Minas Gerais – PUC-Minas
Research Report Poster Display
16-02 Tuesday 5 June 09:00
VCEC Exhibit Hall B & C
CHANGE IN PATIENT PERCEPTION OF FUNCTION AFTER
PHYSICAL PERFORMANCE
Larmer P1 , McNair P, Smythe L, Williams M; 1 Auckland University
of Technology
PURPOSE: To investigate the difference between patient’s perceived
level of function prior to and after actually performing tasks identified
as being of difficulty after discharge from treatment for an ankle
sprain. RELEVANCE: Physiotherapists use outcome measurements
as a way of interpreting the patient’s health status and functional
ability. It is apparent that scores from perceived measures of function
(eg: questionnaires) may not match actual performance levels
attained during physical tasks. Hence there is a need to investigate
the concordance of these measures to ensure that both patients
and therapists have similar perception levels during treatment and
at discharge from treatment. PARTICIPANTS: Thirty two patients
who had suffered an acute sprained ankle and had been treated
at private physiotherapy clinics. The mean age of participants was
31.7 yrs and 50 percent of the participants were male. METHODS:
Patients completed the Lower Limb Task Questionnaire (30 physical
tasks rated from 0-4, with 4 equalling “no difficulty” through to 0
rating as “unable to perform”) on three occasions: on discharge
from physiotherapy treatment, at six weeks following discharge
when the patients presented at the Physical Rehabilitation Research
Centre for testing and then immediately following the testing of two
tasks identified by the patient as being important and of notable
difficulty. The patient performed the identified functional tasks three
WCPT 2007, Research Reports
times. ANALYSIS: The score of perceived function at discharge,
6 weeks following discharge and immediately after performance
of the two tasks were compared. The scores for the two tasks
were summed to give a total score of difficulty. The statistical
analysis involved non parametric analysis (Freidman ANOVA) with
planned contrasts thereafter. The significance level was set at 0.05.
RESULTS: At discharge the mean score (/8) for perception of
function was 5.8/8. At six weeks following discharge the mean score
was not significantly different (mean: 5.6/8), however, perception of
function increased significantly after performance of the two physical
tasks (mean: 7.3/8). CONCLUSIONS: This study demonstrated that
performing functional tasks has benefit in providing patients’ with a
greater perception of their function. Relying on perceived outcome
measurements as the only guide to evaluating a patient’s function
is likely to provide less accurate information concerning functional
ability. IMPLICATIONS: This finding indicates that clinicians should
reevaluate their discharge criteria particularly in relation to using
outcome measurements. Functional tasks should be identified and
performed physically prior to discharge to ensure that patients have
a better appreciation of their level of function. KEYWORDS: Outcome
measurements, Patient Functional Ratings, Ankle sprains. FUNDING
ACKNOWLEDGEMENTS: New Zealand Society of Physiotherapists
Scholarship. CONTACT: peter.larmer@aut.ac.nz
ETHICS COMMITTEE: This study was approved by the Auckland
Ethics Committee on 24th February 2005 Reference number
AKY/04/12/344
Research Report Poster Display
16-06 Tuesday 5 June 09:00
VCEC Exhibit Hall B & C
THE BURDEN OF WAITING FOR KNEE REPLACEMENT
SURGERY: A PRELIMINARY CROSS-SECTIONAL ANALYSIS OF
A PROSPECTIVE COHORT IN QUEBEC
Desmeules F1 , Dionne C1,2 , Belzile É3 , Lauzier S1 ,
Bourbonnais R2,4 , Abdous B1,5 , Frémont P2,3 , Grégoire J1,6 ,
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,
Quebec, Qc, Canada; 3 Laval University Hospital (CHUQ), Quebec,
Qc, Canada; 4 Community Health Care Center (CSSS) de la
Vieille Capitale, Quebec, Qc, Canada; 5 Department of Social and
Preventive Medicine, Faculty of Medicine, Laval University, Quebec,
Qc, Canada; 6 Faculty of Pharmacy, Laval University, Quebec, Qc,
Canada
PURPOSE: To measure pain, function and health related quality of
life (HRQoL) in patients waiting for knee replacement surgery and
to identify demographic, clinical, socioeconomic and psychosocial
characteristics associated with these outcomes. RELEVANCE:
Waiting time for knee replacement surgery is an important problem
in the Canadian health care system. Preoperative function has been
shown to predict postoperative function in knee replacement patients.
Identification of factors associated with worse pain, function and
HRQoL while waiting for surgery could help target patients in need of
rehabilitation before surgery. PARTICIPANTS: From February to July
2006, 66 subjects (18 men and 48 women) aged >40 years, newly
scheduled for primary total knee replacement, were recruited from
the waiting lists of three large hospitals in Quebec City, Canada.
METHODS: Pain and function were measured with the Western
Ontario and McMaster Arthritis Index (WOMAC) and HRQoL with the
SF-36 Health Survey. Independent variables included demographic
characteristics (age, sex, marital status, living situation), clinical
characteristics (body mass index – BMI, duration of symptoms, pain
in the contra-lateral knee, use of a walking aid), socioeconomic
characteristics (educational level, employment status, household
income) and psychosocial characteristics (psychological distress,
social support). ANALYSIS: 95% confidence intervals (95% CI) were
built around the mean WOMAC function score to compare the
Poster Displays, Tuesday 5 June
subjects’ functional status to the Patient Acceptable Symptom State
(PASS) using student t-test. PASS is the value below which patients
can consider their function as good (<31.0 on the WOMAC function
score). Means and 95% CIs of the SF-36 physical (PCS) and
mental (MCS) component scales were compared to Canadian age-
matched normative data using t-tests. Stepwise multiple regression
analysis was used to assess the strength of the associations
between the independent variables and the WOMAC and SF-36
scores. Age and sex were controlled for in all models. RESULTS:
The mean WOMAC function score was significantly higher (worse)
[50.1; 95% CI: 47.0-54.0] than the PASS [31.0; 95% CI: 29.4-
32.9]. The mean PCS score was significantly lower (worse) [30.9;
95% CI: 28.5-33.3] than the mean for the Canadian age-matched
population [47.2; 95% CI: 46.8-47.6]. Higher BMI and the use of
a walking aid were significantly associated with worse function
(p < 0.05) and explained 23% of the variance of the WOMAC function
score (r2 =0.23). Female gender and higher BMI were significantly
associated with worse physical health (p < 0.05) and explained 13%
of the variance of the PCS scale (r2 =0.13). Contra-lateral knee pain
and the use of a walking aid were associated with worse mental
health (p < 0.05) and explained 23% of the variance of the MCS
(r2 =0.23). CONCLUSIONS: Patients entering waiting lists for knee
replacement surgery have very poor function and HRQoL, especially
women, those who use a walking aid, those with a high BMI, and
those who have pain in the contra-lateral knee. IMPLICATIONS:
Rehabilitation interventions before surgery should target individuals
with the characteristics that were found to be associated with
poor function and HRQoL to reduce the burden of patients waiting
for knee replacement surgery. Such interventions could potentially
have a positive impact on postoperative outcomes. KEYWORDS:
Knee replacement surgery, waiting times, rehabilitation. FUNDING
ACKNOWLEDGEMENTS: F. Desmeules is supported by a training
fellowship from the Canadian Institutes of Health Research (CIHR).
CE Dionne is a Quebec Health Research Fund (FRSQ) scholar.
CONTACT: francois.desmeules@uresp.ulaval.ca
ETHICS COMMITTEE: Laval University Medical Centre ethics
committees (SFA- HDQ-CHUL)
Research Report Poster Display
16-10 Tuesday 5 June 09:00
VCEC Exhibit Hall B & C
DETERIORATION OF POSITION SENSE AT THA HIP JOINT
FOLLOWING TOTAL HIP ARTHROPLASTY
Nakagawa N1 , Sakamoto R1 , Kano K2 , Tagomori K3 , Masuhara K4 ,
Shimada T5 ; 1 Department of Physiotherapy, Kansai Medical
College; 2 Department of Medical Rehabilitation, Suita Municipal
Hospital; 3 Department of Medical Rehabilitation, Ryokufukai
Hospital; 4 Department of Orthopedics, Osaka Kouseinenkin
Hospital; 5 Department of Physiotherapy, Kobe University
PURPOSE: The purpose of this study was to clarify the effects
of total hip arthroplasty(THA) on joint position sense at the hip.
RELEVANCE: This study was conducted to make a customized
guide for risk management after THA. PARTICIPANTS: The 108
subjects were not informed of the purpose or the results of the
present study. The age of the subject was 60.5 years old. The
operation manner was unified to the posterolateral approach by
which posterior joint capsule is entirely removed. For all subjects,
the acetabular and femoral components were fixed without bone
cement. The prosthesis used in the operation was the Spongiosa
Metal II Hip Prosthesis (ESKA, Lubeck, Germany). METHODS: The
test of joint position sense was performed by a method assessing
whether or not the subjects detected the neutral position of hip
rotation in passive movement. Each subject was tested weekly from
the 1st to 4th week after surgery. The passive rotation movement
was performed externally from an internally rotated position of 20º at
the speed of 2º/sec, and the angle detected to be the neutral position
of the hip rotation by the subject was recorded. The measurements
S391
were performed three times for each subject and the average was
recorded. ANALYSIS: Time-related changes of the detected angle
were analyzed whether joint position sense on rotational movement
was deteriorated, and how late the impairment remains if it existed.
The data obtained from measurements during 4 weeks, and patient
profile was analyzed using One-factor ANOVA. The Tukey-Kramer
method was used for the post hoc test. All statistical analyses were
performed using SPSS software. RESULTS: A significant shift to
the internally rotated position was observed between the first 1
to 2 weeks and the next 3 to 4 weeks (p < 0.01~p < 0.05). There
was no significant relation between the detected angle and either
their age or amount of leg lengthening. These results may suggest
that intensive care should be taken for early dislocation especially
during 2 weeks postoperatively. CONCLUSIONS: The results from
the present time course study on 108 patients suggested that hip
joint position sense of rotation after THA was deteriorated at 1
to 2 weeks but restored largely at 3 to 4 weeks postoperatively.
Postoperative dislocation of THA is one of the most disabling
complications requiring emergency care. Many causative factors
were suggested to be associated with dislocation. However, a lack of
proprioception as a causative factor for this complication especially
during the immediate postoperative period has rarely been reported.
Little information is available regarding proprioception of the hip joint
following THA. Based on previous cadaver dissections, there is little
doubt that the sensory innovation to the hip joint is disrupted during
the surgical approach although the form and extent of re-innervation
following THA is not clarified. In view of these findings, intensive
care to prevent dislocation is recommended especially during the
first 1 to 2 weeks. IMPLICATIONS: This study hopefully will help
facilitate sysytematic efforts to reduce the incidence of disloca-
tion. KEYWORDS: THA,dislocation,joint position sense. FUNDING
ACKNOWLEDGEMENTS: None. CONTACT: nakagawa@ast.ac.jp
ETHICS COMMITTEE: Ethic committee of Kobe university
Research Report Poster Display
17-14 Tuesday 5 June 09:00
VCEC Exhibit Hall B & C
RELATIONSHIP BETWEEN ACCELERATION OF ABNORMAL
LATERAL KNEE MOTION AND ELECTROMYOGRAPHY OF
THE QUADRICEPS MUSCLES IN PATIENTS WITH KNEE
OSTEOARTHRITIS
Nishigami T1 , Enoki H1 , Nakao S1 , Nomura T2 , Akutagawa T1 ,
Ishida K1 , Tani T1 ; 1 Dept. of Physical Medicine and Rehabilitation,
Kochi Medical School Hospital; 2 Dept. of Physical Therapy,School
of Comprehensive Rehabilitation,Osaka Prefecture,University
PURPOSE: Lateral thrust of the knee on weight-bearing is frequently
seen in patients with medial compartmental osteoarthritis (OA) of
the knee while walking. Lateral thrust may be considered a principal
contributor to OA progression. Although patients with OA of the
knee often received quadriceps training, no improvement in the
lateral thrust was observed. The purpose of this study was to
characterize the acceleration of abnormal lateral knee motion and to
examine the relationship between lateral thrust and electromyography
(EMG) of the vastus medialis (VM) and vastus lateralis (VL) muscles
while level walking. RELEVANCE: If lateral thrust is not correlate
with the EMG date of quadriceps muscles, we have to consider
other exercise to improve lateral thrust. PARTICIPANTS: Eight
subjects with symptomatic knee OA (OA groups), eight asymptomatic
age-matched controls (elderly controls), and seven young controls
participated in this study. The ordinal scale of Kellgren and Lawrence
(0–4) was used to determine OA status Three patients showed
grade 1; one, grade 2; three, grade 3; and one, grade 4 in the
index knee. METHODS: The acceleration and EMG measurement
were obtained during level walking. Three axis accelerometers were
placed on the skin over the caput fibulae and malleous lateralis. The
peak value of acceleration, the time by reaching the peak value of
it (peak time), and mean power frequency (MPF) were measured.
S392
The EMG was recorded using bipolar surface electrodes placed on
the VM and VL muscles. The inter-electrode distance was 20 mm.
The signals from each muscle were sampled at a frequency of 1000
Hz. The onset of the EMG, the offset of the EMG, integrated EMG
(IEMG) from the onset of the EMG to heel contact (On–HC), and
IEMG from heel contact to the offset (On–Off) of the EMG were
measured. IEMG was normalized by IEMG of isometric maximal
voluntary contraction (%IEMG) ANALYSIS: Data from each group
were compared with other groups for significance using Tukey’s
post hoc test for multiple comparisons. Pearson’s correlation was
used to examine the relationship between the acceleration and
the EMG date. The significant level of p < 0.05 was used for each
analysis. RESULTS: OA groups had a significantly short peak
time of lateral acceleration in comparison with the age-matched
controls. Further, the MPF of lateral acceleration for the OA groups
was significantly less than that of the young controls. The peak
time and MPF of lateral acceleration were not correlated with the
EMG date. CONCLUSIONS: Lateral acceleration parameter of the
knee showed no significant correlation with the EMG date. These
results suggest that the lateral thrust of the knee did not improve
despite quadriceps training. IMPLICATIONS: We have to consider
other exercise to improve lateral thrust. KEYWORDS: osteoarthri-
tis;walking;lateral thrust. FUNDING ACKNOWLEDGEMENTS: This
work was supported with Matsushita Electric Works,Ltd. CONTACT:
jm-nishigam@kochi-u.ac.jp
ETHICS COMMITTEE: The ethics committee of Kochi University
Research Report Poster Display
17-18 Tuesday 5 June 09:00
VCEC Exhibit Hall B & C
DETERMINANTS OF SELF-REPORTED AND PERFORMANCE-
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
Rehabilitation, School of Allied Health Sciences, Kitasato University;
3 Department of Orthopaedic Surgery, Kitasato University School
of Medicine
PURPOSE: The Japan Knee Osteoarthritis Measure (JKOM) is
a self-reported outcome for patients with knee osteoarthritis (OA)
developed to reflect a Japanese cultural background. Performance-
based measures and self-reported measures are complementary,
but do not measure the same construct. The purpose of this study
was to assess the difference of determinants between self-reported
and performance-based outcome in Japanese people with knee OA.
RELEVANCE: Understanding the extent to which each of clinical
factors plays a role in determining each outcome is important for
the development of effective interventions. PARTICIPANTS: The
participants were 95 subjects (81 women and 14 men, mean age 64.7
±7.8 yrs, body mass index 24.1 ±3.9 kg/m2 ) with symptomatic and
radiographic knee OA who participate in the Kitasato Knee classroom
in 2004 and 2005. METHODS: The self-reported outcome was
evaluated using the JKOM consisting of 25 items questionnaire. The
JKOM are scored on a 5-point scale with lower scores representing
greater levels of each subscales, and can vary from 25 to 100. It
was reported that the JKOM has sufficient reliability and validity.
The performance-related outcome was evaluated using habitual gait
speed defined as the comfortable walking speed. In addition to the
these outcomes, degree of pain evaluated on a 100 mm visual
analogue scale (VAS), quadriceps strength, range of motion of the
knee, radiographic grade (OA grade) and femorotibial angle (FTA)
evaluated in a standing radiograph were also evaluated. The quadri-
ceps strength was measured by using a hand-held dynamometer
that was fixed to a rigid bar. The quadriceps strength was analyzed
and expressed as the ratio to body weight. ANALYSIS: Correlations
between JKOM, habitual gait speed and clinical characteristics were
WCPT 2007, Research Reports
assessed using Spearman’s rank correlation and stepwise multiple
linear regression analyses, respectively. Statistical significance was
defined as P < 0.05. RESULTS: There were significant correlations
between JKOM and VAS of symptomatic side(R= 0.70), OA grade(R=
0.44), flexion ROM of symptomatic side(R=-0.41), flexion ROM of
asymptomatic side(R=-0.38), quadriceps strength of symptomatic
side(R=-0.45), quadriceps strength of asymptomatic side(R=-0.37),
FTA of symptomatic side(R=0.32). By stepwise multiple linear
regression analysis, VAS of symptomatic side (b = −0.55), quadri-
ceps strength of symptomatic side (b = −0.33) and FTA (b = 0.25)
were determinants of the JKOM (R2 =0.58). In performance-related
outcome, there were significant correlations between gait speed
and VAS of symptomatic side(R=-0.31), quadriceps strength of
symptomatic side(R=0.50), quadriceps strength of asymptomatic
side(R=0.32). By stepwise multiple linear regression analysis,
quadriceps strength of symptomatic side(b = 0.32) and VAS of symp-
tomatic side(b = −0.26) were determinants of the habitual gait speed
(R2 =0.20). CONCLUSIONS: There were differences of determinants
between self-reported and performance-related outcome in Japanese
people with knee OA. Self-reported outcome was more influenced
by the amount of pain. On the other hand, performance-related
outcome was more influenced by quadriceps strength than pain, but
these factors were not sufficient to predict the performance-related
outcome. IMPLICATIONS: Strategies to improve self-reported and
performance-based outcomes in people with knee OA should include
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:
kami-ken@za3.so-net.ne.jp
ETHICS COMMITTEE: The ethics committee of Kitasato University
Hospital
Research Report Poster Display
17-22 Tuesday 5 June 09:00
VCEC Exhibit Hall B & C
SIMPLE HOME-BASED STANDING BALANCE TRAINING AND
ISOMETRIC KNEE EXTENSION EXERCISE IMPROVE FUNC-
TIONAL ABILITY OF PATIENTS WITH KNEE OSTEOARTHRITIS
Chaipinyo K, Karoontrupjareoun O; Division of Physical
Therapy, Faculty of Health Sciences, Srinakharinwirot University,
Nakhon-nayok, 26120 Thailand
PURPOSE: To examine the effects of 4 weeks home-based simple
standing balance training and isometric knee extension exercise on
functional ability and knee muscle strength of patients with knee
osteoarthritis (OA). RELEVANCE: Exercise is crucial for patients
with knee OA. Goals of exercise are functional ability and muscle
strength. However, adherence to home-based exercise program
is a major problem. Simple and effective home-based program
prescribed by physical therapist is required to encourage patients
to continue exercise. PARTICIPANTS: 42 community volunteers
with knee OA according to the criteria of the American College of
Rheumatology (ACR) were randomly assigned to 2 groups: Group
1 Standing balance training with mini squat (n= 24; age 61.9±5.9)
and Group 2 Isometric knee extension training as control (n= 18; age
70.3±6.1). METHODS: Randomized controlled trial. Two groups of
patients performed 1 of 2 home-based exercise programs for both
sides, 5 days/week. Group 1 included stepping forward, backward,
sideward, and mini squat 30 times/day/side. Group 2 was isometric
knee extension exercise in sitting 30 times/day/side.Isokinetic knee
flexor and extensor strength were examined. Measurements of time
required for walking 50 feet, rising from chair and walk 50 feet,
stairs ascent, and stairs descent were made. Self-reported functional
ability with Knee Osteoarthritis Outcome Scores (KOOS) was used
to measure pain, other symptoms related to knee OA, function
in daily living, function in sport and recreation, and knee related
quality of life. Patients were tested at baseline and after 4 weeks
Poster Displays, Tuesday 5 June
training. ANALYSIS: Paired t-test was used to compare the baseline
to after 4 weeks training. Independent t-test was used to compare
the different between 2 groups. RESULTS: Group 1 significant
improvements were isokinetic knee flexor strength, walking time,
stair descent time, pain, other symptoms, and function in daily
living (p < 0.05). Group 2 significant improvements were rising from
chair and walk time, stairs ascent and descent times, pain, other
symptoms, function in daily living, function in sport and recreation,
and knee related quality of life (p < 0.05. Knee extensor strength
showed no significant changes after 4 weeks in both group. No
significant different was found when compared Group 1 to Group
2 on isokinetic knee muscle strength, walking time, rising from
chair and walk time, stairs ascent time, pain, other symptoms,
function in daily living, and function in sport and recreation. Improving
in stair descent time and quality of life was significantly higher
in Group 2 than Group 1 (p < 0.05). CONCLUSIONS: This study
showed effectiveness of 4 weeks home-based simple standing
balance training and isometric knee extension exercise on pain,
other symptoms related to OA knee, and function in daily living.
However, these exercise programs were not sufficient for increasing
knee muscle strength. Further study adding resistance exercise but
still keep the program simple would benefit patients who have muscle
weakness. IMPLICATIONS: Simple standing balance with mini squat
training or isometric knee extension exercise can be used as a simple
home-based exercise for patients with early stage knee OA where
pain and functional ability are major problems and knee muscle
weakness is a minor problem. KEYWORDS: Knee, osteoarthritis,
exercise, functional ability. FUNDING ACKNOWLEDGEMENTS: This
project was supported by Srinakharinwirot University Research Fund.
CONTACT: kanda@swu.ac.th
ETHICS COMMITTEE: Faculty of Health Sciences, Srinakharinwirot
University Human Reseach Ethics Comittee
Research Report Poster Display
19-06 Tuesday 5 June 09:00
VCEC Exhibit Hall B & C
HIP RESURFACING AT ONE YEAR POST SURGERY – DO
PATIENTS HAVE GOOD FUNCTIONAL RECOVERY AND ARE
THEY SATISFIED?
Barker K1 ,
Newman M1 ,
Jenkins C1 ,
Reilly K1 ,
Pandit H2 ,
Beard D2 ;
1 Physiotherapy
Research Unit, Nuffield Orthopaedic Centre NHS
Trust, Oxford, UK; 2 Nuffield Department of Orthopaedic Surgery,
University of Oxford, Oxford, UK
PURPOSE: The purpose of this study was to evaluate functional
status at one-year post surgery in a group of patients and to identify
outstanding rehabilitation needs. RELEVANCE: Currently there is no
concensus about the most appropriate method to rehabilitate patients
following hip resurfacing arthroplasty (HRA). Most are rehabilitated
following a protocol for total hip arthroplasty. Assessment of any
limitation in functional recovery at one year is important to determine
whether rehabilitation protocols need to be modified for this group
of patients. PARTICIPANTS: 125 consecutive patients receiving
a Conserve resurfacing arthroplasty at one orthopaedic hospital.
METHODS: Patients were reviewed one year post surgery. All
patients completed three validated questionnaires the Oxford Hip
Score (OHS), the Hip Osteoarthritis Outcome Score (HOOS) and
the UCLA activity score. Data on range of motion and strength was
collected by clinical examination together with timed performance
tests of walking, balance and sit to stand. ANALYSIS: Data was
summarised and scores for individual questionnaire items calculated.
Any differences between the operated and control limb were explored
using student t-tests. RESULTS: Patients ranged in age from 24–
76 years, mean 56 years. 40% were female and 60% male. At
one year there were significant decreases in the range of motion
of the operated limb compared to the control limb for abduction
(p < 0.001); extension (p < 0.001) and flexion (p < 0.001). 11% had
a positive Trendelenburg sign. The mean OHS was 17.5 (range
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12-55; s.d. 8); mean HOOS 62 (range 38-170;s.d. 27)and mean
UCLA was 6.6 (range 2-9; s.d. 1.6. 16% of patients reported
some continuing functional difficulties. These were predominantly
in putting on/ taking off shoes and socks, bending to pick things
up from the floor, squatting and running. All could climb stairs.
63% could walk an unlimited distance but 6% were limited to
<500metres. 87% were satisfied with their HRA and 13% unsatisfied,
80% still reported some pain in the operated hip. Ninety patients
(86%) experienced no complications, 15 others (14%) reported
bleeding (6 cases), superficial wound infection (3), dislocation (1),
fracture (1) nerve injury (1) other (3). CONCLUSIONS: Whilst most
patients achieved a good functional result from their HRA operation
and were very satisfied, for a significant percentage of patients
joint mobility and selected functional activities remain a problem
one year after surgery. IMPLICATIONS: The review of over a
100 patients suggests that the current strategies for rehabilitating
patients after hip resurfacing arthroplasty are producing suboptimal
results. It is suggested that a revised protocol is needed that
takes into consideration the higher functional expectations of this
younger hip replacement population. The rehabilitation protocol also
needs to address the differing threats of the resurfacing prosthesis
to minimise rehabilitation associated complications. KEYWORDS:
hip resurfacing arthroplasty, rehabilitation, outcome. FUNDING
ACKNOWLEDGEMENTS: Supported by a NOC Hip Walk project
grant. CONTACT: karen.barker@noc.anglox.nhs.uk
ETHICS COMMITTEE: Oxford LREC
Research Report Poster Display
19-10 Tuesday 5 June 09:00
VCEC Exhibit Hall B & C
EFFECTS OF JOINT TRACTION OF UPPER LIMB ON SOLEUS
H-REFLEX IN MAN
Koyama T1 , Yanagisawa K2 , Aizawa J3 ; 1 Department of Physical
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
University Hospital, Tokyo, Japan
PURPOSE: Joint traction is used to increase range of motion and
muscle strength, or to reduce joint pain in physical therapy. Traction
also acts as a stretch stimulus by elongating the muscles. It is not
certain what influence the traction of the upper limb facilitates on
the motoneuron of the lower limb. The purpose of this study is to
examine the effects of joint traction of upper limb on soleus H-reflex.
RELEVANCE: This study relates to the physiological evidence base
of physical therapy. PARTICIPANTS: Sixteen healthy male subjects
who had no orthopedic or neurological disease, ranging in age from
20 to 28 years, participated in this study. This study was approved
by the Ethics Board of Tokyo Metropolitan University, and written
informed consent was obtained from all subjects before testing.
METHODS: In supine position, the subjects were passively kept at
upper limb neutral position and the combined position that was 30º
extended, 20º abducted, 70º internal rotated position of the shoulder
respectively, and their upper limb was pulled distally by a pulley.
Traction force was set to four kinds of loads (no-load, 3kg, 6kg and
9kg). The combined position was used as one of the starting positions
of motion patterns in proprioceptive neuromuscular facilitation (PNF)
approach. Derivation of soleus H-reflex was performed to record to
electromyography (NEUROPACK II+, Nihon Kohden inc, Japan) using
surface electrodes with trancecutaneus stimulation to tibial nerve.
Stimulus intensity was set to 1.12 fold of H-reflex threshold. Single-
square wave, 1 msec pulses, 1 Hz were delivered by a stimulator.
Averaging of 32 pulses was measured as H-reflex amplitudes (peak
to peak) at each testing position. ANALYSIS: A two-factor (two upper
limb positions × four kinds of traction force) with repeated measure
ANOVA was used to identify significant effects. All data analyses were
performed using SPSS for windows 13.0 (SPSS Inc, Chicago). Level
of statistical significance was set at the 0.05 alpha level. RESULTS:
S394
The traction of upper limb significantly increased the amplitude of
the soleus H-reflex. There were no significant differences between
the two positions, and no interaction between positions and traction
forces. Multiple comparisons showed that traction of 6kg and 9kg
significantly increased H-reflex amplitudes compared with no-load.
CONCLUSIONS: This finding suggests that the traction of upper
limb might influence the excitability of soleus motoneuron, and
that the more traction force is increased, the more the excitability
enhanced. IMPLICATIONS: This result may be the physiological
base that can be applied to facilitation approach to the lower limb.
KEYWORDS: joint traction, motoneuron, soleus H-reflex. FUNDING
ACKNOWLEDGEMENTS: None.
ETHICS COMMITTEE: the Ethics Board of Tokyo Metropolitan
University
Research Report Poster Display
20-22 Tuesday 5 June 09:00
VCEC Exhibit Hall B & C
QUADRICEPS EMG IN OPEN AND CLOSED KINETIC CHAIN IN
WOMEN WITH PATELLOFEMORAL PAIN
Stensdotter A1 , Hodges P, Öhberg F, Häger-Ross C; 1 Department
of Community Medicine and Rehabilitation, Physiotherapy, Umeå
University, Umeå Sweden
PURPOSE: The aim of this study was to determine whether quadri-
ceps control is altered (i.e. decreased activity and delayed onset
of vastus medialis obliquus (VMO)) in persons with patellofemoral
pain (PFP), if this occurs in both open (OKC) and closed (CKC)
kinetic chain tasks when executed similarly, and if this can explain the
discrepancies in the literature regarding observed changes in quadri-
ceps coordination in PFP. RELEVANCE: PFP may be associated with
a decreased activity and a delayed onset of electromyographic activ-
ity of VMO relative to the lateral part of the quadriceps muscle. How-
ever, there has been considerable debate regarding the presence of
such changes in coordination. This may be explained by differences
in the experimental task, such as whether the task is performed in a
functional or non-functional manner, and with respect to biomechan-
ical parameters, for instance whether the task is performed in OKC
or CKC. In general, functional tasks have been performed in CKC,
whereas many studies have investigated nonfunctional OKC tasks.
Changes in quadriceps muscle function in PFP have most commonly
been identified in CKC functional tasks. No studies have directly com-
pared quadriceps activation between CKC and OKC tasks in PFP. In
order to understand the efficacy of physiotherapy interventions it is
critical to understand the underlying mechanisms. PARTICIPANTS:
Seventeen females with PFP without pain at the time of testing
(age 27.7±6.6 years) and 17 healthy controls (age 26.0±4.6 years)
participated. METHODS: They performed isometric quadriceps con-
tractions in a reaction-time task in OKC and CKC with matching joint
angles. Only the resulting force vector was manipulated by moving
the application of resistance. Surface electromyographic activity
(EMG) was recorded from the four heads of quadriceps. ANALYSIS:
Onset of EMG activity was determined by a computer algorithm
which served as a guide for manual inspection and correction. Data
was presented to the examiner without reference to muscle or order
of repetition. Peak root mean square (RMS) EMG amplitude was
averaged for each subject over each series of trials and normalized.
Statistical analyses were performed using a repeated-measures-
ANOVA with 1 repeated measure (kinetic chain) and 2 independent
factors (group and muscle). RESULTS: PFP subjects had slower re-
action time in both CKC and OKC, and activated quadriceps relatively
more in CKC than OKC, but did not differ from controls in relative
coordination of the different quadriceps heads. CONCLUSIONS:
Differences between people with PFP and healthy controls showed
task specific changes in motor behavior. As there was no difference
in relative coordination of the quadriceps muscles in the PFP group
the present study suggests that differences between OKC and CKC
are unlikely to explain the discrepancies between previous studies.
WCPT 2007, Research Reports
IMPLICATIONS: Attention should be directed toward that motor
behavior may be task specific and vary with presence or absence
of pain. KEYWORDS: motor behavior, EMG, knee. FUNDING
ACKNOWLEDGEMENTS: Funding: Trygg Hansa’s Research Foun-
dation, Kempe Memorial Foundation, and The Swedish Research
Council (no. 220-3-302). Acknowledgements: Technical assistance:
Helena Grip, Biomedical Engineering & Informatics, Norrland’s Uni-
versity, Umeå, Sweden. CONTACT: Ann-Katrin.Stensdotter@hist.no
ETHICS COMMITTEE: Umeå University Medical Faculty Research
Ethics Committee, Umeå Sweden. (§245/01, dnr 01-166)
Research Report Poster Display
21-02 Tuesday 5 June 09:00
VCEC Exhibit Hall B & C
EVALUATION OF AN ARTHRITIS SELF-MANAGEMENT
PROGRAM: IMPACT ON LIVING
Chan A1,2 , Heck C2,3 , McCullough C1,2 ; 1 Baycrest Centre for
Geriatric Care, Toronto, Canada; 2 University of Toronto, Toronto,
Canada; 3 University Health Network, Toronto, Canada
PURPOSE: To evaluate the impact of an arthritis self-management
program on managing pain, goal setting abilities, activities of daily
living (ADL) and health status of participants. RELEVANCE: Lorig
(2001) reported that a self-management program is effective in
long-term improvement in the health status in people with chronic
diseases. Developing self-efficacy is a key self-management strategy.
Literature informed us that participating in self-management program
results in gaining control and positively influencing health status and
future health behaviours. Baycrest’s Program for Arthritis Control
through Education and Exercise (PACEEx) is an evidence-based
self-management program for community dwelling individuals with
arthritis. This 10-week program (20 sessions) includes non-didactic
education, exercise in warm water and a comprehensive educational
resource package. Participants and caregivers engage in interactive,
experiential discussions, problem solving and personal goal setting.
A physical therapist coordinates and co-facilitates this program.
PARTICIPANTS: Data collected from all participants of PACEEx
from 1998 to 2005. METHODS: Data was collected at two time
periods: admission (T1) and discharge (T2) using the following
outcomes measures: Health Assessment Questionnaire (HAQ),
Program for Rheumatic Independent Self-Management (PRISM) and
Goal Attainment Scaling (GAS). Group data on admission (T1) and
discharge (T2) for the outcome measures studied were analyzed.
ANALYSIS: Descriptive statistics were used to characterize the
demographic profile of the subjects. T-tests were performed to
determine changes in outcomes over time using SPSS software.
RESULTS: Between 1998 and 2005, 23 PACEEx programs with a
total of 327 participants completed the program. The participants
were on average 69.9±12.2 years (range from 27 to 92) and had
been living with arthritis for 14.1±13.3 years (range from 1 to
74). The following significant changes were noted between T1 and
T2: HAQ, pain scores from 1.8±0.8 to 1.5±0.8 (p = 0.00), health
status from 41.9±82.1 to 21.9±97.2 (p= 0.00), Alternate Disability
Index reflecting activities of daily living from 1.1±0.7 to 0.9±0.6
(p = 0.00), PRISM self-efficacy for managing pain from 65.1±29.6 to
73.5±35.9. As measured by GAS, 97% of participants’ goals were
met or exceeded. CONCLUSIONS: The current study with a larger
sample size confirms previous findings (pilot study, 1995; goal review,
2005) that participation in PACEEx resulted in statistically significant
improvements in participants’ ratings of health status, reduction in
pain, improvement in performing activities of daily living, improved
confidence in managing pain and setting goals. A review of goal
attainment showed high levels of goal achievement (97%). This study
provides evidence that Baycrest’s PACEEx is successful in supporting
participants to gain self-management skills, positively influencing
health status and future health behaviours. IMPLICATIONS: The
chronic disease self-management approach demonstrates a shift
from provider based health care delivery to a learning partnership
Poster Displays, Tuesday 5 June
model. The health professional acts as a facilitator as participants
undergo a knowledge transfer and behaviour change process. This
approach meets the self-directed information and skill acquisition
needs of current health care users, contributes to a cost effective
model of health care delivery and has been shown to reduce
emergency room visits (Lorig 2001). KEYWORDS: Arthritis; Self-
management; health status. FUNDING ACKNOWLEDGEMENTS:
Unfunded work. CONTACT: achan@baycrest.org
Research Report Poster Display
21-06 Tuesday 5 June 09:00
VCEC Exhibit Hall B & C
EARLY RANGE OF MOTION AFTER SHOULDER PROSTHESIS:
FRACTURE VERSUS ARTHRITIS
Faessler D1 , Rocourt M2 ; 1 Orthopedic Physiotherapy;
2 Physiotherapy Research, University of Berne, Inselspital, 3010
Berne, Switzerland
PURPOSE: The aim of this retrospective study was to analyse the
range of motion of the operated shoulders at discharge, 6 and 12
weeks after prosthesis for fracture versus arthritis in order to give the
surgeon and physiotherapist an indication of “normal” progress in
mobility. RELEVANCE: One of the main goals of rehabilitation after
shoulder prosthesis is regaining maximum ROM. Motion exercises
are started at the first postoperative day in order to reduce the risk
of postoperative shoulder stiffness. There is, however, a concern
regarding subscapularis failure after shoulder prosthesis for arthritis
or tuberosity migration and malunion after fracture prosthesis.
PARTICIPANTS: We have analysed the postoperative course of
98 persons with shoulder prosthesis between 1995 and 2005. 16
Persons with early complications such as tuberosity migration or sub-
scapularis failure were excluded. A total of 82 persons were divided
into two groups. Group 1(G1): 30 persons(11 men, 19 women, mean
age 67 ±13 years) treated with a hemi prosthesis for a complex frac-
ture of the proximal humerus. Group 2 (G2): 52 persons (14 men, 38
women, mean age 67 ±13 years) treated with a hemi or a total shoul-
der prosthesis for primary or secondary osteoarthritis or rheumatoid
arthritis. METHODS: The rehabilitation followed two different proto-
cols for the first 6 weeks: group 1 was allowed passive elevation to
90º and passive external rotation up to 20º. For group 2 full range of
assistive active elevation and active external rotation up to 20º less
than the opposite side was allowed. Active resistance against the M.
subscapularis was not allowed. After 6 weeks active motion exercises
were encouraged. Passive global elevation in the scapular plane and
passive glenohumeral external rotation were measured at discharge,
6 and 12 weeks after surgery. ANALYSIS: Descriptive statistics and
differences within samples (Friedman-test; post-hoc Wilcoxon) and
between groups (Mann-Whitney-U-test) were computed using SPSS.
RESULTS: For both groups a significant increase in passive elevation
from discharge to 6 and 12 weeks (p < 0.001)was seen. There was
no significant difference between the two groups at discharge (G1:
85º 1; G2: 90º, p = 0.266), but after 6 weeks (G1: 95º, G2: 110º,
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
discharge to 6 and 12 weeks (p < 0.001). Groups did not differ at
discharge (G1: 10º, G2: 0º, p = 0.294) and after 6 weeks (G1: 10º, G2:
15º, p= 0.087), but after 12 weeks they differed significantly (G1: 15º,
G2: 30º, p= 0.001). CONCLUSIONS: Both groups have significant
increases in range of motion for elevation and external rotation from
discharge to 6 and 12 weeks, but the course between the groups
differ significantly. The arthritis group seems to progress faster in
elevation at 6 and 12 weeks, and in external rotation mainly at 12
weeks. IMPLICATIONS: Our results give the physiotherapists an idea
of normal progress in passive mobility after shoulder prosthesis for
fracture versus arthritis without causing damage to the tuberosities or
M. Subscapularis. KEYWORDS: Prosthesis, fracture versus arthritis,
outcome. FUNDING ACKNOWLEDGEMENTS: none. CONTACT:
physio.ortho@insel.ch
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Research Report Poster Display
22-10 Tuesday 5 June 09:00
VCEC Exhibit Hall B & C
THE EFFECT OF AEROBIC EXERCISE ON FATIGUE AND
QUALITY OF LIFE IN MULTIPLE SCLEROSIS
Sayers K1 , Baer G2 , Salisbury L3 ; 1 School of Physiotherapy, Royal
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,
United Kingdom; 3 School of Health and Social Science, University
of Edinburgh Medical School, Teviot Place, Edinburgh, EH8 9AG,
Scotland, United Kingdom
PURPOSE: The purpose of this pilot study was to investigate the
effect of a 6-week aerobic exercise programme on fatigue and quality
of life in a Multiple Sclerosis population. A secondary aim of the study
was to investigate the correlation between the two chosen fatigue
measures. RELEVANCE: Fatigue is one of the most commonly
reported and disabling symptoms of MS (Smith et al, 2005). The
beneficial use of exercise therapy in MS is well documented (Rietberg
et al, 2004). Effects of aerobic exercise on fatigue and how best this
fatigue is measured remain unclear. People with MS report a lower
quality of life than people with other chronic illnesses (Rudick et
al, 1992, Hermann et al, 1996). Aerobic exercise appears to have
a beneficial effect on quality of life (Petajan et al,1996, Mostert
and Kesselring 2002). The type and amount of exercise required
in order to glean benefit, however, requires further exploration.
PARTICIPANTS: 10 ambulatory MS subjects (Expanded Disability
Status Scale EDSS 0-6) participated in the study. Subjects meeting
inclusion criteria were identified from the MS database and were sent
an advertisement and advised to contact the researcher if interested.
METHODS: Subjects were randomly allocated to intervention or
control group. The intervention group attended a 6-week, circuit-
based, aerobic exercise class and undertook independent home
exercise sessions. The control group attended 6 MS related
information sessions over the same period. Patient perceived fatigue
was measured pre and post intervention by the Fatigue Severity
Scale (FSS) and Modified Fatigue Impact Scale (MFIS). Quality Of
Life was evaluated using the Multiple Sclerosis Scale-29 (MSIS-
29). ANALYSIS: Differences pre and post intervention between the
two groups were assessed using descriptive statistics (Microsoft
Excel) and Mann Whitney U Test (SPSS). Spearman’s rank order
correlation coefficient was used to investigate the relationship
between the two chosen fatigue measures. RESULTS: Mann Whitney
U tests show there were no statistically significant differences
in scores between the groups following the intervention period
for FSS (p = 0.264), MFIS (p = 0.074) or MSIS-29 (p = 0.402). The
FSS and MFIS scales were poorly correlated with Spearman’s
rank order correlation co-efficient of 0.489. Descriptive statistics
showed tendancies towards improvement in fatigue, as measured
by the FSS, but the opposite pattern when measured by the MFIS.
Quality of life in the intervention group remained largely unchanged
whereas it deteriorated slightly in the control group. The psychological
subscale of MSIS-29, showed a tendancy towards improvement in
both groups. CONCLUSIONS: Results suggest the FSS and MFIS
may be measuring different aspects of fatigue. The high levels
of fatigue and significant impact of MS on QOL in this sample,
suggests a longer intervention period may be necessary in order to
gain significant benefits from aerobic exercise. IMPLICATIONS: The
addition of quantitative physical activity measures and measurement
of concurrent changes in aerobic fitness would give further weight
to these preliminary research findings. Replication of the trial with
larger sample size and longer intervention period is recommended
to further investigate changes and to determine the most valid and
sensitive measure of patient perceived fatigue in exercise trials.
KEYWORDS: Aerobic Exercise Fatigue Quality of Life. FUNDING
ACKNOWLEDGEMENTS: This research was undertaken as part
S396
fulfillment of an MSc Physiotherapy and was unfunded. CONTACT:
ksayers@rcsi.ie
ETHICS COMMITTEE: Queen Margaret University College, Edin-
burgh, Scotland; Cork Teaching Hospitals, University College Cork,
Republic of Ireland
Research Report Poster Display
22-14 Tuesday 5 June 09:00
VCEC Exhibit Hall B & C
RAPIE COGNITIVE SCREENING IN MULTIPLE SCLEROSIS AC-
COMPLISHED BY THE FREE RECALL AND RECOGNITION TEST
Claesson I1 , Ytterberg C2 , Johansson S2 , Almkvist O3 ,
von Koch L2 ; 1 Department of Physical Therapy, Karolinska
University Hospital, Stockholm, Sweden; 2 Department of Clinical
Neuroscience, Karolinska Institutet, Karolinska University Hospital,
Stockholm, Sweden; 3 Neruotec Department, Karolinska Institutet,
Stockholm, Sweden
PURPOSE: This study sought to investigate the feasibility of the Free
Recall and Recognition Test (FRRT) as a practical screening tool
for cognitive impairment in multiple sclerosis (MS). RELEVANCE:
Detailed assessment of cognitive function is generally not routinely
performed in MS, since using a battery of neuropsychological tests is
time-consuming and requires expert skills. Yet, rehabilitation outcome
is negatively affected by cognitive impairment, and therefore, should
be taken into account. Thus, work is ongoing to find a screening
tool for cognitive impairment in MS, for use in clinics by personnel
with proper training and knowledge in neuropsychological testing.
This tool should be rapid and easily administered, have good
reliability, validity and sensitivity for different severities of MS, and
be accepted by the patients. PARTICIPANTS: Persons with MS
(n=227), outpatients at the Neurological Department in Karolinska
University Hospital. METHODS: Persons with MS were consecutively
recruited and assessed with four cognitive tests; FRRT, Symbol
Digit Modalities Test (SDMT), Paced Auditory Serial Addition Test
(PASAT), and the Mini-Mental State Examination (MMSE). Disease
severity was assessed by the Expanded Disability Status Scale
(EDSS)and grouped into mild, moderate and severe MS. ANALYSIS:
The Spearman Rank Correlation Coefficient was used. One-way
analysis of variance with Scheffe’s post-hoc was used to assess
differences in cognitive performance between the EDSS groups.
Sensitivity, specificity and optimum cut-offs for the FRRT were
calculated using Receiver Operator Curves. Statistical analyses were
conducted using SPSS 13.0. RESULTS: The FRRT, which was
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
FRRT recall rendered 90% sensitivity and 25% specificity, and a cut-
off of 4.2 for the FRRT recognition resulted in 70% sensitivity and
51% specificity. CONCLUSIONS: We conclude that the FRRT proved
feasible as a practical screening tool for cognitive impairment in MS
within a clinical setting. IMPLICATIONS: Rehabilitation personnel
with proper training and knowledge in neuropsychology may use the
FRRT as a simple and rapid screening tool for cognitive impairment
in MS. The result of the FRRT might serve as an indicator of when
special concern is appropriate and when a more detailed cognitive
assessment is necessary. KEYWORDS: assessment; cognition;
multiple sclerosis; neuropsychological tests; validity. FUNDING
ACKNOWLEDGEMENTS: This study was supported by grants from
the Swedish Research Council, Karolinska University Hospital, and
The Swedish Association of Persons with Neurological Disabilities.
CONTACT: ingrid.claesson@karolinska.se
ETHICS COMMITTEE: The ethical committee att Karolinska
University Hospital
WCPT 2007, Research Reports
Research Report Poster Display
22-18 Tuesday 5 June 09:00
VCEC Exhibit Hall B & C
EFFECTS OF GROUP EXERCISE TRAINING ON PATIENTS
WITH MULTIPLE SCLEROSIS
Mutluay F, Caglar A, Siva A; Neurology Department, Cerrahpasa
School of Medicine, Istanbul University, Turkey
PURPOSE: Group training may be considered an alternative to
individual multiple sclerosis (MS) rehabilitation. This study investi-
gates the effectiveness of group exercise sessions on the disability,
impairment and quality of life of MS patients. RELEVANCE: The
efficiency of group exercises in physical therapy sessions for MS
patients has not yet been investigated and may be of considerable
interest to neurological rehabilitation practice. PARTICIPANTS: 28
MS patients (mean age 41.7±9.1 years) with an average Expanded
Disability Status Scale (EDSS) score of 5.2±1.3 were included
to the study. METHODS: This study was designed as a before-
after trial. One-hour exercise classes with groups of four patients
of a similar disability level were trained by a physiotherapist once
per week for six weeks. Individual baseline measures of disability
and impairment were recorded, including functional independence
measurement (FIM), fatigue severity scale, total muscle strength,
perceived exertion level (Borg), and 10m and 20m walking times.
Quality of life was assessed using the MSQOL-54 survey. Individual
assessments were repeated after the training period. ANALYSIS:
Student’s paired-t and Wilcoxon signed rank tests were used to
test difference hypothesis. Analysis of variance (ANOVA) on inter-
group post-training variations was used to detect group differentiation
in training effects. RESULTS: 15 patients in four groups complied
fully with the training schedule. Highly significant increases (p < 0.01)
were recorded for the FIM motor section (+9.5%), and 10m and
20m walking speeds (+15%), while significant (p < 0.05) progress
was observed for total muscle strength (+5.0%), Borg (−9.6%)
and MSQOL-54 physical health composite (+10.3%) scores. The
improvements observed were statistically equal for all groups,
which were at significantly different neurological status (EDSS)
levels. CONCLUSIONS: Group exercise training can reduce motor
impairments, increase mobility and improve the quality of life of
MS patients of various disability levels. IMPLICATIONS: Group
training can replace cost-effectively individual training especially
for less disabled MS patients. KEYWORDS: Multiple sclerosis,
exercise classes, impairement, disability, quality of life. FUNDING
ACKNOWLEDGEMENTS: No special funding has been received for
this work. CONTACT: fatmamutluay@yahoo.com
Research Report Poster Display
24-02 Tuesday 5 June 09:00
VCEC Exhibit Hall B & C
EFFECT OF CONSTRAINT INDUCED MOVEMENT THERAPY ON
HEALTH RELATED QUALITY OF LIFE
Davis S1 , Chiu Y2 , Richards L3 , Fritz S4 ; 1 Brain Rehabilitation
Research Center, NF/SG VA, Gainesville, FL, USA; 2 Department
of Physical Therapy, University of Florida, Gainesville, FL, USA;
3 Department of Occupational Therapy, University of Florida,
Gainesville, FL, USA; 4 Department of Exercise Science, University
of South Carolina, Columbia, SC, USA
PURPOSE: The purpose of this study was to examine long term
effects of Constraint Induced Movement Therapy (CIMT) paired
with Donepezil or Transcranial Magnetic Stimulation (r-TMS) on
health related quality of life (HRQOL) in individuals with chronic
stroke. RELEVANCE: The efficacy of CIMT on motor function has
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
Poster Displays, Tuesday 5 June
were randomly assigned into the following groups: Donepezil (N= 9;
age range: 23-75 years; mean age: 60.8 years; 6M/3F; 4R/5L hemi-
side), Placebo (N= 7; age range: 32-80 years; mean age: 57 years;
3M/4F; 2R/5L), r-TMS (N= 9; age range: 54-78 years; mean age:
68.4 years; 5M/4F; 6R/3L), and Sham r-TMS (N=4;age range: 55-72
years; mean age: 65.5 years; 2M/2F; 4L). METHODS: Participants
in the Donepezil study received placebo or Donepezil 5 mg/day
for 2 weeks increasing to 10 mg/day for 4 weeks. After the first 2
weeks of drug/placebo administration, CIMT was provided in the lab
6 hrs/day for 10 days. For the r-TMS study, participants received
30 minutes/day of r-TMS/sham with 1 hour of CIMT in the lab and
5 hours of home practice for 10 days. The SIS total and physical
domain (PD) scores (i.e. Strength, ADL, Mobility and Hand Function)
were used to measure HRQOL. ANALYSIS: Multivariate analyses on
the change scores (pre – 6 months) were used to analyze changes
in total SIS and PD scores of SIS. The initial Fugl-Meyer upper
extremity (FMUE) motor scores and the Geriatric Depression Scale
(GDS) were covariates. Significance level was set at 0.05. RESULTS:
Statistically significant differences for the total SIS score were found
between pre- CIMT and the 6th month post [F(1,23) = 10.15; p < 0.05].
The PD scores did not show significant differences from pre-CIMT to
6th month post [F(1,23) = 0.153; p > 0.05]. There were no significant
group effects in the total SIS [F(3,23) = 0.34; p > 0.05] and PD scores
[F(3,23) = 0.206; p > 0.05]. Furthermore, there were no interactions
between SIS scores and FMUE or GDS. However, there was a
positive linear relationship between the initial FMUE scores and SIS
scores (F = 11.81; P < 0.01). CONCLUSIONS: CIMT demonstrated
long term overall improvements in HRQOL. This study showed
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
measure this outcome. Although qualitative research is an expanding
aspect of rehabilitation, adding HRQOL assessments may enhance
current quantitative studies. Making a difference functionally with long
term quality of life changes may contribute significantly to stroke
rehabilitation. KEYWORDS: constraint induced movement therapy,
quality of life, stroke. FUNDING ACKNOWLEDGEMENTS: This was
funded by the Brain Rehabilitation Research Center of the NF/SG
Veterans Affairs and VA RR & D. CONTACT: sandra.davis2@va.gov
ETHICS COMMITTEE: Institutional Review Board
Research Report Poster Display
24-06 Tuesday 5 June 09:00
VCEC Exhibit Hall B & C
STANDING AND POSTURAL CONTROL IN PERSONS WITH
HEMIPLEGIA
Dall L; JCVU- Center of Higher Education, Jutland, Denmark
PURPOSE: Rehabilitation after acut apoplexia often focus on ability
of symmetrical weight bearing in standing balance as well as postural
control during functioning. The objective of this study were to
determine the correlation between the patients symmetrical weight
bearing, postural control during daily activities and a walk test.
This in order to determine if improving symmetrical weight bearing
might cause a better postural control during functional activities.
RELEVANCE: This study assesses the relevance of training
symmetrical weight bearing in standing balance in order to improve
functional activities. PARTICIPANTS: 12 subjects experiencing their
first unilateral stroke with mean age of 59 years (range 32-73).
The subjects were included if they were able to stand alone in
20 sec., walk with or without a cane under close supervision and
able to understand and follow simple instructions. All subjects were
inpatients at a rehabilitation unit. METHODS: a prospective non-
experimental cross sectional and longitudinal design. Test–retest
within a month with three tests for balance were conducted. The
weight bearing during comfortable stance was measured over three
trials. Center of pressure (COP) representing symmetrical weight
S397
bearing was estimated using Bertec forceplate. Bergs Balance Scale
measuring postural control during functioning and five-meter walk test
(5mWT) was measured with three trials. ANALYSIS: Spearman’s
rho assessed the degree of agreement between COP and BBS,
between COP and 5mWT and between BBS and 5mWT. RESULTS:
The correlation between COP and BBS showed no correlation when
tested and when re-tested there was moderate correlation with –
0.51 with p < 0.1. There was no correlation between COP and
5mWT. Spearmann’s rho between BBS and 5mWT was 0.85 and
0.58 with p > 0.05. CONCLUSIONS: This study show no correlation
between symmetrical weight bearing during comfortable stance and
postural control in functioning. There is no relationships between
improving symmetrical weight bearing and functioning. This results
supports other studies concluding no relationships when assessing
relationships between symmetrical weight bearing and other tests
measuring functioning despite the small number of participants.
Future studies might investigate if there is relationship between
patients symmetrical weight bearing assessed dynamically and BBS
and a walk test. IMPLICATIONS: The conclusions of the study imply
that training the patients ability to symmetrical weight bearing in
stance don’t improve the patients postural control in functioning. It
is still o good thing to improve the symmetrical weight bearing during
stance if it is the need of the patient. KEYWORDS: correlation,
apoplexia, symmetrical weight bearing, BBS, 5mWT. FUNDING
ACKNOWLEDGEMENTS: The work was unfunded. CONTACT:
lmd@jcvu.dk
ETHICS COMMITTEE: The work was awarded by Den videnska-
belige komite for Århus Amt at the 13/7 2005. Denmark
Research Report Poster Display
25-18 Tuesday 5 June 09:00
VCEC Exhibit Hall B & C
NURSING STAFF’S ATTITUDE AND REPORTED BEHAVIOR
IN PATIENT TRANSFER – AN EDUCATIONAL INTERVENTION
WITH CONTROL GROUP
Kindblom-Rising K1 , Wahlström R2 , Nilsson-Wikmar L1 , Buer N3 ;
1 Dept. of Neurobiology, Caring Sciences and Society, Div. of
Physiotherapy, Karolinska Institutet, Stockholm, Sweden; 2 IHCAR,
Dept. of Public Health Sciences, Karolinska Institutet, Stockholm,
Sweden; 3 Dept. of Health Sciences, Örebro University, Örebro,
Sweden
PURPOSE: To explore and describe nursing staff’s attitudes and
reported behavior before and after an educational intervention in
patient transfer (course in Natural Mobility). RELEVANCE: Decrease
nursing staff’s musculoskeletal strain and promote patients to move
independently. PARTICIPANTS: Ninety nine nursing staff in an
intervention group and twenty seven in a control group voluntary
participated. Their age ranged between 24-64 in the intervention
group and 21-61 in the control group. The average time of work in
health care was 25 years in the intervention group and 17 years
in the control group. Both the intervention group and the control
group answered a questionnaire before and one year after the
intervention. METHODS: A purposely developed questionnaire was
used, based on the results from a previous study, collaboration with
experienced health care staff and relevant literature. A modified
Delphi procedure was used for content validity and a test re-test for
reliability. There were both closed and open-ended questions. The
items were related to ability, body and movement awareness and
communication. Natural Mobility is an educational course in patient
transfer to facilitate nursing staff’s learning process through self-
experience. The aim is to promote patients to move independently,
inspired by the physiotherapist’s manner of supporting the patient
to move. The course is based on theories of movements, fear,
communication and learning. Simple exercises and role changes are
used to increase understanding. The course lasted for two half days
with two weeks interval. There were between 8-18 participants in
each course. ANALYSIS: Descriptive statistics was used to present
S398
the distribution of outcome variables. A modified sign test has
been used to evaluate significance within the intervention group
and compare confidence intervals between the intervention and the
control group. Open ended questions were analysed qualitatively.
RESULTS: The preliminary findings indicate that the issue assessed
as “the most important in patient transfer” before the intervention
was to “lift correctly”, one year later this changed significantly within
the intervention group to “make the patient move independently”,
or “to plan the transfer”. The control group was not significantly
influenced. The questionnaire was significantly influenced to six other
questions “body awareness related to pain, fear related to movement,
the use of one’s hands, activating the patient during patient transfer,
showing the patient with one’s body how to move independently and
certainty in performing patient transfer”. There were no significantly
changes between the groups. In the open questions the staff reported
changes in their verbal instructions in the intervention group, this
was found only in a restricted number of persons in the control
group. CONCLUSIONS: It may be of important value to be aware
of and understand nursing staff’s attitudes and reported behaviour
when designing the structure and content of patient transfer training.
IMPLICATIONS: To inspire physiotherapist’s in developing new
learning strategies in communicating their knowledge, by taking
advantage of nursing staff’s recourses, attitudes and behavior in pa-
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,
Sweden. CONTACT: kristina.kindblom-rising@ki.se
ETHICS COMMITTEE: Research Committ’e Örebro University
hospital, Örebro County Council, Örebro, Sweden Dnr 210/03;
Regional Ethical Review board, Uppsla, Sweden Dnr 2004:M-250
Research Report Poster Display
26-22 Tuesday 5 June 09:00
VCEC Exhibit Hall B & C
AN INVESTIGATION INTO THE INFLUENCE OF SIT-TO-STAND
REPETITIONS IN ACUTE REHABILITATION
Flynn H; St. James’ Hospital, Dublin 8, Ireland
PURPOSE: To examine the training effect of Sit-to-Stand (STS)
repetitions as an adjunct to routine mobilisation on functional status
in an acute rehabilitation service. RELEVANCE: STS is a vital
prerequisite to independent mobility. Difficulty with STS has been
linked with increased risk of falls in the elderly and is correlated
with the need for long-term care1. It has been proven that STS
is more biomechanically demanding than gait or stair climbing,
requiring greater moments of force at the hip and knee1. Carr &
Shepherd (2005) have argued the need for more task-specific
practice in physiotherapy with focus on repetition. However, in acute
rehabilitation, the provision of supervised exercise programmes is
often not possible due to heavy caseloads and time constraints. STS
would appear to be a simple and effective strengthening exercise that
could be easily administered at a patient’s bedside. PARTICIPANTS:
Two groups randomly allocated into a control group (n=4, mean age
83) or experimental group (n=4, mean age 86) from a convenience
sample of those referred for routine mobility physiotherapy. Subject
consent was obtained. Inclusion criteria: 1) Ability to follow simple
instructions, 2) Ability to stand with at least maximal assistance of 2.
One subject from the control group was lost to follow-up. METHODS:
Each group underwent routine mobility practice as prescribed by
their physiotherapist. In addition, the experimental group carried
out 10 STS repetitions with appropriate supervision and cues. The
number of repetitions was increased as able and task- context &
environment were varied where possible. Training continued for 4
weeks. Due to the clinical nature of this trail, variables such as chair
height and use of upper limbs were not controlled between subjects.
Outcomes measures: STS section of BERG balance scale, Timed
STS, Functional Ambulation Category (FAC) and Elderly Mobility
WCPT 2007, Research Reports
Scale (EMS) were assessed pre and post-intervention by a blinded
assessor. ANALYSIS: Paired sample T-tests were used to examine
differences within and between groups. Significance level was set
at p < 0.05. RESULTS: The experimental group showed a mean
22.6% decrease in Timed STS compared with 0.2% in control group.
Within-group analysis for the experimental group showed a significant
increase in EMS scores pre and post-intervention (p = 0.017). Strong
trends of improvement within the experimental group were noted
in all other outcomes (FAC p = 0.051, BERG p = 0.09, Timed STS
p = 0.17). The progression made by the experimental group was
not shown to be significantly greater than that of the control group.
When considering these results, the heterogenous population and
small sample must be acknowledged. Due to the clinical nature of
this trial, several variables were not controlled between subjects,
particularly that of chair height. CONCLUSIONS: Improvements
were demonstrated in STS success and function status. However,
further investigation is warranted in the form of a larger, randomised,
controlled trial. A more sensitive measure of functional change such
as the Timed 10m Walk might also be considered. IMPLICATIONS:
This study would appear to support the use of STS repetitions as
a simple and effective means of achieving improved STS success
and function in clinical practice. KEYWORDS: Sit-to-Stand, training,
function. FUNDING ACKNOWLEDGEMENTS: No funding received.
Research Report Poster Display
27-02 Tuesday 5 June 09:00
VCEC Exhibit Hall B & C
DEPRESSION, COGNITION, AND FUNCTIONAL STATUS IN
SARCOPENIC COMMUNITY-DWELLING ELDERLY IN TAIWAN
Chien M1 , Huang T2 , Kuo H3 , Wu Y1 ; 1 School and Graduate
Institute of Physical Therapy, College of Medicine, National Taiwan
University, Taipei, Taiwan; 2 Department of Radiology, Hoping
Branch, Taipei City Hospital, Taiwan; 3 Department of Internal
Medicine, National Taiwan University Hospital, Taiwan
PURPOSE: To investigate the prevalence of sarcopenia in
community-dwelling elderly in Taiwan and to compare the depression
scale, cognitive function, functional status, and quality of life
between elderly with sarcopenia and normal skeletal muscle mass.
RELEVANCE: Several studies have reported that sarcopenia was
significantly and independently associated with functional impairment
and disability among the elderly, but there has been no systematic
study in Taiwan. Such knowledge is essential for the development
of public health programs for community-dwelling elderly persons.
PARTICIPANTS: Five hundred and two participants aged 18 and
older (257 men and 245 women). METHODS: This study was
a cross-sectional investigation. The presence of sarcopenia was
examined in 302 community-dwellers aged above 65 years. Skeletal
muscle mass (SM) was estimated from bioelectric impedance
analysis measurements. Subjects were considered as sarcopena if
their skeletal muscle mass index (SMI=SM/height2) was less than
2 standard deviations below the mean for young healthy reference
values which were derived from 200 young adults aged 18-40
years. In addition to anthropometric measurements, the collected
variables included: depression scale by Chinese version of the
Geriatric Depression Screening Scale, cognitive function by Mini
Mental State Examination, functional status by Groningen Activity
Restriction Scale, quality of life by Short-Form-36 Health Survey
questionnaire, and physical activity by 7-d recall questionnaire in
the elderly with sarcopenia and normal muscle mass. This study
was approved by the Human Research Ethic Committee of the
National Taiwan University Hospital. ANALYSIS: Quantitative data
were analyzed using the Statistic Package for Social Science (SPSS
for Windows release 11.0). Student t-test was used to examine the
differences of measured variables between sarcopenic and normal
muscle mass group. The relationship between skeletal muscle mass
and measured variables was examined using Pearson’s correlation
coefficient test. RESULTS: The prevalence of sarcopenia was 18.5%
Poster Displays, Tuesday 5 June
in women and 23.4% in men, which were not different from the figures
observed in the western population. The functional limitation was
significantly higher only in men elderly with sarcopenia (p < 0.05).
Depression scale, cognitive function, and quality of life were not
statistically different between sarcopenic and normal muscle mass
groups in both genders (p > 0.05). SMI was correlated significantly
with body mass index and energy expenditure of daily physical activity
in men (r= 0.633 and 0.410, respectively, p < 0.01) and women (r= 602
and 0.556, respectively, p < 0.01). In women, grip strength was also
significantly correlated with skeletal muscle mass (r= 0.236, p < 0.05).
CONCLUSIONS: Sarcopenia exists among the elderly in Taiwan
with the similar risk in white persons. Low skeletal muscle mass
in the elderly was significantly associated with low physical activity.
IMPLICATIONS: These results suggest that intervention to target
increase in physical activity should be emphasis to prevent muscle
loss with aging. KEYWORDS: Aging; Sarcopenia; Skeletal muscle.
FUNDING ACKNOWLEDGEMENTS: This research was supported
by grants from the National Science Council (NSC 94-2314-B002-
089). CONTACT: mychien@ntu.edu.tw
ETHICS COMMITTEE: This study was approved by the Human
Research Ethic Committee of the National Taiwan University Hospital.
Research Report Poster Display
27-06 Tuesday 5 June 09:00
VCEC Exhibit Hall B & C
EXPLORING TWO PERFORMANCE-BASED TESTS IN THE
EVALUATION OF COMMUNITY DWELLING OLDER ADULTS
WITH OSTEOARTHRITIS
Harrison L1 , Sheppard M2 , Zachar K1 , Haab R1 , Fisher K1 ,
Chad K1 , Reeder B1 ; 1 University of Saskatchewan, Saskatoon,
Canada; 2 Saskatoon Health Region, Saskatoon, Canada
PURPOSE: To explore psycho-metric properties of the Functional
Fitness Test (FFT) and Physical Performance Test – 9 (PPT-9)
when evaluating community dwelling older adults with osteoarthritis.
RELEVANCE: Clinicians require tools for a variety of purposes
including: describing/categorizing patient populations, defining health
service needs, monitoring change in conditions; determining progno-
sis or predicting outcomes. Understanding measurement properties
assists clinicians and researchers to select the right tool for the
right patient at the right time and for the appropriate purpose.
PARTICIPANTS: Community dwelling subjects, 50 years or older,
with one of five chronic conditions were recruited through health
professional referral or self-referral to an exercise intervention
program. Fifty-two subjects with osteoarthritis (77% with 1 or 2
joints affected); primarily female (15% male, 85% female); mean
age 62.5 years (SD: 7.6); most living in their own home (81%)
participated. METHODS: Subjects were assessed at baseline and 3,
6, and 12 months after initiation of an exercise program. Evaluators
carried out standardized protocols with subjects completing the 6
tasks in the FFT (chair stand, arm curl, chair sit and reach, back
scratch, 8-Foot Up, 6 minute walk test) and 9 tasks of the PPT
(write a sentence, simulated eating, lift a book onto a shelf, put
on and remove a jacket, pick up a penny from the floor, standing
turn 360 degrees, 50 foot walk test, stair climb, climb one flight
stairs). Subjects completed self-report questionnaires including: the
Medical Outcomes Study Short Form 12 (SF-12) and Physical
Activity Scale for the Elderly (PASE). ANALYSIS: Parametric and
non-parametric descriptive analyses were performed. Correlation
coefficients identifying similar (convergent) and dissimilar (divergent)
domains within and across the different instruments and variables
(multi-trait multi-method analysis (MTMM) were examined. Effect
sizes were calculated to evaluate the discriminative properties of
these tools. RESULTS: Subjects presented with lower SF-12 physical
component scores (mean: 43.5; SD: 8.6) and slightly higher SF-
12 mental component scores (mean: 52.5; SD: 8.1) than norm-
based population data (mean:50). Physical activity levels ranged
considerably as demonstrated by a mean PASE score of 96.9
S399
(SD:48.6). Considerable floor or ceiling effects were observed in 4/9
PPT tests. The MTMM analysis identified those components of the
FFT and PPT-9 representing similar physical domains including: arm
curl (FFT) with the chair stand (FFT) (r = 0.48); simulated eating (PPT-
9) with writing a sentence (PPT-9) (r = 0.64); 8 foot up and go (FFT)
with the 50 foot walk (PPT-9) (r = 0.81) and the chair stand (FFT) with
time to climb stairs (PPT-9) (r = −0.43). Those components showing
higher effect sizes following an exercise intervention included FFT
components (chair stand; 8 foot up and go and 6 minute walk
test) and the PPT components (lift a book and time to climb
stairs). CONCLUSIONS: In this community dwelling population,
four of the PPT-9 components were more affected by floor/ceiling
effects than those of the FFT and a number of test components
measure similar domains while others show good responsive to
change. IMPLICATIONS: Understanding psycho-metric properties
of tests and identifying the physical domains represented by test
components is important information on which clinicians/researchers
select tools and interpret findings. KEYWORDS: Functional Fit-
ness Test; Physical Performance Test; Older adults. FUNDING
ACKNOWLEDGEMENTS: Canadian Institutes of Health Research,
University of Saskatchewan, College of Medicine.
ETHICS COMMITTEE: University of Sasskatchewan, Canada
Research Report Poster Display
28-10 Tuesday 5 June 09:00
VCEC Exhibit Hall B & C
STANDING BALANCE IN UNEXPECTED STIMULATION:A
COMPARISON BETWEEN SUBJECTS WITH AND WITHOUT
OCCLUSION
Hosoda M1 , Isozaki K1 , Takayanagi K2 , Hara K2 , Inoue K2 ,
Kubota A2 , Moriyama H2 , Matsuda T1 , Morita S3 ; 1 Department of
Physical Therapy, Ryotokuji University, Chiba, Japan; 2 Department
of Physical Therapy, Saitama Prefectural University, Saitama,
Japan; 3 Department of Rehabilitation Medicine, Tokyo Medical
and Dental University Graduate School, Tokyo, Japan,
PURPOSE: In the present aging society, falls have become serious
social issues. Falls may cause femoral neck fractures, often making
people bedridden through reduced motor performance and inability
to walk, and eventually may result in loss of independence in ADL. A
study evaluated degrees of influence of various risk factors of falls,
and demonstrated that compromised balancing ability was one of the
most highly influential factors. RELEVANCE: Therefore, to prevent
falls, it is important to examine factors affecting balancing ability.
Thus, we examined whether occlusion associated to improvement
of motor performance, also contributed to improvement of balance.
If occlusion provides improvement of balancing ability, appropriate
occlusion and fitting of teeth and dentures in the elderly would
be more significant factors related to falls. PARTICIPANTS: Thirty
healthy adolescents (15 males and 15 females; mean age, 20.3 SD
1.6 years) with no abnormal equilibrium and stomatognathic functions
were included. METHODS: Occlusion status was evaluated by mea-
suring masseter activities using the EMG system. Balancing ability
was evaluated using the EquiTest system® which measures sway
of the center of gravity of the subject produced by rapid translation
of forceplates as external disturbance. Latency from directly after
application of the external disturbance to initiation of recovery was
calculated by measuring displacement of the center of foot pressure.
Data were compared according to occlusion statuses. ANALYSIS:
Obtained latency data were analyzed using a three-way repeated
measures ANOVA. A significance level of p < 0.05 was considered
statistically significant. The statistical software SPSS version 13.0
(SPSS Inc., Chicago, Illinois, USA) was used. RESULTS: Little
difference was observed in latency following a small disturbance,
while changes toward completely opposite directions were observed
after larger disturbances between with and without occlusion. In
other words, the greater the disturbance, the shorter the latency
arose with occlusion, and the longer the latency occurred without
S400
occlusion. A statistically significant interaction (p < 0.001) between
occlusion and external disturbance was also found. CONCLUSIONS:
This study suggested that occlusion contributed to maintenance of
postural balance and to improvement of stability when unexpected
sway was applied in the standing position. IMPLICATIONS: It is
considered that occlusion contributes to better balancing abilities. In
the future, development of an effective exercise therapy to enhance
bite force, and validation of the effects using this method are required.
KEYWORDS: balance, masseter muscle, postural control, latency,
falls. FUNDING ACKNOWLEDGEMENTS: We would like to express
our sincere gratitude to all the subjects who participated in this study.
CONTACT: ma-hosoda@ryotokuji-u.ac.jp
ETHICS COMMITTEE: Tokyo Metropolitan University
Research Report Poster Display
28-14 Tuesday 5 June 09:00
VCEC Exhibit Hall B & C
THE EFFECTIVENESS OF A SIMPLE EVALUATION APPROACH
TO FALLS RISK ASSESSMENT IN ELDERLY PEOPLE
Ming H, Dongmei C, Sumikazu A, Hitoshi M; International University
of Health and Welfare
PURPOSE: In this study, It developed a trial tool which is portable,
easy to perform and useful for the evaluation of risk of fall, and
discuss the connection of probe reaction time (P-RT), and the gait
rhythm with risk of fall when subjects walking by a self-determined
velocity. RELEVANCE: Fall often occur during walking, especially
when getting up from a chair or floor. It is difficulty to assess all
factors of the risk of fall. In this study, we thought that the evaluation
of the gait cycle rhythm and the probe reaction time is effective
to the detection of the fall risk when subjects walking by a self-
determined velocity. PARTICIPANTS: The subjects were divided into
two groups including 34 older subjects are those who have not
experienced falls (Old no-fall group; 8 males, 26 females) and 18
are those who have experienced falls (Old fall group; 3 males, 15
females). The mean age, were 66.4±7.0years and 68.6±7.3years,
respectively. METHODS: The subjects were asked to walk at a self-
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
to an abdominal region of the subjects. The response signal is
recorded with a digital audio player/recorder hung on the subjects’
chest from the neck. Another play/recorder is attached from the
medial malleolus on a little, collected the landing sound of the foot to
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
to be was measured continuously for 10 times in total at a self-
determined rate. The evaluation of the gait cycle rhythm was adopted
the coefficient of variation (CV) of the time for one gait cycle. Data
was taken into the personal computer, and the DigionSound5 sound-
processing software was used for the analysis. ANALYSIS: Analysis
of variance was used to test for statistically significant differences
among Old no-fall group and Old fall group. RESULTS: A one-way
analysis of variance for probe reaction time showed a significant
effect between Old no-fall group, and Old fall group (F(1, 50)= 5.344,
p < 0.05). Also, coefficient of variation (CV) of the time for one gait
cycle was calculated. Ono-way analysis of variance between groups
and the time for one gait cycle showed a significant effect between
groups (F (1, 50)= 13.72, p < 0.01). CONCLUSIONS: The coefficient
variation of the time for one gait cycle increased, and the probe
reaction time is extended of the Old fall group. IMPLICATIONS: It
was thus found that the probe reaction time and the coefficient of
variation of the time for one gait cycle are reliable and useful for
evaluation of the risk of falls. KEYWORDS: Probe reaction time, falls,
gait. FUNDING ACKNOWLEDGEMENTS: The study is not funded.
CONTACT: huoming@iuhw.ac.jp
ETHICS COMMITTEE: SPTS(society of physical therapy science)
WCPT 2007, Research Reports
Research Report Poster Display
28-18 Tuesday 5 June 09:00
VCEC Exhibit Hall B & C
THE EFFECT OF COGNITIVE TASK ON THE TIMED UP & GO
IN ORTHOPEDIC OUTPATIENTS WITH AND WITHOUT A FALL
HISTORY
Asai T1−3 , Maekawa T2,3 ; 1 Faculty of Rehabilitation, Kobegakuin
university; 2 Graduate School of Health Science, Kobe University
School of Medicine; 3 Kita orthopedic Clinic
PURPOSE: Previous studies have shown that dual task paradigm
is useful to assess a risk of falls. In this study, we examined the
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
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
function was assessed by Mini Mental State Examination and all
subjects scored 25 points or more. Subjects who required a cane
or other walking aids were excluded. METHODS: Time taken to
perform TUG (single task condition) and TUG with verbal backward
counting (dual task condition) was measured using a stop watch.
ANALYSIS: The TUG times under single and dual task condition
were compared using paired t-test. Furthermore, group comparison
was performed for the TUG time difference(Dual TUG – Single TUG)
by ANOVA. The significant level was set at p < 0.05. RESULTS:
There was a significant difference in the time taken to perform TUG
between single task condition and dual task condition(11.3 sec vs.
14.9 sec, t=7.608, p < 0.05). Fallers showed significantly longer TUG
time difference than non-fallers (4.87 sec vs. 2.67 sec, F=6.213,
p < 0.05). CONCLUSIONS: For both groups, a concurrent cognitive
task increased the time taken to complete the TUG, with the greatest
effect in the othopedic patients with a fall history. IMPLICATIONS:
Prospective studies are needed to determine whether dual task TUG
predicts falls in orthopedic outpatients clinics. KEYWORDS: Timed
up & go, Dual task, Fall. FUNDING ACKNOWLEDGEMENTS: None.
CONTACT: asai@reha.kobegakuin.ac.jp
Research Report Poster Display
29-22 Tuesday 5 June 09:00
VCEC Exhibit Hall B & C
THE PSYCHOMETRIC PROPERTIES OF EVALUATION OF
SENSORY PROCESSING FOR CHILDREN IN TAIWAN
Su C1 , Lin K2 , Wu M3 , Yang A4 ; 1 Department of Occupational
Therapy, College of Medicine, National Cheng Kung University,
Tainan, Taiwan; 2 Departments of Physical Medicine and
Rehabilitation, Veterans General Hospital – Kaohsiung, Kaohsiung,
Taiwan; 3 Department of Psychology, National Chung Cheng
University, Chia-Yi, Taiwan; 4 Department of Physical Therapy,
College of Medicine, National Cheng Kung University, Tainan, Taiwan
PURPOSE: This study aimed to examine the reliability and validity of
a sensory history questionnaire, the Chinese Version of Evaluation
of Sensory Processing (ESP), Version 4, for use in Taiwan.
RELEVANCE: Children’s postural control, which has been empha-
sized in the pediatric physical therapy, is influenced by their abilities
of processing sensory inputs. Thus, an appropriate assessment of
children’s sensory processing would be important. PARTICIPANTS:
Forty-eight children with sensory processing disorder (SPD) and
ninety typically developing children (control group) were recruited
in the area of Tainan, Taiwan. The children of SPD group were
recognized and referred based on parent interview and clinical
evaluation by experienced occupational therapists from the pediatric
clinics. The children of control group were recognized through parent
interview by an experienced occupational therapist in the field of
pediatric therapy. There was no significant difference in ages between
Poster Displays, Tuesday 5 June
the two groups (average of age for each group: 6 years 8 months).
The Ethics Committee of Medicine at National Cheng Kung University
approved all procedures, and informed consent was obtained from
all patients for their participation in this study. METHODS: Sample
of convenience was adopted in data collection. All of their parents
(father or mother of the child) were required to fill up the ESP,
a questionnaire designed to identify sensory processing problems
in children from preschool to elementary school age. It consists
of 76 items divided into six sensory system categories: tactile (21
items), proprioceptive (12 items), vestibular (15 items), auditory (10
items), gustatory/olfactory (5 items), and visual systems (13 items).
ANALYSIS: Internal consistency of the items within each of the
6 sensory systems in the ESP was examined by Cronbach’s a.
The discriminative validity was investigated by the Mann-Whitney
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–
0.89). The result of Mann-Whitney U test showed that 55 of the 76
items (75.3%) significantly distinguished between parent ratings of
children with and without SPD. The average total score of two groups
were significantly different (t= 7.111, p = 0.000, two-tailed). By using
receiver operating characteristic procedure, we found that the ESP
score of 286 demonstrating 73% sensitivity and 82% specificity in
predicting children with SPD. CONCLUSIONS: This study supported
the reliability and validity of ESP for use in Taiwan. Furthermore, the
results might be useful in further revisions and refinement of the ESP.
IMPLICATIONS: For physical therapists, the ESP could be used in
screening children’s capacity of sensory processing, as well as the
evaluation of children’s progress of behavioral reactions to sensory
inputs. KEYWORDS: sensory processing, validity and reliability
analysis, parent questionnaire. FUNDING ACKNOWLEDGEMENTS:
This study was partly supported by the National Science Council
(Grant #94-2314-B-006-032) in Taiwan.
ETHICS COMMITTEE: The Ethics Committee of Medicine at
National Cheng Kung University
Research Report Poster Display
30-02 Tuesday 5 June 09:00
VCEC Exhibit Hall B & C
COMPUTERIZED DYNAMIC POSTUROGRAPHY IN SEVEN
YEARS – OLD BRAZILIAN CHILDREN AND YOUNG ADULTS
Sá C1,2 , Perrote R1 , Boffino C2 , Ramos R2 ; 1 IMES University;
2 São Paulo University
PURPOSE: This study was designed to verify how similar are
postural and balance control between Brazilian seven years-old
children and young adults. RELEVANCE: The postural and balance
control system is of great value to motor skill acquisition. Seven
years-old children have finished the development of motor control
structures in nervous system and have already their body segments
and biomechanical parameters similar to adults, regarding relations
in size. Some authors argument that these can be sufficient
reason to explain similarities in postural and balance control
between these two groups. But, we can’t forget that the individual’s
motor activity helps the development and organizes this control.
PARTICIPANTS: 19 children (7 years old) and 38 young adults (age
mean=23.42 years) agreed to participated of the study METHODS:
They were submitted to the Modified Sensory-Organization Test
(MSOT), which is a dynamic computer-based posturography test
(NeuroCom™). Their performance was compared in four different
conditions: (1) eyes open–fixed surface, (2) eyes closed–fixed
surface, (4) eyes open–sway referenced surface, (5) eyes closed–
sway referenced surface. ANALYSIS: Student t-test was used
to compare groups (children X young adults). Significance was
given by p < 0.005. RESULTS: All four performances conditions
showed adults equilibrium score higher than children (p < 0.001).
In condition 1, adults showed (mean ± SD) 94.03±2.18 and
S401
children 88.84±3.80; in condition 2, adults mean values were
92.65±3.35 and children were 85.73±5.45. In condition 4, adults
showed mean values of 85.01±8.68 and children, 64.02±17.48.
And in condition 5 adults present mean equilibrium value score
of 66.56±12.90 and children, 38.16±15.54 CONCLUSIONS: On
our sample, seven years – old Brazilian children showed lower
equilibrium scores than adults in all conditions. This justify that
a special attention must underlined all rehabilitation process and
the training of motor skills for each specific age. IMPLICATIONS:
For physical therapy practice / management KEYWORDS: balance,
children, posturography. FUNDING ACKNOWLEDGEMENTS: None.
CONTACT: cristina.sa@uol.com.br
ETHICS COMMITTEE: Ethics Committe Psychiatry Institute HCF-
MUSP
Research Report Poster Display
30-06 Tuesday 5 June 09:00
VCEC Exhibit Hall B & C
THE EFFECT OF INTENSIVE PHYSIOTHERAPY PROGRAM
FOLLOWING SELECTIVE DORSAL RHIZOTOMY FOR CHILDREN
WITH CEREBRAL PALSY
Chan N1 , Yam K2 , Chan S3 , Poon C3 , Yiu B3 , Leung M4 ;
1 Physiotheraphy Department, Tuen Mun Hospital, Hospital Authority,
Hong Kong; 2 Department of Neurosurgery, Tuen Mun Hospital,
Hospital Authority, Hong Kong; 3 Child Assessment Service,
Department of Health, Hong Kong; 4 Physiotheraphy Department,
AHNH, Hospital Authority, Hong Kong
PURPOSE: Children with Cerebral Palsy (CP) encounter different
degrees of motor disorder which affect by spasticity. Tone manage-
ment with Selective Dorsal Rhizotomy (SDR) follows by intensive
physiotherapy training is an option for improving the physical function
of them. Evidence showed that the procedure of SDR weakens
the muscle and it needs almost one year to return to preoperative
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
months post-operation. RELEVANCE: The success of SDR is very
much depends on the intensity of training after the procedure. An
intensive training program with emphasis on the body alignment
was introduced and this study will provide some references for post-
SDR training. PARTICIPANTS: Children with CP who matched with
the selection criteria were recruited in the SDR clinic. Screening
was performed by the interdisciplinary team including neurosurgeon,
paediatrician and physiotherapist. 27 childrens with CP were enrolled
in the SDR program. METHODS: A single group prospective study
was adopted. Pre-operative baseline assessment was performed
by different therapists who were not involved in the ongoing
treatment. Outcome measures included measurement of muscle
tone by Modify Ashworth Scale (MAS), passive range of motion
of lower limbs, Gross Motor Function Measure (GMFM) and 3-
dimentional gait analysis. SDR procedure was performed under intra-
operative trigger EMG guidance by neurosurgeon. Rehabilitation
started immediately post-operation from day one onward including
in-hospital training for 2 weeks follow by an intensive program
on out-patient basis for 8 weeks, patient would then go back to
community and continue training in school setting until 6 month
post-operation. Reassessment on the outcomes was performed
at 3 and 6 months post-surgery. ANALYSIS: Repeated Measure
ANOVA with SPSS 11.0 was used to analysis the change on pre-
operation, 3 month and 6 month post-operation. RESULTS: The
overall mean age of the 27 clients was 8.4 in which 23 of them
were spastic diplegia. The change of muscle tone by MAS decreased
significantly throughout the time of assessment (p < 0.001, power
= 1). The passive range of motion of hip abduction (p < 0.001,
power=1) and ankle dorsiflexion (p = 0.015, power = 0.752) also
showed significant improvement. Functional improvement by GMFM
(p = 0.006, power = 0.824) was noted. Significant changes were also
S402
found at 3 months for hip abduction (p < 0.001) and ankle dorsiflexion
(p = 0.024) on contrast analysis. For the 3-D gait analysis measured
at pre-operation and 6 month post-surgery, significant improvement
was found in kinematics change with knee extension in initial contact
of stance phase (p = 0.004) and ankle dorsiflexion in mid-stance
(p = 0.009). Kinetic change with ankle power quotient (p = 0.004)
and ankle moment quotient (p = 0.001)were also detected with
good improvement. CONCLUSIONS: The intensive physiotherapy
program post SDR surgery is effective in improving the function
and gait of children with CP. Functions could be regained or even
improved in 3 month post operation. IMPLICATIONS: The intensity
of the rehabilitation program can act as a reference for post-SDR
training. Further study by comparing different rehabilitation program
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: channc1@ha.org.hk
Research Report Poster Display
31-10 Tuesday 5 June 09:00
VCEC Exhibit Hall B & C
THE INFLUENCE OF WAKEFUL PRONE POSITIONING ON
MOTOR DEVELOPMENT DURING THE EARLY LIFE
Kuo Y1 , Liao H1 , Hwang A1 , Chen P2 , Hsieh W3 ; 1 School and
Graduate Institute of Physical Therapy, College of Medicine,
National Taiwan University, Taipei, Taiwan; 2 Institute of Occupational
Medicine and Industrial Hygiene, College of Public Health, National
Taiwan University, Taipei, Taiwan; 3 Department of Pediatrics,
National Taiwan University Hospital, Taipei, Taiwan
PURPOSE: Recently studies found that wakeful prone positioning
was significantly correlated to infant motor development. However,
little was known about the causal effects of prone positioning on
motor development. The purpose of this prospective longitudinal
study was to investigate the influences of early prone wakeful
positioning on the acquisition of later motor milestones and the
motor developmental scores for infants at 4 to 6 months of
age after controlling personal or environmental factors that would
affect motor development. RELEVANCE: As health care providers,
pediatric physical therapists are in an ideal position to address
health promotion issues with their clients even during the early
life. The results of this study can be applied and recommended
in the field of the health promotion for children. PARTICIPANTS:
There were 330 newborns (113 boys) enrolled from the National
Taiwan University Hospital, and followed up at 4 and 6 months of
age. METHODS: Two questionnaires were collected at the above
2 ages to gather the information of personal factors (gestational
age, birth weight, Apgar scores, neonatal complications, gender),
environmental factors (the socioeconomic status of parents, sleeping
positioning, the scores of Home Observation for Measurement of
the Environment Inventory(HOME)), wakeful positions and achieved-
ages of developmental milestones. Among them, 166 infants also
received the developmental test – the Comprehensive Developmental
Inventory for Infants and Toddlers (CDIIT) at 6 months of age to
obtain the results of motor developmental quotients (DQs), including
gross motor and fine motor. ANALYSIS: Cox regression survival
analysis and stepwise linear regression were used to evaluate the
influence of prone wakeful positioning on motor outcomes while
controlling potential confounding variables. The a level was set
at 0.05. RESULTS: After controlling the scores of HOME and
gestational age, infants with early prone experience could achieve
forearm support (odds ratio 1.78 [95% CI 1.09-2.88]) and crawl
(odds ratio 2.56 [95% CI 1.10-5.96]) milestones earlier. Infants
who were placed in prone position with higher duration achieved
forearm support (odds ratio 1.34 [95% CI 1.01-1.79]), roll (odds ratio
1.62 [95% CI 1.18-2.24]) and crawl (odds ratio 1.82 [95% CI 1.15-
2.88]) milestones at earlier ages. Neither the prone experience nor
duration of prone positioning affected the fine motor milestones
WCPT 2007, Research Reports
achievement. Infants who preferred playing in the prone position
got higher gross motor DQs and total motor DQs. CONCLUSIONS:
Early prone wakeful positioning experiences and duration would
affect the achieved-ages of position specific motor milestones, such
as forearm support, roll and crawl. In addition, wakeful prone
preference would account for gross motor DQs and motor DQs.
IMPLICATIONS: The “prone to play” could be advocated in clinics to
enhance the early gross motor development for infants. KEYWORDS:
infant, prone position, motor skills, growth & development. FUNDING
ACKNOWLEDGEMENTS: Bureau of Health Promotion, Department
of Health, R.O.C. CONTACT: hfliao@ntu.edu.tw
ETHICS COMMITTEE: Bureau of Health Promotion, Department of
Health, R.O.C
Research Report Poster Display
31-14 Tuesday 5 June 09:00
VCEC Exhibit Hall B & C
DECREASED SENSITIVITY OF COMPLEX VISUAL PERCEPTION
IN CHILDREN AFTER A MILD TRAUMATIC BRAIN INJURY
Forget R1,2 , Brosseau-Lachaine O3,2 , Gagnon I4 , Faubert J3,2 ;
1 École de réadaptation, Faculté de Médecine, Université de
Montréal (Québec), Canada; 2 Centre de recherche interdisciplinaire
en réadaptation du Montréal Métropolitain (CRIR); 3 École
d’optométrie, Université de Montréal, Montréal (Québec), Canada;
4 Montreal Children Hospital, McGill University Health Center
PURPOSE: Visual disturbances are often reported after Traumatic
Brain Injury (TBI). Moreover, our studies have shown visuo-motor
deficits at 1, 4 and 12 weeks post-trauma in children with mild TBI
(Gagnon et al, 1998; Gagnon et al, 2004). However, no studies
have documented the presence of complex visuo-spatial information
processing deficits in children after a mild TBI. The purpose of
the present study was: 1) to compare the sensitivity to complex
visual information processing of children who have sustained a mild
TBI to that of non-injured children matched for age and gender
and 2) to asses the evolution of visuo-perceptual performance of
children with mild TBI during the first 3 months following the injury.
RELEVANCE: It is important to assess children’s visual perception
after mild TBI to ensure a safer return to their activities and sports.
PARTICIPANTS: Sixteen children with mild traumatic brain injury and
16 matched healthy controls (8 to 16 years of age). All injured children
had been diagnosed with mTBI by professionals of a Pediatric
Trauma Program at the Montreal Children’s Hospital. All participants
had normal or corrected-to-normal visual acuity and normal ocular
health. METHODS: Sensitivity to static and dynamic forms of simple
(first-order, luminance defined) and complex (second-order, texture
defined) stimuli were assessed at 1, 4 and 12 weeks post-injury
and at equivalent time in healthy children. Orientation (vertical vs
horizontal) of static stimuli and motion-direction identification (left vs
right) of dynamic stimuli were measured for all participants. A two-
alternative forced choice procedure and method of constant stimuli
was used to find thresholds for all conditions. In addition, sensitivity to
optic flow, a complex motion stimulus with simulation of an observer
moving in translation through a circular tunnel, was assessed with
coherence thresholds. ANALYSIS: Two way ANOVA comparing
group and with repeated measures on the factor time (i.e. weeks
after injury) were used to analyze each condition RESULTS: No
difference in threshold between groups across all testing conditions
was found for simple, luminance-defined information. The sensitivity
to all complex stimuli (static and dynamic second-order and optic
flow motion) was significantly reduced for the mild TBI children.
Sensitivity to complex moving stimulus was still affected 12 weeks
after the injury. CONCLUSIONS: Results from this study indicate
that children with mild TBI present selective processing deficits for
complex information starting at 1 week post-injury. IMPLICATIONS:
Such measures can be potentially used to compliment existing
diagnostic measures to assess the cognitive status of children who
have sustained TBI. It remains to be determined if this deficit of
Poster Displays, Tuesday 5 June
visual perception of moving stimulus impacts on the motor function.
KEYWORDS: visual perception, static and dynamic stimuli, traumatic
brain injury. FUNDING ACKNOWLEDGEMENTS: Supported by a
grant from the Canadian Institute of Heath Research # MOP-74504.
CONTACT: robert.forget@umontreal.ca
ETHICS COMMITTEE: University of Montreal and Montreal Children
Hospital
Research Report Poster Display
31-18 Tuesday 5 June 09:00
VCEC Exhibit Hall B & C
PREVALENCE OF PAIN IN EMBU POPULATION, SAO PAULO,
BRAZIL
Assumpção A, Cavalcante A, Sauer J, Chalot S, Capela C,
Marques A; Physiotherapy, Speech and Ocupational Therapy
Department of Medicine School of University of Sao Paulo
PURPOSE: Pain is a frequent symptom controlled and produced
by sensory, motivational and cognitive systems that have being
described as an unpleasant sensation. Pain can be classified by
duration in chronic and acute pain and by location in regional and
widespread pain. The aim of this study was to assess pain in the
Embu population of São Paulo, Brazil. RELEVANCE: Pain is the
most important symptom to physical therapy and often used like
guidelines for effectiveness of treatment. Epidemiology pain studies
provide information on pain that can be used by physiotherapists
to propose prevention and treatment actions. PARTICIPANTS: The
sample was selected from individuals in primary health care, aged
between 35 and 60 years in 2003, summing 3109 subjects. In
this sample, 2269 people had a telephone number. METHODS:
Of all 2269 subjects with phone number, we interviewed 768 with
questions about presence of pain, location of pain and time of
pain. The subjects were classified in three groups related to pain
location: No Pain (NP), Regional Pain (RP) and Widespread Pain
(WP), in accordance with the American College of Rheumatology.
ANALYSIS: The data were analysed descriptive statistics. The
prevalence of chronic widespread pain was calculated by Bayesian
Analyses. RESULTS: The mean age of sample was 48 years (7.2)
and women are predominant (77%). The SD group was composed
by 185 subjects, the RP group by 388 subjects and WP groups
by 195 subjects. In all groups women were more prevalent than
men, but the major frequency of female gender was observed in
the WP group. In people with pain, the chronic pain was more
commom, 69.5%. The body parts more painful were thighs (37%),
legs (35%) and lumbar spine (34%). The prevalence of chronic
widespread pain was 24% [95% CI: 21-27%]. CONCLUSIONS: Pain
is frequent in Embu population and probably associated with socio-
demographic factors. The prevalence of chronic widespread pain
was higher than in other published studies. The body parts more
frequently painful had already been described by other authors.
IMPLICATIONS: This study showed that pain is common in the
Embu population and the public health system in general, and
physiotherapists in particular, might propose forms to diminish it.
In this way, it is important to recognize the characteristics of pain
population and the more frequent location of pain. KEYWORDS:
Chronic pain, Widespread pain, Pain, Epidemiology. FUNDING
ACKNOWLEDGEMENTS: Fundação para Amparo a Pesquisa e
Desenvolvimento do Estado de São Paulo – FAPESP (Sao Paulo
State Fundation for Research and Development Support); Conselho
Nacional de Desenvolvimento Cientı́fico e Tecnológico – CNPq
(National Committee of Scientific and Tecnology Development).
CONTACT: anassumpcao@gmail.com
ETHICS COMMITTEE: Ethics Committee for Analyses of Research
Studies of Clinical Hospital of Medicine School of University of Sao
Paulo (process: 161/2004)
S403
Research Report Poster Display
33-02 Tuesday 5 June 09:00
VCEC Exhibit Hall B & C
COUNTERTRANSFERENCE TRIGGERS AND RESPONSES OF
PHYSICAL THERAPISTS AFFECTING THE PATIENT/THERAPIST
RELATIONSHIP
Allen R1 , Koshi L2 , Ashley O3 , Dreier D4 , Carter C5 ; 1 University
of Puget Sound, Tacoma, WA, USA; 2 Apple Physical Therapy,
Tumwater, WA USA; 3 Bay State Physical Therapy, Newton,
MA USA; 4 Kadlec Medical Center, Richland, WA USA; 5 Harrison
Medical Center, Bremerton, WA USA
PURPOSE: The purpose of the present study was to identify internal
and external triggers that initiate countertransference responses in
physical therapists and resulting behavioral manifestations that may
impact quality of patient care. RELEVANCE: Countertransference
(CT) refers to a therapist’s emotional reactions to a patient and/or
the patient’s circumstances. These unconscious emotional reactions
may influence the therapist’s behavior, impacting success of the
patient/therapist relationship, as well as the quality and equity of
patient care. Abundantly addressed in the field of psychology, the
study of CT among other medical practitioners has been limited to
nurses and physicians. Studies exploring CT responses and behav-
iors in physical therapy settings are not apparent in the literature.
PARTICIPANTS: Participants included thirty-eight volunteer licensed
physical therapists (experience range = 0.5–30 years, mean = 10.3
years) attending a continuing education course on CT responses to
patients with systemic pathology. METHODS: During the CT course,
subjects participated in four brainstorming sessions. Two of the
four sessions were used for data collection regarding triggers and
behaviors. During the first session, participants were asked to anony-
mously record patient characteristics associated with both successful
and uncomfortable patient/therapist interactions. The second session
involved small group discussion and the creation of an anonymous list
of behaviors influenced by, or the result of, their emotional responses
to the patient. ANALYSIS: Participants’ responses were entered
into QSR N6 Non-numerical Unstructured Data Indexing, Searching
and Theorizing (Nud*ist) software for data management and coded
a priori using pilot study generated codes. Responses were then
subjected to a code/recode process by four raters. New codes were
generated according to the distinct content of participants’ responses.
Final themes were displayed as a hierarchical organizational tree.
RESULTS: Triggers that led to successful or uncomfortable patient-
therapist interactions fell within seven distinct categories. The four
most frequently recurring themes included the therapist’s perception
of the patient, patient motivation, compliance, and associations
the therapist made between the patient and a member of his/her
own family. Behaviors fell within five different categories. The most
frequently reported themes were personal openness, limiting inter-
action to professional issues, and effort invested in the patient. The
following themes appeared as both triggers and behaviors: avoidance
behaviors, treatment time, and body language. CONCLUSIONS:
Findings indicate that physical therapists report manifesting CT
responses to their patients. These responses may be triggered
by patient characteristics, or by internal associations the therapist
projects onto the patient. Behavioral responses associated with
successful interactions tended to result in therapists providing more
personal approaches to treatment including increased treatment
time, effort, and quality of care. Uncomfortable patient/therapist
interactions led to specific behaviors such as decreased treatment
time, effort, and personal involvement. IMPLICATIONS: Physical
therapists’ CT responses impact the quality and equity of patient
care. By becoming aware of their own CT reactions and behaviors,
physical therapists will be better equipped to provide equitable patient
care. From an understanding of CT dynamics, therapists may learn
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
S404
Enrichment Committee of the University of Puget Sound, Tacoma,
WA, USA. CONTACT: rallen@ups.edu
ETHICS COMMITTEE: Institutional Review Board, University of
Puget Sound, Tacoma, WA
Research Report Poster Display
35-22 Tuesday 5 June 09:00
VCEC Exhibit Hall B & C
WHAT DO AUTHORS OF COCHRANE REVIEWS MEAN BY THE
TERM ‘OLDER’ PEOPLE?
Howe T1 , Elms J1 , Adler B2 , Creed G2 , Stott D2 ; 1 HealthQWest,
Glasgow Caledonian University, Glasgow, UK; 2 2Academic Section
of Geriatric Medicine, Glasgow Royal Infirmary, Glasgow, UK
PURPOSE: To identify Cochrane reviews and protocols that focus
specifically on ‘older people’ and to describe the variations in
criteria used to identify this population. RELEVANCE: The Cochrane
database of systematic reviews potentially contains valuable evi-
dence to support healthcare of older people. However its utility
depends on a consistent definition of what constitutes an ‘older’ per-
son. PARTICIPANTS: N/A METHODS: We searched the Cochrane
Database of Systematic Reviews (CDSR) 2006, Issue 1, using: Aged
explode [MeSH] and key words: old$, elderly, adult$, people, veteran.
Reviews and protocols were eligible if they included a minimum age
limit greater than 40 or stated that their focus was ‘older’ people.
The descriptions of types of participants were extracted from the
text. ANALYSIS: Descritive analysis was undertaken and reported.
RESULTS: The search identified 311 reviews and 67 protocols, of
which 42 reviews and 9 protocols (published between 1998 and
2006) met the criteria, representing 1.6% of reviews and 0.6% of
protocols in the CDSR 2006, Issue 1. Twenty-six reviews and all
nine protocols stated a minimum chronological age, mode 60 years
(n=17), range 40 (n=1) to 65 (n=12). The descriptors that authors
used included: ‘elderly’ (n=12), ‘geriatric’ (n=8) and ‘older adults’
(n=8) in addition 18 reviews focused on reduced cognitive function
in their descriptors. CONCLUSIONS: There are very few Cochrane
reviews or protocols indexed for terms equivalent to ‘older people’.
There is variation in the descriptive terms used to indicate ‘older’, and
in the age restrictions applied. IMPLICATIONS: To optimize the utility
of future reviews the development of a consensus of taxonomy for this
population is recommended. KEYWORDS: older people, Cochrane
reviews. FUNDING ACKNOWLEDGEMENTS: None. CONTACT:
healthqwest@gcal.ac.uk
Research Report Poster Display
36-02 Tuesday 5 June 09:00
VCEC Exhibit Hall B & C
VALIDATION OF THE BRIEF ASSESSMENT OF MOTOR
FUNCTION (BAMF): RELIABILITY AND VALIDITY OF FOUR
MOTOR SCALES
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
WCPT 2007, Research Reports
development of four additional ten-point hierarchical scales: Upper
Extremity Fine Motor (UEFM) and Gross Motor (UEGM) Scales, and
Oral Motor Articulation (OMA) and Deglutition(OMD) Scales. This
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
included 17 Physical Therapists and 13 Occupational Therapists
(UEGM), 28 Occupational Therapists (UEFM), and 28 Speech and
Language Pathologists (OMA and OMD). All have doctoral degrees;
70% have 20 or more years of experience. Reliability: 38 individuals
(ages 6 mo to 20 years; 21 females, 17 males) with a range of cultural
backgrounds and diagnoses, including proteus syndrome, Smith-
Lemli-Opitz syndrome, osteogenesis imperfecta, achondroplasia, and
mucolipidosis were videotaped for the reliability trials. METHODS:
Content Validity: Expert Panel members were asked to rate the BAMF
by responding to six standard questions for each 0-10 skill level on
a specific BAMF scale. Responses ranged from 1 = Disagree to 4
= Agree. Respondents were encouraged, not required, to provide
additional written comments. Reliability: 3 physical therapists, 3
occupational therapists, 3 speech and language pathologists, and
1 student in each discipline rated videotaped motor performances
of ten children with scores 0-10 for each BAMF scale. ANALYSIS:
Content Validity: Central tendency and variability for individual BAMF
items were evaluated with means, ranges and standard deviations.
Reliability: The Kappa Statistic was used to determine inter- and intra-
rater reliability for each BAMF scale. RESULTS: Content Validity:
Respondents reported that BAMF items were easily discriminated
(means 3.31-4.0), should be included (means 3.86-3.89), and were
functionally relevant (means 2.93-3.82), with the exception of two
tasks on the UEGM (means 1.88 and 2.40). Standard deviations
ranged from 0.26-0.97. Several modifications were made to the
BAMF Scales in response to the quantitative data as well as 443
written comments on the questionnaires (UEGM 117, UEFM 86,
OMD 114, OMA 116). Inter-rater reliability values were 0.60(OMA),
0.83(OMD), 0.92(UEGM) and 0.98(UEFM). Intra-rater reliability
values were 0.66(OMA), 0.84(OMD), 0.98(UEGM), and 0.99(UEFM).
CONCLUSIONS: 17 Physical Therapists, 28 Occupational Ther-
apists and 28 Speech and Language Pathologists helped refine
the content of four BAMF motor scales through their quantitative
and qualitative feedback. Kappa reliability values indicate the BAMF
upper extremity scales are highly reliable for screening and baseline
assessment of upper extremity motor skill. The oral motor scales
demonstrate moderate reliability for rapid assessment of oral motor
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-
dent of age and for use in any cultural setting. KEYWORDS: Gross
motor function, fine motor function, oral motor function. FUNDING
ACKNOWLEDGEMENTS: Funded by the Intramural Program,
National Institute of Child Health and Human Development (USA).
ETHICS COMMITTEE: Intramural Program, National Institute of
Child Health and Human Development, USA
Poster Displays, Tuesday 5 June
Research Report Poster Display
36-06 Tuesday 5 June 09:00
VCEC Exhibit Hall B & C
DEVELOPMENT AND RELIABILITY OF A SYSTEM TO CLASSIFY
HAND FUNCTION IN CHILDREN WITH CEREBRAL PALSY:
MANUAL ABILITY CLASSIFICATION SYSTEM (MACS)
Eliasson A1 , Krumlinde Sundholm L1 , Rösblad B2 , Beckung E3 ,
Arner M4 , Rosenbaum P5 ; 1 Department of Woman and Child
Health, Karolinska Institute, Stockholm, Sweden; 2 Department of
Community Medicine and Rehabilitation, Physiotherapy, University
of Umeå, Sweden; 3 Queen Silvia Children’s Hospital, Sahlgrenska
University Hospital, Göteborg, Sweden; 4 Hand Unit, Department of
Orthopedics, Lund University Hospital, Sweden; 5 CanChild Centre
for Childhood Disability Research, McMaster University, Hamilton
ON Canada
PURPOSE: To develop a system to classify how children with cere-
bral palsy use their hands when handling objects in daily activities.
The classification is designed to reflect the child’s typical manual
performance, not the child’s maximal capacity. MACS is not intended
to explain the underlying reasons for limitations of performance or
to classify types of cerebral palsy. MACS is analogous to the Gross
Motor Function Classification System (GMFCS) and can be used for
children and adolescents 4-18 years. RELEVANCE: No classification
of hand function in children with cerebral palsy with a clear functional
perspective has been available. MACS fills this gap and helps
to broaden the perspective of CP beyond gross motor issues.
PARTICIPANTS: 25 parents and 25 therapists were interviewed
about the classification. 168 children/adolescents with cerebral palsy
were classified independently by two therapists. Twenty-five children
were tested independently by their parents and one therapist.
METHODS: The validation was based on the experience within
an expert group representing different professionals, review of the
literature and also on thoroughly analysis of children with cerebral
palsy, across a spectrum of different functional levels. Discussions
continued until consensus occurred, first about the constructs, then
at each level until these were clear and easily understood. The
next step in the validation involved parents and therapists who were
interviewed about the content and the description of levels. Thereafter
reliability was tested between parents and therapists and between
pairs of therapists. ANALYSIS: Textual analysis of the materials from
the interviews of parents and therapists was performed separately
and based on three sets of questions, and for each level of
MACS. The remarks were analysed to understand if the distinction
between levels were apparent or not. For analysis of interrater
reliability Intra-Class Correlation Coefficient (ICC) was calculated.
RESULTS: The MACS is a valid measure reflecting “the children’s
manual ability when handling objects in daily activities”. The reliability
between parents and therapist was 0.96 calculated by Intra-Class
Correlation Coefficient (ICC) (95% confidence interval 0.89-0.98)
indicating excellent agreement. The reliability between therapists was
0.97 (0.96-0.98). CONCLUSIONS: The Manual Ability Classification
System is based upon self-initiated manual ability, with a particular
emphasis on handling objects in daily activities. It is a valid and
reliably classification for children and adolescents with cerebral palsy,
between 4-18 years. Clinicians and parents seem to agree about
meaningful differences between levels resulting in excellent inter-
rater reliability. IMPLICATIONS: Physical therapy interventions for
children with cerebral palsy have by tradition been focused on
gross motor function. Instruments as MACS highlight the importance
of including analysis of hand function in the planning of physical
therapy interventions. KEYWORDS: Child, cerebral palsy, hand
function, reliability. FUNDING ACKNOWLEDGEMENTS: This project
was conducted in collaboration with collages in various places in
Sweden and Melbourne, Australia with funding from Folke Bernadotte
stiftelsen, Jerringfonden and the Swedish Research Council.
ETHICS COMMITTEE: the Etics Research Committee at the
Karolinska Hospital, sweden and the state covernment, Victoria,
Australia.
S405
Research Report Poster Display
37-10 Tuesday 5 June 09:00
VCEC Exhibit Hall B & C
IMPROVING THE SMILE FOLLOWING FACIAL NERVE PARESIS
DURING PHYSIOTHERAPY REHABILITATION WITH THE USE OF
VIDEO SELF-MODELING AND IMPLEMENTATION INTENTIONS
Coulson S1 , Adams R1 , O’Dwyer N2 , Croxson G3 ; 1 School
of Physiotherapy, Faculty of Health Sciences, The University of
Sydney, Australia; 2 School of Exercise & Sport Science, Faculty of
Health Sciences, The University of Sydney, Australia; 3 Department
of otolaryngology, Royal Prince Alfred Hospital, Sydney, Australia
PURPOSE: The inability to smile effectively has been a primary
motivator for getting physical therapy and surgical management of
the face after facial nerve paresis. However, spontaneous, automatic
implementation of an effective smile at the appropriate moment
in social situations often remains a problem in the long term. To
address this problem, as well as to examine ways to increase
transference of smile improvements following physical therapy and
surgical treatments, this study used a protocol of Video Self-
Modeling followed by structured Implementation Intentions in an
attempt to rehabilitate a well-controlled, effective smile after long-
term facial nerve paresis. RELEVANCE: Although there may be
measurable, visible improvements evident during a physical therapy
session or achieved following reanimation surgery, such gains
seldom translate into a well-controlled smile which can be used
in the brief windows of opportunity that arise in social situations.
This may be due to differences between a posed smile and
a spontaneous smile in terms of availability for implementation.
Techniques which improve the accessibility and performance of
a motor skill thus have relevance to physical therapy practice.
PARTICIPANTS: Ten subjects with a lower motor neurone facial
nerve paresis which was greater than 1 year post-onset participated
in this study. METHODS: Video Self-Modeling (video replay of only
best Adapted smiles) and Implementation Intentions (planning and
visualising implementation of Adapted smiles in pre-determined,
specific situations) were used in physiotherapy rehabilitation of an
Adapted (more symmetrical) smile in subjects with facial nerve
paresis. The study design was a prospective, blinded clinical trial.
Ability to produce the Adapted smile on cue was measured using
a reaction time test. ANALYSIS: Analyses of variance (ANOVA)
with planned contrasts were used to examine the effects of smile
type (Adapted or Everyday) on RT and MT data, VAS ratings,
and Facial Disability Index. The averaged scores of data 1 and
data 2 (pre-intervention) measurement sessions were compared
with the averaged scores of data 3 and data 4 (post-intervention)
measurement sessions. A 6 month follow-up was also undertaken.
STATISTICA 7.0 for Windows was used to perform statistical analysis.
RESULTS: After exposure to Video Self-Modeling: (i) reaction time
(RT) to initiation of Adapted smiles became 202 msec faster whereas
RT for Everyday (asymmetrical) smiles became 150 msec slower
(ii) Adapted smiles were completed 521 msec faster (iii) Adapted
smiles had higher Movement Control and Overall Quality ratings
(iv) Self-report on Facial Disability Index social/wellbeing subscale
improved. CONCLUSIONS: Following intervention there were sig-
nificant changes in availability, execution speed and quality of the
smile. Implementation Intentions after Video Self-Modeling ensured
transfer of the Adapted smile to pre-determined everyday situations.
IMPLICATIONS: This study supports these rehabilitation techniques
as being methods that can maximise quality of smiling following
facial nerve paresis. KEYWORDS: facial paresis, edited video-
tape, self-modeling,. FUNDING ACKNOWLEDGEMENTS: Australian
Government Postgraduate Award for Doctoral Studies. CONTACT:
s.coulson@fhs.usyd.edu.au
ETHICS COMMITTEE: Human Research Ethics Committee. The
University of Sydney
S406
Research Report Poster Display
37-14 Tuesday 5 June 09:00
VCEC Exhibit Hall B & C
SATURATION DURING VOLUNTARY APNOEA –
A COMPARATIVE STUDY
Eriksson A1 , Wadell I2 ; 1 Respiratory Medicine and Allergy, University
Hospital, Umeå, Sweden; 2 Physiotherapy, Department of Community
Medicine and Rehabilitation, Umeå University, Umeå, Sweden
PURPOSE: The aim of this study was to investigate whether the
ability to tolerate lengthy voluntary apnoea and thereby hypoxemia,
vary according to VO2max, type of physical activity performed and/or
experience of hypoxemia. RELEVANCE: People with obstructive
sleep apnoea syndrome are usually treated with CPAP. So far
this group is not well studied with intervention of aerobic training.
PARTICIPANTS: Four groups consisted of (1) underwater rugby
players (UW-group), (2) individuals conducting fitness training on
land (FT-group), (3) individuals that didn’t perform fitness training
(DFT-group) and (4) individuals with obstructive sleep apnoea
syndrome (OSAS-group). Each group consisted of 11 participants.
METHODS: All participants underwent spirometer test, test of
maximal voluntary apnoea and submaximal fitness test on bicycle
ergometer. ANALYSIS: The statistical analysis was carried out by
using Statistical Package for Social Studies (SPSS) 10.0, ANOVA
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
the other groups. The UW-group had significantly larger vital capacity
than the OSAS-group. CONCLUSIONS: In this study it seems like
the most important factor for tolerating lengthy voluntary apnoea and
hypoxemia is conscious experience of apnoea and thereby conscious
experience of hypoxemia. It is also likely that physical training
contributed in a positive way both regarding physiological as well
as psychological aspects. IMPLICATIONS: Aerobic training might be
of benefit both for weight loss, to minimize oropharyngial obstruction,
and to reduce the numbers of apnoeas. KEYWORDS: voluntary
apnoea, saturation, heart rate, VO2max, obructive sleep apnoea
syndrome. FUNDING ACKNOWLEDGEMENTS: None. CONTACT:
andreas.eriksson@vll.se
ETHICS COMMITTEE: Ethical committe, Umeå University
Research Report Poster Display
37-18 Tuesday 5 June 09:00
VCEC Exhibit Hall B & C
A COMPARISON OF FREE LIVING ACTIVITY LEVELS BETWEEN
THOSE WITH CHRONIC FATIGUE SYNDROME (CFS) AND
HEALTHY CONTROLS
Paul L, Marshall R, Rafferty D, Jacob F; School of Health and
Social Care, Glasgow Caledonian University, Glasgow, Scotland, UK
PURPOSE: Anecdotally CFS sufferers report that they are profoundly
less physically active and unable to participate in everyday activities
in comparison to their healthy counterparts. The aim of this study
was to objectively compare the level of activity in those with CFS
and a control group, using an advanced accelerometer device.
RELEVANCE: An accurate measure of levels of activity in those with
CFS would help guide physiotherapists in the design and progression
of programmes to increase activity/exercise in CFS. PARTICIPANTS:
Thirteen CFS subjects (11 females and 2 males) who attended
support groups in and around Glasgow volunteered. The control
group were a convenience sample of 13 healthy, age and gender
matched subjects and were recruited from family and friends of the
CFS subjects and also University staff. The mean age of the CFS
group and control group was 47.2 years and 47.5 years respectively.
METHODS: To assess their level of activity each of the subjects
wore an activPAL device for three days. This small activity monitor
is worn on the thigh and objectively records the amount of time
WCPT 2007, Research Reports
the individual spends sitting/lying, standing and walking as well as
the number of steps taken. ANALYSIS: Two sample paired t-tests
were used to compare the four outcome measures between the two
groups. The level of significance was taken to be p < 0.05. RESULTS:
Subjects with CFS spent a significantly greater part of the day sitting
or lying compared with the control group (p = 0.004). Consequently
the time spent standing and walking was greater in the control group
compared to the CFS group (p = 0.03 and p < 0.001 respectively).
Those with CFS took an average of 3992 steps per day compared to
9626 steps taken by the control group (p < 0.001). CONCLUSIONS:
The results of this study support anecdotal and clinical impressions
that people suffering from CFS demonstrate a significantly lower
level of activity compared to their healthy peers. Further comparison
of the pattern of activity between the two groups is underway.
IMPLICATIONS: To avoid the secondary effects of deconditioning
and to improve participation and function physiotherapists should
include appropriate and guided activity management when treating
those with CFS. The activPAL device was an effective method of
determining activity levels in this group and might be a simple tool
for monitoring and guiding therapy. KEYWORDS: Chronic Fatigue
Syndrome, activity. FUNDING ACKNOWLEDGEMENTS: Unfunded.
CONTACT: L.Paul@gcal.ac.uk
ETHICS COMMITTEE: Ethics committee of the School of Health and
Social Care of Glasgow Caledonian University
Research Report Poster Display
38-22 Tuesday 5 June 09:00
VCEC Exhibit Hall B & C
GENDER DIFFERENCES IN HIGH SCHOOL COACH’S
KNOWLEDGE AND ATTITUDES ABOUT THE FEMALE ATHLETE
TRIAD: A PILOT STUDY
Pantano K; Cleveland State University, Cleveland, Ohio, USA
PURPOSE: Women’s participation in athletics has increased since
greater opportunities in sports have been provided. Female athletes
may intentionally or inadvertently restrict their dietary intake and
over-train to gain a competitive edge,which may lead to a loss or
abnormality of their menstrual cycle and the premature development
of osteoporosis. This syndrome, known as the Female Athlete Triad,
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
recognize its warning signs. High school coaches are important in
establishing healthy patterns of behavior early on but their skill in
recognizing the disorder is not known. The purpose of this pilot study
was to describe the knowledge and attitudes high school coaches
in the greater Cleveland, Ohio area have about the female athlete
triad, and to determine if gender differences in knowledge or attitudes
about the female athlete triad exist. RELEVANCE: Understanding
the knowledge high school coaches have about the female athlete
triad provides insight as to where gaps in knowledge exist, and
allows education to be focused in this direction. Raising awareness
and understanding about the syndrome in high school coaches
could lead to earlier intervention and prevention of osteoporosis.
PARTICIPANTS: 63 female and male high school coaches currently
employed in the greater Cleveland, Ohio area. METHODS: A survey
consisting of 30 questions was developed and administered to 63
high school coaches currently employed in the greater Cleveland,
Ohio area. ANALYSIS: Descriptive statistics were used to analyze
the information obtained from the sample of coaches studied.
The Pearson-product moment correlation was used to describe
the relationships between gender of the coach and comfort level
in discussing disordered eating, and menstrual irregularity with
the female athlete, and recognition of the signs and symptoms,
respectively (p < 0.05). RESULTS: Sixty-three high school coaches
(46% female, 54% male) in the greater Cleveland area completed
the survey. Fourteen of the 63 respondents (22%) reported having
heard of the female athlete triad but only 8 (12.7%) could correctly
Poster Displays, Tuesday 5 June
identify all three components. Fifty-two percent reported that irregular
or absent menstruation was a normal consequence of exercise in
female athletes. There was a fair correlation between the coach’s
gender and comfort discussing disordered eating (r = 0.28, p = 0.014),
and comfort discussing menstrual irregularity with female athletes
(r=.39, p = 0.001). There was no relationship between gender and
knowledge in recognizing the signs and symptoms of the female
athlete triad (r = 0.013, p = 0.46). CONCLUSIONS: This pilot study
indicates that high school coaches in the greater Cleveland area lack
knowledge and understanding of the female athlete triad. Further
study must be conducted on a national level to determine the
breadth in which knowledge gaps exist and to assure that prevention
and intervention strategies get quickly established. IMPLICATIONS:
This study suggests that educational programs about the female
athlete triad may be important to implement to high schools
coaches. Physical therapists may be facititate the intiation of such an
educational program. KEYWORDS: Female athlete, menstrual dys-
function, osteoporosis. FUNDING ACKNOWLEDGEMENTS: None.
CONTACT: k.pantano@csuohio.edu
ETHICS COMMITTEE: Drexel University IRB
Research Report Poster Display
39-02 Tuesday 5 June 09:00
VCEC Exhibit Hall B & C
RISK FACTORS FOR INJURIES FROM ROCK CLIMBING
Jones G1 , Llewellyn D2 , Asghar A3 ; 1 School of Allied Health
Professions, Leeds Metropolitan University, Leeds, UK; 2 School
of Clinical Medicine, University of Cambridge, Cambridge, UK;
3 School of Allied Health Professions, Leeds Metropolitan University,
Leeds, UK
PURPOSE: Rock climbing is becoming increasingly popular despite
the risk of serious injury. Previous research has established that
elite indoor climbers are susceptible to overuse injuries of the hand
and fingers. However, the present study examines the prevalence
of climbing injuries in a more diverse group. In addition, self-
efficacy is investigated as a potential risk factor. RELEVANCE:
Information about the aetiology of climbing injuries should form
the basis of communication strategies and educational interventions
designed to prevent injury, and inform rehabilitation PARTICIPANTS:
Of 205 active British rock climbers, 201 (98%) agreed to participate
voluntarily and yielded useable results. The 163 male climbers (M
age = 35.2 years, SD = 11.8) and 38 female climbers (M age =
35.1 years, SD = 10.7) did not differ significantly in age (p > 0.05).
METHODS: Climbers approached in their naturalistic environment
were asked to complete items relating to their climbing behaviours,
injuries, and self-efficacy. Climbing items included number of years
experience, and the frequency and technical difficulty of routes or
problems accomplished in different styles (soloing, traditional leading,
sport leading and bouldering) in the last 12 months. Injury items
included days unable to climb due to climbing injuries, anatomical
location of injuries incurred (related to falling, overuse, and strenuous
moves), and sources of treatment or advice sought. Self-efficacy was
measured using the 10-item Climbing Self-efficacy Questionnaire
(CSQ; developed following an initial pilot study), in which climbers
rate their confidence to accomplish domain specific tasks on a
scale of 0-100. ANALYSIS: Statistical analysis included univariate
statistics, logistic regression and t-tests. RESULTS: Twenty-one
climbers (10%) had been injured as the result of a fall, with 4
reporting upper or lower limb fractures. Sixty-seven (33%) had
incurred overuse injuries, including 35 finger injuries. Fifty-seven
(28%) had suffered injuries from strenuous climbing moves, including
31 finger injuries. The most common sources of advice or treatment
were physiotherapists, other climbers, and physicians. Fall-related
injuries could not be predicted by any of the independent variables.
The probability of sustaining an overuse injury was higher for climbers
who completed difficult climbs whilst soloing or traditional leading
(odds ratio (OR) 1.23; 95% confidence interval (CI) 1.06 to 1.42),
S407
sport leading (OR 1.40; CI 1.18 to 1.66), and bouldering (OR 1.40; CI
1.17 to 1.68). Overuse injuries were more likely for climbers soloing
and traditional leading (OR 1.12; CI 1.01 to 1.24), sport leading (OR
1.12; CI 1.023 to 1.22), and bouldering (OR 1.24; CI 1.08 to 1.43)
more frequently. Bouldering difficulty also predicted injuries incurred
from strenuous moves (OR 1.24; CI 1.04 to 1.49). CONCLUSIONS:
Climbing injuries are relatively common, and medical professionals
provide key sources of advice and treatment. Climbers with the most
ability and dedication are most at risk of injury, particularly finger
overuse. Fall-related injuries are comparatively infrequent, though all
climbers may incur them. Self-efficacy does not appear to predict
climbing injuries. IMPLICATIONS: Climbers should be aware of the
risk factors for injury, warm up progressively, incorporate rest periods,
and recognise injury symptoms when they occur. KEYWORDS:
Exercise, Climbing, Injury. FUNDING ACKNOWLEDGEMENTS: The
second author was supported by The British Academy grant SG-
39588.
ETHICS COMMITTEE: Leeds Metropolitan University, School of
Allied Health Professions, Ethics Committee
Research Report Poster Display
39-06 Tuesday 5 June 09:00
VCEC Exhibit Hall B & C
STRENGTH AND BLOOD PROFILE CHANGES IN FEMALES
WITH POLYCYSTIC OVARY SYNDROME IN RESPONSE TO
EIGHT WEEKS OF RESISTANCE EXERCISE TRAINING
Betts E1 , Brandsen K1 , Jolin K1 , Munger M1 , Nash K1 , Wilson J1 ,
Betts J2 ; 1 Program in Physical Therapy, Central Michigan University,
Mt. Pleasant, MI, USA; 2 School of Health Sciences, Central
Michigan University, Mt. Pleasant, MI, USA
PURPOSE: Polycystic Ovary Syndrome (PCOS) is a complex syn-
drome characterized by menstrual dysfunction, hyperandrogenism,
polycystic ovaries, obesity, and insulin resistance, leading to an
increased risk for the development of cardiovascular disease and type
2 diabetes. Although regular physical exercise is often recommended
to women with PCOS, there is a paucity of research documenting
exercise effects. Evidence for the use of resistance training is
particularly lacking. The purpose of this study was to examine the
effects of an eight-week resistance training program on strength
and select indicators of cardiovascular and diabetes disease risk
in women with a clinical diagnosis of PCOS. RELEVANCE: This
topic is relevant to physical therapy practice, as it addresses
an area of growing concern (cardiovascular disease) in women’s
health. PARTICIPANTS: Following approval from the Institutional
Review Board for the use of human subjects at Central Michigan
University, 11 women volunteers, aged 18-35 years, with a clinical
diagnosis of PCOS were recruited via physician office contact,
word of mouth, and printed advertisements. METHODS: After
health risk stratification and exercise risk appraisal was determined,
anthropometric measurements to determine body mass index (BMI),
fasting blood profiles for glucose (GLU), cholesterol (CHOL), and
triglycerides (TRIG), and muscular strength measurements were
taken pre-training. Resistance training of the large muscle groups of
the upper and lower body using standard weight training apparatus
was then performed 3 days per week for 8 weeks. All pre-test
measurements were repeated post-training. ANALYSIS: Paired t-
tests and ANOVA were used to determine differences in test values
pre- and post-training. RESULTS: Significant increases in strength
( ↑ 24%) were achieved for all muscle groups tested. Improvements
in TRIG ( ↓ 19%) and CHOL ( ↓ 10%) values were also realized
post exercise training. Minimal improvement was noted in resting
GLU levels post-training. No significant change in BMI was seen.
CONCLUSIONS: This study demonstrates that resistance training
in women with PCOS can produce significant strength gains and
concomitant reduction in a number of risk factors for cardiovascular
disease and diabetes. No dietary modifications were prescribed,
therefore these changes resulted in the absence of any significant
S408
change in BMI. Future studies using larger, randomized samples
could strengthen the support for use of this type of training for
women at risk of developing cardiovascular disease. The inclusion
of dietary modification in concert with exercise training would
likely yield greater improvements in blood profiles due to changes
in BMI. IMPLICATIONS: The results of this study suggest that
resistance training can positively influence the factors leading to
cardiovascular disease in a female population at risk. Physical
therapists should consider including this type of training in their
exercise prescriptions. KEYWORDS: Resistance Exercise, Women.
FUNDING ACKNOWLEDGEMENTS: This project was partially
funded by the College of Graduate Studies at Central Michigan
University. CONTACT: betts1ef@cmich.edu
ETHICS COMMITTEE: Institutional Review Board for the use of
human subjects at Central Michigan University
Research Report Poster Display
01-04 Tuesday 5 June 10:30
VCEC Exhibit Hall B & C
WHOLE AGAIN AND HOW TO GET THERE. AN
ANTHROPOLOGICAL STUDY OF EXPERIENCE AND IDENTITY
IN CASES OF LEG AMPUTATION
Oestergaard E; JCVU, University College Jutland, School
of Physiotherapy, Skejbyvej 15, DK-8240 Risskov, Denmark.
Homepages: www.jcvu.dk and www.efaa.dk
PURPOSE: How do people who have had one leg amputated
experience themselves and their body in the period after the
amputation and in taking up everyday life again? Do they become
themselves again, whole again and do they feel integrated into
society again? Which factors are important for this process?
RELEVANCE: Physiotherapists should pay close attention to the
manner in which prostheses are incorporated; to the profound identity
issues raised by the alteration in the body; and to factors important
for feeling whole again. PARTICIPANTS: Fifteen informants: nine
people who had one leg amputated and then had prosthesis, and
six health professionals (four physiotherapists, one doctor and one
physiotherapy assistant). METHODS: Fieldwork for seven weeks in
Denmark using participant observation: passive and moderate (n=6),
active (n=countless); focus group discussion (n=1) and qualitative
interviews: semistructured (n=19), unstructured (n=countless). The
fieldwork took place at different locations. ANALYSIS: My analytical
perspective was anthropological theory about ‘rites de passage’ and
about the body as a subject. RESULTS: All the informants felt
whole and themselves again. For most of them, the prosthesis had
been incorporated (after 12 -3 years), and now felt like a part of
the person and of the body, extending the scope and active radius
of touch and sensation. Most of the informants experienced that
their body now could be absent, after it had demanded focus for
a period of time. Most of the informants felt integrated into society
again. CONCLUSIONS: In a ritual perspective, the informants had
moved from separation through liminality to integration. Separated
from earlier life, body, work and society; through liminality, in
which they were no longer classified and not yet classified, not
themselves, outside society and with an unknown future; finally
integration in themselves, their body and society – now in a new
state. Important factors were: to use the prosthesis as much as
possible, to obtain and maintain phantom sensations, to do specific
physical training, to experience success, to be recognized as a
person, to meet other people with amputated leg(s), to get a job,
to get a car and to have an independent everyday life. Future
studies to recognize important factors in the incorporation process
are relevant. IMPLICATIONS: The ritual perspective can be used in
relation to crisis, diseases and handicaps. It inspires us to consider
the individual human crisis in a society perspective, and it directs
the attention to the characteristics of liminality and to the bodily
aspect of reintegration into society. It is a way to look at the
illness/life process and the new life, which gives meaning because
WCPT 2007, Research Reports
people can see themselves in it. It is relevant for physiotherapists
to work actively with incorporation of the prosthesis and the
maintenance of phantom sensations. After having focused attention
on feeling/sensing the body, this study points out another important
aspect: leaving the bodily focus, letting the body become absent
again allowing attention to be directed elsewhere. It is relevant to plan
experiences of success; immediately after the amputation to request
a visit from another person who has experienced amputation; and
later to plan group activities. KEYWORDS: Amputation, incorporation
of prosthesis, ‘rites de passage’, phantom sensations. FUNDING
ACKNOWLEDGEMENTS: The work was unfunded. CONTACT:
ebo@jcvu.dk
ETHICS COMMITTEE: The Regional Committee on Biomedical
Research Ethics of Aarhus County, Lyseng Allé 1, DK-8270 Højbjerg,
Denmark, fax +4589446111, www.aaa.dk/komite
Research Report Poster Display
01-12 Tuesday 5 June 10:30
VCEC Exhibit Hall B & C
FACTORS INFLUENCING SELF-EFFICACY FOR EXERCISE
AND ACTIVITY IN HOSPITALIZED PATIENTS WITH
CARDIOVASCULAR DISEASE
Cleary K, Kidd J, French M, LaPier T; Eastern Washington
University, Physical Therapy Department, Spokane, WA, USA
PURPOSE: The purpose of this study was to determine if a
relationship exists between exercise and cardiac self-efficacy in
relation to demographics, cognitive function, or prior physical function
in patients with cardiovascular disease (CVD). A secondary purpose
of this study was to determine if self-efficacy and exercise behavior is
different in patients who report a fearing of falling (fallers) vs. patients
who do not report a fear of falling (non-fallers). RELEVANCE: To most
appropriately prescribe exercise, physical therapists must understand
the factors that influence patient self-efficacy. PARTICIPANTS: This
study included 50 patients who were admitted to the hospital for a
CVD related diagnosis. Patients who could not understand English,
were not cognitively intact, or had undergone cardiac transplantation
or ventricular assist device placement were excluded. METHODS:
This prospective descriptive study used a sample of convenience
recruited from a regional medical center. Patient background and
medical information was obtained through chart review and interview.
Patients completed self-report assessments including the Barnason
Efficacy Expectation Scale and the Self Efficacy for Exercise
Behavior Scale (SEEB). In addition, the Physical Function subscale
of the RAND 36-Item Health Survey and the Telephone Interview
of Cognitive Function were used to characterize physical and
cognitive function, respectively. ANALYSIS: Data analysis consisted
of descriptive statistics, correlations, t-tests, and chi-square analysis.
RESULTS: Results indicate that patients with higher financial income
reported higher exercise self-efficacy in resisting relapse, but not
in exercise self-efficacy making time. Patients with higher cognition
and older patients reported higher levels of cardiac self-efficacy.
Further, a positive correlation was found between cardiac self-
efficacy and prior level of physical function. No relationship existed
between body mass index and exercise or cardiac self-efficacy. No
correlation existed between fear of falling and self-efficacy; however,
a higher percent of fallers failed to meet minimum exercise guidelines
as compared to non-fallers. CONCLUSIONS: Results suggest that
patients with higher financial income potentially have greater time
and resources available to exercise and are confident in adhering
to an exercise program when external factors, such as household
chores and social obligations, are present. However, the same
individuals are less confident in exercise adherence when internal
factors are present. Study results also may suggest that patients
with higher cognition have a greater understanding of the importance
of exercise in relation to their condition and associated disease
process and that patients with lower physical function are less likely
to independently engage in previous physical activities after a cardiac
Poster Displays, Tuesday 5 June
event Results also may indicate that age brings experience and
possibly confidence in coping with physical impairments. Fallers failed
to meet minimum exercise guidelines, indicating that fear of falling
may contribute to self-imposed activity restriction. IMPLICATIONS: It
is important to identify the factors that are associated with exercise
self-efficacy. While multiple factors may alter self-efficacy within a
specific patient population, strategies to increase self-efficacy and
patients’ participation in their own care should be implemented. Such
strategies are not only relevant to patients with CVD, but with any
medical diagnosis and across all physical therapy practice settings.
KEYWORDS: cardiovascular disease, exercise, compliance, self-
efficacy. FUNDING ACKNOWLEDGEMENTS: None. CONTACT:
tlapier@ewu.edu
ETHICS COMMITTEE: Spokane – IRB
Research Report Poster Display
02-16 Tuesday 5 June 10:30
VCEC Exhibit Hall B & C
THE IMMEDIATE EFFECT OF CHEST MOBILIZATION
TECHNIQUE IN PATIENTS WITH CHRONIC OBSTRUCTIVE
PULMONARY DISEASE
Tabira K1 , Oike T2 , Kawamata M3 , Sekikawa N4 , Sekikawa K5 ;
1 Department of Physical Therapy, Faculty of Health Science,
Kio University; 2 Department of Rehabilitation Medicine, Tsuda
Hospital; 3 Faculty of Rehabilitation, Seijoh University; 4 Department
of Rehabilitation Medicine, Yoshijima Hospital; 5 Division of Physical
therapy and Occupational Therapy Sciences, Graduate School
of Health Sciences, Hiroshima University
PURPOSE: This study investigated the immediate effect of chest
mobilization techniques in patients with chronic obstructive pul-
monary disease (COPD). RELEVANCE: This study identifies the
effect of chest mobilization techniques in patients with COPD and
suggests strategies for their treatment. PARTICIPANTS: Sixteen
COPD patients (13 male and 3 female, mean+/−SD age 72.2+/− 6.2
yrs) took part in this study. METHODS: We measured pulmonary
function, chest expansion, oxygen saturation (SpO2), pulse rate and
breathlessness before and after treatment. Chest expansion, defined
as the difference in chest girth between maximal inspiration and
maximal expiration, was measured at three levels: the axilla, xiphoid
and 10th rib. Breathlessness was measured with a visual analogue
scale. Patients were treated with chest mobilization comprising rib
rotation, chest wall rotation, lateral flexion of the chest wall, chest
wall extension, and pectoralis major muscle stretch by expert physical
therapists. ANALYSIS: The paired t-test was used to compare
pulmonary function, SpO2 and pulse rate in pre- and posttreatment.
The Wilcoxon test was used to compare chest expansions and
breathlessness in pre- and posttreatment. The same analysis per-
formed in the patients who also demonstrated a restrictive ventilatory
impairment (vital capacity <80% predicted: n=11). Values of p < 0.05
was considered significant. RESULTS: Chest expansion at the level
of 10th rib showed significant improvement and pulse rate was
significantly decreased after treatment. However chest expansion
at the other levels, pulmonary function, SpO2 and breathlessness
were unchanged. In the patients who also demonstrated a restrictive
ventilatory impairment, chest expansion at the level of axilla, xiphoid
and 10th rib all significantly improved and pulse rate was significantly
lower after treatment. CONCLUSIONS: These results suggest that
flexibility of the respiratory muscles and mobility of the costovertebral
joints, facet joints and sternocostal joints were improved flowing
chest mobilization. IMPLICATIONS: We recommend the use of chest
mobilization technique in COPD patients, in particular these who
demonstrate a restrictive ventilatory impairment. KEYWORDS: chest
mobilization, chronic obstructive pulmonary disease, pulmonary
function. FUNDING ACKNOWLEDGEMENTS: None. CONTACT:
k.tabira@kio.ac.jp
ETHICS COMMITTEE: ethics committee in yoshijima hospital
S409
Research Report Poster Display
02-20 Tuesday 5 June 10:30
VCEC Exhibit Hall B & C
PHYSICAL THERAPY MANAGEMENT FOLLOWING CARDIAC
SURGERY: CANADIAN BENCHMARKING SURVEY
Overend T1,2 , Anderson C2 , Jackson J2 , Lucy S1 , Prendergast M2 ,
Sinclair S2 ; 1 School of Physical Therapy, University of Western
Ontario, London, Canada; 2 London Health Sciences Centre,
London, Canada
PURPOSE: To determine the practice of Canadian physical
therapists for patients requiring routine care following cardiac
surgery. RELEVANCE: The literature is conflicting with respect to
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
of a representative sample (n=18) of hospitals performing cardiac
surgery in Canada to determine current physical therapy practice
with respect to the care of patients undergoing coronary artery
bypass surgery and/or cardiac valve surgery. Six physiotherapists
designed the survey questions to address gaps in the literature
identified following a systematic review of physiotherapy care of
patients undergoing cardiac surgery. Survey questions examined
cardiorespiratory care, mobility, exercises, and education provided to
patients requiring routine care following cardiac surgery. The survey
was pilot tested at one centre to determine clarity and ease of
completion. A physical therapist from the cardiac surgery program
at each site was then interviewed by one of two interviewers.
Respondents received a copy of the survey in advance of the
interview. ANALYSIS: Seventeen of the 18 sites participated in the
telephone interview. One site provided written responses. Data from
the surveys were entered in tables and summary statistics calculated.
RESULTS: An average of 21 cardiac surgeries per week (range 6-
42) was performed at the 18 sites. The mode response for length of
stay was 6 days (range 4-10.6). The average staffing across the 18
sites was one physical therapist for 17.6 beds. Patients were seen
preoperatively at 7/18 sites and on postoperative day one (POD-
1)at 16/18 sites. On POD-1, deep breathing and coughing (DB&C)
were performed at 16 sites, upper extremity exercises at 13 sites
and lower extremity exercises at 12. Eight sites reported the use of
incentive spirometers. Twelve sites provided education around self-
treatments (DB&C, bed exercises) and treatment progression. Nine
sites continued to provide cardiorespiratory treatment on POD-3.
There was wide variation in mobility data due to staffing, surgeon
preferences, tradition, and nursing practice. On POD-1, patients
were dangled at 17 sites and mobilized out of bed at 13. By
POD-3, all sites reported patients ambulating 2-5 times per day,
with a range of 50-120 m per session. Seven sites reported doing
stairs with all their patients prior to discharge. Sternal precautions
were variable but all sites reported 5-10 lbs as the upper limit
for lifting. CONCLUSIONS: Within the limitations of survey data,
it appears that Canadian physical therapists may give unneces-
sary cardiorespiratory treatment, after POD-1, to uncomplicated
patients following cardiac surgery. Early mobilization, ambulation and
education appear to be generally common approaches. There is
little consensus around postoperative sternal precautions and some
sites provide cardiorespiratory techniques that are not supported
by the evidence. IMPLICATIONS: There is a need to determine
best practice for physical therapists working with patients requiring
routine care following cardiac surgery. KEYWORDS: cardiac surgery,
practice. FUNDING ACKNOWLEDGEMENTS: London Health Sci-
ences Centre Physiotherapy Research Seed Fund. CONTACT:
toverend@uwo.ca
S410
Research Report Poster Display
02-24 Tuesday 5 June 10:30
VCEC Exhibit Hall B & C
EXERCISE CAPACITY AND QUALITY OF LIFE IN LUNG
TRANSPLANT RECIPIENTS
Tamaki A1 , Chin K2 , Mishima M3 , Bando T4 ; 1 Department
of Physical Therapy, Faculty of Medicine, Kyoto University;
2 Department of Physical Therapeutics, Kyoto University Hospital;
3 Department of Respiratory Medicine, Kyoto University Graduate
School of Medicine; 4 Department of Thoracic Surgery, Kyoto
University Graduate School of Medicine
PURPOSE: From August 2002, lung transplantations from brain-dead
and living donors were performed in our hospital. We examined
the change in exercise capacity, activities of daily living (ADL)
and health-related quality of life (HRQL) in 4 recipients who
survived more than 1 year after the lung transplants. RELEVANCE:
No studies have ever reported about exercise capacity, activities
of daily living, health related quality of life in lung transplant
recipients in Japan. PARTICIPANTS: The patients were 2 males
and 2 females. Two patients had pulmonary emphysema, one had
primary pulmonary hypertension, and one patient had pulmonary
lymphangioleiomyomatosis. METHODS: Six minute walking distance
(6MD), ADL score (Senjyu et al.), leg extension power, and
HRQL (SF-36) of the 4 recipients were measured pre-operation,
at discharge from hospital, a half year after discharge and at
the last examination. The examinations were performed from the
pre-operative period up to 14-44 months following transplantation.
ANALYSIS: Repeated ANOVA was used for statistical analysis.
RESULTS: 6MD values changed from 198m, to 387m, 466m and
546m and ADL scores changed from 18, to 83, 91.3, and 97.8, at
pre-operation, discharge from hospital, half year after discharge and
the last examination respectively. Leg extension powers improved
progressively following transplantation. SF-36 scores approached
those of healthy subjects. CONCLUSIONS: These results indicated
that the exercise capacity and ADL scores improved after lung
transplantation. IMPLICATIONS: The recipients of lung transplants
in our hospital acquired improvement not only in physical ability
but also in HRQL. KEYWORDS: Lung Transplant Recipients,
Exercise capacity, Quality of life, Activities of daily living. FUNDING
ACKNOWLEDGEMENTS: This. CONTACT: tamaki@hs.med.kyoto-
u.ac.jp
ETHICS COMMITTEE: Kyoto University ethics committee
Research Report Poster Display
04-08 Tuesday 5 June 10:30
VCEC Exhibit Hall B & C
DEVELOPMENT OF CRITICAL THINKING IN PHYSICAL
THERAPY EDUCATION: CHALLENGING ASSUMPTIONS, WHILE
INCREASING INDUCTIVE AND DEDUCTIVE REASONING SKILLS
Cech D, Conroy C; Midwestern University, Downers Grove, IL, USA
PURPOSE: A goal of physical therapy entry-level education is to
effectively and efficiently prepare students to utilize current best
evidence and make appropriate clinical decisions. It is important
for the physical therapy education curriculum to assist students in
developing critical thinking and clinical decision making skills. This
study examined changes in critical thinking patterns of physical
therapy students over the course of the entry-level physical therapy
education program, utilizing the Watson Glaser Critical Thinking
Appraisal (WGCTA) and focusing on changes within the 5 subtests of
the instrument. Signifiant changes in critical thinking patterns were
considered in relation to the curricular map and as they reflected
possible influences of the curriculum on development of clinical
problem solving skills. RELEVANCE: This study provides insight
into the development of clinical problem solving skills for physical
therapy students; a method of curricular outcome evaluation; and a
framework for curricular development related to critical thinking and
WCPT 2007, Research Reports
utilization of evidence-based practice principles. PARTICIPANTS:
241 students, graduating from the same 30-month, entry-level,
masters of physical therapy education program participated in this
study. METHODS: Students in the program completed the WGCTA
within 1 month of matriculation, at the beginning of the second year,
and during the final academic quarter. Students had completed full-
time clinical practica immediately prior to WGCTA administration
2 and 3, providing opportuity to incorporate both academic and
clinical learning experiences. ANALYSIS: The Sign test was used
to evaluate the differences between the number of students whose
scores improved and whose scores declined in each of the 5 subtest
areas of the WGCTA. RESULTS: Statistically significant increases
in scores on the inference and deductive reasoning subtests were
seen between the first and third WGCTA administration. On the
inference subscale, Z = −3.393 (Asym Sig 2-tailed = 0.000)and the
deductive reasoning Z = −4.751 (Asym Sig. 2-tailed = 0.000). No
significant improvement was noted in the scores on the recognition
of assumptions subtest (Z = −1.470; Asym. Sig. 2-tailed = 1.41).
Student scores often decreased on the recognition of assumptions
subtest between the administrations. Student score variations on
the second administration of the WGCTA were less predictable than
between the first and third administration. CONCLUSIONS: This data
supports the conclusion that over the course of academic and clinical
education experiences within a physical therapy curriculum, physical
therapy students learn to question their assumptions and pursue
deductive and inductive reasoning in solving problems. Even though
the student’s critical thinking pattern appears to initially become
less predictable, the ability to examine evidence and participate in
clinical reasoning does evolve. Future questions related to this study
should focus on whether the documented changes in critical thinking
support efficient, effective evidence-based physical therapy practice.
More indepth study of influences of curricular models and teaching
strategies on critical thinking should also be done. IMPLICATIONS:
This work does have implications for physical therapy education
and curricular development. Physical therapy education programs
can incorporate this type of information into program evaluation,
curricular development and evaluation of educational methods.
KEYWORDS: critical thinking, PT entry-level education, teaching.
FUNDING ACKNOWLEDGEMENTS: This study was unfunded.
CONTACT: dcechx@midwestern.edu
ETHICS COMMITTEE: Midwestern University Institutional Review
Board
Research Report Poster Display
05-16 Tuesday 5 June 10:30
VCEC Exhibit Hall B & C
INTERNATIONAL SERVICE-LEARNING AND OTHER INTERNA-
TIONAL VOLUNTEER SERVICE OPPORTUNITIES IN PHYSICAL
THERAPY EDUCATION PROGRAMS IN THE USA AND CANADA
Pechak C, Thompson M; Texas Woman’s University, Dallas, USA
PURPOSE: This study examined the prevalence of international
service-learning (ISL) and other international volunteer service (IVS)
in US and Canadian physical therapy (PT) education programs,
faculty’s perceptions of barriers to and benefits of ISL, and program
differences between those with and without ISL/IVS. RELEVANCE:
The PT profession is at a critical point in defining and directing
its role in the global health arena. ISL/IVS opportunities can
facilitate relationships between educational institutions in one country
with educational institutions and/or projects in other countries, and
offer PT students direct participation in examining global issues.
PARTICIPANTS: Questionnaires were sent to directors of all 213
PT education programs in the USA and Canada. METHODS:
Eighty-seven questionnaires from US programs (44%) and 8 from
Canadian (62%) were returned, resulting in an overall response rate
of 45%. Questionnaire consisted of four sections, one optional non-
anonymous section about past and current ISL and IVS sites, and
three anonymous sections that included: (a) demographics, use of
Poster Displays, Tuesday 5 June
ISL/IVS (past 10 years), plans for ISL (next 2 years), and domestic
service-learning and volunteer service (past 10 years); (b) perceived
barriers to ISL in the program, and benefits of ISL in general; and
(c) miscellaneous questions related to membership and international
health groups within the professional organizations of the USA and
Canada. ANALYSIS: Descriptive analyses described respondents,
programs, and their responses. Chi Square examined differences
between programs with and without ISL and/or IVS. RESULTS: In
the past 10 years, 30% of the programs (28% US, 50% Canadian)
had ISL, 23% (24% US, 13% Canadian) had IVS, and 43% (41%
US, 63% Canadian) had ISL and/or IVS. In comparison, 84% (86%
US, 63% Canadian) utilized domestic service in the past 10 years.
Of those that did not utilize ISL and/or IVS in the past ten years, 17%
planned to add ISL and 11% planned to add IVS in the next two years.
No significant differences were found between the programs with ISL
and/or IVS compared to those without either ISL or IVS – in structure
of university, private vs. public, entry-level degree. Lack of funding
and no faculty time were the greatest barriers, and positive effect on
student personal development and facilitates students’ development
of cross cultural competency were the greatest benefits to ISL. US
programs have served in more countries, but Canadian programs
have utilized countries with greater geographic variety. Most US and
Canadian programs have been in the Caribbean, Central America,
and Mexico. CONCLUSIONS: Despite significant barriers, ISL exists
in US and Canadian PT programs. Benefits are consistent with
core professional values and WCPT’s mission. Modest growth of
ISL and IVS is expected. IMPLICATIONS: Future research should
address minimizing barriers, and include examination of successful
programs. KEYWORDS: service-learning, education. FUNDING
ACKNOWLEDGEMENTS: The Health Policy and Administration
section of the American Physical Therapy Association generously
funded the cost of the survey. CONTACT: pechak@tyler.net
ETHICS COMMITTEE: IRB Committee – Texas Woman’s University,
Dallas, Texas
Research Report Poster Display
07-08 Tuesday 5 June 10:30
VCEC Exhibit Hall B & C
VIDEOTAPING PRACTICAL EXAMS FOR STUDENT
SELF-ASSESSMENT: FOSTERING PERFORMANCE AND
PROFESSIONALISM
Phillips B, Kachingwe A; California State University, Northridge, USA
PURPOSE: The purpose of this study was to explore the efficacy
of videotaping practical exams as a mechanism to promote student
self-assessment of skills and professional behavior. Additionally, the
use of video assessment for improving students’ exam scores and
instructors’ accuracy in scoring was explored. RELEVANCE: Self-
assessment is key to professionalism and an integral component of
clinical practice and academic education of physical therapists. These
aptitudes are emphasized in the Normative Model of Physical Ther-
apist Professional Education and bring into question how to teach
and evaluate student self-assessment abilities. PARTICIPANTS: Fifty
students from two clinical courses were randomly assigned to assess
their skills and professional behavior immediately following their
practical exams using either a video tape of their performance or
quiet reflection alone. METHODS: A detailed professionalism rubric
was developed and used in both classes in conjunction with the
skills portion of each exam. Students completed the same scoring
rubric as the instructor. Instructors graded students during the live
practical exam and only this score was used in determining the
student’s grade. The instructors repeated the entire grading process
while viewing the videotaped performance at either 2 days or 2
weeks post-examination to compare live versus videotape grading
consistency. ANALYSIS: One-way ANOVA was used to analyze
differences in final exam scores between video versus non-video
groups and to compare the two groups on agreement of student
self-scoring with instructor live scoring. Two-way ANOVA was used
S411
to examine the effect of time delay in grading the videotaped
performance comparing consistency of instructors’ video grading
with live grading. RESULTS: No significant differences in midterm
scores or final scores were noted between students using video or
no video during self assessment. Both the video and the non-video
groups improved significantly in exam scores by the final exam with
the exception of professionalism scores, which did not significantly
change. Comparing students’ self-scoring with instructors’ scoring
revealed students graded their professional behaviors more critically,
but had inflated views of their skills. When comparing agreement
between students’ self-score and instructors’ score, there were
no significant differences between the video and non-video group.
Instructor scoring live during a practical was significantly different
from scores using the video tape when the variable of time between
live and video grading was introduced. Immediate viewing of the
video resulted in a slight reduction of the student’s score (3%
change in grade) whereas viewing 2 weeks later resulted in a score
close to live scoring. CONCLUSIONS: Students’ self-assessment of
practical exam performance is not enhanced by viewing videotapes
compared to self assessing without the visual aid. Viewing the video
did not improve final exam scores, nor did it improve agreement
with the instructor’s scoring. Rescoring exams on video does not
result in substantial grade changes and thus may be an inefficient
use of instructor’s time. IMPLICATIONS: Use of videotaping to
enhance skills and professionalism through self-reflection may be
more efficiently applied in a formative assessment environment rather
than during a practical exam. Future studies should explore self-
assessment using videotapes in non-threatening practice situations
and with one-on-one feedback. KEYWORDS: videotaping, self-
assessment, professionalism. FUNDING ACKNOWLEDGEMENTS:
This research project was funded in part by the Judge Julian Beck
Instructional Improvement Grant. The authors had no opportunity for
material gain from this project. CONTACT: beth.phillips@csun.edu
ETHICS COMMITTEE: Approved by the Judge Julian Beck Grant
Committee
Research Report Poster Display
08-16 Tuesday 5 June 10:30
VCEC Exhibit Hall B & C
EFFECTS OF HIGH VOLTAGE PULSED CURRENT (HVPC), LOW
LEVEL LASER THERAPY (LLLT) ON THE HEALING PROCESS
OF DIABETIC FOOT ULCERS
Sandoval Ortiz M, Herrera E, Camargo D; Universidad Industrial
de Santander – Bucaramanga, Colombia
PURPOSE: To establish the efficacy of HVPC, LLLT on the healing
course of diabetic foot ulcers RELEVANCE: The experimental design
is the highest level of evidence. This research is the first in our
country that compares two modalities commonly used in physical
therapy for healing diabetic ulcers PARTICIPANTS: Subjects with
controlled diabetes according to WHO criteria, with foot ulcers stage
I to III (Wagner classification). Exclusion criteria were ulcer infection,
amputation, or orthopedic or neuromuscular pathologic conditions.
The research protocol was approved by the Universidad Industrial
de Santander Health Faculty Ethics Committee METHODS: A three
groups double blinded randomized trial: (CG) control group with
standard nursing care, HVG (standard and HVPC: 100 pps, submotor
level, negative polarity during 4 days and then positive to the end of
treatment) and LG (standard and LLLT: punctual, 633 nm, 30 mW,
continuous, 2 J/cm2 in the borders of the ulcer and 1.5 J/cm2 in the
bed). The patients were followed during 16 weeks. The end point was
area reduction  75%. Variables related to neurological (protective
sensation) and vascular (ABI index) status and neuroconduction
parameters (conduction velocity, latency, duration and amplitude)
were measured. Ulcer evaluation included location, area and depth
ANALYSIS: CONSORT recommendations were followed. Multiple
log-binomial regression model was done [alpha=0.05] RESULTS:
Ninety eight patients were assessed for eligibility, 65 excluded
S412
because not meeting inclusion criteria, and 33 were allocated: 11
(CG), 12 (HVG) and 10 (LG); 2, 1 and 1 were lost to follow up in each
of the groups mentioned above. Twenty nine patients were analyzed;
mean age 59.8±11.9 years, 41.4% male, overweight 48.3% and
obesity 27.6%. Diabetes duration 11±9.9 years, and ulcers duration
16.2±34.6 months, 93.1% classified as Wagner I, initial area was
747.3±1495.8 mm2. Altered protective sensation was detected in
72.4% in plantar and 69% in sural. ABI index was normal in 90%.
Absent and abnormal potentials for motor tibial were 3.5% and
65.5%; plantar 48.3% and 13.8%, and sural 31.0% and 20.7%
respectively. Except for area and depth of the ulcers there were
not gross differences between groups. The end point was reached
by 66.7%, 81.8% and 77.8% for CG, HVG and LG respectively.
After adjusting by initial area and depth, multiple binomial regression
model showed RR 1.07 (SE=0.0000738) and 1.32 (SE=0.000137)
for LG and HVG respectively compared to standard nursing care.
CONCLUSIONS: This study showed that the two modalities favor the
healing diabetic foot ulcers IMPLICATIONS: These modalities should
be used as part of the treatment of diabetic ulcers KEYWORDS:
Diabetic foot ulcers, low level laser therapy, high voltage pulsed
current. FUNDING ACKNOWLEDGEMENTS: This research was
financed by the Instituto Colombiano para el desarrollo de la ciencia
y la tecnologı́a, Colciencias. CONTACT: sandoval@uis.edu.co
ETHICS COMMITTEE: The Universidad Industrial de Santander
Health Faculty Ethics Committee.
Research Report Poster Display
08-20 Tuesday 5 June 10:30
VCEC Exhibit Hall B & C
AGE AND DOSIMETRY RELATED TENDON HEALING
RESPONSE IN THE RAT MODEL FOLLOWING LLLT:
STRUCTURAL AND HISTOLOGICAL EVALUATION
Parizotto N, Taciro C; Physical Therapy Department, Federal
University of São Carlos – São Carlos (SP), Brazil
PURPOSE: Due to a complex interaction of medical and epidemi-
ological factors there has been a rapid increase in the size of the
elderly population. With this there has also been a parallel increase in
morbidity associated with age-related delayed tendinopathy healing,
and treatment of such acute and chronic condition costs the Health
Services over 1 billion dollars per year. Despite the obvious clinical
impact, the basic cellular and molecular mechanisms underlying
impaired human tendon healing are largely unknown. However, there
are recent reports about the action mechanism of low level laser
therapy (LLLT) producing accelerated tendon healing, but the real
effects of this therapy associated with aging effects are not yet
known. RELEVANCE: This study evaluated the effects of the LLLT
on repair process of rat calcaneal tendon in different ages and
purposes a relationship among age, tendon healing process and
lasertherapy. PARTICIPANTS: Eighty male Wistar rats were divided
in 2 experimental groups with 40 rats at each one: young group (4-5
weeks old), mature adult (24-25 weeks old). METHODS: Each group
was subdivided in subgroup A (12 session, laser 685nm, 5.4W/cm2, 3
J/cm2), subgroup B (12 session, laser 685nm, 5.4W/cm2, 10 J/cm2);
subgroup C received placebo treatment, and subgroup D not received
any treatment. Every subgroup was totally tenotomized in the medial
region of left calcaneal tendon. They were euthanasied on the
14th post-operative day and their tendons were surgically removed
for a quantitative and qualitative analysis. ANALYSIS: We used
quantitative and qualitative analysis through atomic force microscopy
(AFM) for evaluated alignment, thickness and aggregation of collagen
bundles in mature irradiated groups. Light microscopy was used
to measure quantitative for capillary vessel and fibroblast cell
proliferation. RESULTS: AFM analysis showed better organization
quality (alignment, thickness and aggregation) of collagen bundles
in mature irradiated groups. However, it was found differences
(p < 0.05) in thickness of collagen bundles (TCBs) for several
intersections between subgroups. The mature B subgroup had bigger
WCPT 2007, Research Reports
TCBs (5.69±0.69), and the TCBs subgroup mature D was smaller
(4.51±0.6). The dimensional data showed higher differences in the
subgroup irradiated in mature group than subgroup irradiated in
young group. Histological analysis showed statistically significant
increase in the number of capillary vessels and fibroblast cell
proliferation after LLLT in both young and mature groups, but the
higher stimulation was in the mature group. CONCLUSIONS: Minor
influence of laser radiation in the young group may be justified
by divergence on chemical, physical and metabolic age-related.
Maybe the accumulated oxidative stress resulting from a gradual
shift in the redox status of tissues should be a key mechanism
underlying the aging process and the higher laser effect noted
in the mature group. Age should be considerate an important
parameter in the dosimetry of LLLT. IMPLICATIONS: The results of
this work showed important parameter that it must be considered
in the LLLT of tendon healing, the age. KEYWORDS: Laser,
growth plate, dosimetry, AFM. FUNDING ACKNOWLEDGEMENTS:
CAPES, CNPq, FAPESP. CONTACT: parizoto@power.ufscar.br
ETHICS COMMITTEE: Federal University Animal Ethics Committee
approval.
Research Report Poster Display
10-04 Tuesday 5 June 10:30
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
PURPOSE: The time to peak torque (TPT) and the peak torque
ratio of the lateral to medial rotators (LR/MR) during isokinetic
lateral and medial rotations of the shoulder were evaluated in
subjects with shoulder impingement and in healthy subjects.
RELEVANCE: Studies about time to peak torque can provide
information about the motor unit recruitment of the muscles involved
in a movement. In this case, the medial and lateral rotations of
the shoulder were evaluated. This information is important because
they could bring new information about the motor coordination and
early intervention before clinical disturbance, especially in shoulder
impingement. PARTICIPANTS: Fifteen subjects (26.1±5.1 years)
with shoulder impingement on the dominant side and 9 healthy
subjects (21.5±1.3 years) were evaluated. The clinical diagnosis
of shoulder impingement was made following the clinical criteria:
reproduction of pain by Neer, Hawkins and Jobe tests. Radiography
and ultrasonography for both involved and uninvolved shoulders
were also conducted to confirm the diagnosis. METHODS: TPT and
LR/MR were measured bilaterally during isokinetic concentric lateral
and medial rotations in the scapular plane, at 60º/s and 180º/s, using
an isokinetic dynamometer. The evaluation at each speed consisted
of 5 repetitions of maximal effort during lateral and medial concentric
rotations. ANALYSIS: Mann-Whitney and Wilcoxon tests were used
for the statistical analyses of the peak torque ratio and time to
peak torque. Within groups, dominant and nondominant sides were
compared using Wilcoxon test. The dominant and nondominant sides
of the impingement group were compared to their counterparts in
the control group using Mann-Whitney test. A level of 5% was used
to determine significant differences. RESULTS: The impingement
group showed a bilateral decrease (P < 0.05) in the TPT during
medial rotation for both 60º/s and 180º/s. No differences were found
in the LR/MR between the groups (P > 0.05). CONCLUSIONS: It
is proposed that decreased time to peak torque of the medial
rotators can be used as a tool for early detection of shoulder
impingement. Notably, the decreased time to peak torque of the
medial rotators may occur before the alteration in the peak torque
ratio. IMPLICATIONS: The results show the possibility of an early
functional diagnosis associating time to peak torque with clinical
tests in subjects with impingement syndrome or in subjects with
Poster Displays, Tuesday 5 June
potential to develop this disturbance. This study also supports the
idea that shoulder impingement rehabilitation, mainly in the early
stages, should focus on the bilateral training of the rotator cuff
and proprioception. KEYWORDS: time to peak torque, rotator cuff,
impingement. FUNDING ACKNOWLEDGEMENTS: Paula Camargo
and Michelle Pádua were the recipients of research fellowships from
CAPES and CNPq (Brazilian agencies), respectively. CONTACT:
lalarc79@hotmail.com
ETHICS COMMITTEE: This study was approved by the Ethical
committee of the university and was conducted according to the
Helsinki Statement.
Research Report Poster Display
10-08 Tuesday 5 June 10:30
VCEC Exhibit Hall B & C
EXERCISE PRECONDITIONING ATTENUATES CAPILLARY
REGRESSION IN ATROPHIED SOLEUS MUSCLE
Fujino H1,2 , Kohzuki H1,2 , Takeda I2 , Kajiya F1,3 ; 1 Department
of Cardiovascular Physiology, Okayama University, Okayama;
2 Department of Physical Therapy, Himeji Dokkyo University, Himeji;
3 Department of Medical Engineering, Kawasaki Medical School,
Kurashiki, Japan
PURPOSE: Much less is known about the coupling between
capillary network and muscle disuse atrophy, although atrophy
is characterized by a decrease in muscle volume, mass, and
strength. We have previously reported that muscle atrophy induced
structural alterations in the capillary network, an apoptosis of
endothelial cell of the muscle, and hemodynamic disturbance in
capillaries (Fujino et al., J Appl Physiol, 2005). We propose here
exercise preconditioning as novel approach to retard the detrimental
effects of the atrophy process on the skeletal muscle. We have
also investigated the mechanism of exercise preconditioning to
prevent structural alterations of the capillary network through the
gene expression of angiogenesis-related factors in the rat soleus
muscle following hindlimb unloading with exercise preconditioning.
RELEVANCE: Bed-ridden patients require effective rehabilitation
techniques to counteract inactivity-induced atrophy and facilitate the
recovery process. They require not only therapy to supplement
existing physical activity but also preventive approach, which is
based on their daily activity before “Bed-ridden”. PARTICIPANTS:
Fifteen male Wistar rats were used in this study. They were
randomly divided into an age-matched control group, a hindlimb
unloading for 2-wk without and with exercise preconditioning.
The exercise preconditioning was performed treadmill running (20
m/min, 20ºgrade, 25 min) before hindlimb unloading. METHODS: To
clarify three-dimensional architecture of capillary network, contrast
medium-injected sections were visualized clearly with a confocal
laser scanning microscope. The mRNA for angiogenesis-related
factors, including HIF-1 alfa, VEGF, KDR/Flk-1, Flt-1, angiopoietin-
1 and Tie-2, was analyzed using a real time quantitative reverse
transcriptase-polymerase chain reaction (real time PCR). In addition,
the myofibrillar protein content and myosin heavy chain isoforms were
measured. ANALYSIS: Statistical significance was determined by the
nonparametric Kruskal-Wallis ANOVA test. If significant differences
were observed, then post hoc pairwise comparisons between all
groups were made by Dunn’s method. In all cases, P < 0.05
was considered statistically significant. RESULTS: After hindlimb
unloading, the cross-sectional area of muscle fiber and muscle mass
were significantly decreased in with and without exercise. However,
the exercise preconditioning showed significantly higher myofibrillar
protein content and slow type of myosin heavy chain compared
with hindlimb unloading. The mean capillary density, the number
of anastomotic capillaries, the tortuosity of capillaries and capillary
luminal diameter were significantly smaller in hindlimb unloading
than in control. However, in hindlimb unloading with exercise
preconditioning, these were significantly higher compared with
hindlimb unloading without exercise. Real time PCR analysis showed
S413
that the expression of angiogenic factor mRNAs were decreased in
unloading without exercise preconditioning than in control muscles.
The expression levels of the angiogenic genes were higher in the
exercise preconditioning than the unloading muscles. Especially,
the expression levels of KDR/Flk-1, Flt-1 and Tie-2 genes were
higher in the exercise preconditioning. CONCLUSIONS: Although
hindlimb unloading conditions induced significant reduction of the
capillary network with decreased angiogenic factors, results from
the present investigation indicate that the exercise preconditioning
attenuated the regression of muscle capillary in hindlimb unloading
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.
FUNDING ACKNOWLEDGEMENTS: These findings indicate that
the application of exercise preconditioning might be an effective
countermeasure to muscle atrophy induced by hindlimb unloading.
CONTACT: fujinoh@himeji-du.ac.jp
ETHICS COMMITTEE: All experiments were permitted by the Animal
Experimental Committee of the Himeji Dokkyo University.
Research Report Poster Display
10-12 Tuesday 5 June 10:30
VCEC Exhibit Hall B & C
A DESCRIPTION OF LUMBO-PELVIC CONTROL: ITS ROLE IN
ECCENTRIC CONTROL OF THE HAMSTRINGS MUSCLES
Celebrini R1,2 , Allen T2 , MacIntyre D1,2 ; 1 School of Rehabilitation
Sciences, University of British Columbia, Vancouver, Canada;
2 Rehabilitation Research Lab, GF Strong Rehab Centre, Vancouver,
Canada
PURPOSE: The purposes of this single subject case report were
1) to determine if an instruction to voluntarily pre-contract the lumbo-
pelvic stabilizing muscles, could lead to a change in muscle activation
patterns and 2) to determine the effects of this pre-contraction
on a subject’s performance of an eccentric hamstrings exercise.
RELEVANCE: Despite wide spread use in injury prevention and
performance training, there are no studies indicating that active
lumbo-pelvic stabilization, i.e. voluntarily pre-contracting the core
stabilizing muscles, in healthy individuals, results in improvement of
performance outcomes. This study investigates the effect of active
lumbo-pelvic stabilization on an eccentric hamstrings exercise using
a unique test ideally suited for this purpose. PARTICIPANTS: The
subject was a healthy, 23 year-old male, semi-professional level
soccer player. METHODS: The subject performed 17 eccentric
hamstrings exercises, alternating between “active pre-contraction”
(8 trials) and “no active pre-contraction” (9 trials) of the lumbo-
pelvic stabilizing muscles. The eccentric hamstrings exercises were
performed with the subject starting in a kneeling position with the
ankles stabilized, and gradually lowering his trunk and upper body
to a horizontal position in a controlled motion. Active pre-contraction
involved a voluntary, submaximal contraction of the pelvic floor and
transversus abdominus muscles at the start of the test. Surface EMG
signals of 5 muscle groups were compared for onset and activity. The
angle at which controlled movement was lost was measured using
an Optotrack movement analysis system. ANALYSIS: EMG data
were rectified, filtered and analyzed using custom software designed
within Igor Pro (Wavemetrics). Muscle onset was defined as the time
(seconds) or angle (degrees) at which EMG amplitude exceeded 3
standard deviations above the resting EMG for a period of 400msec.
The “threshold angle” was defined as the knee angle at which joint
acceleration exceeded 120 º/sec2 . This threshold for acceleration was
the point in the exercise when the lowering movement could no longer
be controlled during the exercise as determined by the sharp increase
in acceleration at this point. Trials were averaged for each condition
and means and standard deviations calculated. T-tests were used to
evaluate statistical differences (p < 0.05). RESULTS: Instructions to
“pre-contract” resulted in earlier EMG onset in the proximal muscles
S414
(p < 0.05) and increased EMG signals in all muscles evaluated
(p < 0.05). The “pre-contract” trials showed a significantly greater
threshold angle (p < 0.001), a decrease in peak velocity (p = 0.002),
and a decrease in acceleration (p = 0.008) when compared to the
“no pre-contraction” trials. CONCLUSIONS: These results indicate
that 1) an instruction to “pre-contract” of the lumbo-pelvic stabilizing
muscles can lead to different muscle activation patterns and 2) the
“pre-contraction” resulted in improved performance of an eccentric
hamstrings exercise. IMPLICATIONS: This pilot study may lead to a
prospective experimental design to investigate further the relationship
of voluntarily pre-contracting the lumbo-pelvic stabilizing muscles
and performance parameters. It is reasonable to hypothesize that
improved dynamic control of the lumbo-pelvic region should result in
improvements in such areas as strength and balance performance.
However, at present there is no scientific basis for including this
component into injury prevention and performance training pro-
grams for healthy individuals. KEYWORDS: neuromuscular control,
core, hamstrings. FUNDING ACKNOWLEDGEMENTS: Unfunded.
CONTACT: celebrini@telus.net
ETHICS COMMITTEE: Clinical Research Ethics Committee, Univer-
sity of British Columbia, Vancouver, Canada
Research Report Poster Display
11-16 Tuesday 5 June 10:30
VCEC Exhibit Hall B & C
WHAT CIGARETTE PRICES WOULD BE REQUIRED TO REDUCE
THE SMOKING POPULATION IN JAPAN BY 25 TO 50 PERCENT?
Kawamata M1 , Tsuda T2 , Senju H3 ; 1 Department of Rehabilitation,
Seijoh University, Aichi, Japan; 2 Department of Respiratory
Medicine, Kirigaoka Tsuda Hospital, Fukuoka, Japan; 3 Course
of Health Sciences, Graduate School of Biomedical Sciences
Nagasaki University, Nagasaki, Japan
PURPOSE: It had been reported that smoking was the leading
cause of death for 114,000 people in Japan. The rate of smoking
is higher in Japan than that of other industrialized nations. Lower
cigarette prices in Japan would be responsible for this situation.
Increases in cigarette prices have had an appreciable impact on
smoking prevalence in several countries. However, cigarette prices
that could effectively accomplish a reduction in the size of the
smoking population are not clearly known. The present study aimed
to determine appropriate hypothetical cigarette prices necessary
to achieve 25% and 50% smoking cessation for current smokers
in Japan. RELEVANCE: This study may be able to assist in the
formulation of an appropriate tobacco pricing policy and to prevent
smoking-related diseases in Japan. PARTICIPANTS: 1,671 smokers
were chosen from 450,000 survey monitors. A stratified random
sampling method according to sex and prevalence of smokers in
their age group was utilized. A written consent was obtained for each
subject. METHODS: A questionnaire survey regarding a hypothetical
increase in cigarette prices and smoking behavior was conducted on
them. A questionnaire survey was performed in September 2005 by
using the internet. Main question on the questionnaire survey was
as follows: “If the price of cigarettes is increased to the following
prices, what would you do? Please choose one of the following 4
choices. 1. I would keep smoking the same brand. 2. I would switch
to a cheaper brand and keep smoking. 3. I would quit smoking.
4. Other.” The hypothetical price increases ranged from 300 yen to
1,400 yen. ANALYSIS: Logistic Regression Analysis was applied to
analyze the relationship between the hypothetic increase in the price
of cigarettes and the smoking cessation rate. A value of p < 0.05
was considered significant. RESULTS: The subjects had an average
age of 42 years (range: 20 to 69 years). The percentages of total
subjects who would quit smoking given a cigarette price increase
were 4.9% with a hypothetical price of 300 yen; 23.1% with a
hypothetical price of 400 yen; 43.7% with a hypothetical price of 500
yen; and 77.4% with a hypothetical price of 1,000 yen (1USD=113
YEN, September 2005). The study revealed that the percentage of
WCPT 2007, Research Reports
subjects who would quit smoking was lowest for subjects in their
twenties up to the price range of 700 yen. The results of Logistic
Regression Analysis showed that prices necessary to achieve 25%
and 50% cessation for subjects in their twenties were 430 yen and
550 yen, respectively. CONCLUSIONS: As cigarette prices in Japan
are significantly lower than those in other industrialized nations, it
would be appropriate to set cigarette price to 430 yen to achieve a
25% reduction in the smoking population and to set cigarette price
to 550 yen to achieve a 50% reduction in the smoking population.
IMPLICATIONS: For an appropriate tobacco pricing policy and for
the prevention of smoking-related diseases in Japan. KEYWORDS:
smoking-related diseases, cigarette prices, public health. FUNDING
ACKNOWLEDGEMENTS: Funded by Department of Rehabilitation,
Seijoh University. CONTACT: mikio-kawamata@muh.biglobe.ne.jp
ETHICS COMMITTEE: The ethics committee of Seijoh University
Research Report Poster Display
11-20 Tuesday 5 June 10:30
VCEC Exhibit Hall B & C
PHYSICAL ACTIVITY BY PRESCRIPTION
Varning Poulsen D, Lund B; University College South
PURPOSE: To increase physical activity among citizens in the
primary sector and to develope a trainingskonsortium (network)
between the PT school, private fitness studios and sports clubs in the
community. RELEVANCE: In all civilized societies the consequences
for a physical inactive lifestyles is decreased health, with high
health economical expences for the society and decrease quality
of life for the individual. The usual traditional approach to dealing
with this issue shows low compliance and marginal effekt on
peoples health. Previous experiences are that the participants stop
exercising when the courses stops. Another kind of therapeutic
approach seems to be required. Summarizing this means health
educationaly moving fra a “moralistic” approach to a “democratic”
approach with increase of peoples action competence as a mean!
DESCRIPTION: The physiotherapy department at the University
College South is the project manager and collaborates with general
practitioners, sportsclubs in the community and private fitness
institutions. The target group is people with: Diabetes Mellitus,
Metabolic Syndroms and Coronar Diseases. The age span is from
24 to 75. Course design: 12 participants pr. training group and each
person participates in an individual motivational dialog and test of
condition. These are repeated after 3 months, 6 months and 12
months. The course has a duration of 6 months, and the training
intensity is 3 times pr. week one hour. 48 citizens have participated
at the moment. The training is organised in such a way that it
motivates the participants to engage in new physical activity settings.
The physiotherapeutic approach is to be recognized as the health
educational democratic approach which works with self-efficacy and
developement of action competence in mind. EVALUATION: The
project is still running, and evaluation is therefor not completed at
this moment. The evaluation will be based on: individual dialogs,
tests of condition, focusgroup interviews and evaluation of the
course design and the collaboration and collaborating parts of
the network. CONCLUSIONS: The preliminary conclusion is that
course has a positive impact on the participants and their lifestyle
also after ending the course. IMPLICATIONS: We believe that
outcome of physical activity by prescription could increase more from
focusing on 2 dimensions: • a physiotherapeutic health educational
approach that has an awareness of more than the physiological
impact but also includes the human dimension and quality of life;
• a network orientation between collaborating partners who can con-
tribute with different offers located in the community. KEYWORDS:
Physical Activity; Health Education; Action Competence; Net-
Poster Displays, Tuesday 5 June
work. FUNDING ACKNOWLEDGEMENTS: None. CONTACT:
dorthe.varning.poulsen@cvusyd.dk, bonnie.lund@cvusyd.dk
ETHICS COMMITTEE: Presented at the conference with the
topic: “Enhancing physiotherapy competences in innovative learning
environments”
Research Report Poster Display
13-04 Tuesday 5 June 10:30
VCEC Exhibit Hall B & C
RELATIONSHIP BETWEEN GAIT SPEED AND ACTIVITY AT PRE-
FERRED GAIT SPEEDS ON FLAT GROUND AND TREDMILLS
Saito N; Department Of Physical Therapy,Health Science
University,Yamanashi,Japan
PURPOSE: It has been reported that the preferred gait speed on
treadmills is much slower than that on flat ground, and the gait
speed on treadmills is felt faster. In this study, we compared speeds
and mechanical activities at the preferred gait speeds between gait
on flat ground and gait on treadmill. RELEVANCE: Abbreviation
PARTICIPANTS: Abbreviation METHODS: The subjects were 15
healthy young people (12 men and 3 women) aged 21-22 (mean:
21.1±0.4). The preferred gait speed on flat ground was determined
from the measured time of a 10m gait. Two preferred gait speeds on
the treadmill (SPR-7050, Sakai Medical) were determined. One was
determined by increasing the speed up to the preferred gait speed,
and the other was determined by decreasing the speed down to the
preferred gait speed. ANALYSIS: In each measurement, data were
transmitted from small-sized, tri-axial acceleration transducers (AS-
TG, KYOWA) attached to the back of the subjects and connected to a
PC via a dynamic strain measurement device (DPM-700B, KYOWA)
and an AD converter. The 3 dimensional change of acceleration rate
during the preferred gait was then analyzed using the PC software
(PowerLab System 8, ADInstruments). An integral (total impulse)
of the averaged acceleration rates was determined, and used as
the index of activity. The gait speeds and mechanical activities
wer compared by using one-way analysis of variance (repeated
measures) to find a significant difference. RESULTS: The mean
preferred gait speed on flat ground was 4.98±0.70 [km/h]. The mean
preferred gait speeds on the treadmill with increasing speed and
decreasing speed were 3.85±0.79 [km/h] and 4.00±0.56 [km/h],
respectively. These results indicate the preferred gait speed on flat
ground was significantly faster than that on the treadmill (p < 0.05).
The mean preferred gait activity on flat ground was 379.9±49.2
[N-min/kg]. The mean preferred gait activities on the treadmill with
increasing speed and decreasing speed were 292.1±56.3 [N-min/kg]
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
gait speed on the treadmill was slower than that on flat ground. These
results are identical to those reported previously, and are thought to
be due to the difference in subjective speeds. It has been reported
that energy consumption is greater in a treadmill gait than in a flat-
ground gait at constant speeds. In this study, we compared energy
consumption at the subjective preferred gait speeds, and the results
suggest that the treadmill gait might consume less energy because
it is slower. We measured the changes of gait speed and activity of
young healthy subjects on flat ground and treadmills at their preferred
gait speeds. The results suggest that the values of speed and activity
at preferred gait speed may be higher in flat-ground gait than in the
treadmill gait. IMPLICATIONS: Abbreviation KEYWORDS: Activity,
Preferred gait, Acceleration. FUNDING ACKNOWLEDGEMENTS:
N.A.
ETHICS COMMITTEE: Ethics committee on Health Science
University was approved.
S415
Research Report Poster Display
13-08 Tuesday 5 June 10:30
VCEC Exhibit Hall B & C
ANALYZING ATTENTION POINTS TO DEVELOP TEACHING
PROCEDURES FOR OBSERVATIONAL GAIT ANALYSIS
Watarai M1 , Kaneko S2 , Naka T3 ; 1 Department of Rehabilitation,
St. Luke’s International Hospital, Tokyo, Japan; 2 Tokyo Metropolitan
University of Health Science; 3 Tokyo Metropolitan Institute of
Gerontology
PURPOSE: This research aims to develop the teaching procedure in
gait analysis for physical therapy students or inexperienced physical
therapists by analyzing attention points. RELEVANCE: The teaching
procedure can help the learning process of students and physical
therapists. PARTICIPANTS: 10 physical therapy students took part
in this study. They were already lectured about gait kinematics and
kinetics. The purpose and method of this study was informed and the
consents were acquired. In addition, the Research Ethics Committee
at St. Luke’s international hospital approved this study. METHODS:
10 subjects saw a video of a person’s walking on the treadmill,
and an eye-mark recorder (EMR-8, NAC Inc.) was used to measure
their eye movements. Three trials were performed on each subject.
ANALYSIS: From these data (eye movements), the attention points
were determined. Lengths of attention point trace and stationary
points were calculated. RESULTS: 1, At the beginning of the first
trial, attention points’ traces of all subjects were moving without
stopping. So the lengths of attention point trace were longest of all
trials for all the subjects. 2, As the trials were repeated, the attention
points started to focus on particular areas. The more the trials were
repeated, the shorter the lengths of attention point trace were and
the more the stationary points appeared. CONCLUSIONS: When we
see subjects, especially moving subjects, we try to find the attention
point that represents the feature of the subject. Then we focus on
the feature and analyze the point in detail. Through the process we
can recognize the character of the moving subjects. This process is
called as attention point analysis. This research proved that we use
this process in gait analysis. The knowledge from this study can help
to develop the teaching procedure for observational gait analysis as
we can teach students how to focus earlier on the relevant points of
detail. IMPLICATIONS: For physical therapy education KEYWORDS:
Observational Gait Analysis, Attention Points, Teaching Procedure.
FUNDING ACKNOWLEDGEMENTS: This work was unfunded.
CONTACT: watamasa@luke.or.jp
ETHICS COMMITTEE: Research Ethics Committee at St. Luke’s
International Hospital
Research Report Poster Display
13-12 Tuesday 5 June 10:30
VCEC Exhibit Hall B & C
AGE-RELATED DIFFERENCES IN SPATIOTEMPORAL MARKERS
OF GAIT STABILITY DURING DUAL TASK WALKING
Hollman J, Kovash F, Kubik J, Linbo R; Program in Physical
Therapy, Mayo Clinic College of Medicine, Rochester, MN, USA
PURPOSE: Increased stride-to-stride variability during walking
characterizes gait instability and predicts falls in older adults.
Walking while performing cognitive tasks (dual tasking) is also
associated with increased risk of falling. This study examined
whether variability in gait velocity differs in older adults compared
with middle-aged and younger adults during dual task walking.
RELEVANCE: Understanding the influence of dual tasking on
gait may influence practices designed to minimize fall risk while
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
S416
each of two conditions. In normal walking, subjects walked at self-
selected speeds. In dual task walking, subjects walked while verbally
spelling 5-letter words backward. Gait velocity was measured and
variability in gait velocity was quantified with the coefficient of
variation (%CV). Errors in the cognitive task were quantified in the
dual task condition. ANALYSIS: Analyses of variance (ANOVAs)
with post hoc t-tests were conducted to examine differences in
gait velocity and variability in gait velocity between groups and
between walking conditions. Cognitive performance during dual task
walking was compared between groups with the Kruskal-Wallis
ANOVA by ranks. Relationships between cognitive performance
and walking performance were analyzed with Pearson product-
moment and Spearman rank correlation coefficients. An a value of
0.05 was used for all tests. RESULTS: Older participants walked
more slowly than did middle-aged and younger participants during
normal (122±23, 148±15 and 146±18 cm/s, respectively) and dual
task walking (97±22, 136±16 and 135±22 cm/s, respectively).
Similarly, gait velocity was more variable in older participants than
middle-aged and younger participants in normal (6.1±2.0, 3.6±1.5
and 3.9±2.3%CV, respectively) and dual task walking (9.0±6.5,
5.1±1.6 and 5.2±3.0%CV, respectively). Across groups, gait velocity
decreased and variability in stride velocity increased in dual task
walking. In older subjects only, increased errors in the cognitive
task were correlated with reduced gait velocity (r=-.487) and
increased variability in gait velocity (r=.534). CONCLUSIONS: The
gait changes observed in dual task walking characterize decreased
gait stability and indicate that attention-demanding tasks during
walking have a destabilizing effect on gait that is most apparent in
older people. Performing cognitively demanding tasks during walking
may place older people at greater risk of falling. IMPLICATIONS:
Recognizing the potential role of attention-demanding tasks on
fall risk, one might instruct older individuals at risk of falling to
avoid performing cognitive tasks while walking. In contrast, one
may also recognize the utility of dual tasking and choose to
engage the individual in cognitive activities while walking in an
effort to improve the person’s ability to perform dual tasks in a
safe and functional manner. KEYWORDS: Gait instability; Aging;
Dual task. FUNDING ACKNOWLEDGEMENTS: None. CONTACT:
hollman.john@mayo.edu
ETHICS COMMITTEE: Mayo Foundation Institutional Review Board
Research Report Poster Display
14-16 Tuesday 5 June 10:30
VCEC Exhibit Hall B & C
INFLUENCE OF LEVER ARM AND STABILIZATION ON
MEASURES OF HIP ABDUCTION AND ADDUCTION TORQUE
OBTAINED BY HAND-HELD DYNAMOMETRY
Krause D, Schlagel S, Stember B, Zoetewey J, Hollman J; Program in
Physical Therapy, Mayo Clinic College of Medicine, Rochester, USA
PURPOSE: (1) To assess the intra and inter rater reliability of hip
abduction and adduction strength testing (2) To evaluate torque
values using long and short lever arms, and (3) To evaluate manual
and fixed stabilization on hip adductor strength testing. RELEVANCE:
Given manual muscle testing problems reported because of the force
producing capacity of hip muscle groups as compared to examiner
strength, we propose reliable testing techniques for use by clinicians
and a novel technique for testing hip adductors. PARTICIPANTS:
Twenty-one healthy subjects (12 men and 9 women) were recruited
from the authors’ institution. The age range was 22 to 31 years.
Exclusionary criteria were a history of hip or knee injuries/pathology
on the tested lower extremity. METHODS: Six different testing
positions were performed. Each test was administered three times
on each subject. Examiner A tested each position twice to examine
intra-rater reliability. Examiner B tested each position once in order
to examine intertester reliability compared to examiner A. Examiners
applied force that was sufficient to overcome subject generated force
WCPT 2007, Research Reports
in each testing condition. Test results were recorded using a hand-
held dynamometer. Hip abduction was tested with the subject in
side-lying with the upper thigh positioned at approximately 30º of
abduction. Stabilization at the pelvis was provided by the examiner.
Tests were performed with the dynamometer placed at both short
and long lever positions. Hip adduction with manual stabilization
was tested with the subject in side-lying and the examiner cradling
the non-test extremity. Tests were performed with long and short
lever arms. Hip adduction with fixed stabilization incorporated a 36
cm high padded bench for support of the non-test extremity. The
adduction tests were repeated with the same HHD placements as
with the manual stabilization tests. ANALYSIS: Intratester reliability
was assessed using intraclass correlation coefficient model 3 form 1
(ICC3,1). Intertester reliability was assessed using ICC(2,1). A
t-test was used to assess torque differences between the hip
abductor tests. A two-way repeated measures ANOVA, with lever
arm (short and long) and bench (with and without) as independent
variables, was conducted to examine differences in torque production
(a=.05). Post hoc comparisons were analyzed using paired t-tests
with the Bonferroni-corrected a. RESULTS: Reliability of abduction
testing was greatest in the long lever condition (0.93). Adduction
test reliability was greatest in the long lever condition with bench
stabilization (0.89). Maximal hip abduction torque tested in the long
lever position was significantly greater (t = 9.21, P < 0.001) than in
the short lever position. Maximal hip adduction torque occurred using
a long lever for application of resistance and a bench to stabilize
the non-test leg (F = 15.64, P = 0.001). CONCLUSIONS: Muscle
performance testing of hip abductors and adductors using a hand
held dynamometer can be performed with good to excellent intra
and inter-tester reliability. Hip abduction is best performed using
a long lever. Hip adduction is best performed using a long lever
and a bench to stabilize the non-test extremity. IMPLICATIONS:
This study provides evidence for preferred techniques to test hip
muscle performance in the clinical setting. KEYWORDS: Evaluation,
measurement. FUNDING ACKNOWLEDGEMENTS: None.
ETHICS COMMITTEE: Mayo Foundation IRB
Research Report Poster Display
14-20 Tuesday 5 June 10:30
VCEC Exhibit Hall B & C
THE SLOUCHED POSTURE EFFECT ON EMG OF SHOULDER
GIRDLE MUSCLES DURING ELEVATION ON THE SCAPULAR
PLANE
Sagano J1 , Shirogane S2 , Yoshida N2 , Yamanaka M3 ; 1 Dept of
Rehabilitation Medicine, Fujisawa Shounandai Hospital; 2 Institute of
Rehabilitation Science, Tokuyukai Medical Corporation; 3 Department
of Health Sciences, Hokkaido University School of Medicine
PURPOSE: To investigate the effect of trunk posture (erect or
slouched posture) on the EMG activity of shoulder girdle muscles
(upper trapezius, middle trapezius, lower trapezius, serratus anterior,
and latissmus dorsi) during elevation on the scapular plane.
RELEVANCE: The slouched posture is thought to be one of the
causes of shoulder joint dysfunction. To prevent the trouble of the
shoulder and to develop specific exercises in physical therapy, it
is important to reveal the effect of trunk posture on activation
patterns of shoulder girdle muscles. PARTICIPANTS: A sample
of 9 healthy young subjects with full, pain-free shoulder range of
motion, and no history of shoulder pathology. METHODS: Each
subject was positioned and stabilized while sitting in both erect
and slouched posture. In each sitting posture a three dimensional
electromechanical digitizer was utilized to measure the trunk posture
and humeral position. Trunk angle was defined between a line
passing C6 and Th1 and a line passing th12 and L3. Then
subjects elevated the arm on the scapular plane. The superficial
EMG recorded the output from the target muscles during elevation
on the scapular plane. ANALYSIS: EMG activities were analyzed
while each subject performed humeral elevation in two different
Poster Displays, Tuesday 5 June
seated positions. The data were normalized by maximum voluntary
contraction. And the results were analyzed statistically using a paired
T test. RESULTS: The mean trunk angle of each posture was 10.6
degrees in the erect posture, and 37.7 degrees in the slouched
posture. The slouched posture showed less muscles activity than
erect trunk posture in all muscles. In upward phase, statistically
significant muscle activity differences were seen in upper trapezius,
middle trapezius, lower trapezius, and serratus anterior muscle.
The latissmus dorsi muscle showed no significant difference. In
downward phase, there were significant differences in all muscles
except middle trapezius muscle. CONCLUSIONS: The results in
this study showed trunk posture affects the muscle activity around
shoulder girdles. The slouched posture significantly decreases the
periscapular muscle activity. IMPLICATIONS: The results in this
study suggest that the trunk posture affects the activation patterns of
shoulder girdle muscles. This knowledge may contribute to physical
therapy for shoulder joint. KEYWORDS: The results in this study
suggest that the thoracic posture affects the activation patterns of
shoulder girdle muscles. This knowledge may contribute to physical
therapy for shoulder joint. FUNDING ACKNOWLEDGEMENTS: This
study was unfounded. CONTACT: JunSagano@aol.com
ETHICS COMMITTEE: Ethics committee of faculty of Health Science,
Hokkaido University
Research Report Poster Display
14-24 Tuesday 5 June 10:30
VCEC Exhibit Hall B & C
DEVELOPMENT OF A NEW GLOBAL QUANTITATIVE CLINICAL
POSTURAL ASSESSMENT TOOL
FortinC1,2 , Feldman D3,5 , CherietF1,4 , Labelle H1,2 ; 1 Centre de
recherche CHU Sainte-Justine; 2 Faculté de médecine, Université de
Montréal; 3 École de réadaptation, Université de Montréal; 4 École
polytechnique, Université de Montréal; 5 Groupe de Recherche
Interdisciplinaire en Santé
PURPOSE: Physiotherapists commonly assess posture and tend
to do so qualitatively. Evidence-based practice calls for objective
tools to monitor treatment effectiveness. The purpose of this project
is to identify valid and reliable postural indices (from the current
literature) and construct a quantitative clinical postural assessment
tool that relates posture to muscle involvement that will be useful for
clinicians assessing and treating postural problems. RELEVANCE:
Postural asymmetries may be the cause or consequence of pain,
bony deformity or muscle imbalance. Radiological images verify the
bony structures, however, postural problems are not necessarily
reflected by bony structural problems. Developing a quantitative tool
to assess posture will describe posture in an objective fashion and
will enable monitoring of change over time. This will be useful for
clinicians to describe disease progression, or to demonstrate effec-
tiveness of therapeutic approaches. DESCRIPTION: We conducted
a comprehensive literature search in order to retrieve articles that
describe psychometric properties of postural indices and evaluations
that have been used previously in clinical settings. We used the
following keywords to search for articles on posture from 1980-
2006 in CINAHL, Embase and Medline: posture and assessment,
posture and scoliosis, posture and reliability and posture and low
back pain. EVALUATION: We identified 32 different articles that
responded to our search criteria. Results revealed that none of the
measurement tools based on visual observations (direct or from
photographs) met the criteria of reliability and accuracy to assess
effectiveness of physiotherapy interventions in patients with stroke
or low back pain. Reliability of quantitative clinical methods using
photographs or instruments such as goniometer, inclinometer, tape
measurement, flexi-rule, etc. has been demonstrated. Reliability of
postural body angles was higher in studies using biologically relevant
measurement (relative measurements between body segments) than
those using an external vertical reference line for postural angle
calculation. We identified 14 relevant items representing all body
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segments to be included in this new clinical postural assessment
tool (cervical, thoracic and lumbar curves, head, shoulders, pelvic
and lower limb alignment in three planes). Digital photographs will
be taken and calculation of these angles will be software-based.
Postural asymmetries are associated to corresponding muscular
chain (anterior or posterior) implication. CONCLUSIONS: A postural
assessment tool must contain postural indices that are useful to
characterize the specific pathology. It should be easy and fast to
use, reproducible and sensitive to short-term change, inexpensive,
accessible for use in clinical settings, and should guide clinicians to
understand muscle involvement in those with postural abnormalities.
Measurement of body angles taken from photographs may be the
most comprehensive, accurate and rapid way to assess posture in
a clinical setting. The planned development of a software program
to measure the indices on a digital photograph will simplify the
process and make it more uniform. Based on our literature review and
analysis, we have developed a new clinical postural tool. This new
tool will require a rigorous validation process before its utilization.
IMPLICATIONS: This new tool will improve physical therapy practice
by facilitating the analysis and diagnosis of underlying mechanical
causes of postural abnormalities. KEYWORDS: Posture assessment,
reliability, validity. FUNDING ACKNOWLEDGEMENTS: This project
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.
Research Report Poster Display
16-04 Tuesday 5 June 10:30
VCEC Exhibit Hall B & C
OUTCOME MEASURES OF FUNCTIONAL PERFORMANCE
IN PERSONS WITH ANKLE FRACTURES. A ONE YEAR
FOLLOW-UP
Hugo B1 , Borjesson M1,3 , Karlsson Thur C2,4 , Wretenberg P2,4 ;
1 Section of physiotherapy, Karolinska University Hospital, Stockholm,
Sweden; 2 Section of orthopaedics, Karolinska University Hospital,
Stockholm, Sweden; 3 Department of neurobiology, care sciences and
society, division of physiotherapy, Karolinska Institutet, Stockholm,
Sweden; 4 Department of molecular medicine and surgery, section
of orthopaedics, Karolinska Institutet, Stockholm, Sweden
PURPOSE: Ankle fractures are one of the most common injuries
in the lower extremities, but few studies have been published
evaluating functional performance after ankle fractures with objective
activity tests. Self-selected walking speed is an objective, valid
and reliable test of functional performance and has been used in
many populations, both healthy persons and persons with different
impairments. The aim of this study was to evaluate some commonly
used outcome measures and self-selected walking speed in persons
with ankle fractures. This study was part of a larger study with
the purpose of measuring functional performance in persons with
ankle fractures. RELEVANCE: It is important to find objective activity
tests that are easily performed in a clinical setting. Measurements
of gait speed are easily performed, a stopwatch and a measured
distance is all that is needed. PARTICIPANTS: This prospective study
included 35 patients, aged 17-88 years, with ankle fractures, who
were operated between February and June 2005 at the Karolinska
University Hospital in Stockholm, Sweden. The persons were tested
6 months and 1 year after the operation. Two persons were unable
to attend one of the follow-up meetings and were therefore excluded
from this study. METHODS: Outcome measures were loaded dorsal
and plantar flexion, number of toe rises, ankle circumference
(swelling) and normal and fast self-selected walking speed, combined
with an estimation of pain during walking according to Borg CR 10
scale. The study was approved by the institutional ethics committee.
ANALYSIS: Mean and standard deviation were calculated and
median and range (Borg CR 10 scale). Student’s t-test was used
to calculate differences between the 6 month and 1 year follow-up.
S418
RESULTS: Loaded dorsal flexion improved from 29 to 30 degrees
(p < 0.05), loaded plantar flexion improved from 39.5 to 42 degrees
(p < 0.01), number of toe rises improved from 19 to 21 (p < 0.05) and
swelling decreased from 28.1 to 27.9 centimetres (p < 0. 05). Normal
walking speed increased from 1.28 m/s to 1.39 m/s (p < 0.001). Fast
walking speed increased from 1.83 m/s to 1.97 m/s (p < 0.001). Pain
during walking according to Borg was stated 0 (=no pain) in both
walking speeds at both test occasions. CONCLUSIONS: The tests
of loaded dorsal/plantar flexion, number of toe rises and swelling were
not considered clinically relevant. The tests of self-selected walking
speed were considered clinically relevant. Measurement of self-
selected walking speed is a relevant and objective method to evaluate
functional performance after ankle fractures. IMPLICATIONS: Tests
of walking speed, positive aspect: It is easily performed in a clinical
setting. Limitations: Assumes no other new conditions affecting gait
during the follow-up period. KEYWORDS: ankle fracture, outcome
measures, walking speed. FUNDING ACKNOWLEDGEMENTS: -.
CONTACT: margareta.borjesson@karolinska.se
ETHICS COMMITTEE: Karolinska University Hospital, Stockholm,
Sweden 03-764
Research Report Poster Display
16-12 Tuesday 5 June 10:30
VCEC Exhibit Hall B & C
INTENSIVE FUNCTIONAL REHABILITATION AFTER PRIMARY
TOTAL KNEE ARTHROPLASTY: LONG TERM FOLLOW-UP IN
PARTICIPANTS OF A PREVIOUS RANDOMIZED CLINICAL TRIAL
Moffet H1,2 , Denis M2,3 , Collet J4 , Shapiro S4 ; 1 Department of
Rehabilitation, Faculty of Medicine, Laval University, Quebec City,
Canada; 2 CIRRIS Research Center, Quebec Rehabilitation Institute,
Quebec City, Canada; 3 CHUQ (Hôtel-Dieu Hospital), Quebec City,
Canada; 4 Department of Epidemiology and Biostatistics, McGill
University, Montreal, Canada
PURPOSE: To compare functional ability and quality of life (QOL)
3 years after a primary total knee arthroplasty (TKA) and utilization
of health care services during the 2nd and 3rd year after TKA, in
persons who participated in a previous randomized controlled trial.
RELEVANCE: In a previous study, the effectiveness of an intensive
functional rehabilitation (IFR) program to improve functional ability
and QOL during the first year after TKA has been demonstrated. In
that study, 77 persons with knee osteoarthritis who had undergone
primary TKA were randomized into two groups. Two months after
TKA, half of them received the IFR program consisting of 12
supervised rehabilitation sessions combined with home exercises.
The other participants received the usual care (control group:
CTL). Long term impacts of the IFR program are, however,
unknown. PARTICIPANTS: Sixty-two persons from the previous
cohort participated in a functional ability and QOL evaluation 3 years
after TKA (IFR: n=33 CTL: n=29) and we obtained information from
government statistics data banks for the 2nd and 3rd year after TKA
for 70 persons (IFR: n=35 CTL: n=35). METHODS: Functional ability
was evaluated with the 6-minute walk test (6MWT) and the Western
Ontario and McMaster Universities Osteoarthritis Index (WOMAC).
QOL was evaluated with the Medical Outcomes Study 36-item Short-
Form Health Survey (SF-36). Healthcare services utilization and
medication costs were collected from the Quebec Government Health
Care and Social Services Ministry. ANALYSIS: T-tests for indepen-
dent samples and 95% Confidential Intervals of mean differences
were used to compare groups. RESULTS: Three years after surgery,
no significant difference between groups was demonstrated for the
6MWT. Total and subscale scores from the WOMAC questionnaire
and from the SF-36 were similar in both groups. Two years after
surgery, non-steroid anti-inflammatory medication cost was higher
in the control group (p = 0.01); otherwise, the medication costs
were similar three years after TKA in both groups. Subjects in
the control group required more orthopaedic services during the
second year after surgery (p = 0.02). Those services included medical
WCPT 2007, Research Reports
visits to the orthopaedic surgeon, injections and surgeries. Most
of those services addressed peripheral joint impairments related to
osteoarthritis. Subjects in the IFR had two times more diagnostic
radiology procedures during the second year (p = 0.03). However,
only three patients in each group (8.6%) received X-Rays of the knee.
During the third year after TKA, no significant difference was found
between groups for health care services utilization. CONCLUSIONS:
During the second year after TKA, participants in the control
group required more medication and more medical services than
participants in the IFR group. However, this finding is unlikely due to
IFR only given the short duration of the IFR. Many other factors could
have impacted on the measured outcomes such as physical activity
level, general health and joint condition and ageing. IMPLICATIONS:
No long term benefits of the IFR program were observed in this
study. To maintain the benefits of IFR on functional ability and
QOL after the first year post surgery, the practice of exercises and
physical activities should, most likely, be continued on a regular basis.
KEYWORDS: Health services utilization; Rehabilitation intervention;
Knee surgery. FUNDING ACKNOWLEDGEMENTS: This project was
funded by the Canadian Institutes of Health Research. CONTACT:
helene.moffet@rea.ulaval.ca
ETHICS COMMITTEE: Ethics Committee from Quebec Rehabilita-
tion Institute, Quebec City, Canada
Research Report Poster Display
17-16 Tuesday 5 June 10:30
VCEC Exhibit Hall B & C
AQUATIC EXERCISE COMPARED WITH LAND-BASED
EXERCISE IN PATIENTS WITH KNEE OSTEOARTHRITIS. A
RANDOMIZED CONTROLLED TRIAL
Weile U; Parker Institute, Copenhagen, Denmark
PURPOSE: To compare in the treatment of knee osteoarthritis (OA)
an aquatic with a land-based exercise program focusing on balance,
strength, and function applying similar exercises considering the
different media. RELEVANCE: Physiotherapeutic treatment is a part
of the management of knee OA and is second most frequently
prescribed treatment after medication. PARTICIPANTS: 79 patients
(17 male and 62 female, mean age 68 years old) with knee OA
were randomized into one of three groups: aquatic exercise (n=27),
land-based exercise (n=25), or control (n=27). METHODS: The
intervention groups had two exercise sessions pr week for eight
weeks with a follow-up after 3 months. The outcome measures
were static balance measured on a force plate, isokinetic muscle
strength, KOOS questionnaire, and pain measured on a VAS scale.
The measurements were performed by independent observers.
ANALYSIS: The primary analysis is based on a mixed procedure
via General Linear Model, with the outcome measures as dependent
variables. Subject was applied as random factor, treatment group as
fixed-factor, and for each analysis the individual base-line level was
used as covariate in the 1-way analysis of covariance. In addition,
an intention to treat analysis was included using the last observation
carried forward methodology. RESULTS: Attendance was 92% in the
aquatic group and 85% in the land group. Balance expressed as the
sway velocity, was significantly lower in the aquatic group compared
to the land-based group (0.7032 s vs. 0.8561 s,p = 0.034). Balance
expressed as a percent of maximal stability showed a significantly
better stability in the aquatic exercise group compared to the
control group (79.6% vs. 76.6%, p = 0.030). No significant differences
between groups were observed for muscle strengh, self-reported
daily symptoms, pain, daily function, sport activities, or quality of life
(measured as KOOS). At follow-up, a significant reduction in pain at
rest was observed in the land-based exercise group compared to the
control group (11.2mm vs. −8.3 mm,p = 0.039). A highly significant
difference in adverse effects was observed between the aquatic and
land-based exercise, i.e. 14 participants reported adverse effect in
land-based exercise while only 3 reported adverse effect in aquatic
exercise group (p = 0.0002). CONCLUSIONS: Exercising in water
Poster Displays, Tuesday 5 June
is superior to a land-based program concerning balance. Adverse
events are significantly more frequent with the land-based program
compared to the aquatic exercises. However, no effect on daily
function or pain was observed in either the groups. IMPLICATIONS:
For physical therapy practice. KEYWORDS: Knee osteoarthritis;
Aquatic therapy; Balance. FUNDING ACKNOWLEDGEMENTS: The
study was supported by The Oak foundation, The Research
Foundation of the Danish Physiotherapy Association, The Danish
Rheumatism Association, the Spies foundation, and H:S Central
Research Fund Denmark. Skilful and much- appreciated assistance
was given by supervisor PT,PhD Hans Lund,the Parker Institute,
Copenhagen, Denmark. CONTACT: uw@sfs.dk
ETHICS COMMITTEE: The Scientific-Etical Committee for Copen-
hagen and Frederiksberg, Denmark.
Research Report Poster Display
17-20 Tuesday 5 June 10:30
VCEC Exhibit Hall B & C
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 ;
1 Department of Rehabilitation, Sadamatsu Hospital, Omura, Japan;
2 Department of Physical Therapy, Hiroshima International University,
Higashi-Hiroshima Japan; 3 Department of Physical Therapy, Seirei
Christopher College, Shizuoka, Japan; 4 Department of Mechanical
and Aerospace Engineering, University of Florida, Gainesville, USA
PURPOSE: OAFantasy™ (Keiai Orthopedic Appliance, Japan) is
a unique unloading brace for knee osteoarthritis (OA) providing
excellent clinical results and high compliance. It applies no direct
force on the joint, but separates the medial compartment by utilizing
specially designed hinges, in which the medial hinge extends and
the lateral hinge shrinks as the knee extends, so that the medial
compartment is unloaded requiring less bulky structure. The goal
of this study was to determine if OAFantasy™ has any kinematic
effects on the knees with varus deformity. We hypothesized that it
decreases adduction angle of the knee during open and closed chain
activities. RELEVANCE: This study will provide evidence of the effect
of an unloading knee brace on the joint kinematics. PARTICIPANTS:
Twenty knees of 10 consenting patients with bilateral, primary knee
OA were enrolled in this IRB-approved, prospective study. Knees with
history of traumatic events, ligament injuries, fractures, rheumatoid
arthritis or surgeries were excluded. METHODS: A shape-matching
technique (Banks, 1996) using single-plane frontal fluoroscopy and
CT-based patient-specific knee models were used for kinematic
analyses. Participants underwent CT scan at 1.0 mm slice width
to create geometric bone models of the femur and tibia. Patients
first performed 3 cycles of weightbearing and non-weightbearing
knee extension activities without the brace for each knee, followed
by the same activities with the brace. The range of knee motion
was set between 30 degrees and maximal voluntary extension.
ANALYSIS: A custom program (KneeTrack) produced by a co-
author (SB) were used for the shape-matching procedure to obtain
6 degrees-of-freedom knee kinematics (Fregly, 2005). Cardan/Euler
angle convention (Tupling and Pierrynowski, 1987) was used for
quantitative analyses. Paired t-test and Bonferroni correction were
used for comparisons of flexion and abduction angles (4 tests) and
p < 0.05 were used for the level of significance. RESULTS: None of
the patients experienced increased pain during the experimental ac-
tivities and all performed the requested motions without restrictions.
Two patients (4 knees) were excluded from the analysis due to the
image blur of the video fluoroscopy. Bracing increased the abduction
angle during weightbearing extension by an average 0.64 degree
(p = 0.006) which was significant after Bonferronni correction, while
there were no differences in knee extension nor external rotation
angles. Trigonometric calculation revealed an abduction angle of 0.64
degree was equivalent to 0.56 mm less medial joint compression.
S419
CONCLUSIONS: Effects of OAFantasyTM brace on joint kinematics
was identified and determined. An estimated 0.56 mm decrease of
joint compression was smaller than 5 unloading braces that applied
direct valgus force on the knee (Dennis, 2006). Considering excellent
clinical results of this brace, joint unloading of 0.5 mm may be
sufficient for successful bracing for knee OA. The unique hinge
mechanism that does not require uncomfortable valgus force may
be the key to the success of this brace. IMPLICATIONS: Patients’
compliance for knee brace is a significant clinical challenge and
efforts of reducing weight of the brace and direct force on the joint
have been required. The result of this pilot study provides support
for the efficacy of an advanced hinge mechanism for OA braces.
KEYWORDS: knee osteoarthritis, unloading brace, joint separation.
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.
CONTACT: kazgamada@ortho-pt.com
ETHICS COMMITTEE: Approved by the Ethics Committe at Faculty
of Health Sciences, Nagasaki University
Research Report Poster Display
17-24 Tuesday 5 June 10:30
VCEC Exhibit Hall B & C
MEASUREMENT OF PAIN RELATED FEAR IN PATIENTS WITH
LOW BACK PAIN: CAN IT BE DONE SIMPLY?
Oostendorp R1−3 , Demolon N2,4 , Van der Zanden O2,4 , Duquet W2 ;
1 Radboud University Nijmegen Medical Centre, Nijmegen, The
Netherlands; 2 Free University of Brussels, Faculty of Medicine
and Pharmacology, Brussels, Belgium; 3 Dutch Institute of Allied
Health Care, Amersfoort, The Netherlands; 4 Private Practice for
Physiotherapy, Belgium and The Netherlands
PURPOSE: The study had three objectives: (1) to determine the
prevalence of pain-related fear in patients with chronic low back pain
(CLBP) in a physical therapy private practice setting; (2) to determine
the differences in characteristics of subjects with a high versus low
score on the Tampa Kinesiophobia Scale (TKS); (3) to determine
which question(s) have prognostic value for classifying patients with
CLBP in a high versus low TKS score category. RELEVANCE: CLBP
is one of the most common health problems in primary care. Many pa-
tients are referred to physiotherapy. Since pain-related fear is a very
strong prognostic factor in LBP its recognition is important to make an
adequate choice with regard to physiotherapeutic treatment strategy.
PARTICIPANTS: Patients with LBP (>6 weeks) were recruited from 6
private practices for physiotherapy in The Netherlands and Belgium.
METHODS: Questionnaires were used to collect data on patients’
characteristics (e.g., age, gender, education, duration of LBP, medica-
tion), pain intensity (Visual Analogue Scale [VAS score range 0-100]),
pain-related fear with regard to injury and movement (Tampa Kinesio-
phobia Scale [TKS score range 17-68]), depression (Beck Depres-
sion Inventory [BDI score range 0-63]), pain coping behaviour (Pain
Coping Inventory list [PCI]; six subscales), and activities of daily living
(Oswestry Low Back Pain Disability Questionnaire [OLBPDQ score
range 0-100%]). ANALYSIS: The data were analyzed with descrip-
tive (frequency distribution, central tendency) and (non)parametric
inferential statistics (alpha set at 0.05). Forward stepwise logistic
regression was used to determine which question(s) had the highest
prognostic value to classify patients in a high versus a low TSK
score category. RESULTS: Fifty patients with CLBP participated.
The TKS total score varied between 23 and 57. The median score
(38.5) was chosen as cut-off point for a high (>38.5; n=24) versus a
low (<38.5; n=26) score on the TKS. Use of medication, stopping of
activities/hobbies due to LBP, worrying/catastrophizing, use of rest,
and passive coping strategies were significantly higher (p0.05) in
subjects with a high TKS score. The “agree” option for the statement
“the safest way to prevent an increase in pain is prevention of unnec-
essary movements” (TKS statement 10) had the greatest predictive
value (92%) for identifying subjects with a high TKS score (22 out
S420
of 24 patients). CONCLUSIONS: Pain-related fear of injury and
movement is common in patients with LBP. Patients with a high or a
low TKS score have significantly different characteristics. The “agree”
option for TKS statement 10 is a good prognostic indicator of a TKS
score higher than the median (high score category). IMPLICATIONS:
It is possible to measure pain-related fear in a simple manner in
daily practice. It is important to recognize pain-related fear in patients
with LBP because the best available evidence for physiotherapeutic
treatment for these patients is exercise therapy combined with
cognitive behavioural principles exposing patients to pain-related
activities. KEYWORDS: Low back pain, pain-related fear, physiother-
apy, exposure. FUNDING ACKNOWLEDGEMENTS: No funding was
received for this study. CONTACT: r.oostendorp@kwazo.umcn.nl
ETHICS COMMITTEE: Commissie Mensgebonden Onderzoek, Vrije
Universiteit Brussel, Belgium.
Research Report Poster Display
19-08 Tuesday 5 June 10:30
VCEC Exhibit Hall B & C
THE EFFECTS OF ALTERING INTERVERTEBRAL STIFFNESS
ON PASSIVE MOVEMENT TESTING OF THE CERVICAL SPINE:
A COMPUTER-BASED SIMULATION
Tuttle N, Laakso L, Barrett R; School of Physiotherapy and Exercise
Scicnce, Griffith University, Gold Coast, Australia
PURPOSE: To determine how increasing segmental intervertebral
stiffness affects simulated passive posteroanterior movements (PAs)
to the cervical spine. RELEVANCE: PAs are common techniques
intended to assess stiffness of individual intervertebral motion
segments. PAs were originally considered to produce isolated
accessory glides between vertebrae and were described as though
the PA movement occurred entirely at the target location. It is
now known that PAs affect both local and regional structures, but
it is not known how altered mobility at specific locations affect
PAs. PARTICIPANTS: Computer based simulation. METHODS: A
simplified two-dimensional computer-based model of the cervical
spine was constructed consisting of eight bodies corresponding to the
head and cervical vertebrae linked by seven uniaxial joints. One set
of simulations of PA movements at C4/5 (target level)was performed
with the joints modelled as linear springs with constant stiffness.
Simulations were performed using: 1) normal stiffness values, 2)
increased intervertebral stiffness at the target level and 3) increased
stiffness at C3/4 (adjacent level). Two additional sets of simulations
were then performed with the joints modelled as non-linear springs
with minimal stiffness in the neutral zone and linear interpolations
of stiffness between known data points. Sets of simulations were
performed with the intervertebral stiffness increased in two ways; the
size of the neutral zone decreased and the stiffness within the neutral
zone increased. ANALYSIS: SD curves of PAs were plotted for each
simulation. RESULTS: For the linear model where the stiffness of
each joint was a constant, the stiffness of all PA movements were
also constants. Stiffening the target level resulted in greater effect on
the PA stiffness than increasing the adjacent level. The SD curves
of PAs from the non-linear model consisted of a series of ‘steps’ of
increasing stiffness. Decreasing the size of the neutral zone resulted
in SD curves of similar shape, but shifted horizontally such that
increases in stiffness occurred earlier in the PAs. Increasing the
stiffness within the neutral zone also resulted in a similar shaped
SD curve, but the curve was distorted vertically. The effects on PA
stiffness from increasing stiffness of the target level occurred earlier
in the movement and were greater in magnitude than effects from
increasing stiffness of the adjacent level. CONCLUSIONS: When
intervertebral stiffness was modelled as non-linear, the location and
type of altered intervertebral mobility were reflected in characteristic
changes in the pattern of PA stiffness suggesting ways clinicians
using PAs may be able to localize the location and type of increased
intervertebral stiffness in the cervical spine. IMPLICATIONS: The
results of this study are consistent with pilot data we have collected
WCPT 2007, Research Reports
where differences in stiffness curves of PAs of the cervical spine
in painful and less painful locations were suggestive of both of the
patterns described from the non-linear simulations. Further studies
are underway to clarify the relationship between symptoms and
PA mobility. Recognising the non-linear behaviour of intervertebral
stiffness and the complex relationship between intervertebral mobility
and PA stiffness may result in greater accuracy in the assessment
and interpretation of both manual and instrumented assessment of
passive movements. KEYWORDS: simulations passive movements.
FUNDING ACKNOWLEDGEMENTS: NT is supported by an Aus-
tralian Postgraduate Award. CONTACT: n.tuttle@griffith.edu.au
Research Report Poster Display
19-12 Tuesday 5 June 10:30
VCEC Exhibit Hall B & C
THE COMPARISON OF STRETCHING AND PASSIVE CLOSE
LENGTHENING FOR INCREASING AROM – WHAT IS PASSIVE
CLOSE LENGTHENING?
Ikebuchi N1 , Utsunomiya H2 ; 1 Japanese Physical Therapy
Association,a health care center for the elderly (MIZUHO club,
Japan); 2 JM institute
PURPOSE: In comparison with active range of motion (AROM) of
shoulder joint flexation, this study was undertaken to introduce a
new technique called passive close lengthening (CLOSE) that was
found to be more effective than conventional methods of stretching.
The aim of CLOSE is to bring joint surfaces closer to each other
when bone movement is stopped, after it was moving more – a
technique pioneered by Hatsuo Utsunomiya from Japan. As a result,
this technique made joint movement easier. Based on the results of
research completed, I will present a comparison of the conventional
method with this new technique. RELEVANCE: This study applies
to the Exercise in Track3. PARTICIPANTS: A total of 41 subjects
whose shoulder joints have neither disease nor pain. The subjects
who agreed to participate in this study comprised 31 women and
10 men with a mean age of 82.5±6.7 years (ranging from 66–95
years of age). METHODS: A measured AROM of flexation shoulder
joints while in a sitting position was compared with three patterns:
the control, stretch and CLOSE groups. Within each group, 30
shoulders from among the 41 subjects were randomly selected.
When a subject was chosen more than once, there was at least a
one week gap between testing. The control group was examined to
see whether a change occurred by performing flexure twice. After the
first measurements were taken with the stretch and CLOSE groups, I
used each technique and attempted to move their joints as much as
possible. The second measurements were taken with the subject’s
joints returned to the starting position. The improvement rate was
calculated as follows: Improvement rate (%) = (2nd angle result after
technique applied − the first angle)/(180 − the first angle) × 100.
ANALYSIS: A Wilcoxon signed rank test was used to generate
statistics for the 3 groups. The effects of each technique were
compared using a Mann-Whitney test. RESULTS: The control group
was not a significant difference which indicates that repeating the
procedure twice had no real effect. In the stretch group, the average
pre-angle was137.6±3º, and after stretching it was 141.5±2.7º.
In the CLOSE group, the average pre-angle was136.2±3.3º, and
after CLOSE it was 145.7±3.2º. The significant difference left the
stretch and CLOSE group (p < 0.01). The improvement rate of
the stretch group was 13.6±14.7%, while the CLOSE group was
26.3±20.4%. The result of a Mann-Whitney test showed more
significant improvements in the CLOSE group than in the stretch
group (p < 0.05). CONCLUSIONS: The use of the CLOSE technique
can result in an improvement in AROM. It depends on a lubrication
theory. Although this approach goes against conventional theories
in AROM improvement, we have observed that movement becomes
easier by bringing joint surfaces closer. IMPLICATIONS: For physical
Poster Displays, Tuesday 5 June
therapy practice. KEYWORDS: ROM, CLOSE, lubrication theory.
FUNDING ACKNOWLEDGEMENTS: This research is not funded.
ETHICS COMMITTEE: Based on the Declaration of Helsinki,I got
approval of Mayor of institution and consent of participants.
Research Report Poster Display
19-16 Tuesday 5 June 10:30
VCEC Exhibit Hall B & C
CERVICAL MUSCULOSKELETAL IMPAIRMENTS IN
CERVICOGENIC HEADACHE – A META-ANALYSIS
Gadotti I, Armijo-Olivo S, Magee D; University of Alberta,
Edmonton, Canada
PURPOSE: The differential diagnosis of cervicogenic headache
(CEH) requires the presence of a pattern of symptoms and
cervical musculoskeletal signs that distinguish it from other types of
headaches. The objective of this meta-analysis was to evaluate the
available literature regarding cervical musculoskeletal impairments
(CMI) in patients with CEH when compared with control subjects.
RELEVANCE: The evaluation of musculoskeletal impairments of
the cervical spine can help in the diagnosis of CEH as well in
its overall treatment. PARTICIPANTS: Not Applicable METHODS:
Studies were searched from 1965 up to and including May 2006
and were obtained through a search of bibliographic databases
including Medline-Pubmed, Embase, Cochrane Library and Best
Evidence, ISI Web of Sciences, and CINAHL. Key words used were:
cervicogenic headache, cervical headache, headache, cephalalgia,
cervical vertebrae, neck, neck muscles, neck pain, neck injuries,
and physical/musculoskeletal impairment. The outcomes of interest
were any musculoskeletal impairment in the cervical spine (i.e.
altered range of motion, muscular activity, cervical or head posture,
and muscular function). ANALYSIS: Two trained physical therapists
analyzed all papers for the inclusion/exclusion selection criteria. The
methodological quality of the final selected studies was analyzed
with a methodological scale. This scale considered nine important
methodological issues. Revman 4.2 Software was used to summarize
the effects (standardized mean differences) and odds ratio from the
variables for each CMI. RESULTS: The database search resulted
in a total of 1769 articles. Of these 1769 articles, 21 were selected
as potential studies based on their abstracts. However, only 10 met
the relevance criteria. Three articles were of strong methodological
quality, 4 moderate, and 3 of weak methodological quality. Seven
articles were considered for the meta-analysis. The following
standardized mean differences between patients with CEH and a
control group were found for craniocervical angle: −0.22; complete
cervical rotation: −0.54; cervical flexion-extension: −0.78; cervical
range of motion of rotation with cervical flexion: −2.23; flexor strength:
−0.56; neck flexors endurance: −1.56; flexor muscle performance:
−1.08; proprioception of the neck: −0.07. Odds ratio of having the
flexion rotation test positive for patients with CEH were 107.54 and
manual segmental examination positive at the level Co-C1: 7.89
when compared with control subjects. CONCLUSIONS: Patients with
CEH have altered range of motion in rotation, flexion-extension,
cervical rotation with cervical flexion, altered cervical flexor strength,
and altered cervical flexor endurance when compared with normal
subjects. IMPLICATIONS: Musculoskeletal impairments must be
evaluated in patients suffering from CEH in order to guide diagnosis
and treatment. The cervical flexion-rotation test and cervical manual
segmental motion can assist in the differential diagnosis of CEH and
in the identification of movement impairment at the C1/2 segment.
However, there is a clear need for well-designed controlled trials with
greater sample size using valid and reliable methods to investigate
CMI in CEH. KEYWORDS: cervicogenic headache, musculoskeletal
impairments, meta-analysis. FUNDING ACKNOWLEDGEMENTS:
This study was supported by Alberta Provincial CIHR Strategic
Training Program in Bone and Joint Health, Izaak Walton Killan
scholarship from the University of Alberta, and Physiotherapy
Foundation of Canada. CONTACT: igadotti@ualberta.ca
S421
Research Report Poster Display
20-24 Tuesday 5 June 10:30
VCEC Exhibit Hall B & C
LIVING WITH RHEUMATIC DISEASE: PATIENTS’ EXPERIENCES
OF THEIR INNER STRENGTHS, CAPACITIES AND HEALTH
RESOURCES
Biguet G1 , H. Opava C1,2 ; 1 Karolinska Institutet, Department of
Neurobiology Care Sciences and Society, Division of Physiotherapy;
2 Karolinska University Hospital, Department of Rheumatology
PURPOSE: Many patients suffering from a chronic disease, such as
inflammatory rheumatic disease, have experienced personal health
resources at their disposal that will allow them to live a good life
in spite of symptoms and functional impediments. Health resources
in this context refer to patients’ inner strengths and capacities
that have to do with their experience of well-being and mastery.
The purpose of the study was to explore and describe health
resources based on patients’ experiences of living with inflammatory
rheumatic disease. RELEVANCE: This study is part of a larger
project aimed at elucidating the phenomenon of patients’ personal
health resources in physical therapy in order to form a knowledge
basis for identifying and supporting this resources and thereby
improving well-being and quality of life. PARTICIPANTS: Twelve
patients (nine women, three men) who had lived for several years
with some form of inflammatory rheumatic disease were purposefully
selected for participation. METHODS: Conversational interviews with
open-ended questions were conducted. ANALYSIS: The interviews
were transcribed verbatim for qualitative analysis in accordance with
a phenomenological approach. RESULTS: The essential meaning of
health resources is to become a self-agency in order to not letting
the disease get the upper hand over life, particularly by becoming
pro-active and preventing situations in which one no longer has
“anything left to fight back with” . This requires an ability to plan, adjust
and prioritize that presupposes an ongoing assessment of resources
based on available capacities. It is also a question of being able
to provide a buffer, a reservoir of strength, e.g. by regular exercise,
in preparation for variations in the condition. Prevention does not
exclude negotiation and trading off and paying later strategies, i.e.
patients decide to pay the price for valued activities in the form of
increased discomfort. Nevertheless, the acceptance of temporary
exacerbation does require confidence in the capacity to recover and
once more build up a protective buffer. Central to this assessment
process is the ability to re-evaluate what is worthwhile in life, to project
oneself into the future, to engage in reflective inner dialogues, and
to know and listen to the directions from the body. CONCLUSIONS:
Patients interviewed possessed – some not all of the time – access to
inner strengths and confidence in their health resources, even though
they were intimately aware of difficulties and challenges. Acceptance,
more exactly reconciliation with the condition, confidence in the ability
to actively deal with difficulties, a monitoring and reflective self (self-
knowledge), body awareness and regular physical exercise, seem
to be interesting approaches that affect many of the dimensions
of life and should be taken into account by health professionals.
IMPLICATIONS: Health professionals, including physical therapists,
who traditionally focus on identification and alleviation of impairments
and disabilities, need to learn how to be perceptive to patients’
self-assessed health resources. They should also be aware of the
risk for suppressing the patients from showing responsibility and
initiative in the process of deepening self-knowledge. Finally, more
effort should be put into supporting patients’ confidence in their
personal health resources for promoting well-being and quality of
life. KEYWORDS: coping, health perspective, mastery. FUNDING
ACKNOWLEDGEMENTS: The work was funded by the Swedish
Rheumatism Association, the Center for Health Care Sciences at
Karolinska Institutet and the Swedish Research Council. CONTACT:
gabriele.biguet@ki.se
ETHICS COMMITTEE: The design of the study was approved by the
Ethics Committee, Karolinska Institutet, Stockholm (02/407). Date:
2002-11-04
S422
Research Report Poster Display
21-04 Tuesday 5 June 10:30
VCEC Exhibit Hall B & C
THE EFFECTS OF YOGA ON PEOPLE WITH ARTHRITIS: A
SYSTEMATIC REVIEW
Macri E1 , Newman G1 , Giesbrecht A1 , Werner L1 , Westby M2,3 ;
1 University of British Columbia MPT Program; 2 University of British
Columbia Clinical Faculty; 3 Mary Pack Arthritis Centre
PURPOSE: The purpose of this systematic review was to examine
the chronic effects and safety of a yoga intervention on people
with osteoarthritis (OA), rheumatoid arthritis (RA) and ankylosing
spondylitis (AS). RELEVANCE: Arthritis affects 1 in 6 adult
Canadians and carries with it significant economic and social
consequences. There is an obvious need for treatment approaches
that will help people to manage their condition and improve their
quality of life. Many people living with arthritis are choosing less
conventional forms of exercise such as yoga to meet their exercise
and therapeutic needs. In addition, yoga is being promoted by
health care professionals, yoga instructors and lay people alike as a
beneficial adjunct to the management of arthritis. Despite the growing
use of this form of exercise by people living with arthritis, there
appears to be a paucity of research on yoga’s effects on the disease.
PARTICIPANTS: Studies accepted for review investigated adult
populations with OA, RA or AS. METHODS: Studies were accepted
for review if they investigated any form of yoga done independently
or under supervision. Outcome measures were considered within the
context of the International Classification of Function, Disability and
Health (ICF). Peer-reviewed and non-peer-reviewed original English
language studies of any design were accepted. Seventeen databases
and the internet were searched, references hand-searched, and
experts contacted. ANALYSIS: Due to study heterogeneity, a meta-
analysis of the studies was not possible. Therefore, a rigourous
qualitative analysis of the research was completed. Methodological
quality of each study was determined using a composite of standard
quality assessment tools. RESULTS: Seven studies (N=152) were
reviewed, three investigating OA and four RA. Methodological quality
was relatively weak across all studies, with scores ranging between
3-14 out of 18. Only one study used appropriate randomization. Two
studies blinded the outcome assessor. Intention to treat analysis
was not completed in any studies. CONCLUSIONS: This review
provides Grade B evidence that yoga may improve pain, hand
ROM, joint tenderness, grip strength, function, and quality of life in
people with OA and RA. Yoga appears to be safe for this population
when done under appropriate guidance. In the future, research of
higher methodological quality is needed, where interventions are
described in sufficient detail to replicate and are designed to isolate
the independent variable. Studies should monitor for adverse events
and should include long-term follow-up. Yoga’s effect on people with
AS requires investigation. IMPLICATIONS: Specific details regarding
type of yoga, dosage, poses, props, or modifications cannot be made
at this time due to study heterogeneity, study quality and the generally
poor descriptions of the interventions. Since aerobic capacity has
not yet been investigated for yoga with this population, the authors
suggest yoga be used to complement rather than replace aerobic
exercise for patients with OA or RA who are interested in pursuing
this form of exercise. KEYWORDS: Yoga, Complementary Therapy,
Alternative Therapy, Arthritis, Rheumatic, Ankylosing Spondylitis,
Osteoarthritis. FUNDING ACKNOWLEDGEMENTS: None.
WCPT 2007, Research Reports
Research Report Poster Display
21-08 Tuesday 5 June 10:30
VCEC Exhibit Hall B & C
COMPARISON OF MOBILIZATION AND MOBILIZATION-WITH-
MOVEMENT TO THERAPEUTIC EXERCISE IN THE TREATMENT
OF PRIMARY SHOULDER IMPINGEMENT: A PILOT CLINICAL
TRIAL
Kachingwe A, Phillips B, Sletten E, Plunkett S; California State
University, Northridge, Northridge, CA, USA
PURPOSE: To investigate the effectiveness of joint mobilization
and a mobilization-with-movement technique compared to a su-
pervised exercise program in the treatment of primary shoulder
impingement syndrome. RELEVANCE: Therapeutic exercise has
been shown to be effective in treating primary shoulder impinge-
ment, however very few studies have evaluated the outcomes
of therapeutic exercise combined with joint mobilizations and no
randomized controlled trials have utilized the mobilization-with-
movement approach. PARTICIPANTS: 33 subjects, 17 males, 16
females (mean age 46.4 years; range, 18-74 years) diagnosed with
primary shoulder impingement syndrome participated in this study.
METHODS: Subjects were randomly assigned to 1 of 4 groups:
supervised exercise only, supervised exercise with glenohumeral
mobilizations, supervised exercise with glenohumeral mobilization-
with-movement (MWM), and a control group. The three intervention
groups received physical therapy once a week for 6 weeks.
Outcome measures were assessed by a blinded evaluator at
the beginning of the study and after 6 weeks and included
24-hour pain, pain with the Neer and Hawkins-Kennedy (HK)
impingement tests, shoulder AROM, and shoulder function assessed
with the SPADI. ANALYSIS: Repeated measures ANOVAs with
Tukeys post hoc were conducted for each of the dependent
variables with the pretreatment and posttreatment scores as the
within subjects variable and the four groups as the between
subjects variable. Due to the wide variability between subjects
on pretreatment scores, a percentage of change score from
pretreatment to posttreatment was calculated for each dependent
variable. The difference scores and percentage of change scores
were analyzed using univariate analyses with Tukey’s post hoc.
RESULTS: The MWM group had the highest percentage of
change (improvement) from pre- to post-treatment on all three
pain measures (mean VAS 55.2%; Neer 66.5%; HK 60.2%),
followed by the mobilization group (VAS 44.2%; Neer 57.6%;
HK 52.1%), the exercise only group (VAS 20.8%; Neer 44.0%;
HK 39.5%), and the control group (VAS 14.4%; Neer 46.4%;
HK 11.2%). All three intervention groups had a higher percentage
of change than the control on the SPADI (exercise only, 61.6%;
mobilization, 56.7%; MWM, 55.5%; control, 34.2%). In regards
to flexion and scaption AROM, the MWM group had a higher
percentage of change (46.7% and 66.5%) than the exercise only
group (27.6% and 19.8%) and the control group (42.6% and 29.8%),
and the mobilization group had the lowest percentage of change
(−15.9% and 2.5%). A univariate analyses on the percentage of
change from pre to post-treatment for each dependent variable
found no statistically significant differences (p < 0.05) between the
four groups. CONCLUSIONS: The physical therapy interventions
of glenohumeral mobilizations and mobilization-with-movement in
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
Poster Displays, Tuesday 5 June
authors have any potential for material gain as a result of this
study.
ETHICS COMMITTEE: The committee for the Protection of Human
Subjects, California State University at Northridge, Northridge, CA,
USA
Research Report Poster Display
22-12 Tuesday 5 June 10:30
VCEC Exhibit Hall B & C
RELATIONSHIPS BETWEEN PARTICIPATION AND AUTONOMY
ASSESSMENT AND NEUROLOGICAL ASSESSMENT IN
PEOPLE WITH MULTIPLE SCLEROSIS
Pedro LCHL/FPCE−P , Pais Ribeiro JFPCE−P ; 1 Centro Hospitalar
Lisboa/Faculdade Psicologia Ciencias da Educação – U. Porto;
2 Faculdade Psicologia Ciencias Educação – U. Porto
PURPOSE: Multiple sclerosis is a chronic inflammatory disease of
the central nervous system. The prognosis in terms of development
of disability is unpredictable in the early stages of the disease,
but the risk of developing significant functional deficits is high.
Rehabilitation treatment often represents the only treatment available
to improve some functional symptoms. Recent evidence increasingly
suggests that rehabilitation improves activities, participation in social
activities as well as the quality of life in patients with multiple
sclerosis. RELEVANCE: The aim of the present study is to examine
the relationship between disability and participation / autonomy in
patients with multiple sclerosis. PARTICIPANTS:: 280 patients with
multiple sclerosis were recruited via their physician at a neurology
department of a central hospital in Lisbon. They were eligible for
inclusion in the study if they met the following criteria: diagnosis
according to relevant medical criteria, between 18 and 65 years,
being diagnosed at least 1 year ago, EDSS score under 7. The
mean age was 40 years (range 18- 65), 71.3% were women, 61.1%
were currently married, 63% active workers, mean school level of
12 years, and the mean score of EDSS is 2.8. METHODS: the
study was explorative and descritive the patients diagnosed with
definite MS in contact with Centro Hospitalar Lisboa Ward or a
consultant in neurology, betwwen 16 April 2005 and 30 Marc 2006.
ANALYSIS: Expanded Disability Status Scale (EDSS) is a method of
quantifying disability in multiple sclerosis. EDSS is an ordinal clinical
rating scale ranging from 0 (normal neurological examination) to 10
(death due to MS) in half-point increments. The questionnaire IPA
(Impact on Participation and Autonomy) measures several aspects
of participation and autonomy. The IPA can make a unique and
fundamental contribution since it examines autonomy as opposed
to dependency. The IPA addresses autonomy and participation in 5
domains: autonomy indoors, family role, autonomy outdoors, social
relations, and work and educational opportunities. The IPA is a
generic outcome measure and can be used in populations or with
individuals with a range of diagnoses. They are complementary
assessment tools: RESULTS: The mean score for the variables
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
(M=10.86; SD=4.26), Work and Educational Opportunities (M=15.56;
SD=6.74). The correlations between EDSS and IPA dimensions are
all statistically significant but moderate: Between EDSS and Auton-
omy Indoors (r = 0.54), between EDSS and Family Role (r = 0.59),
between EDSS and autonomy outdoors (r = 0.56), between EDSS
and social relations (r = 0.38), EDSS and Work and Educational
Opportunities (r = 0.52). CONCLUSIONS: In the present study we
inspected the correlation between EDSS and the five IPA domains.
Moderate correlations between the two instruments suggest that
they measure different and complementary aspects. IMPLICATIONS:
Information from the two instruments can give important information
for the rehabilitation programs KEYWORDS: participation/autonomy,
assessment,multiple sclerosis. FUNDING ACKNOWLEDGEMENTS:
None.
S423
Research Report Poster Display
22-16 Tuesday 5 June 10:30
VCEC Exhibit Hall B & C
HAND TRAINING WITH FINALIST AND NON-FINALIST
EXERCISE IN SUBJECTS WITH MULTIPLE SCEROSIS
Gatti R, Cervi P, Viganò L, Prati C, Panzeri C, Sirtori V;
Rehabilitation Department, San Raffaele Hospital – Milan, Italy
PURPOSE: Hand mobility impairment produces functional limitations
in subjects with multiple sclerosis. One of the goals of the rehabil-
itation treatment is to improve the manual functional activities. The
objective of this work is to compare a training using finalist exercises
with another one using non-finalist exercises for studying which
one is more effective. RELEVANCE: The use of the most effective
training for hands rehabilitation is important for the decrease of the
functional limitations in multiple sclerosis subjects. PARTICIPANTS:
The study included 20 subjects with multiple sclerosis, admitted
in the Neurorehabilitation Department of San Raffaele Hospital in
Milan (Italy) and presenting mild and moderate disability. METHODS:
Subjects have been divided in two groups for the training of the right
hand. One group (NFG) executed strength and dexterity training of
the fingers. The other group (FG) executed functional activities and
strength training using a biofeedback device. Each subject made 15
daily rehabilitation sessions. At the be beginning of the first session
and the day after the last session, the Nine Hope Peg Test (NHPT)
and the Jamar dynamometer test were administered to assess
respectively dexterity and strength of the hand. All the subjects
signed an informed consent form and the study was approved
by the Ethical Committee of San Raffaele Hospital. ANALYSIS:
Samples homogeneity has been analysed comparing the two groups
characteristics with the Mann-Whitney test. Efficacy of the treatments
has been analysed with the Wilcoxon test. It has been used the
Mann-Whitney test to compare the improvements of the two groups.
The improvements have been expressed as percentage of the initial
values. RESULTS: The two samples were homogeneous for the
considered variables. The comparison between the values obtained
before and after the period of treatment did not report significant
results. The mean increase of the treated hand was: 11.5+/−23.4%
Jamar, 12.4+/−23.1% NHPT in FG group and 8.3+/−15.2% Jamar
and 2.4+/−16.8% NHPT in NFG group. The mean increase of the
non-treated hand was 8.7+/−19.7% Jamar and 7.2+/−8.2% NHPT
in FG group and 6.3+/−9.5% Jamar and −0.7+/−13.2% NHPT in
NFG group. CONCLUSIONS: Both finalist and non-finalist exercises
can be use to train right hand of subjects with multiple sclerosis.
Only finalist exercises improve dexterity in the non trained hand.
IMPLICATIONS: The sample size studied and, as a consequence,
the power of the statistical tests are small. Should this data be
confirmed, other studies could analyse the efficacy of controlateral
hand training, using finalist exercises, for example in hemiplegic
patients. KEYWORDS: multiple sclerosis, hand, exercise. FUNDING
ACKNOWLEDGEMENTS: N.A.
ETHICS COMMITTEE: Ethical Committee San Raffaele Hospital
Research Report Poster Display
22-20 Tuesday 5 June 10:30
VCEC Exhibit Hall B & C
PARKINSON’S DISEASE: THE USE OF VISUAL CUES AND
IMAGING TO OVERCOME FREEZING AND IMPROVE GAIT
Mitchell J1 , Marple-Horvat D2 ; 1 School of Biological Sciences,
University of Wyoming, Laramie, USA and School of Allied Health
Professions (Physiotherapy), University of the West of England,
Bristol, UK; 2 Department of Physiology, University of Bristol, UK
and Institute for Biophysical and Clinical Research into Human
Movement, Manchester Metropolitan University, UK
PURPOSE: Freezing severely disturbs mobility in people with
Parkinson’s Disease (PD). Various cues have been used to improve
function, with limited success, few valid and reliable research reports
S424
being published currently. This study was designed to demonstrate
the value of actual visual cues and imaging of environmental features
in overcoming freezing and improving gait in PD. RELEVANCE:
There are few treatment interventions to overcome freezing in
patients with PD. Specific visual cues and imaging may be of use
as additional tools to increase patients’ function, independence and
quality-of-life. PARTICIPANTS: Seven volunteers (3 males and 4
females, age range: 53-70, mean age: 63 years) with PD, controlled
by bilateral subthalamic nucleus simulation (STN), were recruited.
None suffered from cardiovascular or musculoskeletal diseases, and
each subject reported freezing. Informed consent was given by each
subject and the study was approved by North Bristol NHS Trust,
Frenchay Research Ethics Committee, UK. METHODS: A repeated
measures experimental design was used, each subject acting as
his/her own control. A Charnwood Dynamics mpx30 (CODA) system
with infrared markers, placed on the shoe heels and toes, left lateral
maleolus, inferior femoral condyle, anterior superior iliac spine, and
head (anteriorly and posteriorly), was used to capture kinematic
data during locomotion in each subject. Two wooden doorframes,
each illuminated by LEDs at 10cm intervals, were positioned on a
walkway, 3m from the starting position and 1.5m apart. The ambient
lighting could be blocked with blinds. Subjects were required to
walk along the walkway, passing through both doorframes, stopping
and turning after the second doorway. Two trials of the following
conditions, in random order, with the STN on, then off, were
carried out: • fully-lit room, both doorways illuminated (baseline
condition) (LP). • darkened room, first doorway only illuminated (DA).
• darkened room, both doorways illuminated (visual cues) (DP).
• darkened room, first doorway illuminated, subjects asked to imagine
the second doorway before proceeding (imaging) (DI). ANALYSIS:
Captured kinematic data were computed and represented graphically.
Individual measurements for gait parameters (stride time, length,
velocity, cadence) were calculated for each subject. Data were
statistically analysed and compared (unpaired t-test). RESULTS:
There was no difference between STN-on and STN-off in time taken
to initiate walking. On walking, no subject froze in the LP or DP
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
and increase in cadence were demonstrated. The DA trials showed
the greatest deterioration in function, and imaging did not improve
gait. CONCLUSIONS: 1. STN did not ameliorate freezing in the
absence of visual cues. 2. Functional mobility improved with the
use of actual visual cues but not with imaging of environmental
features. IMPLICATIONS: The use of relevant, strategically placed
visual cues before negotiating obstacles may be of value in
helping patients with PD overcome freezing and improve functional
mobility. This study serves to inform evidence-based professional
practice. KEYWORDS: Parkinsons Disease, freezing, visual cues
and imaging. FUNDING ACKNOWLEDGEMENTS: Action Medical
Research, UK. CONTACT: mitchja@uwyo.edu
ETHICS COMMITTEE: North Bristol NHS Trust, Frenchay Research
Ethics Committee, UK
Research Report Poster Display
23-24 Tuesday 5 June 10:30
VCEC Exhibit Hall B & C
MEASUREMENT OF CEREBRAL ACTIVATION DURING A
WEIGHT-BEARING TASK OF A LOWER LIMB USING NEAR
INFRARED SPECTROSCOPY
Kaneko J1,2 , Takeda K1,2 , Shiomi T1,2 , Shimoda N1,2 ,
Maruyama H1 , Kato H1,2 ; 1 International University of Health and
Welfare,Japan; 2 CREST,Japan Science and Technology
PURPOSE: Recent studies using functional MRI have shown that
cerebral activation during voluntary upper limb movement is seen
predominantly on the contralateral hemisphere of the brain. However,
WCPT 2007, Research Reports
few studies have measured brain activation during lower limb
movement. The purpose of this study was therefore to localize
brain activation during a weight-bearing task of a lower limb using
near infrared spectroscopy (NIRS). RELEVANCE: Aim of this study
found available evidence on effectiveness of exercise therapy for a
weight-bearing task of a lower limb. PARTICIPANTS: The subjects
included 7 young individuals (4 females and 3 males, 25.7±6.0
years old) who were assigned to a weight-bearing task of a lower
limb. All the subjects gave informed consent to participate in this
study. METHODS: All the subjects were instructed to take a sitting
position in a chair and to press a lower limb against the floor for
8 seconds. A cycle of 25 s rest – 8 s task of a lower limb –
25 s rest – 8 s task of the other lower limb was repeated for 6
times. The brain activation during the task was measured using NIRS
(Hitachi ETG-4000) placing the probes on the scalp overlying both
the frontal and parietal cortices. ANALYSIS: Local brain activation
during the task was considered significant when the elevation
of oxy-hemoglobin was above 2SDs of the baseline. RESULTS:
We observed significant activation of bilateral frontal and parietal
cortices during the task of either lower limb in all the subjects.
CONCLUSIONS: This study showed that the unilateral weight-
bearing task of a lower limb induced bilateral activation of motor-
related cortical areas in healthy young subjects. The finding suggests
that lower limb movement requires bilateral brain activity in contrast
to unilateral upper limb movement which induces predominantly
contralateral brain activation. IMPLICATIONS: The findings of this
study is of considerable importance with regard to physical therapy for
stroke patients, and further studies should be performed on increased
numbers of subjects and patients, focusing on the long-term effects
of therapy. KEYWORDS: brain activation, near infrared spectroscopy,
lower limb movement. FUNDING ACKNOWLEDGEMENTS: This
research was partially supported by CREST,JST,and the Ministry
of Education, Science, Sports and Culture, Grant-in-Aid for Young
Scientists (B),18700466,2006. CONTACT: kaneko@iuhw.ac.jp
ETHICS COMMITTEE: All subjects gave informed to participation in
consent for before experiment
Research Report Poster Display
24-04 Tuesday 5 June 10:30
VCEC Exhibit Hall B & C
THE IMMEDIATE EXERCISE EFFECT OF VOLUNTARY
FACILITATION AT LOWER LIMB BY MIRROR THERAPY
Saito K1 , Sugawara K2 , Fukui Y3 , Yamamoto M3 , Abiko T3 ,
Fukumura K4 , Tomita Y4 , Maruyama H5 ; 1 Department of Physical
Therapy, Waseda College of Medical Arts and Sciences, 354-3,
Sinsyoujikuruwa, Ootaaza, Iwatuki-ku, Saitama, Saitama, 339-8555,
Japan; 2 Division of Physical Therapy, School of Rehabilitation,
Faculty of Health and Social Work, Kanagawa University of Human
Services, 1-10-1 Heisei-cho, Yokosuka, Kanagawa, 238-8522, Japan;
3 Department of Physical Therapy, Tokyo Metoropolitan Rehabilitation
Hospital, 2-14-4, Tsutsumi dori, Sumida, Tokyo, 131-0034, Japan;
4 Department of Biosciences and Informatics, Faculty of Science and
Technology, Keio University, 3-14-1, Hiyoshi, Kohoku-ku, Yokohama,
Kanagawa, 223-8522, Japan; 5 Department of Physical Therapy,
Faculty of Health Science, International University of Health and
Welfare, 2600-1, Kitakanemaru, Ootawara, Tochigi, 324-8501, Japan
PURPOSE: In mirror therapy, the patient recalls movement of the
paralyzed side by visual illusion using a mirror, and actively or
passively moves the paralyzed side. Its effectiveness in treatment
of phantom pain of an amputee and upper limb motor paralysis
after cerebral stroke has been reported. Although the therapy
has been applied to clinical cases, there has been no report
concerning the lower limbs. Further improvement of lower limb
function increases gait ability, and leads to improvement of ADL
and QOL. RELEVANCE: In this study, we performed mirror therapy
using a mirror in patients with cerebral stroke-associated hemiplegia
with difficulty in voluntary plantar dorsiflexion of the ankle joint, and
Poster Displays, Tuesday 5 June
investigated its effect on the improvement of voluntary facilitation
of the lower limb on the paralyzed side by measuring the time
required for plantar dorsiflexion and dorsal angle of the ankle joint.
PARTICIPANTS: The subjects were 6 patients with cerebral stroke-
associated hemiplegia(the mean time after onset: 130.6±90.5 days,
mean age: 54.3±3.8 years). The study was adequately explained
to all subjects, and performed after obtaining informed consent.
METHODS: In the mirror therapy, a mirror was placed so as to
reflect the leg on the non-paralyzed side when the patient looked
at the paralyzed leg in the mirror. The patient voluntarily performed
plantar dorsiflexion (foot tap) of the bilateral ankles for 20 minutes
while looking at the non-paralyzed leg in the mirror. The patient
also tapped the feet, wearing a foot switch on the sole, 20 times
as fast as he/she could without looking at the mirror before and
after foot tap with looking at the mirror. The mean and standard
deviation of the intervals of 20 foot taps at the maximum speed were
calculated using MATLAB (Math Work), and this mean value was
regarded as the maximum foot tap. An electric angle system was
attached to the paralyzed ankle joint, and the dorsiflexion angle was
measured. ANALYSIS: For statistical analysis, t-test was used, and
the significance level was set to lower than 5%. RESULTS: Regarding
the time required for plantar dorsiflexion, the maximum foot tap was
503.9±90.0 ms before mirror therapy and 477.9±92.2 ms after mirror
therapy, showing a significant difference The dorsiflexion angle of the
ankle joint was 15.8±0.2 degrees before and after mirror therapy. The
mean tap interval was shortened after mirror therapy, suggesting that
the repulsive muscular coordination involved in plantar dorsiflexion of
the ankle joint was improved. The dorsiflexion angle of the ankle joint
did not change after mirror therapy. CONCLUSIONS: The patients
may have concentrated on rapid switching of the plantar dorsiflexion,
and may have not paid attention to the angle. Input of visual illusion
by mirror therapy may have affected the motor image formation
on the paralyzed side. IMPLICATIONS: Physical Therapy can help
hemiplegia people by clarify the effect voluntary facilitation of lower
limbs with hemiplegia. KEYWORDS: Mirror Therapy, Hemiplegia,
Voluntary facilitation. FUNDING ACKNOWLEDGEMENTS: unfound.
CONTACT: k-saito@d2.dion.ne.jp
ETHICS COMMITTEE: Tokyo Metoropolitan Rehabilitation Hospital
ethics committee
Research Report Poster Display
24-08 Tuesday 5 June 10:30
VCEC Exhibit Hall B & C
VALIDATING THE RELATIONSHIP BETWEEN THE
SOMATOSENSORY EVOKED POTENTIALS AND RECOVERY OF
SENSATION AND MOTOR ABILITY IN STROKE PATIENTS
Shiratani T1 , Murakami T2 , Arai M3 , Shimizu M4 , Shimizu H2 ,
Yanagisawa K5 ; 1 Graduate student, Institute of Health Sciences,
Faculty of Medicine, Hiroshima University; 2 Division of Occupational
Therapy, Institute of Health Sciences, Faculty of Medicine,
Hiroshima University; 3 PNF Society of Japan; 4 Department
of Physical Therapy, Faculty of Health and Welfare, Prefectural
University of Hiroshima; 5 Department of Physical Therapy, Tokyo
Metropolitan University of Health Sciences
PURPOSE: Clinically, we have experienced how exercising the
involved extremity improves the compensation of sensory and motor
impairment by the sound side in stroke patients. Iwamura et al
(1994) indicated that the interhemispheric transfer of information
occurs at higher levels of hierarchical processing in each hemisphere.
If ipsilateral responses are transmitted through the contralateral
hemisphere, compensation by the sound side may be related to
the recovery of sensory and motor impairment in stroke patients.
The measurement of compensation by the sound side may be
measured by tibial somatosensory evoked potentials (SEPs), which is
an objective method of assessing the integrity of sensory and motor
pathways and areas of the central nervous system. The purpose of
this study was to find the relationships between the SEPs sound
S425
side parameters (latency and amplitude) and the clinical parameters
(kinetic sense of the great toe, sensory discrimination of the planta
pedis, Brunnstrom stage motor function test, and Barthel Index
activities of daily living test). RELEVANCE: If a relationship exists
between the SEPs sound side parameters and clinical parameters,
the improvement of ability on the sound side may be related
to the recovery of the sensory and motor impairment in stroke
patients. PARTICIPANTS: Fourteen patients (6 women, 8 men) with
hemiplegia (mean age: 73.9±10.4; range 28-57 years) participated.
Four cases had right hemisphere damage, and ten cases had left
hemisphere damage. METHODS: The study was approved by the
ethics review board of Hiroshima University, and all subjects were
given a written informed consent. Tibial nerve SEPs were recorded
after stimulation at the ankle, using a frequency of 2Hz, a pulse
duration of 0.2 ms, and enough current to produce minimal twitches
of the thenar muscles. A total of 500 responses were averaged twice
for the sound sides. The following parameters were determined for
both sides: P40 latency, N50 latency, P60 latency, N75 latency, P40-
N50 peak-to-peak amplitude, N50-P60 peak-to-peak amplitude, and
P60-N75 peak-to-peak amplitude. After measuring the SEPs, each
subject was evaluated for the clinical parameters. ANALYSIS: To
assess the correlation between the SEPs and clinical parameters,
we used a regression analysis (Pearson’s correlation coefficients).
RESULTS: The P60 latency of the sound side had a moderate
negative correlation with the Brunnstrom stage (−0.60; P = 0.03). The
P40-N50 amplitude of the sound side had a moderate correlation
with the discrimination sense of the affected side (0.68; P = 0.007).
CONCLUSIONS: The integrity of sensory and motor pathways and
areas of the central nervous system may improve through latency
shunting and amplitude enhancement. IMPLICATIONS: Exercise
of the involved side may promote the general recovery of the
sensory and motor impairment in stroke patients. KEYWORDS:
SEPs, CVA, compensation. FUNDING ACKNOWLEDGEMENTS:
Unfunded. CONTACT: M060982@hiroshima-u.ac.jp
ETHICS COMMITTEE: The study was approved by the ethics review
board of Hiroshima University.
Research Report Poster Display
25-20 Tuesday 5 June 10:30
VCEC Exhibit Hall B & C
ORTHOPEDIC INJURIES AND TREATMENT FOR MUSICIANS
Saito N1 , Akiyama S2 ; 1 International University of Health and
Welfare; 2 International University of Health and Welfare
PURPOSE: The purpose of this research is to investigate musician-
related injuries,treatments,and these therapeutic responses for
musicians in Japan. RELEVANCE: A lot of injuries suffered by
instrumental musicians are musculoskeletal disorders on their upper
extremities due to overuse or misuse. Therefore,they would receive
advices from experts like physical therapists to get rid of the
orthopedic problems.In Japan, however, there are few physical
therapists who have a chance to treat musician’s disorders at medical
institutions. Moreover, knowledge on some of the characteristics of
orthopedic abnormalities are not sufficiently spread among medical
staffs. PARTICIPANTS: Eighty-one professional musicians who had
agreed to the investigation participated in the research. METHODS:
Anonymous questionnaire were distributed to instrumental musicians
by mail. The survey content consisted of five items and fifteen in total
covering symptoms, treatments, and self managements. ANALYSIS:
Data were analyzed with descriptive statistics and displayed using
tables and graphs. RESULTS: Sixty-nine(85%) people had any
kinds of body disorder, and forty(58%) people had received
treatment until now. Among those 42 people, 83% of them were a
practitioner clinic. The most common method of treatment was quasi-
medical practice, such as massage, manipulative, acupuncture, and
chiropractic. Eighty percents of them improved after the massage,
the manipulative, and acupuncture. However, it was only 4% that
have recovered completely. Among such body parts as lips and
S426
teeth, the mandible, the cervix, the shoulder, the arm, the wrist, the
finger, and the low back, most commonly affected parts were found
out to be shoulders, a cervix, and low back. Increased frequency
of occurrence of symptoms and long-lasting conditions were main
reasons to start seeing a doctor. Word-of-mouth information was
the most reliable source to select a place to receive treatment.
CONCLUSIONS: It was shown that many of musicians in Japan also
have occupational chronic injuries. They often received quasi-medical
practices that would bring a prompt relief. When they took medical
treatment, their personal doctors prescribed more medications and
physical medicines, but much less rehabilitations. A lot of musicians
start treatment after the symptoms became worse, but few reached
a complete cure. IMPLICATIONS: Physical therapists in Japan
would be soon working to treat musician’s injuries. I think that
physical therapists will have becomes a chance to intervene for
them by advising the posture while playing, and methods to build up
muscles to treat the cause fundamentally. KEYWORDS: musician,
occupational injury, treatment. FUNDING ACKNOWLEDGEMENTS:
This research is not funded. CONTACT: norika@iuhw.ac.jp
Research Report Poster Display
26-24 Tuesday 5 June 10:30
VCEC Exhibit Hall B & C
WALKING ABILITY OF OLDER ADULTS IN THE COMMUNITY:
AN 8-YEAR FOLLOW-UP STUDY
Ito H1 , Sugiura M2 , Nishizawa S2 , Furuna T3 , Kinugasa T4 ,
Nagasaki H5 ; 1 Ibaraki Prefectural University of Health Sciences,
Ibaraki, Japan; 2 Tokyo Metropolitan Institute of Gerontology, Tokyo,
Japan; 3 Sapporo Medical University, Hokkaido, Japan; 4 University
of Tsukuba, Ibaraki, Japan; 5 Tohoku Bunka Gakuen University,
Miyagi, Japan
PURPOSE: The purpose of this study was to determine the
age-related, and particularly longitudinal, changes that occurred
in walking ability in older adults in a rural Japanese community.
RELEVANCE: Assessment of age-related changes in walking ability
is a prerequisite for physical therapy for the elderly, because our
previous studies have demonstrated that the baseline walking ability
can predict future functional status and the likelihood of falls,
institutionalization, and mortality. PARTICIPANTS: The cohort was
part of a group of 734 residents aged 65 and over from a rural
area of Akita Prefecture, Japan, who participated in the Medical
Science Research Activity of the Tokyo Metropolitan Institute of
Gerontology–Longitudinal Interdisciplinary Study on Aging (TMIG-
LISA). In our study, 380 elderly subjects (146 male, 234 female)
received walking ability measures in both the baseline research and
the follow-up research 8 years later. From the baseline data, the
subjects were divided into four groups: 65–69 years (211 subjects, 88
male, 123 female); 70–74 years (105 subjects, 37 male, 68 female);
75–79 years (49 subjects, 17 male, 32 female), and over 80 years
(15 subjects, 4 male, 11 female). METHODS: In the walking test,
participants walked a straight and level walkway 11 meters long
at their preferred speed, and then at maximum speed. Toward the
middle of the walkway (about 3 to 8 meters from the start), the
number of steps, along with the total distance and time taken, were
measured manually. Velocity, step length, cadence, and walk ratio
(step length/ cadence) were calculated. ANALYSIS: We calculated
the 8-year relative changes in the gait parameters measured at
baseline and at follow-up, where: relative longitudinal change rate =
(8-year follow-up measurement – baseline measurement) / baseline
measurement x 100. To detect longitudinal changes in walking ability,
ANOVA with age-group and gender serving as factors was applied
to the relative longitudinal change rate for each walking variable.
RESULTS: When we controlled for gender, significant (P < 0.001)
correlations were observed between the baseline and the 8-year
follow-up study (at preferred walking speed, for velocity r = 0.47, step
length r= 0.53, cadence r = 0.38, and walk ratio r = 0.52; at maximum
walking speed, for velocity r = 0.65, step length r = 0.62, cadence r
WCPT 2007, Research Reports
= 0.54, and walk ratio r = 0.52). Remarkable longitudinal changes
were found in maximum walking speed (male −14.11%, female
−15.08%) and step length (male −9.46%, female −10.16%) but not
in cadence. ANOVA revealed that the relative longitudinal change
in step length at both the preferred and maximum walking speeds
increased significantly with increasing age group. CONCLUSIONS:
Even after 8 years, subjects tended to maintain the individuality
of their walking traits, and this was particularly true for maximum
walking speed. There were remarkable relative longitudinal changes
in maximum walking speed and step length. In particular, step length
became shorter with advancing age. IMPLICATIONS: Step length
measurement is a good indicator of longitudinal changes in the
walking ability of the aging. KEYWORDS: logitudinal study, aging,
walking ability. FUNDING ACKNOWLEDGEMENTS: This study was
part of a research project,Tokyo Metropolitan Institute of Gerontology
Longitudinal Interdisciplinary Study on Aging(TMIG-LISA), and was
partially supported by the Ministry of Education, Culture, Sports,
Science and Technology Grant-in-Aid for Exploratory Research.
CONTACT: itoh@ipu.ac.jp
ETHICS COMMITTEE: This wor approved by the ethics committee
of Tokyo Metropolitan Institute of Gerontology
Research Report Poster Display
27-04 Tuesday 5 June 10:30
VCEC Exhibit Hall B & C
AGE-RELATED EFFECTS OF A COGNITIVE TASK ON VELOCITY
AND FRONTAL PLANE STABILITY DURING NARROW-BASE
WALKING
Kelly V1 , Schrager M2 , Price R1 , Ferrucci L2 , Shumway-Cook A1 ;
1 Department of Rehabilitation Medicine, University of Washington,
Seattle, Washington, USA; 2 Clinical Research Branch, National
Institute on Aging, Baltimore, Maryland, USA
PURPOSE: The purpose of this study was to examine age-related
effects of a cognitive task on velocity and frontal plane stability
during narrow-base walking. RELEVANCE: Age-related changes in
frontal plane stability during walking are associated with impaired
balance and increased fall risk in older adults. Clinically, tandem
and narrow-base walking are used to assess gait stability. Adding
a cognitive task to narrow-base walking (i.e. dual tasking) may
further challenge stability, allowing identification of early balance
deficits not detected under single task conditions. Assessment of
dual task walking performance may also reflect age-related changes
in functional mobility, because mobility during daily life often requires
the performance of concurrent cognitive or motor tasks (e.g. talking or
carrying objects). PARTICIPANTS: Thirty healthy adults participated,
categorized by age: <65, 65-74, 75 years, with 10 individuals per
group. METHODS: Participants were asked to walk at a comfortable
pace within a narrow path under both single and dual task conditions.
In the dual task condition, participants were asked to say the days
of the week backwards while walking within the narrow path. We
examined spatiotemporal characteristics of gait and center of mass
(CoM) parameters using a 3-dimensional VICON motion analysis
system (Lake Forest, CA). ANALYSIS: Visual 3D (Gaithersburg, MD)
was used to calculate the whole body CoM from a 13-segment
model with head, trunk, pelvis, and bilateral foot, shank, thigh,
upper arm, and forearm segments. Custom software was used to
calculate gait velocity, step length, step width, mediolateral (M-L) CoM
displacement, and M-L CoM peak velocity. Statistical comparisons
were performed using analysis of variance with 2 task conditions
(single v. dual) and 3 age groups. Post hoc analyses were conducted
for significant (p < 0.05) main effects. RESULTS: The percent of
accurate steps did not differ significantly between groups and was not
affected by performance of a secondary task. Both age (p = 0.001)
and the performance of a secondary task (p = 0.000) decreased gait
velocity, with no interaction effect. Similarly, both age (p = 0.000) and a
secondary task (p = 0.011) decreased step length, with no interaction
effect. There was no effect of age or a secondary task on step
Poster Displays, Tuesday 5 June
width. Participants 75 years had greater M-L CoM displacement
than those <65 years (p = 0.03), but dual task performance had no
effect on this variable. Participants 75 years also had greater M-L
CoM peak velocity than those <65 years (p = 0.001), but a secondary
task did not effect M-L CoM peak velocity. CONCLUSIONS: Age-
related changes in both velocity and frontal plane stability are
evident during narrow-base walking. Performance of a secondary
task resulted in decreased gait velocity and step length for all age
groups. Contrary to our hypothesis, the addition of a secondary
task did not affect M-L CoM control in these healthy older adults.
IMPLICATIONS: Screening tools that are sensitive to fall risk are
important to identify older adults who may benefit from balance and
gait rehabilitation. Further research is needed to determine if narrow-
base walking with and without a secondary task can be used to
identify older adults with pre-clinical instability or an increased risk
for falls. KEYWORDS: Gait, Center of Mass, Dual Task. FUNDING
ACKNOWLEDGEMENTS: This research was funded by the National
Institute on Aging. CONTACT: vekelly@u.washington.edu
ETHICS COMMITTEE: An independent institutional review board
approved the protocol for the Baltimore Longitudinal Study on Aging.
Research Report Poster Display
27-08 Tuesday 5 June 10:30
VCEC Exhibit Hall B & C
EXTENDING PHYSIOTHERAPY ROLES IN CASE-FINDING AND
SPECIALIST INTERVENTION IN OLDER PEOPLE’S INPATIENT
SERVICES: EVALUATION OF AN INNOVATIVE MODEL
Buttery A, Langley J, Hopper A, Harari D; Guy’s and St Thomas’
NHS Foundation Trust London, UK
PURPOSE: We evaluated a novel service for older people admitted
to a large teaching hospital in London, UK. The Older Persons
Assessment and Liaison Team(OPAL), consisting of a specialist
physiotherapist, nurse, and half-time geriatrician, screen all general
medical patients aged 70+ within 24 hours of admission using a
Comprehensive Geriatric Assessment(CGA) tool to identify patient’s
with moderate-to-high clinical risk. Depending on clinical need,
actions include: rapid transfer to older persons specialist unit, case
management on general medicine wards and referral to specialist
clinics (e.g. falls, continence, day hospital). The service aims to
improve patient pathways and reduce length of stay(LOS) for older
medical inpatients through early, targeted intervention. RELEVANCE:
Older people, often with chronic conditions and disabilities, have
high levels of use of Emergency Departments(EDs) and subsequent
hospital admission. With admission figures predicted to rise, national
initiatives to decrease hospital admissions and LOS for older
people are at the forefront of government policy. One possible
method of achieving this is case screening. Models of care for
screening older persons presenting to EDs and those admitted to
hospital, have shown benefits in some countries. We recognised
that physiotherapists, with effective case-management skills, could
provide leadership in such integrated models of inter-professional
working. PARTICIPANTS: Women and men 70 years admitted to
general medical wards at St Thomas Hospital, London. METHODS:
We carried out a prospective ‘before-OPAL’ (August 2004) and
‘after-OPAL’ (August 2005) evaluation on 50 consecutively admitted
patients. Participants were categorised as medium-to-high risk using
the CGA tool performed by OPAL staff. A blinded independent
evaluator retrieved and compared data from hospital notes and
service data. No ethical approval was required for this service
evaluation. ANALYSIS: Baseline characteristics of the 2 groups were
compared. Proportions of prevalence of problems (ADL dependency,
falls history, mobility impairment, delirium and other domains of the
CGA tool) were compared. We compared the proportions of problems
identified and addressed by OPAL intervention, to ‘before-OPAL’. The
proportion of patients referred to inpatient specialist rehabilitation
units and outpatient clinics were compared. A ‘before’ and ‘after’
bivariate analysis was undertaken using a Mann-Whitney U test
S427
for LOS and mean number of days before transfer to specialist
elderly care unit(ECU). We excluded patients with LOS>50 days
for analysis. RESULTS: Mean ages of the groups (before-OPAL
80.4±6.6 years, after-OPAL 83.4±8.0 years) were comparable. A
significant difference was found in the mean LOS (before-OPAL
13.1±11.7 days, after-OPAL 9.0±7.7 days p < 0.018). Mean delay
for transfer to the ECU before-OPAL was 9.0(±8.2)days compared to
2.4(±1.8)days after-OPAL(p < 0.0001). Differences in the prevalence
of problems identified and addressed by OPAL were evident in most
domains including falls(before 0/27, after 21/23), functional depen-
dency (before 12/39, after 22/25)and sensory impairments(before
2/30, after 32/33). CONCLUSIONS: CGA screening and specialist
intervention including ward-based case-management and rapid care
pathways implementation, improve quality of patient care and
general hospital performance. IMPLICATIONS: This innovative case-
screening service demonstrates physiotherapists’ ability to pro-
actively manage older peoples care. Screening systems enabling
faster access for older people to specialist interventions including
physiotherapy should be a priority for older people’s research.
KEYWORDS: older persons, screening, emerging roles. FUNDING
ACKNOWLEDGEMENTS: No funding was received. CONTACT:
amanda.buttery@gstt.nhs.uk
Research Report Poster Display
28-16 Tuesday 5 June 10:30
VCEC Exhibit Hall B & C
THE CONSIDERATION OF FALLING FACTOR FOR THE
ELDERLY -AN ELECTROMYOGRAPHIC STUDY-
Furukawa K1 , Shimino T2 , Yaguchi J3 ; 1 Seijoh Rehabilitation
Academy; 2 Seijoh University; 3 SAKAI Medical Co., Ltd
PURPOSE: The clarification for mechanism of elderly physical
functional erosion has been addressed in various disciplines. The
factors that lead to this erosion were muscle fiber atrophy and
loss. These alterations may result in sluggish movement and muscle
weakness, thus will be forecast to cause elderly falling. The aim of
this study is to manifest the physiological changes for capital lower
extremity muscles with advancing age. RELEVANCE: If current study
will be able to suggest these typical changes with aging, it may
assist to prescribe training program for the elderly. PARTICIPANTS:
Sixty-eight healthy women aged 20-80 were participated. They had
no history of any trauma and disorder of bilateral legs. They were
given written informed consent prior to participation to this study.
METHODS: They resisted against maximum manual resistance to
their knee extension – flexion and ankle dorsi – plantar flexion for 5
seconds. Surface EMG signal from vastus lateralis, semitendinosus,
tibialis anterior and medial gastrocnemius of each task were
recorded. All experimental procedures was approved by research
ethics committee of author’s academy. ANALYSIS: For 5 seconds
detected signal, median frequency values (MDF) of each subjective
muscle were calculated by Fast Fourier Transform algorithm using
intermediate 3 seconds signal, and analyzed correlationship between
MDF and age. Significant level was set at p < 0.05. RESULTS: The
MDF of two thigh muscles showed no significant difference with
advancing age. MDF of tibiaris anterior decreased significantly with
aging (p < 0.01), whereas that of medial gastrocnemius increased
(p < 0.05). CONCLUSIONS: The results in current study showed
that these two leg muscles had different alteration of fiber type
composition with advancing age. Generally, tibiaris anterior is
activated through gait cycle, and enhanced activations are observed
at heel strike in initial stance phase and at initial swing phase.
On the other hand, gastrocnemius is activated from midstance to
the end of stance phase, and show highly activations at push off
for acceleration. Hence, these muscles are required quick reaction
to change gait cycle, and this conflicting fiber type alterations
may be affected the timing of toe clearance. It is known that the
falling of elderly was often due to “stumble”, not for “knee break”.
In addition to this phenomenon, elderly ankle flexibility diminish
S428
progressively with aging. Therefore, if executing training program
for the elderly, we should give much thought to these important
considerations. IMPLICATIONS: If this conflicting alterlation will be
improved, it will reduce elderly falling. KEYWORDS: elderly, fall,
sEMG. FUNDING ACKNOWLEDGEMENTS: The author wishes to
thank all participants and my colleagues.
ETHICS COMMITTEE: Research ethics committee of Seijoh
Rehabilitation Academy
Research Report Poster Display
28-20 Tuesday 5 June 10:30
VCEC Exhibit Hall B & C
DEVELOPMENT OF AN EMERGENCY DEPARTMENT SCREEN
TO IDENTIFY OLDER ADULTS AT RISK FOR FALLS
Newton R1 , Gentile N2 , Klima D3 , Lidicker J4 ; 1 Department
of Physical Therapy, Temple University, Philadelphia, PA, USA;
2 Department of Medicine, Temple University, Philadelphia, PA, USA;
3 Department of Physical Therapy, University of Maryland-Eastern
Shore, MD,; 4 Center for Statistical and Information Science, College
of Health Professions, Temple University, Philadelphia PA, USA
PURPOSE: To develop and validate an ED fall risk screen to
predict future falls. RELEVANCE: A growing segment of the global
population is over 60 years. A major health concern is falling.
Elders entering the Emergency Department (ED) for a myriad of
reasons often return home to potential declines in health. The ED
is an opportune time to determine their risk for falls and provide
referral to physiotherapy. PARTICIPANTS: Adults over 60 years
were recruited from: ED (n=51), university faculty, senior housing
and assisted living facilities (n=123). METHODS: Based on our
research and evidenced-based studies, a Fall Risk Screen was
developed that consisted of 9 questions addressing major fall risk
factors and a Six-Item Mental Status Screen. Fifty-one ED clients
received the screen and a 6-week follow-up survey. Based on their
results, the Fall Risk Screen was modified to include: Activities
Specific Balance Confidence Scale (ABC); Multi-Directional Reach
Test (MDRT), Timed Up and Go (TUG), Stance Tests (ST), 20
foot walk test and Gait Stability Ratio (GSR). The modified version
was tested on 123 community-based independent walkers, including
those using a cane or walker (AD), and who were not terminally
ill. Of those, 107 received a score >3 on the Six Item Mental Status
Screen and subsequently received a 3-month follow-up questionnaire
assessing falls and fear of falling (n=102, mean age = 79.8+10.8
yrs). The study was approved by the University’s Institutional Review
Board. ANALYSIS: Data were entered into SPSS 14.0 Statistical
Package. Descriptive statistics were used to characterize the sample,
and logistic Regression to determine which variables predicted falls
at 3 months. RESULTS: At baseline, the majority of subjects self-
reported no problems with balance or walking, and 56% used
an AD. Most common co-morbidities were poor vision (93%) and
arthritis (66%). Scores on assessments were: MDRT-Forward 7.8+3
in; MDRT-Backward 3.8+2.6in; MDRT-Right 5.4+2.8in; MDRT-Left
5.3+2.6 in; TUG 16.4 +8.3 sec; SLS-left leg (SLS-L) 7.1 +9.5 sec;
GSR 2.2+0.8 m/sec. Mean ABC score was 67+24. Twenty-three
falls were reported one month prior to baseline assessment and
21 falls were reported at 3-month follow-up. Logistic regression
analysis revealed a significant interaction between AD and past
history of falls (p = 0.021) where those elders reporting a past history
of falls and also used an assistive device had a 60% likelihood
of falling at 3 months (other combinations were all less than 22%
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
WCPT 2007, Research Reports
or Rehabilitation services for additional testing and provision of fall
prevention strategies is warranted. KEYWORDS: older adults, fall
risk screen, falls. FUNDING ACKNOWLEDGEMENTS: College of
Health Professions, Temple Unviersity, Philadelphia PA. CONTACT:
roberta.newton@temple.edu
ETHICS COMMITTEE: Temple University Institutional Review Board
Research Report Poster Display
29-24 Tuesday 5 June 10:30
VCEC Exhibit Hall B & C
VALIDITY OF A MODIFIED WALK TEST FOR CHILDREN WITH
DISABILITIES
Goin J, Kerr E, Wedgworth P, Effgen S; Department of
Rehabilitation Sciences, University of Kentucky, Lexington, KY, USA
PURPOSE: The purpose of this study was to determine if a more
convenient, 3 minute walk test (3MWT) would yield similar results
to the commonly used 6 minute walk test (6MWT) in children
with disabilities. RELEVANCE: Physical therapists require accurate,
timely measures of physical performance. Determining if the 3MWT
yields similar results to the longer 6MWT would allow therapists to
use a test requiring less testing time; less exertion and sustained
participation from the child; and increased examination efficiency.
PARTICIPANTS: Twenty-two children (11 males, 11 females) with
varied disabilities (e.g. cerebral palsy, Down syndrome, mental
retardation), ages 6 to 20 years (X= 12.39 years, SD= 4), volunteered
for this study. Each child had to meet established inclusion/exclusion
criteria to participate. METHODS: The 6MWT protocol of the
American Thoracic Society was followed for data collection. The
distance the child walked in the first 3 minutes of the 6MWT was
also recorded. ANALYSIS: Data was analyzed using the paired
sample t-test comparing the distance walked the first 3 minutes to
the distance walked the last 3 minutes of the 6MWT. The Pearson
correlation was used to determine the correlation between age of
the child and distance walked. RESULTS: The paired sample t-test
indicated there was no significant difference between the distance
walked in the first 3 minutes compared to the distance walked
the last 3 minutes of the 6MWT (t= 1.241). The mean difference
between the distance walked the first 3 minutes (654 ft./ 196.2m)
and the last 3 minutes (628 ft./188.4m) was only 27 ft. (7.8m).
Eleven of the participants decreased their distance walked during
the last 3 minutes. The Pearson correlation coefficient was used to
determine differences in distances walked based on the age of the
child. There was a significant difference for both the first 3 minutes
(r = 0.623, p = 0.01) and last three minutes walked (r = 0.594, p = 0.01)
compared with the age of the child. CONCLUSIONS: Based on our
data, the 3MWT is a valid substitution for the 6MWT for children
with disabilities. There was a correlation between the age of the
child and distance walked, with older children walking further in
both the first and last 3 minutes. Future tests with more subjects
would increase the validity of the findings where the analyses
can be broken down by age and diagnosis of the participants.
IMPLICATIONS: Based on the statistical analysis of the data, a
3MWT would be an appropriate modification of the 6MWT for some
children with disabilities. A shorter test accommodates those who
fatigue easily, have low endurance, and have low tolerance for walking
6 minutes consistently. KEYWORDS: Pediatrics, Gait, Measurement.
FUNDING ACKNOWLEDGEMENTS: This study was not funded.
ETHICS COMMITTEE: Medical Institutional Review Board, Office of
Research Integrity, University of Kentucky
Poster Displays, Tuesday 5 June
Research Report Poster Display
30-04 Tuesday 5 June 10:30
VCEC Exhibit Hall B & C
ENERGY EXPENDITURE INDEX AND HEART RATE DURING
AMBULATION OF CHILDREN WITH CEREBRAL PALSY, ACTIVE
AND SEDENTARY PEERS
Fleming Walsh S1,2 , Karapondo D1 , Bryanna L1 , Brittany P1 ;
1 The University of Findlay; 2 Rocky Mountain University of Health
Professions
PURPOSE: This study examines the differences in the Energy
Expenditure Index (EEI) and heart rate in children who are active
or sedentary as well as in children with cerebral palsy (CP).
RELEVANCE: All children, with and without disabilities, are at an
increased risk for inactivity and decreased fitness. Many health
care professionals, including physical therapists are needed to lead
and develop health promotion plans for children. PARTICIPANTS:
Ten children diagnosed with varying degrees of CP and scored on
the Gross Motor Function Classification System I-III, (GMFCS), ten
children defined as physically active, and ten children defined as
sedentary, between the age of 4-10 years, participated in this study.
Active and sedentary groups were defined using the Modifiable Activ-
ity Questionnaire for Adolescents and their participation in athletics.
METHODS: The walking protocol consisted of 3 bouts of walking
for 3 minutes. Data gathered during the walking protocol included:
resting heart rate, (HRrest) heart rate maximum during ambulation
(HRmax), time for heart rate to recover to resting(HRrecover), and
distance walked (D). EEI was calculated using the equation EEI =
HRmax – HRrest/(D/3.0 minutes). ANALYSIS: MANOVA testing was
used to analyze the differences between groups and post-hoc tests
were performed using Games-Howell analysis. RESULTS: MANOVA
demonstrated significant between group differences with respect to
HRmax, D, EEI and HRrecover. No between group difference was
found for HRrest. Post-hoc testing revealed children with CP had
higher HRmax and EEI and decreased D versus active children
(p = 0.048, p = 0.019, and p = 0.001, respectively). Children with CP
also displayed increased EEI (p = 0.039) and D (p = 0.007)when
compared to children who were sedentary. In addition, children
who were sedentary had significantly higher EEI compared to
children who were active (p = 0.002). Post-hoc testing was unable
to determine the nature of the omnibus difference for HRrecover.
CONCLUSIONS: This study demonstrates children participating in
significant amounts of physical activity expend less energy during
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
even though their resting heart rate did not show a significant
difference. This increased EEI was due to an increased HRmax
and decreased D ambulated. Limitations of this study include:
limited sample size, lack of randomization, environmental conditions,
anxiety of participants, and possible unreliability of the heart rate
monitors. Suggestions for future study include:increasing the sample
size; attempting to quantify how much physical activity a child
without disabilities needs to engage in for optimum health benefits;
quantifying energy expended during other typical play activities
for children with cerebral palsy; and quantifying how this energy
expenditure changes as the level of disability varies in children with
cerebral palsy. IMPLICATIONS: There appear to be many possible
causes for increased energy expenditure among children with CP
during ambulation. Physical therapists should consider this increased
energy demand on children with CP when utilizing ambulatory
activities and other activities of daily living during treatment, such
that attention is given to allow for adequate rest and recovery.
KEYWORDS: Energy expenditure; Cerebral palsy; Health promotion.
FUNDING ACKNOWLEDGEMENTS: This work was funded in part
by a grant from Special Olympics and the generosity of The University
of Findlay. CONTACT: walsh@findlay.edu
ETHICS COMMITTEE: The University of Findlay IRB; Rocky
Mountain University of Health Professions IRB
S429
Research Report Poster Display
30-08 Tuesday 5 June 10:30
VCEC Exhibit Hall B & C
RELATIONSHIP BETWEEN MUSCLE THICKNESS AND MOTOR
FUNCTION IN CHILDREN WITH MODERATE TO SEVERE
CEREBRAL PALSY
Ohata K1 , Tsuboyama T1 , Haruta T2 , Ichihashi N1 , Nakamura T3 ;
1 School of Health Sciences, Kyoto University; 2 Mukougaoka
yougogakkou, school for physically handicapped children;
3 Graduate school of medicine, Kyoto University
PURPOSE: The muscle weakness of people with cerebral palsy
(CP) affects their motor function. However, it is not clear whether
muscle volume is associated with the motor function or activities
evaluated by validated assessment tools such as the Gross Motor
Function Measurement (GMFM) or the Pediatric Evaluation of
Disability Inventory (PEDI) in children with CP. The purpose of
this investigation was to examine whether muscle thickness (MTH)
has a relationship with GMFM and PEDI scores. RELEVANCE:
This study may clarify the value of MTH as a quantitative muscle
evaluation for children with cerebral palsy. PARTICIPANTS: Thirty
six children with moderate to severe CP (16 females and 20
males; mean age 11.9y; range 6y to 18y, the Gross Motor Function
Classification System level II to V) participated in this study.
METHODS: MTH was measured by B-mode ultrasound images of
the quadriceps muscle on both thighs. The muscle thicknesses were
normalized according to their body weights. The motor function and
the function of activity of daily life were evaluated by GMFM-66
and PEDI mobility scores, respectively. ANALYSIS: The correlation
between the weight-normalized MTH and GMFM-66 or PEDI mobility
scores was examined by Pearson correlation coefficient. Significant
levels were set at P < 0.05. RESULTS: The results showed that
the weight-normalized MTH is significantly related to the GMFM-
66 (r=.60, p < 0.001) and PEDI mobility scores (r=.59, p < 0.001).
CONCLUSIONS: The weight-normalized MTH reflects the motor
function in children with CP. It seems a useful method of quantitative
muscle evaluation. IMPLICATIONS: The results of this study provide
a basis for the study of relationship muscle atrophy and motor
function in children with CP. KEYWORDS: Muscle thickness, Motor
function, ADL status. FUNDING ACKNOWLEDGEMENTS: this study
was unfunded. CONTACT: oohata@hs.med.kyoto-u.ac.jp
ETHICS COMMITTEE: Kyoto University Graduate School and
Faculty of Medicine Ethics Committee.
Research Report Poster Display
31-12 Tuesday 5 June 10:30
VCEC Exhibit Hall B & C
OBSERVATIONAL LEARNING OF A NOVEL MOTOR SKILL IN
CHILDREN WITH COGNITIVE DELAYS: A SINGLE-SUBJECT
DESIGN
Benner S1 , Long T2 , Moerchen V3 ; 1 Department of Physical
Therapy and Rehabilitation Science, University of Maryland
School of Medicine, Baltimore, MD, USA; 2 Center for Child and
Human Develoment, Georgetown University, Washington, DC, USA;
3 Human Movement Science, University of Wisconsin-Milwaukee,
Milwaukee, WI, USA
PURPOSE: The use of peers as models for teaching new skills to
children is a common practice for physical therapists and educators.
The effectiveness of using peer models for teaching new gross motor
tasks to children who have cognitive impairments has not been
previously examined. The purpose of this study was to assess the
effect of peer modeling on motor skill acquisition of a novel task
in two children with cognitive impairments, as well as in a child
who is developing typically. RELEVANCE: Families, educators, and
therapists often expect children with cognitive impairments to benefit
from peer modeling when included in the general education setting.
This study provides preliminary evidence on the effectiveness of peer
S430
modeling in an inclusive educational setting for learning and retaining
a novel motor skill. PARTICIPANTS: Three children between the
ages of 5-7 years were chosen to be subjects. Two of the three
subjects had cognitive impairments that placed them in the range of
mild mental retardation. One of the three subjects was developing
typically. A 5-year-old peer model was selected to demonstrate
the novel motor task. METHODS: A modified ABA single-subject
design was used to track the acquisition and retention of the skill
in two children with cognitive impairment and one child with typical
development. Self-propulsion of a novel riding toy was selected
as a novel motor task. ANALYSIS: Graphical analysis of baseline,
intervention, and retention phases was used to evaluate the rate of
change in each subject’s performance. RESULTS: After observing
the peer model, all subjects acquired and retained the ability to propel
the novel riding toy. The subject with mild cognitive impairment had
the most variability of performance during the intervention phase, but
also had inconsistent attention to the modeled task. The subject with
moderate cognitive impairment, in contrast, had the highest rate of
skill acquisition during peer modeling. CONCLUSIONS: The findings
support the efficacy of peer modeling as a method of teaching
motor skills to children with cognitive impairments. IQ alone did not
affect the rate of acquisition and retention of the motor skill in this
learning context. Maintaining attention to the model may be critical
to learning in a peer-instructed environment. Adult support during
peer modeling may be required for children with attentional deficits
to benefit from observational learning. IMPLICATIONS: This study
provides preliminary evidence that children with cognitive delays can
learn and retain a new motor task by observing the performance of a
peer model in a structured, adult directed environment. This approach
may prove to be an effective practice model that provides motivation
and socialization in learning. Use of observational learning may allow
more efficient use of therapist time and is and is more consistant
with the goals for educational inclusion. Further study, including
a larger group of subjects and comparison to alternative methods
of instruction, will add to the evidence pertaining to the ability of
children with cognitive impairments to learn from peer modeling.
The role of attention in motor learning through peer modeling
also warrants further examination. KEYWORDS: Observational
learning, Cognition, Pediatrics. FUNDING ACKNOWLEDGEMENTS:
Unfunded. CONTACT: sbenner@fredco-md.net
ETHICS COMMITTEE: Internal Review Board of the Human
Research Protection Office at University of Maryland Baltimore
School of Medicine.
Research Report Poster Display
31-16 Tuesday 5 June 10:30
VCEC Exhibit Hall B & C
MAGNETOENCEPHALOGRAPHIC STUDY OF HYPERALGESIA
INDUCED BY CAPSAICIN
Kawamura H1 , Ushida T2 , Tani T2 , Tsurumi T1 , Shimizu M3 ;
1 Division of Physical Therapy, School of Rehabilitation, Faculty
of Health and Social Work, Kanagawa University of Human
Services, 1-10-1 Heisei-cho, Yokosuka, Kanagawa 238-8522,
Japan; 2 Department of Orthopaedics, Kochi Medical School,
Kohasu, Nankoku, Kochi 783-8505, Japan; 3 Department of Physical
Therapy, Faculty of Health and Welfare, Prefectural University of
Hiroshima, 1-1 Gakuen-cho, Mihara, Hiroshima 723-0053, Japan
PURPOSE: The purpose of this study was to investigate brain
responses to the application of capsaicin cream and slight electrical
stimulation on the dorsal side of a hyperalgesic forearm with the
use of magnetoencephalography (MEG). RELEVANCE: We hope to
improve the evaluation of pain in physical therapy. PARTICIPANTS:
Eight normal adult volunteers, who ranged in age from 25 to 45 years
(31.4±6.6), were our subjects. All the subjects gave their informed
consent. The Hiroshima University Ethics Committee approved the
study. METHODS: The electric stimulation was given at the site
of the capsaicin application using a stimulus pulse delivered at an
WCPT 2007, Research Reports
interval of 2Hz at rest, awake with eyes closed, and in a sitting
position. The MEG recordings were performed using a 204-channel
wholehead magnetometer. The MEG was recorded 100 times for 50
seconds each and then averaged. The moment (Q) of the equivalent
current dipoles (ECDs), peak latency, and the estimated sites of
the ECDs of the right cerebral hemisphere were estimated by using
MEG. ANALYSIS: The MEG was measured a total of three times,
once prior to and two times after an application of 1% capsaicin
cream to the dorsal side of the left forearm. The quantity of pain
incurred by the capsaicin cream application was recorded with the
Visual Analogue Scale (VAS). We chose to measure the MEG when
the VAS was reported to be 2 and 4. The sites of the ECDs were
identified through overlays of the axes that fit between the axes of
the coordinate system derived from MEG and magnetic resonance
imaging recordings. RESULTS: The Q tended to increase linearly for
2 and 4 on the VAS scale after the capsaicin cream was applied. The
Q of 4 on the VAS scale especially increased significantly. There were
two types of changes in the estimated sites of ECDs coinciding with
the changes from prior to 2 and 4 on the VAS. One was the changing
from the primary somatosensory cortex in prior to the supplementary
motor area (SMA) in 2 and 4 on the VAS. The other was the SMA
estimated sites of ECDs coinciding with the changes from prior to
2 and 4 on the VAS. CONCLUSIONS: The Q tended to increase
linearly for 2 and 4 on the VAS scale after the capsaicin cream was
applied. There were two types of changes in the estimated sites of
ECDs coinciding with changes from prior to 2 and 4 on the VAS.
The changes of brain responses for the distal electric stimulation
were identified as the estimated changes of Q and ECDs sites. The
MEG data from the distal constant electric current stimulation to the
forearm was mostly likely detected in the brain through the influence
of sensitization of the dorsal horn of the spinal cord. IMPLICATIONS:
We believe that quantities of pain can be evaluated objectively on the
basis of the Q and ECDs sites for evaluation of pain in physical ther-
apy. KEYWORDS: magnetoencephalography (MEG), hyperalgesia,
capsaicin. FUNDING ACKNOWLEDGEMENTS: Unfunded.
ETHICS COMMITTEE: The Hiroshima University Ethics Committee
Research Report Poster Display
31-20 Tuesday 5 June 10:30
VCEC Exhibit Hall B & C
EFFECTS OF MECHANICAL NOCICEPTION ON HEART RATE
VARIABILITY AND SKIN CONDUCTANCE IN HEALTHY HUMAN
PARTICIPANTS
Shay B, Morrison G; Dept. of Physical Therapy, University of
Manitoba, Winnipeg, Canada
PURPOSE: Objective measurement of pain has been part of
the focus of pain research. It has been suggested that the
autonomic nervous system (ANS) may play a significant role in
pain physiology. There is little clinical research with respect to
interventions for pain and their effect on the ANS. Skin conductance
(SC) and heart rate variability (HRV) have been proposed as
accurate measures of autonomic activity. HRV as the summation
of sympathetic/parasympathetic effects at the sinus node provides
information towards dominant autonomic tones within the individual.
This study uses SC and HRV to measure ANS responses to
mechanical nociception and, provides further understanding in the
relationship between nociception and the ANS. RELEVANCE: Skin
conductance (sudomotor activation) has been used to indicate SNS
activity in pain/stress states. Using HRV as a quantitative indicator
for pain is a unique approach that can further our understanding
of pain and the autonomic nervous system. PARTICIPANTS: Ten
healthy males aged 21-36 years were recruited from the University
of Manitoba staff and students. Participants were excluded if they
reported any painful conditions, tobacco, alcohol, drug or medication
use. METHODS: The Polar S810i heart rate monitor was used to
collect HRV data. SC was monitored via skin electrodes on the 2nd
and 5th phalanges bilaterally. Mechanical nociception (assessed by
Poster Displays, Tuesday 5 June
verbal pain rating scales) was created by pinching the skin of the
lateral forearm with a small battery clip. Participants were positioned
supine in a temperature controlled, soundproof cubicle. After heart
rates (HR) reached a steady baseline, control HR were collected,
followed by clip application for 5 minutes and then continuous
monitoring for an additional 40 minutes recovery time. ANALYSIS:
R-R intervals (ms) were downloaded via infrared interface to a
PC into Polar Precision software where data was divided into
five minute bins for comparison. Standard deviation values were
computed for each bin to represent the R-R interval variability.
HRV was normalized to percent control at baseline. SC values
were exported to SigmaPlot software and divided into five minute
bins consistent with HRV data. Mean values were computed for
each bin. Kruskal-Wallis tests for repeated measures were used
to determine differences between control, nociceptive and recov-
ery conditions. Differences (p > 0.05) were considered significant.
RESULTS: Skin conductance measured ipsilateral to the noxious
stimulus was significantly increased during the clip application
and for 30 minutes after the clip was removed. Contralateral SC
was increased significantly during the clip application but was not
different within 5 minutes of clip removal. HRV either increased or
decreased between the conditions. CONCLUSIONS: Increased skin
conductance indicating activation of the SNS appears related to
mechanical nociception. R-R interval variability increased/decreased,
suggesting that the ANS is perturbed in response to mechanical
nociception. Further studies need to be done to determine the
specific variables related to these responses. IMPLICATIONS:
To date, there are no documented studies using HRV as an
objective indication of pain. This experiment provides important
information on autonomic pertubations in response to nociception.
The results may provide clinicians with objective means to evaluate
pain and the response to treatment intervention. KEYWORDS:
heart rate variability, sympathetic nervous system, pain. FUNDING
ACKNOWLEDGEMENTS: Manitoba Medical Services Foundation,
MMSF:2005. CONTACT: bshay@cc.umanitoba.ca
ETHICS COMMITTEE: University of Manitoba, Faculty of Medicine,
Bannatyne Research Board
Research Report Poster Display
32-24 Tuesday 5 June 10:30
VCEC Exhibit Hall B & C
THE PUBLIC IMAGE OF PHYSIOTHERAPY IN AUSTRALIA: A
QUALITATIVE INQUIRY
Chapman L1 , Ruston S1 , Beecham R1 , Spry S; 1 School of
Community Health, Charles Sturt University, Albury, Australia
PURPOSE: This project was undertaken as an Honours project
for a Bachelor of Physiotherapy degree at Charles Sturt University
in Australia. The research question addressed why people do not
seek physiotherapy when experiencing common musculoskeletal
conditions, such as back pain. This presentation focuses on
an aspect of this investigation: how consumers perceive the
Physiotherapy profession in Australia. RELEVANCE: The importance
of this project relates to international findings that Physiotherapy
is not clearly differentiated from its competitors and that this is
detrimental to its market performance and professional standing.
In Australia, as in other western countries, physiotherapists deliver
services in competition with a variety of alternative health providers,in
a marketplace that is changing to reflect the health characteristics
of the local population, and where there is increasing consumer
demand for choice and client-focused care. The relevance of this
presentation, therefore, concerns the need for the Physiotherapy
profession to understand its image in order to promote its services.
PARTICIPANTS: Six participants were recruited who had never
been to physiotherapy, in order to access general perceptions about
physiotherapy. Participants were recruited using a ‘snowball’ strategy,
by using a personal contact to gain access to an appropriate
sample. METHODS: In researching consumer behaviour, the use
S431
of a variety of research approaches produces richer information,
and more effective marketing strategies. Quantitative information is
available about what the general public in Australia know about
physiotherapy, and qualitative studies have examined how clients
perceive physiotherapy services in a variety of settings. However,
the perceptions of people who do not go to physiotherapy has
not been investigated. This study involved inspection of publicly
available promotional material from the Australian Physiotherapy
Association (APA) and competitor professions. Interviews were
conducted, which are reported elsewhere (report in progress). This
abstract reports on the findings of an aspect of these interviews that
involved participant description of images depicting a physiotherapist
providing treatment, published by the APA. ANALYSIS: Analyses for
the whole study involved first and second order coding of interview
data and thematic analysis of promotional and website material
about physiotherapy and its competitors. For this presentation, data
relevant to the image of physiotherapy have been extracted from
the overall analyses. RESULTS: The major themes with respect
to the image of the profession were a strong association with
sport and a traditional, medical model of health care, and difficulty
distinguishing physiotherapy from alternative services. Participants
recognised a typical physiotherapist image: relatively young, often
female, fit and ‘sporty’. In addition, participants identified issues
of physical and emotional disempowerment accompanying the role
of ‘patient’. CONCLUSIONS: There is a mismatch between what
the Physiotherapy profession aims to be, and how it is perceived,
which limits access to potential clients and restricts performance in
the health marketplace. IMPLICATIONS: From this study will come
a better understanding of the professional image of Physiotherapy
in Australia and how to develop marketing strategies that consider
consumer preferences, our competition and how to reach different
target populations. Further research is needed into how services
may be improved to better meet consumer needs. KEYWORDS: Pro-
fessional image, Marketing of physiotherapy, Consumer perceptions.
FUNDING ACKNOWLEDGEMENTS: This project was unfunded.
ETHICS COMMITTEE: School of Community Health Ethics Commit-
tee, Charles Sturt University
Research Report Poster Display
33-04 Tuesday 5 June 10:30
VCEC Exhibit Hall B & C
PATIENT EDUCATION IN PHYSICAL THERAPY PRACTICE: A
GROUNDED THEORY INVESTIGATION
Rindflesch A; Mayo Clinic College of Medicine, Rochester, MN
PURPOSE: Patient education is a critical component of the practice
of physical therapy. It has been shown to be used extensively
in practice. Research of patient education in physical therapy is
scarce and terms used for patient education differ from other
professions. Much of the research that has been done has focused
on frequency of use or in measuring effectiveness in persons with
specific pathologies. Never has a study proposed a theory supporting
patient education derived directly from observations of physical
therapists practicing patient education. This study examines the
practice of patient education in physical therapy using a grounded-
theory qualitative approach. The primary purposes of this study
are to establish a theory for the practice of patient education
in physical therapy and to outline the process by which physical
therapists educate patients. Because physical therapy and patient
education are practiced across diverse settings, three of the most
common areas of practice were chosen to collect data: acute
care, outpatient, and inpatient rehabilitation. RELEVANCE: This
study contributes to the evidence base supporting the practice of
patient education in physical therapy. Currently there is no published
research proposing a theory supporting patient education that is
derived directly from observations of physical therapists practicing
patient education. This study is relevant because patient education
is such a large part of practice. PARTICIPANTS: Nine physical
S432
therapists were chosen for this study, three from each of the
following areas of practice: acute care, inpatient rehabilitation, and
outpatient orthopedics. All therapists practice within a mid-western
academic medical center. Therapists were nominated by their peers
as outstanding patient educators before being asked to participate.
METHODS: First, therapists were interviewed as a group during a
one-hour session, answering questions about the practice of patient
education in physical therapy. Second, each therapist was observed
in practice working with at least three patients. Sessions were
audiotaped, transcribed, and themes emerged resulting in model
formation and theory identification. Finally, all therapists were asked
to verify the results. ANALYSIS: Qualitative thematic analysis using
the constant comparative coding method. RESULTS: Results show
the inseparability of patient education from the practice of physical
therapy. Each are intertwined. Physical therapists seek to empower
patients through patient education. Empowerment is the purpose
of patient education. Physical therapists use informal methods to
evaluate readiness to learn, to deliver patient education, and to
evaluate its effectiveness. Examples of methods will be shared.
CONCLUSIONS: Physical therapists perform patient education ex-
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
that a theory supporting the practice of patient education has been
identified, the theory brought forward here can and should be
further tested in other physical therapy settings. KEYWORDS: Patient
education. FUNDING ACKNOWLEDGEMENTS: None. CONTACT:
rindflesch.aaron@mayo.edu
ETHICS COMMITTEE: Mayo Institutional Review Board
Research Report Poster Display
35-24 Tuesday 5 June 10:30
VCEC Exhibit Hall B & C
CONTENT VALIDITY OF THE DUTCH VERSION OF THE
ACTIVITIES SCALE FOR KIDS (ASK-NL)
van der Net J1 , Stukstette M1 , Takken T1 , Engelbert R1 , Young N2 ,
Helders P1 ; 1 University Children’s Hospital UMC at Utrecht, The
Netherlands; 2 Laurentian University, Sudbury, ON, Canada
PURPOSE: To determine content validity of the Dutch translation of
the ASK (ASK-NL). RELEVANCE: Insight in children’s capabilities
and level of performance are important for healthcare professionals
for their clinical reasoning process by formulating and evaluating
treatment goals. The ASK is a generic self report measure to
describe and evaluate change in the level of daily life capabilities
and performance in children 5-15 years (Young, 2000). As part of a
translation and cross cultural validation process the content validity of
the ASK-NL was established. PARTICIPANTS: In order to investigate
the content validity of the ASK-NL, 13 healthcare professionals
(teachers, pediatric physiotherapists, occupational therapists, and
physiatrists) were recruited at a school for special education, a centre
for pediatric rehabilitation and a primary care facility for children.
In order to investigate the difficulty of the 38- items of both the
ASKc-NL and ASKp-NL floor and ceiling effects were calculated in a
sample of 97 children (14 healthy and 83 a various musculoskeletal,
neuromuscular and miscellaneous conditions). Informed consent
of all children was obtained. The local board of ethics approved
this study. METHODS: Feasibility and quality of evaluative and
discriminative characteristics were determined with a questionnaire.
Demographics, level of experience and years of practice were
gathered from the healthcare professionals. Floor and ceiling effects
were examined by exploring the range of scores among the sample
of selected children and their primary care takers. ANALYSIS:
Qualitative analysis of the questionnaire was performed using SPSS
11.5 and Kwalitan-students version. Descriptive statistics were used
to describe floor and ceiling effects in the total scores. RESULTS:
Thirteen healthcare professionals completed the content validity
WCPT 2007, Research Reports
questionnaire. Mean age 43 years (SD 8.1). Mean number of years
of practice 16 years (SD 8.8). 100% of the respondents reported
that all relevant aspects of physical functioning were represented
in the ASK-NL. 92% distinguished the capability and performance
version as distinct constructs. 85% reported that the length of the
ASK-NL was average compared to instruments they used. 77%
of the respondents wanted to add more items to the 38 items
and 53.8% wanted to remove one to three items. Ninetyseven
children completed the ASK-NL their total scores ranged from
22.1–100 ASKc and 12.5–100 ASKp. No floor effects were found
for both the ASKc and the ASKp. Ceiling effects were aware in
13.3% ASKc and 8.4% ASKp. CONCLUSIONS: Content validity
of the ASK-NL was rated as good by experienced healthcare
professionals. ASK scores among children with musculoskeletal,
neuromuscular and miscellaneous conditions show very limited c
IMPLICATIONS: The ASK-NL provides rehabilitation specialists of
a well designed and well perceived generic functional outcome
instrument. KEYWORDS: Functional Outcome; Physical Activity;
Childhood. FUNDING ACKNOWLEDGEMENTS: not applicable.
CONTACT: j.vandernet@umcutrecht.nl
Research Report Poster Display
36-08 Tuesday 5 June 10:30
VCEC Exhibit Hall B & C
THE VALIDITY OF THE RT3 ACCELEROMETER TO MEASURE
PHYSICAL ACTIVITY IN PATIENTS WITH COPD
Mc Groarty M1 , O’ Dwyer J1 , Shanahan C1 , Hussey J1 , O’
Connell F2 , Kealy S2 ; 1 Discipline of Physiotherapy, School of
Medicine, Trinity Centre for Health Sciences, Dublin, Ireland; 2 St.
James Hospital, Dublin, Ireland
PURPOSE: To investigate the validity of the RT3 accelerometer
in the measurement of physical activity and inactivity in subjects
with COPD. RELEVANCE: An objective and valid outcome measure
of physical activity is needed in the characteristically sedentary
COPD population. Rehabilitation aims to improve exercise tolerance
and functional activity in this population. The RT3 (a triaxial
accelerometer) is a battery-powered device that measures physical
activity in three planes of movement and could potentially be used
as an outcome measure in the rehabilitation setting. PARTICIPANTS:
A sample of fifteen patients (nine male & six female) was recruited
from St. James’ Hospital pulmonary rehabilitation programme, Dublin,
Ireland. To be eligible for inclusion the participants had to be able
to walk on a treadmill continuously for five minutes without the
assistance of oxygen therapy. Patients with unstable or severe
cardiovascular disease, a neuromuscular or disabling cognitive
disorder were excluded from the study. METHODS: Accelerometers
were worn at the waist on the right hand side. The subjects were
required to sit quietly for 5 minutes, walk at 1.5km/hr on a treadmill
and sit for a further 5 minutes. Estimated energy expenditure from
the RT3 (kcal/min/kg) was compared to EE measured by a portable
indirect calorimeter (kcal/min/kg). ANALYSIS: ANOVA was employed
to compare the mean of each activity mode. Correlations were
analysed with the Pearson correlation coefficient to identify any
relationship between VM counts and measures related to EE. The
level of agreement between the measures was analysed using a
graphical technique by plotting the difference against the mean of
the measures. RESULTS: The results indicate that the RT3 has the
ability to distinguish between inactivity and activity (P < 0.0001). The
RT3 was found to consistently underestimate EE in all cases when
compared to indirect calorimetry (bias 0.004, 0.02, 0.006 kcal/min/kg
during baseline, treadmill walking and recovery respectively). When
both activity modes were combined, analysis of the data returned a
significant correlation between VM counts measured by the RT3 and
EE measured by indirect calorimetry (r =0.89 P < 0.001). There was
also a significant correlation between the RT3 VM counts and the
VO2 uptake calculated by indirect calorimetry (r = 0.87, P < 0.001).
CONCLUSIONS: The RT3 was found to be sensitive to changes
Poster Displays, Tuesday 5 June
in physical activity in a laboratory-based protocol using rest and
treadmill walking. While EE as measured by the RT3 has limitations,
the RT3 can be used in the classification of physical activity. This
device could be used clinically to determine habitual physical activity
in this group of patients. Future research could focus on advances
in technology such as mobile phones, Blackberry® technology,
and global position systems (GPS) in conjunction with the RT3.
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
was partly funded by the Chartered Physiotherapists in Respiratory
Care, Ireland. CONTACT: catherineshanahan@gmail.com
ETHICS COMMITTEE: The study was approved by St. James
Hospital and Federated Dublin Voluntary Hospitals Joint Research
Ethics Committee.
Research Report Poster Display
37-12 Tuesday 5 June 10:30
VCEC Exhibit Hall B & C
GENERAL DEVELOPMENT IN FEMALES WITH RETT
SYNDROME, FOCUSING ON ABILITIES, DEFORMITIES AND
MANAGEMENT: THE SWEDISH RETT CENTER SURVEY
Larsson G1 , Lindström B2 , Witt Engerström I3 ; 1 Swedish Rett
Center, Frösö Strand, Box 601, S-832 23 Frösön, Sweden;
2 Dept of Community Medicine and rehabilitation, Building15, Umeå
University, Sweden; 3 Swedish Rett Center, Frösö Strand, Box 601,
S-832 23 Frösön, Sweden
PURPOSE: The aim of this study was to describe the early
development in individuals with the diagnosis Rett syndrome (RTT)
using parents’ information. RELEVANCE: This research provides
physical therapists with information important to clinical work. About
the development of RTT and about the possibility for some to keep,
re-gain, learn new abilities after the regression that is part of the syn-
drome. PARTICIPANTS: 125 out of all 178 families in Sweden with
a girl/woman diagnosed with Rett syndrome in 1997. METHODS: In
1997 a questionnaire was sent to all 178 families in Sweden with
a girl/woman diagnosed with RTT. Information received from 125
cases provided us with families’ description of early development in
gross motor function, fine motor function and communication/social
interplay. ANALYSIS: Descriptive analysis was made of the closed
questions and a qualitative analysis of the open-ended questions.
RESULTS: Best abilities of the persons with RTT before regression
were presented, 62% lost their best abilities, 22% kept them and 5%
kept them with deterioration. Seventy-three per cent learnt to walk,
20% stopped walking and 2% retrained walking. Concerning feeding,
69% learnt to feed themselves, 57% lost this ability, 7% re-trained the
ability and 5% learnt to feed after regression. Sixty-four per cent were
one year or younger when a deviation in development was noted.
Sixty answers reported the girl was late in developing functions while
35 reported sudden loss of reached abilities. Seventy-four per cent
developed a scoliosis and 83% reported other deformities of which
deformities in feet were the most common. Postural control was poor
since all but 15 girls/women leant in various directions when sitting,
i.e. they did not keep an upright position when sitting. Transitional
movements were difficult to perform, which also may indicate poor
postural control. In 80% of cases the families were those who first
suspected that something was wrong in the child’s development.
CONCLUSIONS: There is loss of function in this group but the pos-
sibility for some to keep abilities, re-train/re-gain abilities and achieve
abilities after regression is most important to keep in mind when plan-
ning for intervention. IMPLICATIONS: It is essential that medical staff
are aware of the different ways RTT develops in order to give families
early appropriate support and a plan for intervention. More research
has to be focused on management and treatment to help persons
with Rett syndrome keep and develop abilities according to their
individual resources. KEYWORDS: Foot deformities, loss of function,
S433
motor development, physiotherapy, posture, re-train/re-gain function,
scoliosis. FUNDING ACKNOWLEDGEMENTS: We are grateful for
the support from the Medical Research Foundations of the Northern
University Region, from Östersund Hospital and from the Marcus and
Amalia Wallenberg Foundation. CONTACT: gunilla.e.larsson@jll.se
ETHICS COMMITTEE: This study was approved by the ethical
committee at the University of Umeå (§15/97, dnr 97-1)
Research Report Poster Display
37-16 Tuesday 5 June 10:30
VCEC Exhibit Hall B & C
A REVIEW OF GRADED EXERCISE TRAINING FOR CHRONIC
FATIGUE SYNDROME/ MYALIGIC ENCEPHALOPATHY (CFS/ME)
Larun L1 , Festvåg L2 ; 1 Norwegian Knowledge Centre for the Health
Services; 2 Physiotherapy Consultant, Oslo
PURPOSE: To assess and synthesize the evidence base for
treatment of Chronic Fatigue Syndrome/ Myalgic Encephalopathy
(CFS/ME), with special emphasis on Graded Exercise Therapy
RELEVANCE: CFS/ME is characterized by persistent and unex-
plained fatigue and low tolerance for physical and mental exercise,
resulting in severe impairment in daily functioning. These patients
are often referred to physiotherapists. PARTICIPANTS: The review
included five studies concerning GET, with a total of 336 patients, of
which most were women. Mean illness duration was two years. The
participants were included if they satisfied either the Oxford or the
CDC 1994 criteria. METHODS: The literature search was performed
in the databases Cochrane Database of Systematic Reviews (CDSR)
and Database of Abstracts of Reviews of Effects (DARE) in The
Cochrane Library, as well as in MEDLINE, EMBASE, PsycINFO and
AMED. Home pages from relevant organisations (e.g. AHRQ) were
hand searched and articles from experts or patients considered. The
search for systematic reviews was done in November 2005 and the
one for recently published RCTs and CCTs in April 2006. Patients
with Chronic Fatigue Syndrome (CFS), Myalgic Encephalopa-
thy/myelitis (ME), postviral fatigue syndrome (PVFS) and Chronic
Fatigue and- immunodysfunctionsyndrom /CFIDS) were included.
Interventions could be any kind of physical activity for CFS/ME. All
outcomes were considered, fatigue, physical and mental health and
quality of life are reported. ANALYSIS: The review team, consisting
of experts from different disciplines and methodological expertise,
has performed a health technology assessment according to inter-
nationally approved principles. Two patient organisations gave input
during the process. The level of documentation was done according
to GRADE. RESULTS: Graded exercise therapy (GET)usually aims
to improve aerob capacity, but our studies describe different forms
of exercise varying from what would be called pacing (40% VO2
max) to exercise intending to increase aerob capacity (75% VO2
max. If exercise exceeds 70% of VO2 max drop out was high (RR
1.73 (95% CI 0.92 to 3.24). The intervention period was 12 weeks,
3-5 times per week with a minimum of 30 minutes duration. At 12
weeks individually adapted GET were more effective on fatigue than
treatment as usual(SMD −0.77, 95% CI: −1.6 to −0.28). This was not
significant after 24 weeks. There was no significant effect on depres-
sion and QoL. The documentation is low. CONCLUSIONS: Graded
Exercise Therapy for CFS patients suggests a reduction of fatigue,
but did not document effect on depression or quality of life. Drop-out
was high, especially with high intensity exercise. IMPLICATIONS:
There are insufficient studies as to the better treatment for severely
ill or disabled sufferers. The evidence base for children and young
people is scarce. For the remaining patienst with CFS/ME the level
of documentation is low or very low. There is a need for research
related to all aspects of exercise and physical activity for the CFS/ME
group. KEYWORDS: Chronic Fatigue Syndrome,CFS,Myalgic En-
cephalopathy,ME, Graded Exercise Therapy,GET, Physical activ-
ity, Exercise. FUNDING ACKNOWLEDGEMENTS: The Norwegian
Knowledge Centre for the Health Services. CONTACT: lille-
beth.larun@nokc.no
S434
Research Report Poster Display
37-20 Tuesday 5 June 10:30
VCEC Exhibit Hall B & C
PREVALENCE OF FIBROMYALGIA AND ASSESSMENT OF
ASSOCIATED SYMPTOMS, FUNCTIONAL DISABILITY AND
QUALITY OF LIFE, IN EMBU, SAO PAULO, BRAZIL
Assumpção A, Cavalcante A, Sauer J, Chalot S, Capela C,
Marques A; Physiocaltherpy, Speech an Ocupational Therapy
Department of Medicine School of University of Sao Paulo
PURPOSE: Fibromyalgia is a rheumatic syndrome characterized
by chronic widespread pain, tender points, fatigue, sleep disorders
and morning stiffness. Functional Disability and negative impact in
the quality of life are also frequent. Studies show a fibromyalgia
prevalence around 2% and 3%. The aim of this study was
to assess the prevalence of fibromyalgia, associated symptoms,
functional disability and quality of life in residents of Embu, SP,
Brazil. RELEVANCE: Physiotherapy and exercise in general have
being described as an important form of treatment to fibromyalgia
patients, improving pain, functional disability and quality of life of
fibromyalgia patients. With the fibromylagia prevalence, the health
care system could prepare the physioterapists to treat this kind
of patients properly. PARTICIPANTS: The sample was selected in
individuals of the primary health care, aged by 35 and 60 years
old. Of all 2269 subjects with phone number, we interviewed 768
with questions about presence of pain, pain location and time of
pain. Of these subjects, 304 were personally evaluated. METHODS:
The subjects were interviewd by phone with questions about pain
and pernosinally evaluated about tender points examination and
assessment of pain by the Visual Analogue Scale (VAS), sleep
disorders by the Post Sleep Inventory (PSI), fatigue by the Chalder
Fatigue Scale, functional disability by Stanford Health Assessment
Questionnaire (HAQ) and quality life by the Fibromyalgia Impact
Questionnaire (FIQ). ANALYSIS: The data were analysed using
Descriptive, Baeysian and Interferential Analyses (Kruskal-Wallis,
Friedmam, ANOVA, with significance level of 5%) RESULTS: The 768
subjects were distributed in three groups: Without Pain (WP) – 185
individuals, Regional Pain (RP) – 388 individuals and Widespread
pain (WpP). In the sub-sample of 304 subjects, the groups of
chronic widespread pain were classified in Fibromyalgia (FM), with 19
subjects, and Non-Fibromyalgia, with 87 subjects. The mean age was
47.9 (7.2) years old for 768 sample and 49.1 (6.8) for the 304 sub-
sample. The prevalence of chronic widespread pain was 24%, with
95% credibility interval [21%; 27%] and fibromyalgia prevalence was
4.4%, with 95% credibility interval [2.6%; 6.3%]. CONCLUSIONS:
The fibromylagia prevalence in Embu, Brazil is similiar to other
countries for people aged between 35 and 60 years old. Pain, sleep
disorders, fatigue, functional disability and quality of life were worse in
the FM Group, followed by WpP, RP and WP. IMPLICATIONS: The
physiotherapits should take care for fibromyalgia patients because
they are in large number in the world and with importants symptons.
While fibromyalgia cure is not discoverd, physiotherapy is one
of the most effect treatment to improve the quality of life of
that patients. KEYWORDS: Prevalence, Fibromyalgia, Pain, Sleep
disorders, Fatigue, Disability evaluation, Quality of life. FUNDING
ACKNOWLEDGEMENTS: Fundação para Amparo a Pesquisa e
Desenvolvimento do Estado de São Paulo – FAPESP (Sao Paulo
State Fundation for Research and Development Support); Conselho
Nacional de Desenvolvimento Cientı́fico e Tecnológico – CNPq
(National Committee of Scientific and Tecnology Development).
CONTACT: anassumpcao@gmail.com
ETHICS COMMITTEE: Ethics Committee for Analyses of Research
Studies of Clinical Hospital of Medicine School of University of Sao
Paulo (process: 161/2004)
WCPT 2007, Research Reports
Research Report Poster Display
38-24 Tuesday 5 June 10:30
VCEC Exhibit Hall B & C
THE RELATIONSHIP BETWEEN DECLINE ANGLE WITH
RUSSIAN HAMSTRING AND HAMSTRING STRENGTH AND ITS
EFFECT AFTER EXERCISE
Matsui H, Urabe Y, Tanaka K, Tanaka T, Sasaki R, Miyagawa K;
Department of Sport Rehabilitation, Graduate School of Health
Science, Hiroshima University, 1-2-3 Kasumi, Minami, Hiroshima
734-8551, Japan
PURPOSE: Anterior Cruciate Ligament (ACL) injuries often occur
during sports activities. We need to act immediately for establishing
its prevention strategy. Proper neuromuscular control of joint
movement is necessary for ACL injury prevention. The jump landing
motion is one of the most typical mechanisms of ACL rupture.
Female athletes showed relatively low muscle activation of hamstring
muscles compared to the male at landing. Hamstring muscles
have synergy function with ACL. If contraction force of hamstring
muscles is increased, it may help to prevent ACL injuries. Russian
(Nordic) Hamstring (Myklebust et al. 1998) is a kind of exercise
for the strengthening hamstring. The purpose of this study was
to demonstrate the relationship between the decline angle during
the Russian Hamstring and hamstring strength, and investigate
the effect of the Russian Hamstring exercise. RELEVANCE: If
Russian Hamstring is effective for strengthening hamstring, Russian
Hmastring is the necessary exercise for prevention of ACL injury.
PARTICIPANTS: One hundred twenty seven female volunteered this
study. All of them were belong to local high school basketball team.
The mean (±SD) age was 16.1±0.8 years, height was 160.7±5.9
cm, and body weight was 53.5±5.7 kg. METHODS: The maximum
trunk decline angle during the Russian Hamstring was measured
by digital goniometer. The position was maintained over 2 seconds
by hamstring contraction to prevent the trunk from touching floor.
Isometric maximum hamstring contraction force was measured by a
hand held dynamometer in prone position at the knee flexion angle
of 60º. The subjects were divided by two groups at random. Sixty
seven of the subjects were assigned to the exercise group, and
the others were assigned to the control group. The exercise group
performed the Russian Hamstring exercise of 10 times everyday for
three months. All subjects were measured the decline angle and
hamstring strength before and after the three months. ANALYSIS:
The correlation between the decline angle and hamstring strength
was analyzed using Peason’s correlation coefficient. Paired-t test
was used to compare the mean values of the decline angle between
before and after the three months. P value of less than 0.05 was
considered statistically significant. RESULTS: The mean decline
angle was 27.0±8.3º, and the mean hamstring strength was 6.1±1.1
N/kg before the exercise. The decline angle and hamstring strength
showed significant correlations (r = 0.37, p = 0.0002). Significant
increase of the decline angle and hamstring strength was found in the
exercise group (p < 0.05). CONCLUSIONS: These results showed
that we could use Russian Hamstring as an assessment tool of
hamstring function. In addition, we showed the baseline data of the
Russian Hamstring among Japanese female high school basketball
players. It is interesting that the decline angle and hamstring strength
were increased by such a simple and short-term exercise. Russian
Hamstring is simple, useful, and convenience to develop hamstring
strength and to assess their function of hamstring. We believe that
the Russian Hamstring is one of the most effective exercises for
prevention of ACL injury. It is necessary to compare between the
effect of Russian Hamstring and the other exercise in future study.
IMPLICATIONS: We showed the speriority of Russian Hamstring.
KEYWORDS: Russian Hamstring, ACL injury, prevention. FUNDING
ACKNOWLEDGEMENTS: This study was done anything no grant
and commercial support. CONTACT: h-matsui22@hiroshima-u.ac.jp
ETHICS COMMITTEE: The ethics committee of Hiroshima university
Poster Displays, Tuesday 5 June
Research Report Poster Display
39-04 Tuesday 5 June 10:30
VCEC Exhibit Hall B & C
A SURVEY OF UNITED STATES PHYSICAL THERAPY FACULTY
ON ENTRY-LEVEL WOMEN’S HEALTH CURRRICULAR
CONTENT
Boissonnault J; University of Wisconsin-Madison
PURPOSE: To determine what US faculty in professional physical
therapy (PT) programs believe are important women’s health
content areas for inclusion in PT entry-level curricula. Additionally,
to contribute to the process of greater, and more standardized,
representation of women’s health PT content in US entry-level PT
curricula. RELEVANCE: This survey research, in combination with
two other studies, has served as the basis for development of “Guide-
lines for Women’s Health Content in Professional Physical Therapy
Curricula” published by the Section on Women’s Health(SOWH),
APTA. These guidelines assist schools in development of specific
women’s health content. PARTICIPANTS: Each of the 200 PT
programs in the USA METHODS: A mail survey was sent to each
program. The survey asked respondents to determine importance for
inclusion in entry-level and post-professional curricula each women’s
health academic content area listed. The survey tool was developed
by Dr.Laura LaProta Crum and Dr. Susan Smith for use at Texas
Women’s University, Houston, TX, and had been used to survey
a random sample of clinician-members of the SOWH. Responses
from the current study’s cohort of academicians were statistically
compared with responses form the Crum/Smith cohort. Section 3
of the survey also asked questions about strategies and challenges
in integration of women’s health content into current curricula.
ANALYSIS: 1.Section 1, Demographic information, was analyzed to
determine whether respondenders varied from a antional database
of PT faculty maintained byt he APTA. “Z” scores were computed
to provide statistical analysis on variables of faculty apoointment,
numbers of faculty in clinical practice, and full or part-time status.
2.Fisher-Irwin Exact Test was employed to determine if membership
in any of the demographic categories in section one influenced the
results of Section 2 (rating the content areas). 3.Fischer-Irwin Exact
Test was used to compare responses of Section 2 of this survey
with the Crum/Smith cohort. 4.Indepth analysis of the question (18)
on propriety of training entry-level students in internal examination
was conducted to determine whether particular faculty demographics
influenced the response to this controversial question using the
Fisher-Irwin Exact Test. RESULTS: Survey response rate was 64%.
1.Slight variances between the database for this survery from the
APTA national database on percentages of full time appointments.
2.Demographic information collected did not influence responses to
Section 2 of the survey. 3.Analysis via a Fischer-Irwin Exact Test
of Significance revealed no significant differences between cohorts.
4.No significant differences were found relating demographics to
response to question 18. Descriptive statistics of frequency counts
and percentages allowed generation of a list of content categories
that 75% of respondents felt important to include in both entry-
level and post-professional academic programs. CONCLUSIONS:
Academic faculty in the United States were able to identify and
differentiate areas of women’s health practice they felt important
to include in entry-level and post-professional physical therapy
curricula. IMPLICATIONS: This survey ressearch of faculty opinions
on women’s health content in entry-level and post-professional
physical therapy curricula has assisted the SOWH of the APTA
in development of “Guidelines for Women’s Health Content in
Professional Physical Therapy Curricula”. KEYWORDS: Curricula,
entry-level, women’s health. FUNDING ACKNOWLEDGEMENTS:
Women’s Health Academic Leadership Aswrd (AG 00744), a K-
07 grant from the National Institute on Aging, a division of the
National Institute of Health. PI-Molly Carnes, MD MPH. CONTACT:
boissj@surgery.wisc.edu
ETHICS COMMITTEE: Human Subject Review, University of
Wisconsin, School of Education. November, 2001
S435
Research Report Poster Display
39-08 Tuesday 5 June 10:30
VCEC Exhibit Hall B & C
MUSCULOSKELETAL DYSFUNCTION IN FEMALE CHRONIC
PELVIC PAIN: A BLINDED STUDY OF EXAMINATION FINDINGS
Neville C1 , Fitzgerald C1 , Furno N1 , Hynes C1 , Badillo S1 , Tu F1,2 ,
Mallinson T3 ; 1 Rehabilitation Institute of Chicago, Dept. of Physical
Medicine and Rehabilitation; 2 Evanston Northwestern Healthcare
Dept. of Obstetrics and Gynecology; 3 Rehabilitation Institute of
Chicago, Center for Rehabilitation Outcomes Research
PURPOSE: The purpose of this study is to determine if women
with chronic pelvic pain (CPP) present more commonly with positive
musculoskeletal findings than women without CPP. RELEVANCE:
Musculoskeletal factors significantly contribute to female pelvic pain.
No gold standard diagnostic tests exist for pelvic musculoskeletal
problems. Studies defining such clinically useful tests are needed
to further refine a rational approach to CPP diagnosis and
management. Blinded case control studies of musculoskeletal factors
in female CPP are needed to confirm the validity of diagnostic
tests. PARTICIPANTS: Thirty-one non-pregnant female participants,
14 with CPP and 17 without pain, between the ages of 18 and
55 were recruited. Cases must have reported a history of at
least 3 months of pelvic pain (not solely menstrual pain), while
control participants must have had no history of back or pelvic
pain. METHODS: Thirteen commonly used physical examination
maneuvers were performed on all participants by one physiatrist and
one physical therapist, respectively. All investigations were blinded
as to the participants’ pain status. The physical examination included
assessment of posture, pelvic joint function, core muscle strength,
hip joint status, and pelvic floor muscle status. ANALYSIS: The
relative frequency of positive findings between groups was assessed
using chi-squared test of proportion. P value <0.05 was considered
statistically significant. RESULTS: Overall, on average pelvic pain
patients were more likely to have abnormal musculoskeletal exam
findings identified by physical therapists, including pelvic floor muscle
weakness (57% vs 13%) and tenderness (64% vs 6%), abdominal
muscle weakness (93% v 59%), positive forced Faber’s (57% vs
12%), and positive standing forward flexion (100% vs 58%); all
p values <0.05. Physicians found a higher frequency of positive
posterior pelvic pain provocation testing in pain patients only
(21% vs. 0%). A total pelvic musculoskeletal dysfunction score
was calculated after removing pelvic symmetry, Gillet’s, forward
flexion and active straight leg raise (due to lack of reliability or
discriminative ability), and was found to be higher for pain patients
on physical therapist evaluation (5.1±1.8 vs 2.6±1.5, p < 0.001) and
of borderline significance among physiatrists (3.9±1.2 vs 2.9±1.6,
p = 0.06). Preliminary results of a three cluster analysis on the total
pelvic musculoskeletal dysfunction score (out of 9) suggests that
a score of 0-2 positive findings is inconsistent with a diagnosis of
pelvic musculoskeletal pain dysfunction, while a score of 5 or higher
is consistent with global pelvic musculoskeletal pain dysfunction.
CONCLUSIONS: Findings, although preliminary, suggest that several
frequently used and simple diagnostic tests can be used to identify
patients with musculoskeletal issues related to CPP. Future studies
are needed to replicate results in similar patient cohorts, and to
further refine an optimal battery of tests. IMPLICATIONS: Earlier
and more precise diagnosis of musculoskeletal pelvic pain will result
in earlier intervention and treatment, reducing chronic pain morbidity.
KEYWORDS: pelvic pain, chronic pain, musculoskeletal dysfunction.
FUNDING ACKNOWLEDGEMENTS: This research was funded by a
grant from the Section on Women’s Health of the American Physical
Therapy Association. CONTACT: cneville@ric.org
ETHICS COMMITTEE: This research was approved by the
Northwestern University – Office for the Protection of Research
Subjects (OPRS), Chicago, Illinois.
S436
Research Report Poster Display
02-01 Tuesday 5 June 14:00
VCEC Exhibit Hall B & C
CELLULAR FEATURES OF SKELETAL MUSCLE INJURY AND
APOPTOSIS IN THE VASTUS LATERALIS OF PEOPLE WITH
COPD
Mathur S1,2 , Koehle M3 , Road J4 , Duronio V4 , Reid W1,2 ; 1 School
of Rehabilitation Sciences, UBC, Vancouver, CANADA; 2 Vancouver
Coastal Health Research Institute, Vancouver, CANADA; 3 School
of Human Kinetics, UBC, Vancouver, CANADA; 4 Department of
Medicine, UBC, Vancouver Canada
PURPOSE: The purpose of this study was to quantify cellular
features of skeletal muscle injury and determine the presence of
apoptosis in the vastus lateralis (VL) muscle of people with chronic
obstructive pulmonary disease (COPD). RELEVANCE: People with
COPD exhibit skeletal muscle dysfunction, which may be due to
abnormalities observed at the cellular level. Skeletal muscle injury
and apoptosis are two cellular alterations that may contribute to
skeletal muscle dysfunction in people with COPD. Factors such as
disuse, systemic inflammation and oxidative stress may make the
skeletal muscle of people with COPD susceptible to skeletal muscle
injury and apoptosis. PARTICIPANTS: Twenty people with COPD (9
men, 11 women; aged 68.2 ±10.0 yrs, BMI = 26.6±4.7) and 20
controls, matched for age, sex and body mass index participated
in the study. People with COPD had moderate to severe disease
and had a FEV1 /FVC = 52±14% compared to 77±9% in controls
(p  0.001). METHODS: Needle biopsies of the VL were quick-
frozen, sectioned (10 mm thick) and stained with hematoxylin and
eosin (H & E) to examine features of muscle injury under the
light microscope. Point counting was used to quantify area fractions
(AA ) of normal muscle, abnormal muscle, connective tissue and
adipose. The presence of apoptotic myonuclei was detected using
TUNEL and immunohistochemistry against caspase-3. The number
of positive myonuclei per 200 muscle fibres were counted using
an unbiased counting frame. ANALYSIS: One-way ANOVA was
used to compare the cellular features of muscle injury, number
of apoptotic nuclei detected by TUNEL and caspase-3 between
groups. Significance was set at p  0.05 and adjusted for multiple
comparisons. RESULTS: People with COPD had higher (AA ) of ab-
normal muscle compared with controls (0.9±0.2% versus 0.3±0.3%,
p = 0.011). The most common abnormal feature was small, angular
fibers. There were few apoptotic nuclei detected using TUNEL and
caspase-3 in both the people with COPD and the controls. The
mean number of TUNEL positive nuclei was 2±2 and 2±3 in COPD
and controls, respectively (p = 0.30) and caspase-3 positive nuclei
was 1±1 and 2±2, respectively (p = 0.15) per 200 muscle fibres.
CONCLUSIONS: People with COPD show cellular features that
are consistent with skeletal muscle injury and this may contribute
to altered skeletal muscle function. Apoptosis does not appear to
be present in this sample of people with COPD. IMPLICATIONS:
Chronic disuse, systemic inflammation and oxidative stress may
lead to cellular abnormalities in skeletal muscle of people with
COPD that are consistent with muscle injury. Exercise prescription
to optimize skeletal muscle function should be judicious in order to
preserve and improve skeletal muscle function and minimize further
injury in people with COPD. KEYWORDS: COPD, skeletal muscle,
apoptosis, muscle injury. FUNDING ACKNOWLEDGEMENTS: The
study was supported by the Canadian Institutes of Health Research
and the British Columbia Medical Services Foundation. CONTACT:
wdreid@interchange.ubc.ca
ETHICS COMMITTEE: This study was approved by the Clinical
Research Ethics Board at The University of British Columbia.
WCPT 2007, Research Reports
Research Report Poster Display
02-05 Tuesday 5 June 14:00
VCEC Exhibit Hall B & C
THE EFFECT ON SELF-PERCEIVED COMPETENCE WHEN
USING “EMERGENCY RESPIRATORY ON CALL WORKING:
GUIDANCE FOR PHYSIOTHERAPISTS” – A PILOT STUDY
Broad M1 , Cross J2 , Harden B3 , Quint M4 , Ritson P5 , Thomas S6 ,
Taylor A7 ; 1 Cardiff and Vale NHS Trust, Cardiff, UK; 2 University
of East Anglia, Norwich, UK; 3 Winchester Health Trust, Winchester,
UK; 4 Queen Alexandra Hospital, Cosham, Portsmouth UK; 5 Royal
Liverpool Childrens NHS Trust, Liverpool, UK; 6 University of
the West of England, Bristol UK; 7 Cardiff University, College of
Medicine, Cardiff, UK
PURPOSE: To compare the self perceived competence of physio-
therapists using “Emergency Respiratory On Call Working: Guidance
for Physiotherapists” (Known as Emergency Duty Guidelines – EDG)
with those who had not received this guidance. RELEVANCE: Out
of hours working and maintenance of competence is a problem
that has been addressed nationally within the UK. The Health
Professions Council (HPC) requires that all physiotherapists are
able to demonstrate their competence appropriately. The EDG
were developed to support staff in identifying learning needs and
aid in demonstrating competence in this field. This is the first
study to investigate the effect on competence when using the
EDG. PARTICIPANTS: Seventy-six physiotherapists from 2 hospitals
matched for size and speciality. The Intervention Group used
the EDG; the Control Group did not. METHODS: A prospective
parallel group design with assessment of self perceived competence
measured using a questionnaire. This questionnaire has previously
been piloted nationally and quantifies the elements identified within
the EDG through the use of Likert scales. ANALYSIS: Data from
completed questionnaires were analysed by calculating sum scores
and comparisons made using Mann Whitney U Tests. Comparisons
were made between the total score, the scores of the four
individual sections of the questionnaire and between the different
grades of staff. Free texts comments were examined using content
analysis. RESULTS: Sixty-five (85.5%) returned questionnaires, with
equal representation of physiotherapy staff grades across the 2
hospital sites. Sum scores for each scaled item demonstrated
no statistically significant difference in the overall scores for the
2 groups or the different physiotherapy grades within the study
groups. There was a non-significant trend for the intervention group
to have higher scores. Subgroup analysis of the elements of
competence in the questionnaire (assessment, treatment and range
statements) highlighted four differences. Significance was taken as
p < 0.05 − Treatment scores (the ability to plan implement and
revise treatments) were significantly higher for junior staff in the
control group (p = 0.048). − Range statements scores (perceived
competence in different situations) were significantly higher for senior
II staff in the intervention group (p = 0.033). − Assessment scores
(different elements of the assessment process) were significantly
different in senior I staff (p = 0.027). There was also borderline
significance on range statement scores (p = 0.052) both were in
favour of the intervention group. Content analysis of the open
comments demonstrated junior staff had more concerns over training
and experience before working in the emergency duty setting.
Senior staff had more concerns over non-respiratory issues and
had more worry and anxiety concerns with regard to confidence
in ability. CONCLUSIONS: Use of the EDG may improve self-
perception of competence as measured by questionnaire but a
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
Poster Displays, Tuesday 5 June
national level are recommended. KEYWORDS: Physiotherapy, Com-
petence, “On Call”. FUNDING ACKNOWLEDGEMENTS: Unfunded.
CONTACT: mabroad@ntlworld.com
ETHICS COMMITTEE: South East Wales Research Ethics Commit-
tee, UK
Research Report Poster Display
05-01 Tuesday 5 June 14:00
VCEC Exhibit Hall B & C
PERCEIVED USEFULNESS OF RECIPROCAL PEER TEACHING
(RPT) AMONG PHYSICAL THERAPY STUDENTS IN THE GROSS
ANATOMY LABORATORY
Youdas J, Krause D, Hellyer N, Hollman J, Rindflesch A; Program
in Physical Therapy, Mayo Clinic College of Medicine, Mayo Clinic,
Rochester, MN 55905
PURPOSE: The first purpose of this study was to assess the
perceived usefulness of RPT among first year physical therapy
students as a method for learning and teaching human anatomical
relationships in the dissection laboratory. The second purpose was
to determine if exposure to RPT during a semester course in
gross anatomy had an effect on students’ anatomy course grade.
RELEVANCE: RPT could be a valuable resource for learning and
teaching anatomical concepts whereby classmates alternate roles
of tutor and tutee. PARTICIPANTS: The DPT Class of 2008 (RPT)
consisted of 21 women and 6 men whose ages ranged from 21
to 29 years. The DPT Class of 2007 (no-RPT) consisted of 15
women and 6 men whose ages ranged from 22 to 30 years. This
study was approved by the Mayo Clinic Institutional Review Board.
METHODS: The DPT Class of 2008 was exposed to RPT. During
the semester each laboratory dissection group of 4 students was
responsible for teaching their classmates on 2 separate occasions.
Students serving as tutors worked in pairs and rotated among their
classmates within the laboratory, illustrating anatomical concepts
previously discussed in the classroom. At the completion of the
course students were queried about the perceived usefulness of
the RPT experience using a 12-item survey instrument that used
a 5-point Likert scale. The median antomy course grade (MACG)
for the Class of 2008 (RPT) and Class of 2007(no-RPT)was also
compared statistically. ANALYSIS: Descriptive data was compiled
for each item of the 12-item survey using frequencies for ordinal
scale data. The internal consistency of the survey instrument was
assessed by the Cronbach’s alpha. MACG for the Class of 2008
and Class of 2007 was compared statistically using a Mann-Whitney
U-test. RESULTS: Cronbach’s alpha was 0.85. Students provided
the strongest responses for survey items that assessed teaching
and learning (median Likert scores ranged from 4 to 5). MACG
for the Class of 2008 (MACG = 3.70)was significantly greater than
MACG for the Class of 2007 (MACG = 3.30; Z = −2.19; p = .029).
CONCLUSIONS: First year physical therapy students perceived the
use of RPT in the dissection laboratory as a valuable resource for
learning and teaching anatomical concepts. The RPT experience
promoted cooperative learning among classmates. Based upon
MACG, The DPT Class of 2008 (RPT) developed a more effective
learning strategy when learning anatomical relationships than the
Class of 2007 (no-RPT). IMPLICATIONS: Classmates alternating
roles of tutor and tutee is an effective method for learning anatomical
concepts stressed in the dissection laboratory. Additionally, first-year
DPT students also perceived the RPT experience would be helpful
when communicating with patients. KEYWORDS: Physical therapist
education. FUNDING ACKNOWLEDGEMENTS: This work was not
funded. CONTACT: youdas.james@mayo.edu
ETHICS COMMITTEE: Mayo Clinic Institutional Review Board
S437
Research Report Poster Display
05-09 Tuesday 5 June 14:00
VCEC Exhibit Hall B & C
STUDENT ATTITUDES AND PERCEPTIONS ABOUT
COMPUTER-BASED NEUROANATOMY LEARNING MODULES:
FACTORS AND IMPLICATIONS FOR SUCCESSFUL COMPUTER
BASED INSTRUCTION WITHIN CLINICAL EDUCATION
McKeough M1 , Leimone S2 , Bagatell N3 ; 1 Sacramento State
University, Sacramento, Sacramento County; 2 Shenandoah
University, Winchester, Fredrick County; 3 University of Southern
California, Los Angeles, Los Angeles County
PURPOSE: The purpose of this study was to examine students’
attitudes towards 3 computer-based neuroanatomy learning modules,
to assess what components were primary factors in establishing
these attitudes, specifically in relation to the Technology Acceptance
Model and the Self-Efficacy Theory, and to discuss the implica-
tions of these attitudes for successful computer based instruction
within a clinical education environment. RELEVANCE: As more
clinical educational programs enlist the assistance of technology
to improve learning outcomes it becomes essential to establish
the efficacy of these adjuncts to traditional instructional techniques.
PARTICIPANTS: Seventy-seven entry-level health care professional
students who were matriculated in an introductory neuroanatomy
course served as subjects in this study. METHODS: Students
reviewed 1, 2, or 3 neuroanatomy learning modules (Dorsal Column
Medial Lemniscal System, Spinothalamic System, and Central Visual
Pathway). Students independently identified which modules they
would review and then used them as supplementation to the
professor’s lectures. Students completed a survey to evaluate the
learning modules. ANALYSIS: Quantitative analyses were used
to assess student attitudes and satisfaction. SPSS version 13.0
was utilized for analysis of quantitative data. Qualitative data were
theme-coded according to topic and compared with quantitative
data. RESULTS: Quantitatively, students reported that they valued
computers and their general use, they enjoyed using the learning
modules, and they valued their use within the neuroanatomy
course. Students did not prefer computer-based learning over
traditional lecture format. There were no significant differences
between groups using the various modules (p  0.05). Qualitative
analyses indicated that the modules were useful in learning or
reinforcing neuroanatomical concepts and improving clinical problem
solving skills. Students reported that the visual representation
of the systems, the ability to control the use of the modules,
and the navigational fidelity of the modules were key usability
components. CONCLUSIONS: The results of this study extend the
literature supporting the efficacy of computer-based instruction to
include introductory neuroscience education for entry-level health
care professionals. Generally students reported positive attitudes
towards the computer-based neuroanatomy learning modules as
supplementation to traditional lectures. Specifically, usefulness
and usability were attributes that contributed to the effectiveness
of the modules. Increased clinical self-efficacy stemmed from
computer animation highlighting the anatomy and physiology of
functional systems and computer simulation of patient cases showing
signs and symptoms of specific lesions. IMPLICATIONS: The
computer-based learning modules examined in this study were
effective in helping entry-lebel health care students learn and
make clinical application of neuroanatomy information. KEYWORDS:
Computer-based instruction, functional neuroanatomy, clinical self-
efficacy, introductory health care professional education. FUNDING
ACKNOWLEDGEMENTS: This work was unfunded. CONTACT:
mmckeough@csus.edu
ETHICS COMMITTEE: Institutional Review Board of Shenandoah
University
S438
Research Report Poster Display
06-13 Tuesday 5 June 14:00
VCEC Exhibit Hall B & C
UNDERSTANDING EARLY PROFESSIONAL SOCIALIZATION
OF PHYSICAL THERAPY STUDENTS: A CRITICAL STEP IN
FACILITATING PROFESSIONAL DEVELOPMENT
Bartlett D1 , Lucy D1 , Bisbee L1 , Conti-Becker A2 ; 1 School of
Physical Therapy, The University of Western Ontario, London,
Canada; 2 Faculty of Health Sciences, The University of Western
Ontario, London, Canada
PURPOSE: To gain an understanding of the early professional
socialization of physical therapy (PT) students. RELEVANCE: Prepa-
ration of students to enter current PT practice requires more than
professional knowledge and therapeutic skills. Today’s graduates
are required to have highly-developed professional behaviours and
critical thinking and clinical reasoning skills to deal with rapidly
changing environments from the outset. PARTICIPANTS: Forty-
two students, 32 women and 10 men (mean age at admission
of 24.0 (SD = 1.6) years), enrolled in the 1st class of our newly
developed masters program provided data in the form of reflective
journals. Forty-four students, 33 women and 11 men (mean age
of 24.0 (SD = 3.0) years), enrolled in the 3rd class participated in
member checking. METHODS: Students in the 1st class wrote 3-
page reflective journals on a critical learning incident after each of
their second junior, intermediate, and final senior clinical experiences.
Students in the 3rd class, who had also written reflective journals
at the same points, provided member checking of results from
the 1st class at the corresponding times. ANALYSIS: Reflective
journals were analysed separately at the three points. At each
occasion, journal passages were coded into 4 conceptual areas
comprising communicative, cognitive, professional, and affective
domains. Each domain contained 4 to 6 subdomains. Each author
independently reviewed the passages collated by subdomains and
together we identified major themes. RESULTS: At the junior level,
the major themes were emotions, self confidence, professionalism
in the real world, communication, and learning by doing. At the
intermediate stage, major themes were idealism versus realism,
depth of communication with clients, and breadth of communication
with family members and colleagues. Aspects of clinical learning
were variable at this point and self-confidence remained important.
After the senior placement, most students were deeply engaged
with their clients and self confidence had developed to the point
of self-efficacy. Tensions between the ideal and the pragmatics
of actual practice strengthened and self as mentee (rather than
object of evaluation) or mentor emerged. Each theme is supported
by representative quotes. The themes were subsequently verified,
and enhanced, by the member-checking process. CONCLUSIONS:
These results, compiled in a booklet, contribute to foundation
knowledge required by PT educators, including clinical instructors,
by explicitly describing the early professional socialization of PT
students. IMPLICATIONS: This booklet is a resource to Clinical
Instructors and Academic Faculty to guide students. Students can
use and reflect on these results to assure and support their learning.
Future work will focus on the correspondence between students’
and faculty members’ judgments about reflective pieces being “as
expected”, “more advanced than expected”, or “less advanced than
expected” for students at different stages of professional preparation.
KEYWORDS: professional socialization and development. FUNDING
ACKNOWLEDGEMENTS: This study was funded by the Provost’s
Academic Support Fund of The University of Western Ontario.
CONTACT: djbartle@uwo.ca
ETHICS COMMITTEE: The University of Western Ontario Research
Ethics Board for Health Sciences Research Involving Human
Subjects
WCPT 2007, Research Reports
Research Report Poster Display
06-17 Tuesday 5 June 14:00
VCEC Exhibit Hall B & C
PROFESSIONAL COMPETENCIES IN PHYSIOTHERAPY:
COMPARING STUDENTS OF PHYSIOTHERAPY ON
POST-SECONDARY AND POLYTECHNIC LEVELS IN FINLAND
Harjulehto E; South Carelia Polytechnic, Health Care and Social
Services, Lappeenranta, Finland
PURPOSE: Track 4: Education. Topics: Educational research.
Working as experts of social welfare and health care, physiotherapists
need a high degree of professional competence in their working
life. During the 1990s, through educational reform in Finland, the
training of physiotherapists changed from a post-secondary level to
the polytechnic or university level. Relatively few studies comparing
the education on the post-secondary level to the education on the
polytechnic level have been carried out, and none of these have
concerned the training of physiotherapists. One purpose of this study
was to compare how the students from both levels viewed their
professional competencies upon graduation. Another goal was to
evaluate and improve teaching. RELEVANCE: The research helps
the teachers to develop their teaching and gives advice about
choosing the educational methods. It also provides information
on the professional competence of the students. PARTICIPANTS:
The research population consists of students of physiotherapy who
attended South Carelia Polytechnic (formerly Health Care College)
during 1990–2003. 65 students from both levels of education filled in
the questionnaire measuring professional skills. METHODS: Student
professional skills were measured using a questionnaire developed
for this purpose by South Carelia Polytechnic. The questionnaire
consisted of 59 questions covering all areas of physiotherapy care.
ANALYSIS: The material was analyzed using SPSS software. Factor
and regression analyses were carried out and the material was tested
for differences between the two levels of education. The results
of the analyses were used to describe the variances in readiness
for self-directedness, and to compare professional competencies
between post-secondary level graduates and polytechnic graduates.
RESULTS: Regarding professional skills, seven elements emerged
as crucial: co-operative skills, the ability to work as a part of
a multidisciplinary professional team, the ability to improve the
proficiency of the organization, the ability to improve one’s own
professional skills, physiotherapeutic skills, interpersonal skills and
the ability to educate oneself and assess oneself. All down the line,
students at the post-secondary level evaluated themselves as better
than polytechnic students in their own assessments. In regard to
physiotherapeutic skills, which require manual skills, there was a
nearly statistically significant difference between the two levels of
education. The variance of professional skills, on the other hand, was
similar on both levels. (Students who were about to graduate from
post-secondary level emphasized the importance of multidisciplinary
interaction to a greater extent than their peers at polytechnic level.)
CONCLUSIONS: Based on the results of this study, it is possible
to formulate recommendations for further action at polytechnics.
Improvements should be made especially in the fields of educational
content, teaching methods, and working habits. IMPLICATIONS:
The Physiotherapy education on polytechnic levels in Finland should
facilite more the student’s manual skills. The students need also
supporting and encouragement from their tutors. KEYWORDS:
professional skills, expertise, vocational training, polytechnics –
physiotherapy. FUNDING ACKNOWLEDGEMENTS: Funding ac-
knowledgements: South Carelia Polytechnic, Lappeenranta, Finland.
CONTACT: eeva.harjulehto@scp.fi
ETHICS COMMITTEE: Ethics approval was granted by the Dean of
the School of Health Care and Social Services, Dr. Taru Juvakka.
Poster Displays, Tuesday 5 June
Research Report Poster Display
08-01 Tuesday 5 June 14:00
VCEC Exhibit Hall B & C
THE EFFECTS OF TREADMILL RUNNING AFTER THE
APPLICATION OF THERAPEUTIC HEATING ON PREVENTING
MUSCULAR ATROPHY
Sakaguchi A1 , Oki S2 , Kanai S2 , Hasegawa M2 , Shimizu M2 , Ono T2 ,
Otsuka A2 ; 1 Prefectural University of Hiroshima, Graduate school
Comprehensive scientific research, Program in Health and Welfare:
Mihara City, Hiroshima, Japan; 2 Department of Physical Therapy,
Prefectural University of Hiroshima: Mihara City, Hiroshima, Japan
PURPOSE: Therapeutic heat has long been used clinically to
increase tissue extensibility, decrease muscle spasm and raise the
pain threshold. On the other hand, in recent studies, it has been
reported that heating therapy can be used to prevent muscular
atrophy. We studied the effects of therapeutic heating before active
exercise on preventing muscular atrophy. RELEVANCE: Heat alone
may prevent muscular atrophy, but it may be more effective clinically
to use therapeutic heat together with therapeutic exercise to get
better effects. PARTICIPANTS: Female Wistar rats(12 weeks old)
were used in this study. METHODS: The ankle joint was immobilized
in full planter flexion by a cast. The rats were divided into six groups.
The first group was the control (Control). In the second group, the
ankle of each rat was immobilized without therapy performed (cast).
In the third group, the cast was removed daily, and treadmill running
was performed once a day (treadmill). In the forth group, the non-
casted leg of each rat was immersed in a hot bath (42 degrees)
once a day (heat). In the fifth group, the casted leg of each rat was
immersed in a hot bath once a day (cast and heat). In the last group,
the cast of each rat was removed daily, and immersed in a hot bath
before treadmill running (heat and treadmill). We compared the wet
weight of the soleus muscles after one week. ANALYSIS: The Tukey
multiple comparison (SPSS, version1.3) was used for the comparison
between groups. RESULTS: Muscular atrophy occurred in the
cast, treadmill, and cast and heat groups. There was a significant
decrease (p < 0.01) in the wet weight of the soleus muscles for
these groups. However the heat and heat and treadmill groups were
similar to the control group. CONCLUSIONS: As a result, we have
demonstrated the effectiveness of therapeutic heating before running
exercise on preventing muscular atrophy in rats, and we believe
that the same results may be found in future studies on human.
IMPLICATIONS: A combined physical therapy treatment program
of heat and exercise may be beneficial for preventing muscular
atrophy in patients. KEYWORDS: therapeutic heating, therapeutic
exercise, muscular atrophy. FUNDING ACKNOWLEDGEMENTS:
None. CONTACT: excelsaka@yahoo.co.jp
ETHICS COMMITTEE: This experiment received the approval of the
prefectural Hiroshima University animal experiment ethics committee.
Research Report Poster Display
08-05 Tuesday 5 June 14:00
VCEC Exhibit Hall B & C
CLINICAL PERSPECTIVES IN FITTING THE WALKAIDE2
FOOT-DROP STIMULATOR
Robertson J1 , Whittaker M2 ; 1 Physical Therapy, Acquired Brain
Injury Program, G.F. Strong Rehabilitation Centre, Vancouver, B.C.,
Canada; 2 Physical Therapy, Spinal Cord Program, G.F. Strong
Rehabilitation Centre, Vancouver, B.C., Canada
PURPOSE: To show that clinician observations and assessments
provide researchers with clinical insights and observations that
may provide a better understanding of the reasons for success
or failure of devices designed to improve gait in people with
neurological conditions. RELEVANCE: Clinical observations and
rationale around the fitting of a Functional Electrical Stimulation (FES)
program for foot-drop may help bring these devices, often stuck
in research labs, into the clinical setting with resulting treatment
S439
and functional advantages. PARTICIPANTS: As part of a multi-
centre study of 24 subjects who participated to assess a new,
‘WalkAide2’ (WA2), foot-drop stimulator, 6 are reported on who,
in the opinion of the investigators, derived significant benefit from
WA2 use. METHODS: The WA2 provided the option of ‘tilt sensor’
control eliminating the need for a connected insole ‘heel sensor’.
As per the study design walking speed was assessed under 2
conditions, with and without the WA2, for normal walking speed
over a 10m straight course and normal walking speed around a
10m figure of 8 during which physiological cost index (PCI) was
also calculated. Usage (hours/day) and numbers of stimulus trains,
representing steps/day,were also downloaded from the WA2 usage
log. WA2 use was for a period of 3 months, subjects brought in
monthly for follow-up testing. The six subjects reported on were all
programmed to walk using ‘tilt sensor’ as the control mechanism
for the stimulation. Almost all continued using the WA2 after their
3 month retest. Those who continued beyond the 3 months were
retested after 6 months of WA2 use. ANALYSIS: Comparisons were
made between the therapy using the WalkAide2 and the subject’s
preferred method of walking which included an ankle support (AFO
or Malleoloc Ankle Support) and/or a cane for the 6 subjects in
this presentation. This allowed for the separation of the specific
effects of the device and the effects of increased walking and
strengthening of muscles that may have resulted secondarily from the
Peroneal Nerve Stimulation, (PNS). Statisitical tests were conducted
to justify pooling data from various Centres. Tests compared any
influence of patient demographics, (e.g., age, weight, sex, preferred
walking aids), baseline PCI and walking speed on the outcomes.
RESULTS: 6 subject’s who showed significant benefits from WA2
use are described most providing additional clinical challenges that
had to be met before the benefits could be realized. The WA2
preambulation clincial considerations were many and are listed. The
final subject described would not have been accepted under the
inclusion criteria but knowledge of the WA2’s ability to facilitate
the whole stepping action plus clinical assessment demonstrating
that this was his main problem allowed this subject to ahieve an
important functional goal. CONCLUSIONS: Technology may have
more widespread application if therapeutic considerations are a
fundamental part of the assessment process. IMPLICATIONS: Very
slow walkers and even non-ambulatory individuals were shown in this
study to eventually benefit with meaningful functional gains. Adjunct
therapy administered prior to programming the WA2 appeared
to facilitate better outcomes. Without a full clinical assessment
candidates who could benefit from this technology might be over-
looked. KEYWORDS: Walkaide2; Functional Electrical Stimulation;
Clinical. FUNDING ACKNOWLEDGEMENTS: Dr. Richard B Stein,
University of Alberta, Edmonton, Principal Investigator for the
‘Multicentre Prospective Study to assess the WalkAide2’. CONTACT:
Jenny.Robertson@vch.ca
ETHICS COMMITTEE: The University of British Columbia Office of
Research Ethics
Research Report Poster Display
08-09 Tuesday 5 June 14:00
VCEC Exhibit Hall B & C
ELECTRICAL STIMULATION OF MYOBLASTS DEVELOPS
SPONTANEOUSLY CONTRACTING MUSCLE FIBERS
Kawahara Y1,3 , Yamaoka K2 , Umeda C1 , Yoshimoto R1 ,
Kajiume T2 , Sasaki A1 , Wu S1 , Nitta J1 , Manabe T1 , Kanno M1 ,
Nakagawa K1 , Naminohira K1 , Fushimi T1 , Fujimura M1 , Yuge L1,3 ;
1 Graduate School of Health Sciences, Hiroshima University,
Hiroshima, Japan; 2 Graduate School of Biomedical Sciences,
Hiroshima University, Hiroshima, Japan; 3 Space Bio-Laboratories
Y. K., Hiroshima University, Hiroshima, Japan
PURPOSE: Electrical stimulation has been clinically used for treat-
ment of muscle atrophy. However, the effect of electrical stimulation,
physiological and molecular biological effects on myoblasts during
S440
cell differentiation, has remained to be elucidated. RELEVANCE: We
investigated that relationship between physical stimuli and in vitro cell
culture model for electrocal stimulation effects. PARTICIPANTS: L6
rat myoblast cells (IFO50364; Health Science Research Resources
Bank, Osaka, Japan). METHODS: L6 were seeded in 100-mm culture
dishes, at a density of 2.5 x 105 cells per dish, and maintained in a
high-glucose Dulbecco modified Eagle’s medium (DMEM) containing
10% fetal bovine serum (FBS). When L6 cells reached confluence
on culture day 6, they were transferred into FBS-free medium and
then exposed to electrical stimulation via field electrodes (5min) on
days 6, 8, 10, and 12 (group E) using a stimulator (SEN-2201;
Nihon Koden, Tokyo, Japan) to pass rectangular current pulses
(2.0 msec, 50 V, 0.5 Hz) between two platinum wires placed in
the culture medium. Control cells were not exposed to electrical
stimulation field during experimental period (group C). ANALYSIS:
The effect of electrical stimulation was examined for an ability
to induce morphological, physiological, and molecular biological
effects on myoblasts during cell differentiation. RESULTS: Spindle-
shaped myoblasts were observed on culture day 1. Some myoblasts
began to fuse by day 5, forming myotubes with multiple nuclei.
On day 7, thin, single nuclear-chain myotubes were formed in
control cultures, whereas myotubes in the electrically stimulated
cultures were fused laterally to form thick myotubes. On day 14,
numbers of thick myotubes clearly increased in group E (7 to 8
myotubes), whereas fewer myotubes were present in group C. The
electrical stimulation accelerated the appearance of myotubes, and
subsequently produced spontaneously contracting muscle fibers.
Measurement of membrane potential showed that the contracting L6
cells had functional ion channels and gap junctions. In the electrically
stimulated cells, protein expression of MyoD family, myogenin and
Myf-6, was enhanced. Expression of gap junction protein, connexin
43, was increased and maintained at a high level in the electrically
stimulated cells by western blot analysis and immunostaining.
CONCLUSIONS: The differentiation of myoblasts was accelerated
by the application of electric stimulation, and even striated muscle
cells were obtained. These results suggest the possibility that
electric stimulation, effectively used in clinical therapy of muscle
atrophy, facilitates not only the development of existing muscle
fibers but also the differentiation of myoblasts. IMPLICATIONS:
This experimental system may also help clarify the mechanisms
underlying the beneficial effects of physical stimulation that are often
seen in the field of physical medicine. KEYWORDS: myoblast, electri-
cal stimulation, differentiation. FUNDING ACKNOWLEDGEMENTS:
None. CONTACT: ryuge@hiroshima-u.ac.jp
Research Report Poster Display
09-13 Tuesday 5 June 14:00
VCEC Exhibit Hall B & C
THE USE OF POSITRON EMISSION TOMOGRAPHY AND
[18 F]FLUORODEOXYGLUCOSE FOR IMAGING OF MUSCULAR
ACTIVITY DURING EXERCISE WITH A STRIDE ASSISTANCE
SYSTEM
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,
Tokyo, Japan; 2 Positron Medical Center, Tokyo Metropolitan
Institute of Gerontology, Tokyo, Japan; 3 Tokyo Metropolitan Institute
of Gerontology, Tokyo, Japan; 4 Honda R&D Co., Ltd., Fundamental
Technology Research Center, Saitama, Japan
PURPOSE: This study investigated the use of positron emission
tomography and [18 F]fluorodeoxyglucose (FDG PET) for quantitative
and objective evaluation of muscle activity during walking. For this
study, we evaluated regional changes in glucose metabolism of
the skeletal muscles of the lower extremities that were induced by
an automated stride assistance system (SAS). We validated the
usefulness of FDG PET for investigating muscle activities during
various walking patterns induced by the SAS, which was developed
by Honda (Honda R & D Co. Ltd., Wako, Japan). RELEVANCE:
WCPT 2007, Research Reports
Imaging the activity of individual muscles is useful for exercise
prescriptions for rehabilitation and sports science and for evaluation
of rehabilitation tools. PARTICIPANTS: Ten healthy young males
aged 20–29 years. METHODS: The subjects underwent FDG PET
twice during walks for 50 min, which were done with or without a SAS.
The PET scans were conducted using a Headtome-V (Shimadzu
Corp., Kyoto, Japan) in the two-dimensional mode. The images
were reconstructed using a back-projection algorithm with a second-
order low-pass filter with a 1.25 cycles/cm cutoff frequency. Eleven
regions of interest (ROIs) in the central or activated regions of
skeletal muscles were studied. The ROIs were identified bilaterally
on three successive slices of PET images related to a CT image.
The total volumes of ROIs ranged between 4.2 cm3 and 4.4 cm3.
Glucose metabolism in ROIs was estimated from the standard
uptake value (SUV) for FDG, which was defined as SUV = C/D/w,
where C (Bq/ml), D (Bq), and w respectively represent radioactivity
present in the tissue, the injected dose, and body mass. ANALYSIS:
Student’s t-test was used to assess differences in walking ratios
measured over 500 steps in each subject with and without the
SAS. A paired t-test was conducted to assess differences in FDG
uptake with or without the SAS. RESULTS: Walking ratios of seven
subjects were increased significantly by the SAS. Three subjects who
decreased their walking ratios were excluded from further analyses
because we discussed the usefulness of FDG PET under well-
worked conditions of the SAS. In paired t-tests, the SAS significantly
increased FDG uptakes by the tibialis posterior and the medial
gastrocnemius. The FDG uptake ratios, defined as the SUV after
walking with the SAS divided by that after walking without the SAS,
of the tibialis posterior and medial gastrocnemius were, respectively,
2.12 and 2.37. The SAS demonstrated no significant effects on
any of the other muscles. CONCLUSIONS: We verified that FDG
PET is useful for quantitative evaluation of muscle activity during
walking with or without the SAS. Glucose utilization of the tibialis
posterior and medial gastrocnemius increased when walking ratios
were increased using SAS. IMPLICATIONS: FDG PET is particularly
beneficial for measuring the activity of deep muscles for evaluation
of rehabilitation tools. KEYWORDS: walking assistance, FDG, PET.
FUNDING ACKNOWLEDGEMENTS: This study received no funding
support. CONTACT: shimada@tmig.or.jp
ETHICS COMMITTEE: Tokyo Metropolitan Institute of Gerontology,
Tokyo, Japan
Research Report Poster Display
09-17 Tuesday 5 June 14:00
VCEC Exhibit Hall B & C
HAND VOLUME ESTIMATES FROM METRIC MEASUREMENTS
Hill C, Sims N, Mayrovitz H, Hernandez T, Greenshner A, Diep H;
Nova Southeastern University, Ft. Lauderdale, FL USA
PURPOSE: The purpose of this study was to develop and test a
metric measurement procedure and algorithm that could usefully
estimate hand volumes as an alternative to water displacement.
RELEVANCE: Determining upper extremity limb volume and its
change during therapy for edema or lymphedema is needed to
assess treatment efficacy and outcomes. A near circular cross-
section of the arm permits its volume to be accurately estimated with
tape-measure-determined circumferences and suitable calculation
formulae. However, because of the hand’s shape, circumference-
determined-volumes may not be accurate. PARTICIPANTS: Both
hands of thirty volunteers were evaluated. METHODS: The method
tested uses a caliper to measure hand dimensions at standardized
locations and calculates volume (Vm) by a mathematical algorithm.
ANALYSIS: Vm was compared to volumes measured by water dis-
placement (Vw) and tape-measure-circumferences (Vt) in 30 subjects
(60 hands) using regression analysis and limits of agreement (LOA).
RESULTS: Vw and Vm (mean±standard deviation) were similar
being 368±102 ml vs. 369±98 ml respectively and were highly
correlated: Vm=0.949Vw + 20.6 ml, r = 0.987, p  0.001. The LOA
Poster Displays, Tuesday 5 June
for absolute volume differences and percentages were respectively
±33.3 ml and ±9.9%. Circumference-determined-volumes (Vt =
485±134 ml), overestimated hand volume compared to Vm and
Vw (p  0.001). CONCLUSIONS: Results indicate that this metric
method is useful when hand volumes are needed, but water
displacement is either not available or is contraindicated, as when
open wounds are present. IMPLICATIONS: For those practices that
don’t have access to water displacement equipment or the water
displacement is contraindicated, the metric method is a viable al-
ternative. KEYWORDS: hand volumetric measurements. FUNDING
ACKNOWLEDGEMENTS: None. CONTACT: mayrovit@nova.edu
ETHICS COMMITTEE: Nova Southeastern University’s Internal
Review Board
Research Report Poster Display
09-21 Tuesday 5 June 14:00
VCEC Exhibit Hall B & C
FREQUENCY ANALYSIS METHOD USING SURFACE ELEC-
TROMYOGRAPHY – COMPARISON BETWEEN DWT AND CWT
Nagase S1 , Tsurusaki T2 , Hirata K1 , Hamamoto T1 ; 1 NagasakiYurino
Hospital; 2 Graduate School of Health Sciences, Nagasaki University
PURPOSE: Wavelet transformation (WT) is used as the time-
frequency analysis for surface electromyography (SEMG).Data are
presently processed using the continuous wavelet transformation
(CWT) to derive an average scalogram, from which the instanta-
neous mean frequency (IMNF) is calculated.However, because the
frequency component of the IMNF consolidated, to comprehend the
distribution frequency is difficult using the IMNF.We supposed that
the data can be processed using the discrete wavelet transformation
(DWT) to derive the distribution frequency.The present study
compares DWT and CWT on the same SEMG. RELEVANCE: The
SEMG might be able to assess muscle contraction. PARTICIPANTS:
Twenty healthy female volunteers (mean age 23.4±1.3 y) provided
written, informed consent to participate in the study. METHODS:
We obtained SEMG signals from the biceps brachii with the elbow
joint flexed at 90º. Disposable electrodes were pasted onto the
biceps brachii at intervals of 20 mm centre-to-centre and then
the elbow was continuously and incrementally loaded to extension
using water.Isometric elbow flexion force and muscle torque was
measured when the participants were no longer able to maintain
the elbow joint flexed at 90º. ANALYSIS: Data were recorded in
a computer at a sampling frequency of 1 kHz and the IMNF was
calculated using MATLAB 6.5.1.Wavelet analysis comprises high-
scale, low-frequency components (approximations) and low-scale,
high-frequency components (details). The decomposition process
can be iterated with successive approximations being decomposed
in turn, so that one signal can be broken down into many lower
resolution components.Parameters were the power of detail level j
(PD(j)), the summation of each level of PD(j) (TPw) and the PD(j)
minus the TPw ratio (RPD(j)).Analytical parameters were calculated
by performing the DWT at Daubechies 5 and decomposition level
5.The SEMG data were statistically evaluated using a two-way
analysis of variance (ANOVA). RESULTS: The IMNF and RPD (3)
decreased, whereas the RPD (4) increased based on the increase
in %MVC. CONCLUSIONS: Early studies indicated that slow type
motor units are reflected in a lower frequency and that fast type motor
units are reflected in higher frequency.The IMNF in fact increased
and decreased the frequency at muscle contraction.DWT analysis
allowed visualization of muscle contraction according to frequency
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: sin_nagase@yahoo.co.jp
S441
Research Report Poster Display
11-05 Tuesday 5 June 14:00
VCEC Exhibit Hall B & C
THE CHARACTERISTICS OF THE POSTURAL CONTROL IN
PATIENTS WITH TYPE 2 DIABETES
Nagy E1 , Feher Kiss A1 , Horvath G2 , Barnai M1 , Varkonyi T3 ;
1 University of Szeged Faculty of Health Department of
Physiotherapy; 2 University of Szeged Faculty of Medicine
Department of Physiology; 3 University of Szeged Faculty of
Medicine Department of Internal Medicine
PURPOSE: The objective of the present study was to compare the
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
and repetitive falls. PARTICIPANTS: 17 middle aged patients with
type 2 diabetes recruited from a diabetes clinic took part in the study.
METHODS: The COP displacement was quantified in Romberg
position under two visual conditions (eyes open (EO) and eyes closed
(EC)) on a stable and foam surface. Three successive trials have
been performed in each condition. The mean sway velocity (MSV)
was determined by Neurocom Basic Balance Master. According to
the MSV values measured on the foam surface the subjects were
divided into three groups: Normal (N), High (H) and Fixing (F).
(Subjects were considered as F if they have high MSV in EO and
normal MSV in EC condition). First the sway path was calculated
in anteroposterior (AP) and mediolateral (ML) directions. Secondly
the data were analysed by fast Fourier transformation in various
frequency bands (low: 0.-0.1 Hz; middle low: 0.1-0.5 Hz; middle
high: 0.5-1 Hz; high: 1-3 Hz). ANALYSIS: All data were subjected
to analysis of variance in order to make comparisons between the
groups and the experimental situations. The post hoc test was the
LSD multiple comparisons test. RESULTS: The sway path on foam
surface was significantly larger with EC than EO in all groups, except
in ML direction, where the F group did not showed difference with
changing the visual condition. In the AP direction both the F and
H groups displayed a significantly higher sway path with EO than
the N group, whereas in ML direction only the F group did. In
the EC condition the H group differs significantly from both the F
and N group in both directions. The frequency analysis revealed
that in the AP direction in each frequency band in all groups the
lack of visual input increased the frequency power except in the
high frequency band in the F group. More interesting differences
were observed in the ML direction where the frequency power with
EO was significantly higher in the F group than in the N and H
groups in each frequency band, however, that with EC seemed
to be normal. CONCLUSIONS: About one third of our patients
have chosen a fixing strategy to maintain upright standing on foam
surface, especially in the ML direction that might be explained by
the increased personal threat caused by unstable base of support.
However, interestingly they showed extreme large power with EO
condition, which might be as a results of better utilising of visual
information allowing a greater degree of freedom in the control of their
hip joint. IMPLICATIONS: In fixing patients the physiotherapeutic
interventions have to focus on the control of ML balance which is
under hip control. Additional research is needed to clarify the effect of
physiotherapy on the postural performance. KEYWORDS: diabetes,
postural control, fixing. FUNDING ACKNOWLEDGEMENTS: This
work is an unfunded work. CONTACT: nedit@efk.u-szeged.hu
ETHICS COMMITTEE: University of Szeged Etics Committe
S442
Research Report Poster Display
12-13 Tuesday 5 June 14:00
VCEC Exhibit Hall B & C
THE TRUNK VELOCITY OF PATIENTS IS IMPORTANT FOR
THEIR EASY STANDING UP
Momose K1 , Miwa M2 , Suzuki K2 , Ihashi K2 ; 1 Division of
Physical Therapy, Shinshu University School of Health Sciences;
2 Department of Physical Therapy, Yamagata Prefectural University
of Health Sciences
PURPOSE: It is important that the position of the lower extremity
and upper body movement velocity for standing up. When patients
sit with knee extension, patients can not stand up slowly. On the
other hands, it is easy that patients move their trunk fast. The
relationship of the trunk velocity and lower extremity position is
not clear. The purpose of this study is to estimate of the velocity
of the trunk for successful standing up. Standing up is one of
the difficulty movements for person with a stroke. RELEVANCE:
During the treatment of person with a stroke, physical therapist
take advantage of kinesiology for analyzing patient movement and
teaching to be suitable moving methods for each patient. This study
provides one of the causes of failed standing up and makes target
velocity clear for successful standing up. PARTICIPANTS: Seven
young subjects participated in this study. They did not have any
neuromuscular disease and problem of bones and joints. Subjects
understood informed consent in this study. METHODS: Seven
cameras were used to record subjects’ performance. Three force
plates were used to collect ground-reaction force. Each segment
angular velocity and joints moment were calculated by computer.
Electromyography was detected from 7muscles. The subjects sat on
the chair with knee flexion 80 degree, and hip flexion 90 degree
and trunk perpendicularly. The subjects want to stand up with
variety trunk velocities. The velocity changed from slow to fast.
At first, the subjects did not stand up some slow velocities, and
then they could stand up some fast velocities. Then, they sat with
knee flexion 90, 100, 110, 120 and 130 degree. They tried to
successful standing up as slow as possible. ANALYSIS: Student’
t test was used for comparison of difference between unsuccessful
stand up and successful stand up velocities. The association between
velocity and knee joint moment measured by correlation coefficient.
RESULTS: With knee flexion 80 degree, mean the trunk velocity of
successful standing up, 112.8 deg/sec, was significantly (p < 0.01)
faster than that of unsuccessful stand up, 41.3. The 80 deg/sec
is divided successful and unsuccessful standing. Forward bending
angle of trunk was not significant, mean bending angle was 63.5
and 59.7 degree both successful and unsuccessful standing up with
knee flexion 80 degree. Trunk velocity with knee flexion 80 degree
was significantly faster than the other knee flexion angle. The body
bending angle was decrease when knee joint flexed from 80 degree to
130degree. CONCLUSIONS: The trunk velocity, bending angle and
knee joint angle are important for successful standing up. Subjects
can stand up with fast trunk movement during knee extension position
with large trunk bending. When knee flexion position from 90 to
130 degree, subjects can stand up with very slow trunk movement
with small trunk bending angle. IMPLICATIONS: It is easy to stand
up with fast trunk movement, even if knee joints extended. Normal
subjects can stand up any knee joint position. On the other hand fast
movement is difficult for person with a stroke. Therefore, they have to
bend their knee joints to stand up safety. KEYWORDS: trunk velocity,
standing up, motion analysis. FUNDING ACKNOWLEDGEMENTS:
N.A. CONTACT: kmomose@shinshu-u.ac.jp
WCPT 2007, Research Reports
Research Report Poster Display
12-17 Tuesday 5 June 14:00
VCEC Exhibit Hall B & C
DOES FUNCTIONAL REACH TEST REFLECT
MULTIDIRECTIONAL BALANCE CONTROL ABILITY?
Shiomi T1 , Saito A1 , Maruyama H1 , Fujita H; 1 International
University of Health and Welfare, Otawara, Tochigi, Japan
PURPOSE: Among dynamic balance measures, Functinal reach
test(FRT) is one of the commonly used. FRT was desined to
measure the limit of stability in anterior direction during standing. It
is, however, unknown that FRT measures really mean multidirectional
balance ability. The purpose of the present study was to determine
whether FRT reflects the limits of stability in multidirection and
stand for an index of dynamic control ability. RELEVANCE: Balance
ability is one of the essential components of motor function and
its evaluation is prerequisite for the physical therapy intervention.
The ability to maintain dynamic balance control is critical for the
successful performance of most daily living. Dynamic balance is
complex, and no single measure that tests all aspects of the dynamic
balance control is available. PARTICIPANTS: Thirtythree young and
seventeen elderly volunteered participated in this study. Subjects
consisited of a group of the younger(N=33;15 males and 18 females)
and of the elderly(N=17; 10 males and 7 females).The mean height
and weight were 165.4±7.6cm, 59.1±8.8kg,for the younger and
154.8±10.1cm, 55.5±10.7kg for the elderly, respectively. METHODS:
Three dynamic balance tests were conducted in this study.FRT:
measuing the maximal distanse that subjects could reach forward
horizontally while maintaining on a fixed base of support. Cross
test(CRT):volutarily leaning their bodies as much as possible forward,
backward,rightward, and leftward in a standing position. Rotation
test(ROT):shifting their bodies in such a manner as large circle
as possible possible may be drawn with center at their feet in
a standing position. The excursion sway distance of center of
pressure(CP) of each test was measured by the posturogram(Active
Balancer,ANIMA,JAPAN). ANALYSIS: The measurements of three
tests were expressed by means and standard deviations. The signif-
icant differences of means and standard deviations were determined
by using the t-test. Pearson’s product moment correlation coefficient
was used to calculate correlations among the measurements data.
RESULTS: The younger group had significantly greater excursion
sway distance of CP in CRT, ROT, and the FRT compared with the
erderly group (p < 0.05).Functional reach measures were associated
with the anteroposterior excursion sway distance of CP. The Peason’s
correlation coefficient was 0.67 and the R2 using linear regression
was 0.45. In both group, a significant correlation existed between
CRT and ROT in a range generated by forward and backward
exursion sway distance of CP(X), a range generated by rightward
and leftward sway of CP(Y), and area(XY)(p < 0.001). No signifiant
correlation existed between FRT and CRT or FRT and ROT in X,Y,and
XY(p < 0.05),respectively. CONCLUSIONS: FRT in an index for
determining forward limit of stability and indicates only unidirectional
balance control stability, so never reflecting multidirectional balance
control ability. IMPLICATIONS: Careful consideration will be needed
for interpreting the FRT measurement data. KEYWORDS: Functional
reach test, dynamic balance test, multidirectional balance. FUNDING
ACKNOWLEDGEMENTS: This work was unfunded. CONTACT:
tshiomi@iuhw.ac.jp
ETHICS COMMITTEE: This reserch was approved by the In-
ternational University of Health and Welfare ethics comittee in
20/APR/2005.
Poster Displays, Tuesday 5 June
Research Report Poster Display
12-21 Tuesday 5 June 14:00
VCEC Exhibit Hall B & C
ASSESSING BALANCE WITH THE STAR EXCURSION BALANCE
TEST IN PRE-ELDERLY
Sasaki R, Urabe Y, Tanaka K; Hiroshima University
PURPOSE: The ratio of elderly population older than 65 years has
reached over 20% of our whole population, and it becomes increased
year by year in Japan. Falling is one of the most serious health
issue in elderly. Fractures by falling, especially in femoral neck, would
greatly compromise activities of daily living in elderly people. Balance
is an important factor to prevent falling. Clinically, static balance
tests such as single-leg stance, functional reach test were often
used to evaluate of balance capability in elderly. However, it may be
important for the elderly to assess their balance in dynamic situation.
Therefore, the purpose of this study was to assess dynamic balance
by using the star excursion balance test (SEBT) and compare with
static balance in pre-elderly people. RELEVANCE: Assessing the
dynamic balance by using the SEBT may be helpful for fall prevention
in elderly. PARTICIPANTS: Eighteen healthy pre-elderly volunteered
in this study. Participants were 13 males and 5 females, whose mean
age (± SD) was 62.8 ±6.1 years, height was 160.3 ±8.6 cm, and
body weight was 56.3 ±10.0 kg. No participants had any significant
musculoskeletal disorder. METHODS: We used the SEBT which
measures reach distance of each limb in 8 directions. The reliability
of it was reported by Kinzey in 1998. The reach directions were
guided by 8 lines: anterolateral (AL), anterior (ANT), anteromedial
(AM), medial (MD), posteromedial (PM), posterior (PO), posteorateral
(PL), and lateral (LAT). The reach distances were normalized to
subjects’ height. In addition to the SEBT, we measured single-leg
stance time with opened and closed eyes. Single-leg stance can
assess static balance. ANALYSIS: Pearson’s correlation coefficients
were performed to assess correlations between reach performance
of the SEBT and the duration of the single-leg stance with eyes-
open/closed conditions. The data were analyzed by using Stat View J
5.0(SAS Institute Co., USA). The significance level was set at P < 0.05
for all analyses. RESULTS: The correlation between the SEBT and
eyes opened single-leg stance ware not statistically significant in
this study. The PM reach direction was most strongly related to the
eyes-closed single-leg stance (r = 0.58). In addition, the correlation
between the eyes-opened single-leg stance and PO was r = 0.57,
and PL was r = 0.52, respectively (p < 0.05). CONCLUSIONS: We
measured the SEBT and the single-leg stance time with eyes-
opened and closed. Statistical analysis showed the distance of
3 reach directions (PM, PO, PL) was significantly correlated with
single-leg stance time with eyes-closed. The result of SEBT in 3
directions, PM, PO and PL, might play an important role in balance
evaluation because these results include both static and dynamic
balance components. IMPLICATIONS: Dynamic balance training of
3 directions may be useful to prevent the falling in the future for pre-
elderly. KEYWORDS: star excursion balance test, falling prevention,
pre-elderly people. FUNDING ACKNOWLEDGEMENTS: This study
was not supported by any grant or commercial resource. CONTACT:
rieko-sasaki@hiroshima-u.ac.jp
ETHICS COMMITTEE: The Ethics Committee of Hiroshima Univer-
sity
S443
Research Report Poster Display
14-01 Tuesday 5 June 14:00
VCEC Exhibit Hall B & C
REPOSITION ACCURACY AND COORDINATION OF THE LOWER
EXTREMITY IN SUBJECTS WITH KNEE OSTEOARTHRITIS
Wang T1,2 , He H1 , Shih Y1 , Chen W1,2 , Yen L2 ; 1 Faculty of
Physical Therapy, National Yang-Ming University, Taipei, Taiwan;
2 Department of Rehabilitation Medicine, Cheng-Hsin Rehabilitation
Medical Center, Taipei, Taiwan
PURPOSE: The purposes of this study were 1) to compare the lower
extremity (LE) proprioception and coordination between subjects with
knee osteoarthritis (OA) and their matched controls; 2) to determine
the relationships between the LE proprioception and coordination and
their related factors; 3) to determine the relationships between the
LE proprioception, coordination and physical function. RELEVANCE:
Although proprioceptive and coordination training become more pop-
ular when treating subjects with knee OA, there have been few clinical
methods to evaluate the neuromuscular control ability of the entire
lower limb. In addition, the factors which affect the proprioception and
coordination of the entire LE are not clear. PARTICIPANTS: Forty-
two participants (7 males, 35 females; mean age=61.76±8.24 yrs)
with knee OA and 42 age- and gender-matched healthy volunteers (7
males, 35 females; mean age=61.62±10.81 yrs) participated in this
study. METHODS: After an initial evaluation, all subjects were tested
by the Functional Squat System (Monitored Rehab System B.V., 2031
CW Haarlem, The Netherlands) for quantifying their LE propriocep-
tion and coordination. Pain was recorded using a numerical rating
scale during each test for subjects with knee OA. Western Ontario
and McMaster Universities Osteoarthritis Index (WOMAC)disability
score was also obtained for the OA group. Five times sit-to-stand test,
timed up and go test, and nine-step stair climbing and descending
test were used to assess the physical function for both groups.
ANALYSIS: Two-way mixed ANOVAs with pairwise comparisons
were used to determine the between- and within-group differences
in all study parameters. Stepwise multiple regressions were used
to explore the relationships between the related factors and the
LE proprioception or coordination parameters. Pearson’s correlation
coefficients were used to determine the relationships between LE
proprioception or coordination parameters and physical function. The
level of statistical significance for each test was set at a < 0.05.
RESULTS: Results of this study showed that subjects with knee OA
demonstrated decreased coordination than their matched controls
both in the affected and unaffected limbs, but no statistical differences
were found between the affected and unaffected limbs in the knee
OA group. However, the LE proprioceptive reposition accuracy was
not significantly different between the patient and the control groups.
There were no significant differences in all LE proprioceptive testing
parameters for either leg in the knee OA group. Resistance, testing
limb position, stair climbing and descending activity, knee range
of motion, body mass index, and exercise habit were found to
be significant factors related to the LE proprioception of patients
with knee OA. Resistance, movement phase, age, BMI, exercise
habit, radiographic status, knee range of motion, and disability score
were found to be significant factors related to the coordination in
subjects with knee OA. Physical function tests were found to be
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:
tjwang@ym.edu.tw
ETHICS COMMITTEE: Institutional Review Board, Cheng-Hsin
Rehabilitation Medical Center, Taipei, Taiwan
S444
Research Report Poster Display
14-05 Tuesday 5 June 14:00
VCEC Exhibit Hall B & C
RELATIONSHIP BETWEEN TIBIAL ROTATION STRENGTH AND
ROTATION OF THE TIBIA DURING SINGLE-LEG DROP LANDING
Kiriyama S1 , Sato H2 ; 1 Graduate school of medical science, Kitasato
University; 2 Kitasato University, School of Allied Health Sciences
PURPOSE: Female athletes have a higher incidence of sustaining
a serious noncontact anterior cruciate ligament (ACL) injury than
male athletes participating in the same sport. The aim of this study
was to investigate the relationship between tibial rotation strength
and rotation of the tibia during a single-leg drop landing. We also
compared gender differences in muscle strength and degree of
rotation of the tibia. RELEVANCE: It is important to make functional
risk factors known in order to provide an effective training and
rehabilitation program to prevent ACL injury. PARTICIPANTS: Eighty-
one female and 88 male healthy young subjects, 14 to 23 years of
age, volunteered to participate in this study. METHODS: Subjects
performed single-leg drop landings from 20-cm heights. Femoral
and tibial kinematics were measured using three-dimensional motion
analysis techniques during the drop landings. Maximal isometric
tibial rotation strength was measured at 30 degrees of knee
flexion in a supine position using a dynamometer. ANALYSIS:
Internal rotation angles of the tibia with respect to the femur were
calculated using MATLAB software. Muscle strength was normalized
with respect to body mass. An independent t-test was used to
compare between genders for maximum tibial internal rotation
angle, tibial rotation strength and external-rotator-to-internal-rotator
strength ratio. A Pearson correlation coefficient was measured to
compare maximum tibial internal rotation angles with tibial rotation
strength. The level of significance was set at 0.05. RESULTS:
Females exhibited significantly greater tibial internal rotation angles
than males during single-leg drop landing (female: 12.0±12.57º,
male: 7.9±7.91º, p<0.05). Females also had significantly less tibial
rotation strength compared to males (external rotator: female;
0.27±0.069Nm/kg, male; 0.38±0.084Nm/kg, p<0.001, internal rota-
tor: female; 0.34±0.087Nm/kg, male; 0.40±0.081Nm/kg, p<0.001)
and a significantly lower external-rotator-to-internal-rotator strength
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
of tibial external rotator muscles, which inhibit internal rotation of
the tibia, may lead to large tibial internal rotation movement during
the single-leg drop landing. Therefore, it was suggested that these
factors increase the risk of ACL injury in females. IMPLICATIONS:
Improving biceps femoris muscle strength training and rehabilitation
might help to decrease rates of ACL injury. KEYWORDS: rotation,
gender, ACL. FUNDING ACKNOWLEDGEMENTS: NA. CONTACT:
going-steady-78-kiri.com@hotmail.co.jp
Research Report Poster Display
14-09 Tuesday 5 June 14:00
VCEC Exhibit Hall B & C
SHIFT PHASE BETWEEN PELVIS AND TRUNK MOTION
INCREASED WITH RUNNING SPEEDS
Nishimori T1 , Ito A2 ; 1 Department of Physical Therapy, Kansai
Vocational College of Medicine, Osaka, Japan; 2 Osaka University
of Health and Sport Sciences, Graduate School, Laboratory of
Sport Biomechanics
PURPOSE: This study investigated the phase difference between
pelvic rotation and trunk rotation during running. RELEVANCE: In
1987, Hinrichs described that the action of the arms and upper
trunk provide most of the angular momentum in the horizontal plane
needed to put the legs through their alternating strides in running as
well as walking. However, these studies have mainly been limited
WCPT 2007, Research Reports
to running over a narrow range of speeds. We consider that a
difference between pelvic and upper trunk rotation is needed in
walking, the inertia moment of the trunk is large, it is conversely
disadvantageous that the trunk rotates significantly in faster running.
PARTICIPANTS: The subjects were six male sprinters.: average age,
19.7±0.52 years, 100 meter best record time, 11.0±0.28sec. No
subjects were injured during this experiment. METHODS: Running
conditions were as follows: 2.5 m/s, 4.5 m/s 6.5m/s and maximum
speed for running. Running was recorded using three high speed
video cameras and ground reaction force. After digitizing the 29
landmarks, each partial coordinates value was calculated. Matsui’s
coefficient of the body segment inertia parameter was used in
this research, and the body’s center of gravity was computed.
The horizontal movement of the center of gravity estimated the
average gait speed over 2 steps. Positive rotation of the pelvis
and trunk about the vertical axis of the global coordinate system
occurred on the transverse plane ANALYSIS: Cross-correlation
analysis was measured to identify the phase difference (%) between
pelvic and trunk rotation. When the phase difference (%) was
50%, the relationship of phase shift between pelvis and trunk
indicated a complete inverse-phase. When the phase difference (%)
was 0%, the relationship of phase shift between pelvis and trunk
indicated complete synchronicity. The relationship between the phase
difference (%) and actual gait speed (m/s). The statistical procedures
used Pearson’s regression analysis. RESULTS: The phase difference
between pelvis and trunk rotation (%) decreased significantly with
the running speed (r = 0.70, p < 0.001). CONCLUSIONS: The result
of this research revealed that shift difference between pelvis and
trunk rotation varied with changes in running speed. It is quite
inverse-phase between pelvis and trunk in slow running speed.
However, it became a coordinate phase in increased with running
speed. IMPLICATIONS: The result of this research revealed the shift
difference between pelvis and trunk rotation increased with running
speeds. The decrease in shift difference at faster running may be
an effective strategy to induce a rigid trunk. KEYWORDS: Running
speeds, pelvis, Phase shift. FUNDING ACKNOWLEDGEMENTS:
Nothing. CONTACT: nisimori@kansai.ac.jp
ETHICS COMMITTEE: Ethics Committee of Kansai vocational
college of medicine
Research Report Poster Display
15-13 Tuesday 5 June 14:00
VCEC Exhibit Hall B & C
THE INFLUENCE EXERTED BY DETAIL OF KNOWLEDGE OF
RESULTS(KR) ON PERFORMANCE IN A PARTIAL WEIGHT
BEARING(PWB) TASK
Watanabe M, Tani H; Department of Physical Therapy, School
of Nursing and Rehabilitation Sciences at Odawara, International
University of Health and Welfare,Kanagawa,Japan
PURPOSE: In the initial process of motor learning, it is reported
that feedback is one of the most powerful variables influencing motor
learning. But the optimal relative frequency for giving feedback is
not 100 percent. In this research, the influence that differences in
the detail of KR used as a feedback, exerted on motor learning was
examined in PWB task. RELEVANCE: PWB is a skill that physical
therapists often teach. For example, PWB is practiced for hemiplegia
or fracture using a mirror or a scale feedback. But it is difficult for
the patients to achieve the correct weight. PARTICIPANTS: The
participants were 18 healthy adults. The content of the experiment
was explained by document and oral presentation beforehand, and
the participants’ consent was obtained. The participants were divided
into 2 groups: Group D(detailed group) was told the difference from
the target weight in kilograms, and Group C(coarse group) was told
the difference by 9 broad statements. METHODS: The task was
to assume a load of 1/3 body weight on the left leg from right leg
standing. The start posture was right leg standing on a parallel bar
internal detector, and the participants were orally prompted to start
Poster Displays, Tuesday 5 June
the task. After the signal had been amplified with a strain amplifier
(Kyowa YB-503A), it was input to a computer through an analog to
digital converter. KR was presented to the participants orally on the
basis of that value. The experiment schedule was composed of a
pre-acquisition phase (3 trials), an acquisition phase (15 trials) and a
retention phase of 5 min after and 24 hr after (3 trials each). KR being
presented every 3 trials in the acquisition phase. At the end of the
experiment the participants answered a questionnaire on the difficulty
of the task and the focus of their attention. ANALYSIS: Absolute
error (AE) for blocks of 3 trials was calculated as an independent
variable for analysis. Performance in the acquisition and retention
blocks was evaluated using two-way analysis of variance. RESULTS:
There was no difference in AE between groups C and D in the
pre-acquisition phase. In the acquisition phase, AE decreased from
51.3% to 17.2% in Group D, and from 44.4% to 13.1% in Group
C. A main effect for block [F(4,64) = 9.55, p < 0.001] was observed.
But a main effect for group was not observed. In the retention
phase, a main effect was observed for neither block nor group.
CONCLUSIONS: In this study, KR was effective for both groups in
PWB task. Thus, a difference in the detail of KR does not influence
motor learning. IMPLICATIONS: The results suggest that patients
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
the detail of KR should be investigated in the future. KEYWORDS:
Knowledge of result,Motor learning,Partial weight bearing. FUNDING
ACKNOWLEDGEMENTS: I thank participants who had this study
cooperate and Professor Hiroaki Tani whom I taught it to. CONTACT:
mwatanabe@iuhw.ac.jp
Research Report Poster Display
15-17 Tuesday 5 June 14:00
VCEC Exhibit Hall B & C
CONTEXTUAL INTERFERENCE EFFECT IN MOTOR LEARNING
IS ATTENUATED BY CORTICAL STIMULATION IN HUMAN
MOTOR CORTEX: A KINEMATIC ANALYSIS
Lin C1 , Wu A2 , Winstein C1,3 ; 1 Division of Biokinesiology and
Physical Therapy at the School of Dentistry, University of Southern
California, Los Angeles, CA, USA; 2 Department of Neurology,
David Geffen School of Medicine, University of California, Los
Angeles, CA, USA; 3 Department of Neurology, Keck School of
Medicine, University of Southern California, Los Angeles, CA, USA
PURPOSE: Our previous research showed that the contextual
interference (CI) effect in motor learning is attenuated by cortical
stimulation applied over human motor cortex (M1). Here, we
applied kinematic analysis to determine the locus of this effect
in the learning of three arm movement tasks, each with unique
spatial and temporal components and under CI practice conditions
including either blocked (low CI) or random (high CI) task practice.
RELEVANCE: Learning more about the role of human motor cortex
in motor learning can inform the development of evidence-based
clinical practice strategies for rehabilitation of patients with brain
damage. PARTICIPANTS: Sixty one young adults were randomized
into one of six practice groups, resulting from three stimulation
conditions (Control, TMS, Sham-TMS) and two levels of CI (Blocked,
Random). METHODS: For the stimulation groups, single-pulse TMS
was delivered after each of 144 movements, over the biceps-
hotspot of M1 at 120% of motor threshold. ANALYSIS: Performance
accuracy in temporal (time) and spatial (amplitude) parameters
was measured across acquisition and two no-stimulation retention
(immediate and delayed) phases. RESULTS: For the acquisition
phase, all groups improved with practice, p < 0.05. In delayed
retention, the Random-Control group showed better retention of the
temporal, but not spatial parameter than for the Blocked-Control
group (p = .02, p = 0.197, respectively). TMS attenuated the CI effect:
there was no significant difference between the Random-TMS and
S445
the Blocked-TMS groups for the temporal parameter. TMS degraded
both temporal (p = 0.03) and spatial (effect size = 0.94) parameter
learning compared with that for the Random-Control group. This
was not the case for the blocked practice groups, which performed
similarly at retention. CONCLUSIONS: These results, together with
those from the Sham TMS groups suggest that the contextual
interference effect in motor learning is primarily mediated through
temporal parameter learning and that cortical stimulation during
practice leads to greater attenuation in random compared with
blocked practice condition. IMPLICATIONS: Understanding the role
of motor cortex in learning of movement kinematics will contribute to
evidence-based physical therapy practice for rehabilitation of patients
with brain damage. KEYWORDS: motor learning, kinematics, motor
cortex, practice order, transcranial magnetic stimulation. FUNDING
ACKNOWLEDGEMENTS: This study was supported in part by the
California Physical Therapy Association (CW, CL), a student research
award (CL) from North American Society for the Psychology of Sport
and Physical Activity, and NINDS K23-NS045764 (AW). CONTACT:
chienhol@usc.edu
ETHICS COMMITTEE: Institutional Review Board of the University
of Southern California Health Science Campus.
Research Report Poster Display
15-21 Tuesday 5 June 14:00
VCEC Exhibit Hall B & C
ACL INJURY PREVENTION PROGRAM AND THE EFFECT
ON DECREASING ACL INJURY INCIDENCE IN FEMALE HIGH
SCHOOL BASKETBALL PLAYERS
Urabe Y1 , Sasaki R, Tanaka K, Matsui H, Koshida S, Miyashita K;
1 Department of Sports Rehabilitation, Graduate School of Health
Sciences, Hiroshima University
PURPOSE: Many studies have been investigated to identify the
mechanism of non-contact anterior cruciate ligament (ACL) injury.
It is currently accepted that the ACL injuries occur during stopping,
cutting, or jump-lading with slight knee flexion and knee vulgus. The
number of ACL injury incidence has not been successfully decreased
yet. Therefore, we developed the ACL injury prevention program.
The purpose of this study is to report the effect of the ACL injury
prevention program after 12 months period. Our program requires
only 10 minutes, whereas the programs reported previously requires
approximately 30 minutes. RELEVANCE: If our ACL program is able
to decrease the number of ACL injury incidences, it will enhance
the current knowledge of ACL injury prevention. PARTICIPANTS:
180 female basketball players from ten local high schools were
participated in our study. The subjects were divided by two groups at
random. 92 subjects attended the ACL prevention program (exercise
group). They were instructed to perform the exercise program
before every regular practice session. 88 subjects attended only
regular practices (control group). METHODS: The exercise program
consists of strengthening, balance, and jump-landing exercises.
Exercise attendances, injury profiles, and the physical fitness levels
of all subjects were measured in every three months. In addition,
proprioceptive function is important for neuromuscular system. We
used our original instrument for the measurement of joint position
sense. ANALYSIS: Paired t-test was used to compare the data
between before and after the exercise and between two groups.
The level of statistical significance was set at 0.05 in this study.
RESULTS: The compliance of the ACL injury prevention program
after 12months was 85% (78 subjects) in the exercise group and
75% (66 subjects) in the control group. Two ACL injuries occurred
during the intervention period in the exercise group. The calculation
of the ACL injury ratio was 0.037 per 1,000 practice hours. Four
(0.080) ACL injuries occurred in the control group. There was no
notable finding in the characteristics of ACL injured subjects. The
results of the physical fitness measurement after 12months were
increased from 19 to 41% in the exercise group. The control group
showed relatively lower improvement of the physical fitness when
S446
compared to the exercise group. Absolute errors, which represent
the joint position sense, were found to be from 4 to 10 degrees.
There was no significant difference in joint position sense between
pre and post-program period and between ACL injured and non-
injured subjects. sense. CONCLUSIONS: The calculation of the ACL
injury rate in the female athletes was found to be from 0.2 to 0.5 per
1,000 practice hours in this study. Our results showed lower incidence
rate of ACL injury in the exercise group, which was about half of
control group. Since the program requires only 10 min, subjects
were able to continue the prevention program. IMPLICATIONS:
Although shorter time is required for the single exercise session in our
program, the greater effect on decreasing the ACL injury incidence
was observed compared with previous studies. KEYWORDS: ACL
injury prevention, proprioceptive function, female athletes, basketball.
FUNDING ACKNOWLEDGEMENTS: This study was suported by
JSPS KAKENHI 18500405. CONTACT: yurabe@hiroshima-u.ac.jp
ETHICS COMMITTEE: Graduate School of Health Sciences,
Hiroshina University
Research Report Poster Display
17-01 Tuesday 5 June 14:00
VCEC Exhibit Hall B & C
FUNCTIONAL AND MORPHOLOGICAL ADAPTATIONS OF
DIAPHRAGM MUSCLE TO INTERMITTENT STRETCH IN AGED
RATS
Imagita H1 , Kanemura N2 , Moriyama H3 , Miyata H4 ; 1 Department
of Physical Therapy, Faculty of Health Sciences, Kio University;
2 Graduate School of Health Sciences, Hiroshima University;
3 Department of Physical Therapy, Faculty of Health Sciences,
Saitama Prefectural University; 4 Department of Biological Science,
Graduate School of Medicine, Yamaguchi University
PURPOSE: The purpose of this study, we evaluated age-related
changes in the rat diaphragm and changes in muscle fibers
after unilateral phrenic nerve denervation (DNV). RELEVANCE: To
determine physiological, histochemical and biochemical properties
of diaphragm muscle (DIA). PARTICIPANTS: Young (2.5-month,
n=18) and Old (24-month, n=18) male Wistar rats were used in
this study. METHODS: The unilateral diaphragms of nine rats in
each age group was denervated by cutting the phrenic nerve at
the cervical level, and sham operation was performed on the other
nine in each. The undenervated side diaphragms of young and old
sham rats were studied to investigate the age-related changes. Four
weeks after the denervation, isometric contraction properties, fiber
type composition, and expression of myosin heavy chain (MHC)
isoforms in all groups were observed. All procedures used in this
study were approved by the Animal Use Committee at Yamaguchi
University which followed the Japanese Physiological Society Animal
Care Guidelines. ANALYSIS: Each treatment group was compared
to sham groups or between age groups with similar treatments by an
unpaired Student’s t-test. P value of less than 0.05 was regarded to
be statistically significant. RESULTS: Age-related changes included
prolongation of isometric contraction time and one-half relaxation
time, increases in cross-sectional areas of muscle fibers such as
slow-twitch oxidative (SO) and fast-twitch oxidative glycolytic (FOG)
fibers, and relative increases in myosin heavy chain 1 (MHC 1),
resulting in fast to slow transition of diaphragmatic muscle fibers.
DNV induced characteristic changes in diaphragmatic muscle fibers
such as hypertrophy of FOG fibers and inhibition of SO fiber atrophy,
in addition to regressive changes such as decreases in contraction
force and peak twitch force, prolongation of isometric contraction
time and one-half relaxation time, and rapid atrophy of fast-twitch
glycolytic (FG) fibers. These changes were also observed in young
rats. In old rats, DNV did not induce significant changes in the
peak twitch force, isometric contraction time and one-half relaxation
time. In addition, cross-sectional areas of SO, FOG, and FG fibers
decreased in old rats. In particular, FG fibers were atrophied by 50%
or more. Moreover, significant increases in MHC2a and significant
WCPT 2007, Research Reports
decreases in MHC 2d and MHC 2b were also observed in SDS-
PAGE. CONCLUSIONS: The diaphragm muscle is continuously and
stereotypically activated throughout life to maintain ventilation. The
denervated hemidiaphragm of hypertrophy has been attributed to the
repetitive, unopposed stretching of the denervated hemidiaphragm
resulting from the rhythmic contractions of the intact, contralateral
hemidiaphragm. These findings suggest that decreased sensitivity
to mechanical stress prevents adaptation of skeletal muscles to
various exogenous factors in old rats. Although stretching has been
used as a therapeutic technique in the field of physical therapy, an
animal model of respiratory intermittent stretch used in this study
may be a novel therapeutic technique that is useful for preventing
muscle atrophy or increasing muscle strength. IMPLICATIONS:
These results clarified that aging decreases the stretch sensitivity. In
the future, it is necessary to investigate in ways of how to prevent age-
related changes in skeletal muscles. KEYWORDS: Rat diaphragm
muscle, aging, denervation. FUNDING ACKNOWLEDGEMENTS:
None. CONTACT: h.imagita@kio.ac.jp
ETHICS COMMITTEE: The Animal Use Committee at Yamaguchi
University which followed the Japanese Physiological Society Animal
Care Guidelines
Research Report Poster Display
17-09 Tuesday 5 June 14:00
VCEC Exhibit Hall B & C
EFFECT OF IMMOBILIZATION ON COLLAGEN IN RAT SOLEUS
MUSCLE
Hibino I1 , Okita M2 , Inoue T3 ; 1 Department of Physical Therapy,
Japan College of Medical Care and Welfare,Nagoya,Japan; 2 Faculty
of Care and Rehabilitation, Seijoh University,Tokai,Japan; 3 Program
in Physical and Occupational Therapy, Graduate School of Health
Sciences, Nagoya University,Nagoya,Japan
PURPOSE: Immobilization of a joint induces decreased muscle
elasticity, a condition called muscle contracture, but the mechanism
is still not clear. Collagen has several important functions as the
major structural component of muscular connective tissue. In the
mechanism of the muscles contracture, we have assumed that the
increase of collagen’s intermolecular cross-links and/or the change
of expression of collagen’s species in muscular tissue. The aim of
our study was to clarify the mechanism of muscle contracture in
the rat by determining changes in ankle joint mobility and collagen
in muscular tissue after immobilization. RELEVANCE: Muscle
contracture remains perhaps the single most frequent problem faced
by physical therapists. This study provides some information on the
mechanism of muscle contracture. PARTICIPANTS: Twenty male
Wistar rats, 8 weeks old, were divided randomly into control (n=10),
and experimental (n=10) groups. METHODS: The experimental
protocol was approved by the Ethics Review Committee for Animal
Experimentation at our institution. In experimental group, bilateral
ankle joints of each rat were fixed in full plantar flexion with plaster
casts, the soleus muscles being immobilized in shortened position.
The ankle joint was immobilized for 1 and 3 weeks, five rats
being used in each immobilization period. Five untreated control
rats also were tested weekly. ANALYSIS: At 1 and 3 weeks after
immobilization, rats were anesthetized with pentobarbital sodium and
the range of motion (ROM) on dorsiflexion of the ankle joint was
measured with a goniometer. After the measurement of ROM in each
immobilization period, bilateral soleus muscles was excised, weighed
and were used as a sample of biochemical analysis. The changes
in the ratio of type III to type I collagen after immobilization were
examined on polyacrylamide gel electrophoresis. Hydroxyproline
was determined for estimation of the insoluble collagen content
in muscular tissue. RESULTS: Ankle joint mobility decreased with
longer periods of immobilization. The ratio of type III to type I collagen
was increased after immobilization. The insoluble collagen content to
represent as a percent of wet weight was increased 3 weeks after
immobilization, but did not show change 1 week after immobilization.
Poster Displays, Tuesday 5 June
CONCLUSIONS: Our results suggested that muscle contracture
occurred after 1 week immobilization, and progressed with longer
periods of immobilization. Consequently, muscle contracture is
caused by the increase of the ratio of type III to type I collagen
in the early stage of immobilization, and the insoluble collagen
content was increased 3 weeks after immobilization. This change
indicate that the intermolecular cross-links become more stable
and mature, it may play a progressive role in muscle contracture
in the late stages of immobilization. IMPLICATIONS: The results
of the present study may be provided new information on the
mechanism of muscle contracture. KEYWORDS: Immobilization,
Muscle contracture, Collagen. FUNDING ACKNOWLEDGEMENTS:
This study was supported in part by a Grant-in-Aid for Scientific
Research from the Ministry of Education, Science, Sports and Culture
of Japan (Grant no. 18500428). CONTACT: i.hibino@jcmw.ac.jp
ETHICS COMMITTEE: The experimental protocol was approved by
the Ethics Review Committee for Animal Experimentation at Seijh
university
Research Report Poster Display
18-13 Tuesday 5 June 14:00
VCEC Exhibit Hall B & C
THE SIGNIFICANCE OF SELF-EVALUATED HEALTH CARE
RESOURCES IN THE REHABILITATION PROCESS FOR
INDIVIDUALS WITH LOW BACK PAIN
Knudsen H1,2 , Møller H1 ; 1 Master of Science in Rehabilitation,
University of south Denmark, Odense, Denmark; 2 CVSU Fyn,
Physiotherapy, Odense, Denmark
PURPOSE: It is a fact in international literature that low back
pain (LBP) derives from multiple factors, including biological,
psychological, social, and business-related and cultural factors. In
the future, the patient’s own self-evaluation of their health and
resources during rehabilitation will be a significant factor in the
rehabilitation process. Previous studies and healthcare reports
state that it is vital that the individual takes a central role in
the rehabilitation process. Rehabilitation is a goal driven, time
limited process of cooperation between the individual, relatives and
professionals. The objective is that the individual, who runs the
risk of back-related functional limitation, achieves an independent
and meaningful life. Rehabilitation is based upon the individual’s
entire lifestyle, and consists of a coordinated, integrated and science-
based strategy. As such, the goal of the study has been to achieve
an increased understanding and insight into the rehabilitation of
individuals with low back pain, and to consider the consequences
of the use of self-evaluation resources in relation to achieving
individual rehabilitation goals. RELEVANCE: It is necessary for
physiotherapists to understand the significance of self-evaluation
healthcare resources for individuals with low back pain to be able
to plan a physiotherapeutic intervention as part of the patient’s
comprehensive rehabilitation. PARTICIPANTS: The study included
seven participants. Participants were selected based on the following
criteria: Individuals who have previously had LBP, and who are
evenly distributed across Antonsky’s Sense of Coherence (SOC)
scale, with a uniform distribution of gender and age. METHODS:
The research methodology uses the qualitative research method
with semi-structured interviews. ANALYSIS: The selected analytical
strategy is based on Huberman and Mile’s interactive model and the
hermeneutic spiral. RESULTS: The study shows that participants
experiencing a meaningful rehabilitation, have a greater degree of
self-motivation and increased desire to control their own situation,
regardless of the resources available. The majority of participants
experience a barrier in the form of insufficient coordination in relation
to their overall rehabilitation programme, which means that they
do not achieve their personal goal. In this situation, the majority
of the participants experience that their personal resources are
inadequate. These individuals do not experience a meaningful or
fully coordinated process of rehabilitation, thus feeling that the
S447
therapy they have received has not met their needs. A smaller
group of individuals, with a high SOC score, many resources
and the ability to be flexible, are able to set meaningful goals
for their own rehabilitation. CONCLUSIONS: Self-evaluated health
resources have a significant impact on how individuals with low
back pain manage their rehabilitation process. When rehabilitation
is not organized according to individual goals, but has been chosen
according to the method used by the social and healthcare system,
the majority of participants believe their resources are inadequate
with regard to achieving their personal goals. It is recommended
that futures studies consider the significance of the organization
of the rehabilitation process. IMPLICATIONS: It is recommended
physiotherapist to highlight and involve personal healthcare re-
sources in the rehabilitation process as well as map out the barriers
individuals experience when trying to reach their personal goals.
KEYWORDS: low back pain, self-evaluated healthcare resources
and rehabilitation. FUNDING ACKNOWLEDGEMENTS: The study
is unfunded. CONTACT: hkk@cvsu.dk
ETHICS COMMITTEE: The ethics committee of Vejle and Fyns
county. Vejle-fynkomiteen@ouh.fyns-amt.dk
Research Report Poster Display
18-17 Tuesday 5 June 14:00
VCEC Exhibit Hall B & C
AN INVESTIGATION INTO PHYSICAL THERAPY TREATMENTS
FOR LUMBAR SPINAL STENOSIS
Tomkins C, Crites-Battie M, Forman H, Gordon E, McPhail J,
Wong J, Andrew K; University of Alberta
PURPOSE: Lumbar spinal stenosis (LSS) is a common cause
of lower back and leg pain in older adults. Physical therapy is
considered a non-surgical treatment option for LSS. The purpose
of this investigation was to determine what treatments are being
accessed by patients, as well as what treatments are being offered by
physical therapists for LSS patients in Canada. RELEVANCE: Little
is known regarding the current provision and use of physical therapy
treatments for patients with LSS. Further information on this topic
would be helpful to inform physical therapists and others of current
practices for this patient group, as well as to guide future research
regarding efficacy of physical therapy for LSS. PARTICIPANTS: The
study participants were part of a multi-centre prospective cohort
study of prognostic factors and outcomes of LSS being conducted
in Alberta, Canada. The participants had been referred by general
practitioners or specialists to any of four adult imaging facilities for
lumbar spine imaging. All subjects had LSS confirmed on imaging,
as well as through a subsequent visit to an orthopaedic or neuro-
surgeon (n=75). In addition, physical therapists working in clinics
in the Edmonton region of Alberta were invited to complete a
separate mailed clinician survey. METHODS: All participants with
LSS completed a telephone interview following their lumbar imaging
that included whether or not current treatment was being received,
and if so, what kind, using a standardized questionnaire. A separate
mail survey was developed and distributed to physical therapists
regarding how they treat LSS. The survey included questions on
therapist characteristics, treatment goals, treatments offered, and
beliefs about physical therapy and surgical treatment efficacy for
LSS patients. ANALYSIS: The data from patient and therapist
surveys were summarized using descriptive statistics. RESULTS:
The responses from 75 LSS patients indicated that 25 (33%) had
recieved passive physical therapy (PT), and 24 (32%) received active
PT. Of the patients indicating that they had received passive PT, the
majority reported massage (48%), followed by heat/ice (24%). Of
those indicating they received active PT, most received strengthening
(42%), flexibility exercises (33%) and aerobic conditioning (25%).
The physical therapists indicated that they offer a broad array of
treatments to LSS patients, including therapeutic exercise (96%),
patient education (96%), modalities (90%) and manual therapy
(88%). CONCLUSIONS: Our results indicate wide variability in the
S448
treatment types being offered to and accessed by patients with
LSS. The more commonly reported treatments such as manual
therapies, and various types of therapeutic exercise may be priorities
for randomized clinical trials of treatment efficacy of physical therapy
for LSS, which are currently lacking. IMPLICATIONS: The results of
this investigation may help in setting priorities for clinical research
into the use and efficacy of physical therapy treatments for patients
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: ctomkins@ualberta.ca
ETHICS COMMITTEE: Human Research Ethics Board at the
University of Alberta
Research Report Poster Display
18-21 Tuesday 5 June 14:00
VCEC Exhibit Hall B & C
CONDITIONAL DEFICITS AFTER SURGICAL HIP DISLOCATION
Rocourt M1 , Luder G, Deschner G, Radlinger L; 1 Physiotherapy
Research, University Hospital Berne, Switzerland
PURPOSE: The aim of this study was to characterize the
deficits concerning conditional aspects such as strength, power
and endurance 3 and 12 months after surgical hip dislocations.
RELEVANCE: After this surgery the persons walk with reduced
weight-bearing (15 kg) for 8 weeks. Due to this partial immobilization
hypotrophy of muscles and other tissue can be expected 3 months
after surgery. The identification of subsequent deficits is important for
the establishment of an adequate therapy and exercise programme.
The fact that these persons do not have physical therapy allows us
to evaluate the extent to which these deficits are resolved by natural
improvement one year after surgery. PARTICIPANTS: This cross-
sectional prospective study involved a total of 91 persons 3 months
after surgical hip dislocation (G3, n=29, 28.1±5.8 years, 76.7±17.1
kg), 12 months after surgery (G12, n=28, 30.1±5.1 years, 80.4±15.7
kg) and a control group (G0, n=34, 28.0±4.9 years, 67.4±11.0 kg)
consisting of healthy individuals without any pain or disability in
the lower limbs or back. METHODS: The following measurements
have been performed with all persons: maximum voluntary isometric
contraction (MVIC) and rate of force development (RFD) for hip
abduction and knee extension (force sensor) combined with surface
EMG of the relevant muscles (M. gluteus medius and M. tensor fascia
latae respectively M. vastus medialis) and aerobic threshold (cycle
ergometer). ANALYSIS: The strength and endurance measurements
were normalized to body weight. Descriptive statistics and group
differences (nonparametric: Kruskal-Wallis-H; Mann-Whitney-U-test)
were computed using SPSS. RESULTS: For hip abduction strength
we have seen a significant deficit 3 months and one year after
surgery in comparison to the control group. The mean MVIC for
hip abduction was 1.7±0.37 N/kg for G0, 1.02±0.48 N/kg for G3
and 1.37±0.53 N/kg for G12 with differences of −40% and −19%
between G0 and G3 (p = 0.000) respectively G12 (p = 0.009). The
mean RFD for hip abduction was 28.6±12.0 Nm/s/kg for G0,
14.6±10.3 Nm/s/kg for G3 and 19.4±8.8 Nm/s/kg for G12 and
showed deficits of −49% and −32% between G0 and G3 (p=
0.000) respectively G12 (p = 0.000). The mean power at aerobic
threshold was 1.24±0.45 Watt/kg for G0, 0.75±0.29 Watt/kg for G3
and 0.82±0.35 Watt/kg for G12. Differences of −39% and −34%
between G0 and G3 (p = 0.000) respectively G12 (p = 0.000) were
found. CONCLUSIONS: Significant differences between persons
after surgical hip dislocation and healthy for strength, power and
endurance still persist one year after surgery. This shows that
an adequate therapy is necessary to reach a normal condition
at the level of healthy persons. This could be important for the
functional stability of the hip and might reduce the negative process
of osteoarthritis. IMPLICATIONS: Based on these results we suggest
that physical therapy would be useful for patients after surgical hip
WCPT 2007, Research Reports
dislocation to gain better strength and endurance. The therapy and
exercise concept will consequently be investigated in a further study.
KEYWORDS: Immobilization, surgical hip dislocation, conditional
deficits. FUNDING ACKNOWLEDGEMENTS: Swiss Association of
Physiotherapy, Switzerland. CONTACT: lorenz.radlinger@insel.ch
ETHICS COMMITTEE: The study was approved by the Ethics
Committee of Canton Berne, Switzerland
Research Report Poster Display
20-09 Tuesday 5 June 14:00
VCEC Exhibit Hall B & C
COMPARISON OF THE EFFECTIVENESS OF A BEHAVIOURAL
GRADED ACTIVITY PROGRAM AND MANUAL THERAPY IN
PATIENTS WITH SUB-ACUTE NECK PAIN
Pool J1 , Ostelo R1,2 , Bouter L1 , De Vet R1 ; 1 EMGO institute VU
University medical centre Amsterdam; 2 Department of Allied Health
Care Research, Amsterdam School for Allied Health Care Education
PURPOSE: The objective was to assess if a behavioural graded
activity programme is more effective than manual therapy in patients
with sub-acute neck pain. RELEVANCE: Neck pain is a common
musculoskeletal disorder and approximately one-third of all adults
will experience neck pain during the course of 1 year.The evidence
regarding the effectiveness of conservative therapies for neck pain
is still inconclusive but manual therapy, a typical hands-on therapy
seems to be an effective therapy for neck pain. It is hypothesized
that psychological and social aspects play an important role in
the transition from sub-acute to chronic pain. Behavioural Graded
Activity, a typical hands-off therapy, can influence pain behaviour and
pain intensity by focussing on those aspects, and shows promising
results in other pain conditions. PARTICIPANTS: i46 patients were
included in the study.The inclusion criteria were: non-specific neck
pain, age between 18 and 70 years, and a new episode of pain.
METHODS: At baseline, 146 patients completed a questionnaires on
demographic variables as well as primary and secondary outcomes.
Primary outcome measures are Global Perceived Effect, the Neck
Disability Index and Pain. Secondary outcome maesures are the
4 dimension psychological symptomatology questionnaire (4DSQ)
to measure: somatisation, distress, depression and fear, and the
Pain Coping and Cognition List PCCL to measure: catastrophysing,
coping, and internal and external pain control. The Tampa Scale
for Kinesiophobia (TSK)and the level of chronicity was assessed
with the Graded Chronic pain Scale (GCPS). Follow-up measures
were conducted at 6, 13, 26 and 52 weeks. ANALYSIS: A multilevel
analysis was performed, with two levels: patients and therapists.
For continuous data a linear regression model was used and
for dichotomous outcomes a logistic regression model was used
in which the odds ratio (OR) and 95% confidence interval (CI)
were calculated. RESULTS: Prelimary results showed no significant
difference between either interventions in the short term as well
as in the long term results. Both therapies showed a significant
decrease of pain within 13 weeks which maintained at 52 weeks,
and a percieved effect of 79% for BGA and 76% for manual
therapy at 52 weeks. CONCLUSIONS: Both therapies are effective
in patients with sub-acute neck pain. Taking into account the effort
of training physical therapist to conduct the BGA program, and the
number of treatment sessions used, usual care manual therapy is
probably more useful in this population. IMPLICATIONS: Manual
therapy is more useful in sub-acute neck pain KEYWORDS: Neck
Pain, randomised clinical trial, Behavioural Graded Activity, Manual
Therapy. FUNDING ACKNOWLEDGEMENTS: ZonMW Pain-2 grant
940-31-060. CONTACT: j.pool@vumc.nl
ETHICS COMMITTEE: VU university ethical committee
Poster Displays, Tuesday 5 June
Research Report Poster Display
20-13 Tuesday 5 June 14:00
VCEC Exhibit Hall B & C
THE RELATIONSHIP OF KNOWLEDGE TO PREVALENCE OF
OSTEOPOROSIS, FALL AND FRACTURE RISK FACTORS IN
COMMUNITY DWELLING ELDERS
Burke-Doe A1,3 , Hudson A2 , Werth-Allen H4,5 ; 1 Assistant Professor
Department of Physical Therapy, California State University,
Fresno; 2 Assistant Professor Department of Nursing, California
State University, Fresno; 3 Fellow Central California Healthy Aging
Institute, Fresno, California; 4 Physical Therapist Kaiser Hospital
Vallejo, California; 5 Fellow Kaiser Permanente Vallejo Physical
Orthopaedic Manual Therapy & Musculoskeletal Primary Care
PURPOSE: Many seniors are unaware of osteoporosis risk factors
despite available information and public awareness programs on
prevention and treatment. The purpose of this study was to
identify the relationship of osteoporosis knowledge to prevalence
of risk factors for osteoporosis, fractures, and falls in an affluent
independent community-dwelling elderly population. RELEVANCE:
Community based osteoporosis education and screening should be
comprehensive, personalized and provided by a healthcare team
that includes a physical therapist who is knowledgeable about
osteoporosis in order for informed decisions about bone health to
be developed. PARTICIPANTS: The study assessed 49 community
dwelling seniors residing in an independent living community. Forty
one females, 8 males with ages ranging from 78-98 years and
a mean age of 84.4 years participated in the study. METHODS:
Forty-nine seniors completed a series of questionnaires and clinical
testing procedures to identify health history, osteoporosis knowledge,
balance confidence, general health, osteoporosis risk, fitness and
activity levels, home safety, calcium and vitamin D intake and fall
risk. ANALYSIS: All data analysis was conducted using SPSS
version 11.0 for Windows (SPSS Inc. Chicago, Ill.) Participant
demographic characteristics were summarized using conventional
descriptive statistics. Bivariate correlations were performed to
determine the relationship between osteoporosis knowledge and
osteoporosis risk factors, as well as, physical activity and physical
performance measures. Spearman rho and Pearson’s correlation
coefficients were calculated depending on the data (nominal, ordinal
or continuous). RESULTS: Participants had limited knowledge of
osteoporosis risk factors; with the average number of risk factors
present being 5.5 and only 57% of participants had previously
received bone density testing. Participants had limitations in agility,
balance, strength and flexibility in upper and lower extremities.
Inadequate calcium and vitamin D intake was identified with only 48%
reporting calcium supplementation. Correlations were found between
osteoporosis knowledge and both balance efficacy (r = 0.294, P
= 0.043) and fall risk (r = 0.472, P = 0.001). CONCLUSIONS:
Despite an increase in effective identification and treatment for
osteoporosis in the last decade, participants demonstrated gaps
in knowledge of osteoporosis, perception of risk and limited risk
reduction strategies. IMPLICATIONS: Physical therapy clinicians
should include intake questions in the areas of height, weight,
fall and fracture history, current medications and supplements and
use specific functional fitness and balance measures to determine
fall and fracture risk and to devise a comprehensive individualized
treatment plan. KEYWORDS: osteoporosis, knowledge, risk factor,
prevention. FUNDING ACKNOWLEDGEMENTS: Funding for this
research was sponsored by the Central California Center for Health
and Human Services, California State University, Fresno. CONTACT:
annied@csufresno.edu
ETHICS COMMITTEE: This study was approved by the Institutional
Review Board of California State University, Fresno which insured
protection of human subjects.
S449
Research Report Poster Display
20-17 Tuesday 5 June 14:00
VCEC Exhibit Hall B & C
INFLUENCE OF FOOT POSITION AND HIP ADDUCTION ON
MUSCLE EMG ACTIVITY OF THE LOWER EXTREMITY DURING
A WALL SQUAT
Jeno S, Relling D, Romanick M, Mabey R, Eken J, Jesperson A,
Sletten H, Mohr T; Department of Physical Therapy, University
of North Dakota School of Medicine and Health Sciences, Grand
Forks, USA
PURPOSE: The purpose of this study was to determine the influence
of foot position and contraction of the hip adductors on EMG
activity in muscles of the lower extremity during a wall squat.
RELEVANCE: Clinically, many different techniques are utilized to
increase recruitment of the vastus medialis oblique (VMO) for
patients with lower extremity dysfunction, specifically patellofemoral
pain or dysfunction. The wall squat is a common exercise utilized
early in the intervention progression for patellofemoral dysfunction
and has been theorized to recruit the VMO. While an adduction
contraction during a free standing squat demonstrates increased
VMO activity, the influence of foot position and adductor contraction
on recruitment of lower extremity musculature has not been fully
elucidated. PARTICIPANTS: Eleven healthy females (ages 22-24
years) without history of knee or hip pathology voluntarily participated
in this IRB approved study. METHODS: Through the use of surface
electrodes, EMG activity was recorded for the adductor longus
(AL), vastus lateralis (VL), VMO, biceps femoris (BF), gastrocnemius
(GN), and tibialis anterior (TA) muscles of the subject’s dominant
leg (10 right, 1 left). Each subject performed a series of 3 wall
squats to a depth of 45 degrees of knee flexion in each of 3
different randomized foot positions [neutral rotation, 30 degrees
internal rotation (IR), and 30 degrees external rotation (ER)] with and
without a self-selected, submaximal isometric adduction contraction.
ANALYSIS: MyoResearch® XP software (Noraxon Inc, Scottsdale,
AZ) was used to rectify, smooth (RMS 50), and normalize the EMG
data. EMG activity in the experimental conditions was normalized
to a free standing squat. A repeated measures ANOVA was used
to compare the muscle activity in the 3 different foot positions
with and without the adduction contraction. Alpha equals 0.05 for
all analyses. RESULTS: Statistically significant differences were
observed in EMG activity between conditions for all muscle groups.
LSD post hoc comparisons revealed EMG activity of the VMO and
VL was greatest during wall squats with hip adduction regardless
of foot position; BF and TA activity was greatest in ER with hip
adduction; AL activity was greatest in neutral with hip adduction; and
GN activity was greatest in IR with hip adduction. CONCLUSIONS:
The results of this study indicate that for healthy subjects, the
addition of a self-selected, submaximal isometric contraction of the
hip adductors augments the EMG activity of the muscles in the lower
extremity during a wall squat activity. Specifically, the increased VMO
and VL activity with adduction may benefit rehabilitation programs
specific to patellofemoral dysfunction. Foot position affected the EMG
activity for BF, TA, and GN muscles. Further research is warranted
employing this protocol with clients experiencing patellofemoral
pain or dysfunction. IMPLICATIONS: Clinically, combining a wall
squat and submaximal hip adduction contraction augments muscle
recruitment in the lower extremity. Specifically, VMO and VL activity
can be increased by holding a ball between the knees. At the same
time, increased recruitment of leg musculature during a wall squat
activity suggests care must be exercised with clients rehabilitating
foot or ankle dysfunction. KEYWORDS: biomechanics, wall squat,
EMG. FUNDING ACKNOWLEDGEMENTS: None.
ETHICS COMMITTEE: University of North Dakota Institutional
Review Board – project #IRB-200603-289
S450
Research Report Poster Display
21-21 Tuesday 5 June 14:00
VCEC Exhibit Hall B & C
DIFFICULTIES ENCOUNTERED BY ADULTS WITH
DEVELOPMENTAL CO-ORDINATION DISORDER(D.C.D.) AND
THEIR COPING STRATEGIES
Lee M, Yoxall S, Smith G; Lee Medical Practice, Denham, England
PURPOSE: The aim of this study was to determine whether
problems associated with D.C.D. persisted into adulthood and also
whether they became more manageable. The authors hoped to
determine what strategies had been identified as being useful to
overcome any difficulties that may have persisted. RELEVANCE:
Whilst the awareness of physical co-ordination difficulties has been
well documented, little appreciation has been given to the other,
less obvious, aspects of D.C.D. These may include poor short-
term memory, lack of self-confidence, reduced self-esteem, and
poor organisational and social skills. All ultimately impacting on
the activities of daily living. By gathering information on adult
perspectives the study could help to ensure that therapy programmes
for children do not focus purely on physical aspects but address the
other areas highlighted above. Coping strategies for all environments
could then be facilitated earlier. PARTICIPANTS: 186 questionnaires
were sent to the parents and relatives of children receiving
physiotherapy treatment for D.C.D at one clinic. METHODS: This was
a qualitative design questionnaire based study looking to determine
which of the respondents indicated a familial predisposition to D.C.D.
ANALYSIS: Responses were analysed using Microsoft Office Excel
2003 spreadsheet RESULTS: A total of 107 (58%) questionnaires
were returned. Of these 50 (46%) indicated a familial pre-disposition
to D.C.D. giving a participant group of 50 for analysis. Of this:
* Ten (20%) reported co-morbidity of dyslexia and D.C.D. * Forty
(80%) reported a detrimental impact on school life. This was related
to a poor ability to focus and concentrate; poor memory; poor
handwriting; poor ability to read and spell; poor self-confidence and
self-esteem and difficulty with completing tasks. * Twenty four (48%)
reported that their difficulties had an impact on their willingness
or ability to participate in sports. * Twenty six (52%) reported that
they do not participate in regular sporting activities as adults. *
Twenty three (46%) reported an adverse effect on their ability to
socialise. * Twenty four (48%) reported difficulties continuing to
impact into adulthood. * Twenty two (44%) had developed coping
strategies which included: Using a computer; Listing jobs; Having
assistance of another adult; Carefully preparing for new situations;
Practising specific skills. CONCLUSIONS: The study confirmed that
problems with D.C.D. do persist into adulthood. Participants within
the study reported continued difficulties with short-term memory,
social and organisational skills, time management, concentration,
handwriting speed and self-confidence IMPLICATIONS: The study
highlighted the difficulties associated with D.C.D. in adulthood.
Consequently treatment programmes for children with D.C.D should
encompass strategies to cope with difficulties beyond the purely
physical. This will encourage children with D.C.D. to develop
ways to cope with any persisting areas of weakness, which may
continue to impact on their daily life in adulthood. KEYWORDS:
D.C.D., adulthood, strategies. FUNDING ACKNOWLEDGEMENTS:
Equazen 31 St Petersburgh Place, London W2 4LA, England.
CONTACT: michele@leemedical.fsnet.co.uk
WCPT 2007, Research Reports
Research Report Poster Display
22-01 Tuesday 5 June 14:00
VCEC Exhibit Hall B & C
PARTIAL BODY WEIGHT SUPPORT TREADMILL TRAINING IN
AN INDIVIDUAL WITH SPINO-CEREBELLAR ATAXIA: A PILOT
STUDY
Zucker-Levin A, Hatten M, Shrank A, Thompson K, Venczel J;
The University of Tennessee, Health Science Center
PURPOSE: To determine the effectiveness of parital body weight
support treadmill training (PBWSTT) in an individual with spino-
cerebellar ataxia (SCA), unknown type. RELEVANCE: SCA is a
progressive disorder causing degeneration of the Cerebellum and
sometimes the spinal cord. Treatment is palliative including rehabili-
tiation to address functional impairments. The use of PBWSTT for
individuals with neurologic disorders is well documented suggesting
that improvement of funtional performance is often attributed to
“central pattern generator” activation at the spinal cord level. The
effects of PBWSTT for individuals with SCA is not reported in the
literature. PARTICIPANTS: A single 57 year old female with an
8 year history of SCA. She was independent for all ADL/IADL’s
with the use of a rolling walker. Meds: Tizanidine, 2mg Qd.
This study was approved by the Institutional Review Board of
the University of Tennessee, Health Science Center and informed
consent was obtained prior to testing. METHODS: Single subject
time series case design (O1,X,O2,O3). Initial baseline performance
(O1) was established, re-evaluation after 6 weeks of intervention
(O2) and then again 6 weeks after treatment was discontinued (O3).
Dependent variables included: Temporo-spatial gait parameters of
step length and walking velocity measured by the GAITRite™ system
(GAITRite™ Gold, CIR Systems, PA, USA), The Berg Balance
Scale (BBS), timed 25 foot walk, and the Paced Auditiory Serial
Addition Test (PASAT). The Biodex Offset Unweighing System and
Rehabilitation Treadmill 600 (Biodex Medical Systems, Inc, NY, USA)
was used to unweigh the participant during the intervention phase
of the study. PBWSTT was performed TIW for 6 weeks with the
participant walking a maximum of 3 walks per session. Body weight
support (BWS) started at 30% and treadmill speed was set to
participants comfort. Alteration of walking speed and modification of
BWS was based on observational gait analysis of the participants gait
quality. Session duration was determined by participant endurance
with a maximum of 20 minutes per walk allowing a 5 minute rest
break between walks. ANALYSIS: Single subject analyses and
pre/posttest analyses were conducted on all data. O1 to 02, 02 to
03 and 01 to 03 comparisons were made using the C-statistic for
single subject design. RESULTS: Total distance, average velocity,
and total time while walking on the treadmill significantly increased
(p < 0.05) from pre to post treatment (O1-O2). Walking velocity
overground decreased as did step length from pre to post treatment
(O1-O2) and then returned to pre-treatment (O1)numbers after 6
weeks “off” treatment (O2 -O3). BBS improved 01-02 and was
maintained from O2-O3; 25’ walk time and PASAT did not significantly
change. CONCLUSIONS: PBWSTT improved performance while
walking on the treadmill and on the BBS. Post intervention (O2) step
length and walking velocity decreased when walking overground;
however, this decrease was not maintained 6 weeks “off” training.
The researchers hypothesize that this decrease in walking speed
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:
azuckerlevin@utmem.edu
ETHICS COMMITTEE: The University of Tennessee, Health Science
Center Internal Review Board
Poster Displays, Tuesday 5 June
Research Report Poster Display
23-09 Tuesday 5 June 14:00
VCEC Exhibit Hall B & C
THE EFFECT OF A WALKING AID ON GAIT IN NON-AMBULANT
PEOPLE AFTER STROKE
Tyson S1 , Rogerson L2 ; 1 Centre for Rehabilitation and Human
Performance Research, University of Salford, Salford UK; 2 South
Manchester PCT, Manchester UK
PURPOSE: To assess the effect of a walking aid on gait impairments
(speed, and affected step length), walking disability and patient
satisfaction in non-ambulant people with stroke who were under-
going rehabilitation RELEVANCE: More than two-thirds of people
with stroke who are able to walk use a walking aid. However the
use of walking aids, particularly during rehabilitation is controversial.
This is because some physiotherapists, particularly those following a
‘traditional’ Bobath approach (also called the Neuro- Developmental
Theory) believe that using a walking aid can have a detrimental
effect on hemiplegic gait. We aimed to test this clinical belief.
PARTICIPANTS: 20 people with a hemiplegia following a 1st-time
stroke were recruited from the stroke rehabilitation units of four
NHS Trusts (UK). They were all receiving physiotherapy to restore
walking. They were unable to walk in every-day life but were
able to walk 5m with stand-by assistance during physiotherapy.
Their mean age was 65.6 years (sd = 10.3 yrs), mean time
since stroke was 6.45 weeks (sd = 5.7 weeks), 14 (72%) had
a left hemiplegia. METHODS: A same-subject randomised cross-
over design was used in which participants walked with a walking
stick (or cane) and no aid (the control condition) in a randomised
order. The following measures were taken; gait speed and affected
step length (10m walk test) walking disability (Functional Ambulation
Category, FAC) and participant satisfaction (questionnaire) in a one-
off session; the participant having been fitted with the walking aid
and given an opportunity to practice earlier in the day. ANALYSIS:
Wilcoxson Signed Rank Tests RESULTS: There was a significant
improvement in walking disability when walking with the aid (FAC=
1.8 (sd=0.51) vs 1.1 (sd=0.3) without and aid (p = 0.000)), but
the walking aid had no effect on the gait impairments. Mean
speed with an aid was 0.28 m/s (sd=0.15); without an aid it was
0.3m/s (sd= 0.14) (p = 0.143). Mean step length on the affected
leg was 0.53m (sd=0.16) with an aid; without an aid it was 0.51m
(sd=1.7) (p = 0.726). Participants were positive about the aid; 45-
65% (n=9-13) felt it improved different aspects of their gait, 80%
(n=18) found the appearance acceptable, 70% (n=14) would choose
to walk with an aid now (in every-day life) rather than delay
walking until a better quality gait pattern without an aid had been
achieved. CONCLUSIONS: A walking aid can have a significantly
beneficial effect on walking disability but not gait impairments in
non-ambulant people with stroke and patients feel positive about
using it. IMPLICATIONS: The clinical belief that using a walking
aid can have a detrimental effect on hemiplegic gait in people
used-going rehabilitation to restore walking has not been supported.
To the contrary, the use of a walking had a beneficial effect on
functional mobility (walking disability). KEYWORDS: Stroke, walking,
walking aids, physiotherapy. FUNDING ACKNOWLEDGEMENTS:
Physiotherapy Dept of North Manchester Hospital, Pennine Acute
NHS Trust, Association of Chartered Physiotherapists in Neurology,
Physiotherapy Research Society, Halo Healthcare Ltd, Medistox Ltd.
CONTACT: s.tyson@salford.ac.uk
ETHICS COMMITTEE: North Manchester Local Research Ethics
Committee
S451
Research Report Poster Display
23-13 Tuesday 5 June 14:00
VCEC Exhibit Hall B & C
INFLUENCES OF WALKING SPEED ON DYNAMIC FOOT
PRESSURE AND CENTER-OF-PRESSURE (COP) PATTERNS IN
HEMIPLEGIC PATIENTS FOLLOWING STROKE: A PRELIMINARY
STUDY
Lin S1 , Tang P1 , Chen S; 1 School and Graduate Institute of
Physical Therapy, College of Medicine, National Taiwan University,
Taiwan (R.O.C.)
PURPOSE: The purpose of this study was to investigate how walking
speed affect the dynamic foot pressure and COP patterns of both
lower extremities in hemiplegic patients after stroke. RELEVANCE:
This investigation advances the understanding of the relationship
between gait speed and foot dynamics in hemiplegic stroke.
PARTICIPANTS: Seven hemiplegic patients with mild-to-moderate
stroke (mean age=56.7±12.5 years old, post-stroke time=10.3±7.9
months) participated in this study. METHODS: Each subject walked
along a 6-m-long walkway at three different self-perceived walking
speeds- the slow, comfortable, and fast speeds. Dynamic foot
pressure data included the gait cycle time, normalized loading
time, normalized force impulse, and average force in the whole-
foot and three specific-foot regions (heel, mid-foot, and forefoot
regions). COP data, including COP excursion (COPEx ), COP A-P
velocity (COPAPV ), and COP trajectory smoothness index (COPSI =
COPEx /COP displacement), were also analyzed. Dynamic foot
pressure and COP data were collected by using the Pedar in-shoe
measurement system (Novel gmbh, Munich, Germany). Walking
speed was determined by the GaitMatII system (E.Q. Inc., USA).
ANALYSIS: A one-way repeated measures (RM) ANOVA was
performed to determine differences among the three walking speeds.
The 3 (Speed) by 2 (Limb) two-way RM ANOVAs were used to
compare the effects of walking speed and lower extremity on the
dynamic foot pressure and COP parameters. RESULTS: Walking
speeds of the fast- (1.02±.34m/s), comfortable- (.68±.04m/s), and
slow-speed (.45±.01m/s) conditions were significantly different from
each other (p < 0.001). As the walking speed increased, gait cycle
time (p < 0.001) and normalized loading time (p < 0.001) significantly
shortened, regardless of the extremities. For both lower extremities,
normalized force impulse of the forefoot region (p = 0.014), average
force of the whole foot and the forefoot regions (p = 0.011 and
0.013), and COPAPV (p = 0.016), were significantly greater while
walking fast compared to walking comfortably. Significantly longer
COPEx in the slow-speed walking, compared with comfortable-
speed walking, was observed in the affected (p = 0.013), but not
the unaffected, lower extremity. COPSI was significantly greater in
the slow-speed walking than comfortable-speed walking (p = 0.011),
indicating the greater COP curvature was observed in slow speed
walking. CONCLUSIONS: Patients with mild-to-moderate stroke
were able to adopt different walking speeds volitionally. Such gait-
speed adaptability was accompanied by changes in their dynamic
foot pressure and COP patterns of both unaffected and affected
lower extremities. The ability of these patients to generate greater
force, especially in the forefoot region of both lower extremities,
appears to be associated with their ability to walk fast. Compared
to the other two speeds, slow-speed walking poses a greater
direction control challenge on these patients, as revealed by
the greater COP smoothness index. IMPLICATIONS: Adopting
different walking speeds alters the foot dynamics and difficulty of
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: r94428004@ntu.edu.tw
ETHICS COMMITTEE: NTUH 90-06098
S452
Research Report Poster Display
23-17 Tuesday 5 June 14:00
VCEC Exhibit Hall B & C
A FOLLOW-UP OF TWO DIFFERENT PHYSICAL THERAPY
REGIMES ON PARTICIPATION AND ACTIVITY ACCORDING TO
ICF. A RANDOMISED CONTROLLED TRIAL
Langhammer B1 , Lindmark B2 , Stanghelle J3 ; 1 Oslo University
College, Faculty of Health, Physiotherapy Programme, Norway;
2 Uppsala University, Institution of Neurosciences,Physiotherapy
Programme, Sweden; 3 Sunnaas Rehabilitation Hospital,
Nesoddtangen, Norway
PURPOSE: Our main objective in this study was to evaluate two
different exercise approaches during the first 12 months post stroke,
and to study the possible effects of these two regimes on I-ADL, the
6-Minute Walk Test (6MWT), Berg Balance Scale (BBS), Timed Up
and Go (TUG), grip strength and Modified Ashworth Scale (MAS).
A second objective was to find out to what extent parameters such
as gait performance, postural control, grip strength and muscle tone
could be considered explanatory factors of I-ADL 3 months and 12
months post stroke. RELEVANCE: The study evaluates effects of
two different exercise approaches in the post stroke period which is
highly relevant for physiotherapy practice. PARTICIPANTS: A double-
blind longitudinal randomised trial of first-time-ever stroke patients.
Seventy-five patients were included: 35 in an intervention group (IG)
and 40 in a regular training group (RG). After discharge from acute
rehabilitation, patients allocated in IG had regular physiotherapy for
a minimum amount of 80 hours during the first year. Patients in
RG were not recommended any specific therapy besides treatment
when needed. METHODS: Information on I-ADL, 6- Minute Walk
Test (6MWT), Berg Balance Scale (BBS), Timed Up and Go (TUG),
grip strength (Martin Vigorimeter), Modified Ashworth Scale (MAS),
and pulse monitoring during activities. ANALYSIS: A two- way
analysis of variance (ANOVA) was used for 6MWT and TUG, and
the Friedman two-way analysis of variance by rank for I-ADL by
Fillenbaum, BBS and MAS. The significance level was set at p < 0.05.
Spearman rank correlation coefficients were calculated to search
for the associations between I-ADL by Fillenbaum and other tests.
A stepwise linear regression analysis was performed in the two
groups, with the scores I-ADL 2 and I-ADL 7 entered as dependent
factors, and total scores for 6 MWT, BBS, TUG, grip strength and
MAS entered as independent factors on two different occasions:
at 3 months and at 12 months. The significance level was set at
p < 0.05. RESULTS: One year post stroke both groups showed higher
participation in all items of I-ADL and improved 6MWT, BBS scores,
TUG and grip strength. At 3, 6 and 12 months of follow-up there
were significant differences in favour of RG. 6MWT and BBS showed
significant associations with the different I-ADL items; TUG displayed
moderate correlations to some of the I-ADL items. Grip strengths
were moderately associated with I-ADL items. CONCLUSIONS: I-
ADL, gait, balance and grip strength improved to similar degrees
in both IG and RG. The test occasions themselves were probably
strong motivators for training, irrespective of group allocation. This
indicates the importance of regular follow-up in the motivation for
regular exercise post stroke. IMPLICATIONS: Patients with stroke
cannot attain the level of function of healthy counterparts, and it is
therefore urgent that supportive services from the community are
provided, as well as regular exercise opportunities. The possibilities
for adapted physical activities and supportive services need to be
strengthened and made varied and flexible, so that the services
can meet the requirements of stroke patients. KEYWORDS: I-ADL,
6MWT, BBS, grip strength, tonus, post-stroke exercise, long-term
follow-up. FUNDING ACKNOWLEDGEMENTS: No extra funding.
CONTACT: Birgitta.Langhammer@hf.hio.no
WCPT 2007, Research Reports
Research Report Poster Display
24-21 Tuesday 5 June 14:00
VCEC Exhibit Hall B & C
PREVALENCE OF THE COMPONENTS OF METABOLIC
SYNDROME IN PATIENTS PARTICIPATING IN STROKE
REHABILITATION
MacDonald C1 , MacKay-Lyons M1,2 ; 1 Capital District Health
Authority; 2 Dalhousie University
PURPOSE: To document the prevalence of the components of
metabolic syndrome(MetS) in individuals participating in stroke
rehabilitation. RELEVANCE: MetS is comprised of a constellation
of risk factors for cerebrovascular and cardiovascular disease. The
National Cholesterol Education Program(NCEP) defines MetS as
the presence of 3 or more of the following: fasting plasma glucose
>6.1 mmol/l, triglycerides >1.7 mmol/l, high density lipoproteins (HDL)
<1.0 mmol/l in males and <1.3 mmol/l in females, blood pressure
>130/85 mmHg and/or medication, waist circumference >102 cm in
males, 88 cm in females. While the prevalence of MetS in the general
population is known to be approximately 23.7%, its prevalence in
the stroke population has not been well documented. Because of
the role that exercise plays in moderating the components of MetS,
prevalence figures are of particular clinical relevance for the subgroup
of patients post-stroke who are involved in physical rehabilitation
(25-30% of the total stroke population). PARTICIPANTS: A review
was conducted of the health records of 156 patients (81 males, 75
females: 66 ±12.8 years of age) who participated in an in-patient
stroke rehabilitation program. METHODS: The presence of the
components of MetS in patients participating in stroke rehabilitation
was recorded. Variables included resting blood pressure, presence
of anti-hypertensive medications, body mass index(BMI), triglyceride
and HDL levels, albumin, presence of diabetes mellitus(DM)
and fasting blood glucose level. In addition sex, age, cardiac
history, smoking history, stroke location, time post-stroke, Locomotor
Functional Independence Measure, # of co-morbidities and # of
medications were recorded. ANALYSIS: Descriptive statistics (i.e.
means, standard deviations and percentages) were calculated for all
variables. RESULTS: 52 (33%) of the sample were hypertensive,
132 (84%) were either hypertensive or on hypertension medications,
99 (63%) had decreased HDL, 53 (34%) had elevated triglycerides,
47 (30%) had DM, 44 (28%) had elevated fasting blood glucose
levels and 20 (13%) had a BMI >30 kg/m2 . 48 (30.6%) met the
NCEP criteria for MetS; 29 females and 20 males with a mean
age of 67.5 years (±9.98) and an average time post-stroke of 7.8
weeks (±7.5). 84% of those with MetS were hypertensive or on anti-
hypertensive medications. Within the group of those with MetS, mean
value for BMI was 28.6kg/m2 (±6.0), mean triglyceride level was
2.5mmol/l (±2.1), HDL mean was 0.87mmol/l (±0.21) and fasting
blood glucose mean was 6.8mmol/l (±2.25). CONCLUSIONS: The
prevalence of MetS in patients participating in a stroke rehabilitation
program was substantially higher than in the general population.
Moreover, the vast majority of this patient population had one or more
of the components of the syndrome. A limitation of the study is that
only patients participating in post-stroke rehabilitation were reviewed.
70-75% of the total stroke population do not participate in stroke
physical rehabiliation, therefore; further study may be warrented in
examining the prevalence of MetS in this subgroup. IMPLICATIONS:
These findings underline the critical need for physiotherapists to
educate patients participating in stroke rehabilitation that lifestyle
modifications (i.e., daily physical activity and proper nutrition)
play a key role in secondary prevention of cerebrovascular and
cardiovascular disease. KEYWORDS: Stroke; Metabolic syndrome;
Cardiovascular risk factors. FUNDING ACKNOWLEDGEMENTS:
The work was unfunded. CONTACT: christinapt@hotmail.com
ETHICS COMMITTEE: Capital Health Research Ethics Board
Poster Displays, Tuesday 5 June
Research Report Poster Display
25-01 Tuesday 5 June 14:00
VCEC Exhibit Hall B & C
VALIDITY OF A VIRTUAL REALITY ENVIRONMENT FOR MOTOR
LEARNING IN STROKE
Knaut L1,3 , Subramanian S2,3 , Henderson A3,4 , Levin M2,3 ; 1 School
of Rehabilitation, University of Montreal; 2 School of Physical &
Occupational Therapy, McGill University; 3 Jewish Rehabilitation
Hospital site of CRIR; 4 Department of Neurology and Neurosurgery,
McGill University
PURPOSE: Our goal was to study the validity of making pointing
movements in a virtual reality environment (VE) created to optimize
motor learning after stroke. Performance outcomes (precision, speed,
and smoothness) and behavioral measures (arm movement patterns)
of pointing movements made by patients with hemiparesis made
in a VE were compared to those made in a physical environment
(PE – “real-world”). RELEVANCE: Interventions done in VE may
be effective in diminishing sensorimotor impairments in patients
with stroke. This new approach allows therapists to incorporate
important elements of motor retraining that induce experience-
dependent plasticity such as: task-specificity, repetition intensity,
feedback and motivation. However, it is unknown if people execute
movements in VEs similarly to those performed in PEs and if this
is a necessary element for training gains to be transferred to the
“real-world”. PARTICIPANTS: Adults with chronic hemiparesis due
to stroke and Chedoke-McMaster Arm Scores ranging from 3-6 out
of 7, indicating moderate to severe motor impairment, were recruited
from 3 establishments associated with the Centre for Interdisciplinary
Research in Rehabilitation of Montreal (CRIR). Healthy age-matched
subjects were also recruited. METHODS: Subjects were asked to
point as quickly and as accurately as possible to 6 targets (12
trials/target, randomized) placed in different areas of the sagittal
ipsilateral and contralateral 3D workspace. Movement to each target
had different levels of difficulty and required different arm movement
patterns. In the PE, the targets consisted of 6 x 6 cm squares
placed at 2 heights at arm’s length. In the VE, the size and location
of the targets were identical to those in the PE but they were
viewed in a fully immersive and interactive environment via a head-
mounted display. Arm and trunk kinematics were recorded in both
environments with an Optotrak Motion Analysis System (6 markers,
100 Hz, 5 s). ANALYSIS: The values obtained were analyzed with
SPSS 10.0 for Windows. Two-way ANOVAs with repeated measures
and factors “environment” (physical vs. virtual) and “group” (healthy
vs. stroke subjects) were used to evaluate the relationship between
those variables. Minimal significance level was p < 0.05. RESULTS:
Pointing in VEs and PEs was similar in terms of movement patterns
in both healthy subjects and in patients with stroke. Furthermore,
arm kinematics were related to the severity of stroke impairment.
Overall, participants rated the activity in VE as being more engaging
and motivating than moving in the PE. CONCLUSIONS: For most
patients with stroke, movements made in VE are similar to those
made in PE. The question of whether this is a necessary feature
for motor gains to be transferred to real-world activities needs to
be addressed. IMPLICATIONS: Movement training performed in
fully immersive virtual environments may be a means by which to
introduce more motivating and challenging training environments into
rehabilitation programs aimed at maximizing motor recovery of the
paretic arm in patients with stroke. KEYWORDS: Arm movement,
hemiparesis, and exercise. FUNDING ACKNOWLEDGEMENTS:
This study was supported by Canadian Institutes of Health Research
(CIHR) and Canadian Foundation for Innovation (CFI). CONTACT:
betoknaut@hotmail.com
ETHICS COMMITTEE: Centre for Interdisciplinary Research in
Rehabilitation of Montreal (CRIR)
S453
Research Report Poster Display
25-05 Tuesday 5 June 14:00
VCEC Exhibit Hall B & C
DOES CLOSED KINETIC CHAIN ACTIVITY IMPROVE HAND
FUNCTION IN PATIENTS WITH STROKE? A RANDOMIZED,
DOUBLE-BLINDED, CONTROLLED STUDY
Alattas A1 , Sabbahi M2 , Roddey T2 , Hamilton M2 , Olson S2 ,
Alnaser M2 ; 1 King Faisal Specialist Hospital & Research Center,
Riyadh, Saudi Arabia; 2 Texas Woman’s University
PURPOSE: Clinicians utilize closed kinetic chain (CKC) activities
in stroke rehabilitation to enhance recovery, increase function of
the hand, decrease muscular tone, and facilitate activation of weak
muscles. However, there is no published study that has evaluated
the effect of the CKC activity over an extended time period using
electrophysiological tests, motor capacity, or functional status of the
upper extremity. The aim of this study was to evaluate the effect of a
four-week, CKC home training program on the reflexive, volitional,
and functional levels of upper extremity capability for moderate-
level stroke patients. The moderate-level was defined as obtaining
a score between 10 and 18 out of 56 in the Fugl-Meyer score of
the upper extremity section. RELEVANCE: Evidence-based support
of common treatment procedures is needed stroke rehabilitation.
PARTICIPANTS: Eleven subjects at least 1-year post-stroke (4
females and 7 males), mean age of 66 years (±10.3), and of any
ethnicity participated as a sample of convenience from a local stroke
support group in the study. Inclusion Criteria: normal or impaired
sensation to light touch or pinprick, passive wrist extension of 40º,
a score of 24 on the Mini-Mental State Examination (MMSE),
had a stroke involving the middle cerebral artery as confirmed by
magnetic resonance imaging (MRI) or computerized tomography
(CT) report. METHODS: Using a double-blinded, placebo-controlled,
randomized design, subjects were placed either in treatment or
control groups. The treatment group (4 subjects) performed one
minute of weight bearing on the palm of the hand with full elbow
extension for five repetitions, using 10% of her/his body weight,
three times per day. The control group performed bilateral shoulder
flexion exercises with unimpaired arm assisting the impaired arm 30
times per session, 3 sessions per day. Four dependent variables
were collected in a random sequence before and after one month of
the treatment. The dependent variables included flexor carpi radialis
(FCR) Hoffman reflex (H-reflex), surface electromyography (SEMG)
from extensor indices and FCR muscles, Klein-Bell Activities of Daily
Living (ADL) scale score, and Upper Extremity Fugl-Meyer scale
score. The peak-to-peak amplitude of the FCR H-reflex was recorded
from the impaired arm while bearing weight on the palm at 10%
of body weight. Sixteen traces were collected during four trials (4
traces / trial). SEMG was recorded during the CKC activity. Four
traces were collected during four trials (one trace/ trial) from both
muscles. ANALYSIS: Two analyses of covariance (with pre-test as
the covariate) were conducted for the FCR H-reflex and the SEMG
data. Two Mann-Whitney U tests were conducted for the Fugl-Meyer
scale score and Klein-Bell ADL score. Alpha was set at 0.0125 for
each of the four tests. RESULTS: No statistically significant difference
was found in the four tests after the intervention with p value of 0.053
for H-reflex, 0.075 for the EMG, 0.042 for Klein-Bell ADL scale, and
0.11 for the Fugl-Meyer scale. CONCLUSIONS: The CKC activity did
not show significant effect measured by the four dependent variables
although data show a trend toward improvement in the treatment
group. IMPLICATIONS: More research needed KEYWORDS: Closed
Kinetic Chain, electrophysiological test, stroke, functional tests, motor
functional test. FUNDING ACKNOWLEDGEMENTS: A scholarship
from King Faisal Specialist Hosptial and Research Center, Riayadh,
Saudi Arabia. CONTACT: aaalattas@hotmail.com
ETHICS COMMITTEE: INSTITUTIONAL REVIEW BOARD at Texas
Woman’s Unviersity, Houston, TX, USA.
S454
Research Report Poster Display
26-13 Tuesday 5 June 14:00
VCEC Exhibit Hall B & C
PASSIVE SITTING VS. ACTIVE SITTING IN A ROCKING CHAIR
Väänänen I; Lahti University of Applied Sciences, Innovation
Centre, Lahti, FINLAND
PURPOSE: The purpose of this study was to research and develop
rocking chair as an auxiliary aid furniture for older people‘s reha-
bilitation. RELEVANCE: Physical inactivity is a common problem.
Yesterday‘s playing human (Homo ludens) is now sitting human
(Homo sedens). It is accepted that regular physical activity promotes
health and the ability to function and work. The therapeutic qualities
of the rocking chair have been studied. Furthermore, an adapted
version has been developed from an ordinary rocking chair for use in
rehabilitation, but the benefits of the rocking in a rocking chair are not
known. PARTICIPANTS: To the first and second part of this study par-
ticipated eight male subjects (77±3 y). In the third part of this study
nine female subjects (78±7 y) rocked 30 minutes and sat 30 minutes
in an office chair separate days. METHODS: In the first part the
electromyographic muscle activity (EMG) level of m rectus abdominis
while rocking in a rocking chair was quantified. The EMG activities
while rocking were compared with the EMG level during maximal
voluntary isometric contraction. In the secondly part, the training
effects of the six weeks rocking chair training to m rectus abdominalis
compared to the traditional resistance strength training with elderly
men were clarified. Subjects rock daily 30 minutes in a rocking chair,
and controls had resistance strength training twice a week. Sit-up test
was used to evaluate the training effects. In the third part the changes
of the volume of the lower extremity after 30 minutes rocking in a
traditional rocking chair and sitting in an upright chair with armrests
were compared. The volume measurement of one leg was done be-
fore and after. ANALYSIS: The differences between the groups were
evaluated with t-test. RESULTS: The EMG activity during rocking was
5% of the maximum EMG level. The rocking chair group increased
their sit-up test repetitions by 44% (P = 0.054) and the strength
training group by 29% (P = 0.25). After the rocking the volume of the
lower extremity decreased 34 ml and after sitting on an office chair it
increased 161 ml (P = 0.047). CONCLUSIONS: The first part of this
study showed that rocking in a rocking chair activates the m rectus
abdominis, and therefore rocking in a rocking chair could be used as
a training method for neuro-muscular activation in rehabilitation with
elderly men. The significant training effect to the abdominal muscles
remained open because the preliminary character (small number of
the subjects) of the second part of this study. The third part of the
study showed that rocking in a rocking chair could protect the swelling
of the lower extremities instead of sitting in an upright chair with arm-
rests. IMPLICATIONS: These results indicate that rocking chair could
be used as a training method for neuro-muscular activation in reha-
bilitation and active sitting method in prevention of the oedema of the
lower extremities in cases of inactive elderly to put into practice with-
out expensive equipments and staff in home. KEYWORDS: Rocking
chair, sitting, eldery people. FUNDING ACKNOWLEDGEMENTS:
Finnish Furniture Foundation, Eimi Kaluste Padasjoki FINLAND.
CONTACT: ilkka.vaananen@lamk.fi
ETHICS COMMITTEE: The ethical committee of the Social and
Health Services department of the City of Lahti, Finland
Research Report Poster Display
26-17 Tuesday 5 June 14:00
VCEC Exhibit Hall B & C
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
WCPT 2007, Research Reports
<60 years (yr) of age have similarly been indicated. On the other
hand, males are more susceptible to mental fatigue than females
among white-collar workers. Furthermore, although higher self-rated
unhealthy risk prevails in males of>60 yr of age, studies on the
relationship between self-rated health and exercise performance
have not been attempted. The present study elucidated to analyze
the relationship between self-rated health and the actual exercise
performance status in retired males. RELEVANCE: Self-rated health
not only affects life expectancy such as mean life expectancy, but
also serves as a useful health index. This study demonstrated
the necessary support of physical therapy related with the habit
of continuous exercise in contribution to enhancement of self-rated
health in male retirees. PARTICIPANTS: The subjects were 654 male
retirees (>55 yr of age) who had retired from Japanese corporations
within the past 3 yr. Of these subjects, 552 were in the middle-age
group with age <65 (mean age: 60.9±1.6) yr, while the remaining 102
were in the elderly group with age>65 (66.4±1.6) yr. METHODS: The
study was conducted via the mail system. Performance of exercise
was evaluated with a 2-stage assessment system by asking the
subject if he was “performing” or “not performing” exercise/sports
at the time of the study. In monitoring the actual status of exercise
performance, the increase and decrease of performance frequency
of exercise/sports was compared with the status before retirement,
using a 5-stage assessments scoring system. Based on a 4-stage
evaluation system, self-rated health was scored according to the
self-rating health assessment method of Haga et al. ANALYSIS:
By homogeneity analysis, the category of each assessment index
was scored and distributed on 2-dimensional coordinates, and
the position relationships of the middle-age and elderly groups
with the respective categories were compared. RESULTS: Based
on the results of homogeneity analysis, scores of the respective
quantified categories were plotted, and categories with position-
proximity correlation included “performing”, “increased”, “unchanged”,
“very healthy” and “just healthy” in the middle-age group. As for the
elderly group, the categories were “performing”, “decreased”, “just
healthy” and “not healthy”. CONCLUSIONS: In the middle-age group,
the performance frequency of exercise/sports in current exercise-
performers was either increased or unchanged compared with the
status before retirement; a tendency of excellent self-rated health
was indicated. On the other hand, the performance frequency of
exercise/sports in current exercise-performers of the elderly group
indicated a mixed outcome; a tendency with good and poor self-
rated health. IMPLICATIONS: Less than half of the Japanese
population harbor excellent self-rated health. The findings in this
study demonstrated that the middle-age male retirees performed or
continued to perform exercise/sport at the same or greater frequency
compared with the status before retirement, probably contributing to
excellent self-rated health. Accordingly, educational activities from the
aspect of physical therapy related to the habit of continuous exercise
are considered necessary. KEYWORDS: male retirees, self-rated
health, exercise. FUNDING ACKNOWLEDGEMENTS: This study
was supported by grants from the Health Promotion Service for the
Elderly, Ministry of Health, Japan (2000).
ETHICS COMMITTEE: The service funds granted by Ministry of
Health, and the Committee of Health Promotion and Definite Aim
in Life.
Poster Displays, Tuesday 5 June
Research Report Poster Display
28-01 Tuesday 5 June 14:00
VCEC Exhibit Hall B & C
SAFETY VERSUS PRIVACY – ELDERLY PERSONS’
EXPERIENCES OF A MOBILE SAFETY ALARM
Melander Wikman A1 , Fältholm Y2 , Gard G3 ; 1 Luleå University
of Technology, Department of Health Science, SE-971 87 Luleå,
Sweden. Phone +46 920 49 34 58 Fax. +46 920 49 38 50 e-mail:
anita.melander-wikman@ltu.se; 2 Luleå University of Technology,
Department of Work Science, Luleå, Sweden; 3 Luleå University
of Technology, Department of Health Science, Luleå, Sweden
PURPOSE: The purpose was to develop and test mobile information
and communication technology (mICT), in the form of a mobile
safety alarm, and to explore how this mobile safety alarm was
experienced from an empowerment perspective. RELEVANCE:
Future demographic development means an increased elderly
population in Sweden. One of the greatest challenges for a society
with an ageing population is to provide high-quality health and social
care. Many elderly people stay active and healthy at higher ages;
however, an increased mean age does not always mean increased
health. The demographic development is often described as a huge
problem but there is also an approach where “the elderly boom”,
seen as a cluster, also can be seen as an opportunity for growth. New
information and communication technology (ICT) and services aiming
at the improvement of the health, comfort and safety of elderly people
are being developed and tested. From research it is well known that
dimensions of empowerment have an impact on preserving health;
and it is also important for the individual to feel safe. In order to enable
elderly people to stay at home as long as possible, various kinds
of assisted technology are often used: safety alarms are common
and are used by elderly people and also by those with functional
limitations. PARTICIPANTS: The participants that tested the mobile
safety alarm were five elderly people with functional limitation (for
example, after a stroke) and four healthy elderly people from a
pensioners’ organisation. METHODS: The methodology used was
an intervention with a mobile alarm containing a drop sensor and a
positioning device, as well as qualitative interviews with the research
persons. ANALYSIS: In order to analyse the results, qualitative
content analysis was used. RESULTS: The result showed that the
mobile safety alarm that was developed and tested was seen as
offering increased opportunity for mobility, both in terms of being able
to be more active and as an aid to self-determination. The fact that
the test participants were located by means of the positioning device
was not experienced as violating privacy as long as it was clear that
the person her/himself could decide to use the alarm. The mobile
safety alarm that was tested was a prototype in development and
the research persons saw themselves as participants closely and
actively involved in the development process, who contributed their
recommendations for improvement. CONCLUSIONS: Conclusions
that can be drawn are that it is important for elderly persons to actively
participate in the development process of new assistive technologies.
In development, methodologies for empowerment of the elderly
should be used. IMPLICATIONS: Mobile safety alarms can in the
future make it easier for elderly persons to be active and mobile and
this might increase the options for elderly people to stay healthy.
KEYWORDS: Elderly, Information and Communication Technology
(ICT), Mobility, Privacy, Safety,. FUNDING ACKNOWLEDGEMENTS:
Norrbotten Research Council, Sweden and Centre for Distance-
spanning Healthcare (CDH), Luleå University of Technology, Luleå,
Sweden. CONTACT: anita.melander-wikman@ltu.se
ETHICS COMMITTEE: Committee of research ethics at Umeå
university
S455
Research Report Poster Display
29-09 Tuesday 5 June 14:00
VCEC Exhibit Hall B & C
COULD THE KINESIO TAPING REPLACE THE BANDAGE
IN THE DECONGESTIVE LYMPHATIC THERAPY FOR
POSTMASTECTOMY LYMPHEDEMA?
Tsai H1 , Hung H2 , Tsauo J2 ; 1 Department of Rehabilitation,
National Taiwan University Hospital Bei-Hu Branch, Taipei, Taiwan;
2 School and Graduate Institute of Physical Therapy, College of
Medicine, National Taiwan University, Taipei, Taiwan
PURPOSE: Decongestive lymphatic therapy (DLT) is a common
management for lymphedema. Patients have poor compliance in
using short-stretch bandage and compression garment due to the
humid climate in Taiwan. Applying Kinesio-tape (K-tape) becomes
a new choice in the field of physical therapy. The inventor Dr.
Kase claimed that the K-tape can improve circulation and remove
congestion. However, there is insufficient evidence to show the
clinical effects of K-tape. The purpose of this study is to investigate
the treatment effects of traditional decongestive lymphatic therapy
and modified decongestive lymphatic therapy which replace bandage
with K-tape and compare the treatment effects between these
two treatments. RELEVANCE: This study provides information
about clinical management of lymphedema. PARTICIPANTS: Forty-
one women with unilateral breast-cancer-elated lymphedema who
have suffered lymphedema for at least 3 months were recruited
in this study. METHODS: All subjects were randomized to DLT
group (bandage group) or modified DLT group (taping group) and
evaluated for 3 times, before and after 4-weeks of control period
and after intervention period by a physical therapist blinded to
the randomization. The evaluation items included physical therapy
assessment, the severity of swelling, water composition of the
upper extremity, severity of fibrosis, lymphedema related symptoms,
the upper extremity function and quality of life. Subjects in each
group received treatments including skin care, 30-minute manual
lymphatic drainage, 1-hour pneumatic compression therapy and 20-
minute exercise during the intervention period. Otherwise, subjects in
bandage group received additional bandage treatment and subjects
in taping group received additional K-tape treatment. Each group
were treated 2hour/seccion, 5session/week with the entire course
taking 4 weeks. ANALYSIS: Independent two samples t-test/Mann-
Whitney U test/ chi square test were used to analyze the differences
of all the confounding factors, outcome variables at baseline and
total improvements between groups. RESULTS: Both groups had
significant reduction (p < 0.05) in severity of swelling, imbalance of
water composition, and lymphedema related symptoms during the
intervention period. Bandage group had significant increases of
fibrosis over dorsal area of the upper arm during the control period.
Taping group had improvements in role function which is one of the
items in quality of life measurement during the intervention period.
The upper extremity function scores had no significant changes
during the control and intervention periods in both groups. There
was no significant difference between groups except the severity
of fibrosis. The reduction of fibrosis in bandage group is more
than in taping group in dorsal area of the upper arm and ventral
area of the forearm. The acceptance of Kinesio Tape is better than
bandage including longer using time, less difficulty, more comfortable
and convenient (p < 0.05). CONCLUSIONS: Kinesio Taping could
replace the bandage in DLT. Further study should investigate the
rationale of the Kinesio Taping. IMPLICATIONS: Findings suggest
that patients with unilateral breast-cancer-related lymphedema may
have another choice for treatment by Kinesio Taping. KEYWORDS:
postmastectomy lymphedema, taping, decongestive lymphatic ther-
apy. FUNDING ACKNOWLEDGEMENTS: National Science Council
of Taiwan. CONTACT: r93428006@ntu.edu.tw
ETHICS COMMITTEE: ethics committee of NTUH
S456
Research Report Poster Display
29-13 Tuesday 5 June 14:00
VCEC Exhibit Hall B & C
CURRENT MOBILIZATION PRACTICES WITH PATIENTS WITH
INDWELLING FEMORAL LINES WITHIN UNIVERSITY HEALTH
NETWORK, TORONTO, CANADA
Fenton A1 , Cote N2 , Hawn T3 , Quan V4 , Chen A5 , Hoy C6 ,
McIntyre K7 , O’Brien M8 , Heck C9 ; 1 University Health Network,
Toronto, Canada; 2 University Health Network, Toronto, Canada;
3 University Health Network, Toronto, Canada; 4 University Health
Network, Toronto, Canada; 5 University of Toronto, Toronto,
Canada; 6 University of Toronto, Toronto, Canada; 7 University of
Toronto, Toronto, Canada; 8 University of Toronto, Toronto, Canada;
9 University Health Network, Toronto, Canada
PURPOSE: To determine current mobilization practices of physical
therapists (PT), physicians and nurses with patients with indwelling
femoral lines, and to make recommendations regarding promoting
safe practices for healthcare professionals working with this popula-
tion. RELEVANCE: In clinical practice, early mobilization in patients
with indwelling femoral lines may be delayed due to the belief that
mobilization may result in perforation of the vessel, movement of the
line, and/or dislodgement of the line. While there is little reported in
the literature regarding safety concerns to support the restriction of
mobilization there is also a lack of studies to support the promotion
of mobilization in this population. PARTICIPANTS: In phase one, 31
nurses, 17 PTs and 13 physicians completed a questionnaire regard-
ing their mobilization practices. In phase two, three focus groups were
conducted: one with nine PTs, two with nursing groups, each with
eight participants. METHODS: A two-phase, cross sectional, mixed
methodological design was used. Phase one involved the distribution
of an electronic questionnaire. Domains of the questionnaire included
demographics, characteristics of current working environments,
current mobilization practices with four types of femoral lines (arterial,
central venous, rigid and semi-rigid vascular catheters) issues,
concerns, and rationale supporting current practice. Phase two
consisted of three, 30-60 minute focus groups designed to further
explore the issues surrounding current mobilization practices and
safety concerns identified in phase one. ANALYSIS: Descriptive
statistics were used to characterize the demographic profile of the
subjects. Analysis of variance was used to determine between group
differences (professional groups and types of femoral lines). Content
of the audio-taped focus groups was transcribed verbatim and
analyzed using the method of constant comparison and organized
using NVivo computer software to identify key themes. RESULTS:
Approximately two thirds of all respondents were female, with the
physicians comprising the majority of male respondents. The majority
of respondents had received Baccalaureate degrees (49.2%), worked
full-time (90.3%), and had over ten years of work experience (66.7%).
Half of respondents practiced in the Medical Surgical Intensive Care
Unit. Over 50% reported mobilizing patients by dangling, transferring,
and performing hip range of motion (ROM) up to 60º with all lines.
Of the factors guiding clinical practice, safety concerns and clinical
experience were identified by all groups. However, significantly fewer
physicians compared to PTs and nurses reported that line occlusion,
breaking and shifting, as well as internal/external bleeding, present
safety concerns. From the focus groups, four themes were identified
(mobilization, variations in current practice, critical incidences and
precautions). CONCLUSIONS: Patients with indwelling femoral lines
are currently mobilized at UHN with the belief that the benefits
outweigh the risks. IMPLICATIONS: To maximize the safety of these
mobilization practices, patients should be screened by the healthcare
team for cognitive status and overall medical condition. Furthermore,
proper orientation and education about the structure, purpose, and
inherent risks of each type of femoral line should be encouraged
for all healthcare professionals within and across units at UHN
to increase the practice of mobilization. KEYWORDS: mobilization
practices, femoral lines, arterial lines, central venous lines, vascular
catheters, physical therapy. FUNDING ACKNOWLEDGEMENTS:
WCPT 2007, Research Reports
The authors would like to acknowledge the funding received from
the Allied Health Research Fund, University Health Network, Toronto,
Canada. CONTACT: amanda.fenton@uhn.on.ca
ETHICS COMMITTEE: University Health Network Research Ethics
Board, and University of Toronto Research Ethics Board
Research Report Poster Display
29-17 Tuesday 5 June 14:00
VCEC Exhibit Hall B & C
RATIONALE FOR ADHERENCE TO PHYSICAL THERAPY HOME
EXERCISE PROGRAMS IN ADOLESCENCE WITH ORTHOPEDIC
CONDITIONS OR CEREBRAL PALSY
Stiller C, Brosko E, Salla K, Shea K, Stewart N; Oakland University
PURPOSE: Just as with other populations, adolescents often
display difficulty consistently performing a home exercise program
(HEP). The purpose of this qualitative study was to identify the
rationale for adherence and nonadherence with HEPs in adolescents
with orthopedic conditions or cerebral palsy. RELEVANCE: In
the pediatric population, a lack of adherence to a HEP may
cause delayed development, unnecessary alterations of a treatment
program, and diminished clinical outcomes. Identification of the
rationale for adherence and nonadherence in this population will
help physical therapists facilitate compliance with HEPs, leading
to greater attainment of therapeutic goals and increased functional
outcomes for patients. PARTICIPANTS: A convenience sample of
22 adolescents (14 males/8 females), ages 12 to 18 years old,
11 with orthopedic conditions and 11 with cerebral palsy, who
had received a HEP as part of their physical therapy treatment
participated in the study. METHODS: Following completion of a
demographic questionnaire, subjects participated in one-on-one
interview consisting of twenty-eight open-ended, guiding questions
designed to elicit subjects’ opinions regarding the importance of a
HEP, their reasons for adherence or nonadherence with the HEP,
and their insight into techniques physical therapists might employ to
improve adolescent adherence to a HEP. ANALYSIS: Median age,
average length of physical therapy treatment and adherence rates for
both groups were calculated. Interview data was transcribed and the
constant comparative method of qualitative data analysis was used to
identify themes and concepts and formulate a conceptual framework
to improve adherence to physical therapy HEPs in adolescents.
RESULTS: Subjects with orthopedic conditions had a median age of
15.6 years old and an average length of physical therapy treatment
of 6.7 months. The median age for subjects with cerebral palsy was
14.4 years and the average length of treatment was 45.4 months.
Average adherence rates for subjects with orthopedic conditions
was 80.5%, compared to 38.0% for those with cerebral palsy.
Qualitative analysis of interview data revealed seven major factors
that facilitated adherence in these subjects, including: motivation, ed-
ucation, perceived benefits, independence, type of goals, perceived
seriousness and perceived absence of barriers. Both groups of
subjects could identify benefits of adherence, serious consequences
of nonadherence and barriers to completing the HEP. Subjects with
orthopedic conditions, however, demonstrated more traits related to
the seven factors (such as internal motivation, independence when
exercising and short term, personal goals) compared to their peers
with cerebral palsy. CONCLUSIONS: Adolescents with both chronic
conditions, such as cerebral palsy, and more acute problems, such
as orthopedic conditions are influenced by similar factors related to
adherence to a HEP. Those with orthopedic conditions, however,
display more traits related to the seven factors identified as important
for adherence by the subjects in this study. Future studies should
focus on repeating this study with adolescents with other chronic and
acute conditions and on prospective quantitative studies with larger
sample sizes. IMPLICATIONS: Therapists can facilitate adherence
in their adolescent patients by incorporating the principles, such
as short term and personal goals, internal motivation, appropriate
education and independence, related to the seven factors described
Poster Displays, Tuesday 5 June
by the subjects in this study. KEYWORDS: home exercise program,
adherence, adolescents. FUNDING ACKNOWLEDGEMENTS: This
study was supported by a Graduate Student Research Grant from
Oakland University. CONTACT: cstiller@oakland.edu
ETHICS COMMITTEE: Oakland University Institutional Review
Board
Research Report Poster Display
30-21 Tuesday 5 June 14:00
VCEC Exhibit Hall B & C
FACTORS INFLUENCING ADHESION TO A GUIDANCE COURSE
FOR CAREGIVERS OF CHILDREN WITH CEREBRAL PALSY
Mazzitelli C1,2 , Santos Melo M1 , Pimentel Piemonte M1 ;
1 Department of Physical Therapy, Faculty of Medical Science,
University of São Paulo, São Paulo, Brazil; 2 Physical Therapy
Course, Universidade Metodista de São Paulo, São Bernardo do
Campo, Brazil
PURPOSE: To verify factors surrounding caregivers of children with
Cerebral Palsy that may influence adhesion to a home exercise
guidance program. RELEVANCE: Cerebral Palsy is acknowledged to
be the most common neurological pathology in children. Given that
motor deficits in such patients are life-long, long-term physiother-
apeutic care is needed, overloading physiotherapy services made
available for this patient group. Therefore, the family becomes an
important ally in the rehabilitation process, as through their support,
therapeutic benefits can be both enhanced and widened. However,
in underdeveloped countries, besides poor health infrastructure
hampering these children’s access to quality rehabilitation services,
generally low education also hinders cooperation and support of the
families. Few studies have been performed to assess and identify the
relevant factors for a good family-therapist partnership, where such
information is essential in enabling a guidance program to be devised.
PARTICIPANTS: Twelve caregivers of children with Cerebral Palsy
were randomly selected, aged 38.78 ±10.58 years, comprising 10 fe-
males and 2 males with schooling of 9.82 ±6.01 years, a depression
level of 7.82 ±7.51, Mini-mental score of 26.8 ±4.42 and a socio-
economic level of 18.5 ±7.38 (class range from A2-D). METHODS:
Following selection and consent, caregivers were assessed on the
Beck’s Scale, Mini Mental State Exam, the Brazilian Economic Clas-
sification Criteria to ascertain socio-economic level, along with ques-
tions on Schooling. Subsequently, guidance was given for 5 exercises
to be carried out at home on the child. Guidance encompassed pro-
vision of a drawing of the exercise together with explanatory descrip-
tion, demonstration and explanation by the therapist, finalizing with
performing of exercises by the carer to enable checking of the manner
of execution and to allow any necessary corrections to be made.
Carers and children were followed for 12 months with bimonthly
reassessments to check exercise evocation (spontaneous recall,
upon seeing drawing, or cannot remember) and application (good,
reasonable or poor). ANALYSIS: Data collected were analyzed
using correlation tests to verify correlation amongst different carer
characteristics and the reassessments on guidance. RESULTS: A
significant correlation was observed between the carer’s mental state
and their ability to evoke exercises (correlation: −0.9410 / p = 0.0001),
between carer’s mental state and application (correlation: −0.7892
/ p = 0.011) and between socio-economic level and number of
exercises evoked (correlation: −0.7252 / p = 0.027). CONCLUSIONS:
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.
CONTACT: elisapp@usp.br
S457
Research Report Poster Display
31-01 Tuesday 5 June 14:00
VCEC Exhibit Hall B & C
CONGENITAL MUSCULAR TORTICOLLIS: RETROSPECTIVE
STUDY ON THREE DIFFERENT PHYSIOTHERAPY TREATMENT
PROTOCOLS COMPARING FUNCTIONAL AND COSMETIC
RESULTS AT 12 MONTHS
Davidson A, Innocenti D; Physiotherapy Dept., Meyer Paediatric
Hospital, Florence, Italy
PURPOSE: Considering the lack of homogeneity in physiotherapy
treatment of congenital muscular torticollis (CMT) in Tuscany,
this retrospective study compares the efficiency and efficacy of
the three different protocols applied. RELEVANCE: The interna-
tional literature underlines the effectiveness of early conservative
physiotherapy in preventing functional and cosmetic sequelae in
babies presenting CMT. Aside from the general agreement of
the importance of the differential diagnosis and that stretching,
active ROM exercises and positioning are the basis of successful
treatment, controversy remains on modality and intensity of stretching
techniques, complementary exercises and home program. Protocols
must consider the cost–benefit impact of the treatment strategies
chosen, preferring the minimal complexity and use of resources
which garantee maximum results. PARTICIPANTS: Physiotherapy
treatment performed was examined in 109 babies affected with CMT
seen in the Physiotherapy Department of Meyer Pediatric Hospital
between 1995-2003. METHODS: Three different treatment groups
were compared: protocol A= medium intensity and complexity;
protocol B1 = less intense and complex than protocol A; protocol
B2 = more intense and complex than protocol A. The three groups
were also compared to a control group C of untreated babies.
Three functional and cosmetic results were measured (spontaneous
posture in inclination of neck, passive rotazione of neck to affected
side, facial hemi-hypoplasia) and compared at the age  12 months
to examine which protocol was the most efficient. The complexity
and intensity was based on the amount of stretching done at home
by parents and relatives, the number of people involved in the
stretching exercises, the frequency of ambulatory treatments and the
type of complementary corrective exercises carried out. ANALYSIS:
Neck ROM and posture was quantified by goniometric reading,
and facial hemi-hypoplasia by presence or absence. RESULTS:
The protocol of medium intensity and complexity proved the most
efficient (cost-benefit ratio) in preventing a negative functional and
cosmetic outcome in that it produced the same results as the more
intensive and complex programme. Both proved better that the less
intense protocol.The study also showed the important preventive
effect of physiotherapy in this condition: only 2% of the treated babies
needed corrective surgery compared to 36% of the untreated babies.
CONCLUSIONS: In CMT stretching carried out by one person at
home three times a day and minimal ambulatory sessions proved
efficient in obtaining maximum results. More intensive and complex
treatments do not seem to give better results. As treatment is actually
proposed in all cases of CMT, more studies for a classification based
on prognostic signs are needed which would allow the exclusion from
treatment of babies who will have a good spontaneous recovery.
IMPLICATIONS: Careful consideration must be given to not under
or over treat babies with CMT. KEYWORDS: Congenital Torticollis –
Physiotherapy. FUNDING ACKNOWLEDGEMENTS: No funding
support was used for the study. CONTACT: a.davidson@meyer.it
S458
Research Report Poster Display
32-13 Tuesday 5 June 14:00
VCEC Exhibit Hall B & C
SELF REFERRAL(DIRECT ACCESS) TO PHYSIOTHERAPY:
WHAT DO THE PHYSIOTHERAPISTS AND REFERRING
DOCTORS THINK? RESULTS OF A NATIONAL TRIAL
Webster V1 , Holdsworth L2 , McFadyen A1 ; 1 Glasgow Caledonian
University, Glasgow Scotland; 2 Forth Valley NHS, Stirlingshire,
Scotland; 3 NHS Scotland
PURPOSE: Within the UK recent healthcare reforms have called
for the development of services which put patients at the centre
of healthcare delivery. This has prompted the development of a
range of services including patient self referral to physiotherapy.
RELEVANCE: Patient self referral has for many years been resisted
by the NHS due to the belief that services would be inundated. A
recent multi-centred trial conducted in Scotland reported that this
was not the case and self referral was feasible and appropriate.
This follow up study aimed to identify the views and perceptions
of all stakeholders. PARTICIPANTS: 64 Clinical Physiotherapists
(PTs) and 97 General Practitioners (GPs) from 26 primary care
locations representing a range of socio-economic and geographical
settings and who had participated in the trial were contacted. The
response rate was 73.5% for Physiotherapists and 72.2% for General
Practitioners (n=47 and n=70 respectively). METHODS: At the end
of the trial, questionnaires were sent to clinical physiotherapists and
GPs involved in the study to ascertain their views and perceptions
of self referral and any impact it had. ANALYSIS: All questionnaires
were analysed using PinPoint software using appropriate descriptive
and non-parametric tests. Frequency distributions were reported in
percentages. Comments were transcribed verbatim and analysed to
identify themes. RESULTS: The majority of GPs (71.4%) noticed no
change in the number of musculoskeletal patients consulting them
but. 56.5% of PTs thought their referral rates had increased uring
the study year. 95.8% of GPs were either confident or very confident
in physiotherapists abilities to diagnose and treat appropriately
musculoskeletal conditions. 71% of GPs and 76.6% of PTs were
comfortable or very comfortable with physiotherapists acting as first
point of contact, although 48.9% of PTs thought not all physio-
therapists were experienced enough. Only 34% of physiotherapists
considered the public were knowledgeable regarding physiotherapy.
37% GPs did not support physiotherapist issuing repeat prescriptions
compared to 10% of physiotherapists. Vast majority of GPS (91.4%)
and PTs (90%) indicated they thought physiotherapists should be
able to request X rays. Only 10% of Physiotherapist felt issuing
repeat prescriptions should not be a physiotherapy role. 87.2% of
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
certificates. Only 2.8% of GPs questioned did not want Self referral
to physiotherapy to continue. Many areas for discussion were raised
by both GPs and PTs in their comments. CONCLUSIONS: Both
General Practitioners and Physiotherapists were overwhelmingly in
favour of the continuation of self referral to physiotherapy. High levels
of support were identified for physiotherapists acting as first point
of contact practitioners. Areas for role extension were identified and
supported by almost two thirds of both groups IMPLICATIONS: This
study has found that the majority of stakeholders were fully supportive
of this development but some issues were identified by both
physiotherapists and general practitioners. When developing new
physiotherapy services it is essential that the views of stakeholders
are sought. KEYWORDS: Self referral (direct access), views and
perception, national trial. FUNDING ACKNOWLEDGEMENTS: This
work was undertaken with the support of the participating sites and
from our employer organisations Glasgow Caledonian University and
NHS Forth Valley. CONTACT: v.webster@gcal.ac.uk
ETHICS COMMITTEE: Ethical approval for the study was granted
by the Multi-centred Research Ethics Committee (Scotland) ref. No.
MREC/02/0/37.
WCPT 2007, Research Reports
Research Report Poster Display
33-21 Tuesday 5 June 14:00
VCEC Exhibit Hall B & C
THE MANAGEMENT OF PRESSURE ULCERS BY HOSPITAL
PHYSIOTHERAPISTS IN THE GAUTENG PROVINCE, SOUTH
AFRICA
Mothabeng J, Nel M, Stevens R, De Kock C, Swart M; University
of Pretoria, Pretoria, South Africa
PURPOSE: Pressure ulcers are a serious and prevalent medical
problem encountered in the medical and rehabilitation setting, often
interrupting rehabilitation. Although physiotherapists have various
modalities that can be used to enhance wound healing, the
researchers noticed that in some hospitals pressure ulcers were not
treated by physiotherapists. The purpose of this pilot study was to
investigate the management of pressure ulcers by hospital physio-
therapists in the Gauteng Province, South Africa. RELEVANCE: The
presence of pressure ulcers interrupts the progress of rehabilitation,
resluting in unnecessarily prolonged hospitalization. Physiotherapy
can contribute to the holistic management of pressure ulcers and
facilitate the rehabilitation process. PARTICIPANTS: Seventy five
physiotherapists out of the one thousand one hundred members
of the South African Society of Physiotherapy working in the
Gauteng provice consented to participate in the survey. METHODS:
A descriptive survey using a web-based questionnaire was em-
ployed. ANALYSIS: Descriptive statistics were used to analyse
the data. RESULTS: Seventy five completed questionnaires were
received. Sixty seven percent indicated that PU are not treated
by physiotherapists in their hospitals, and the main reason for no
treatment was that patients were not referred. Almost all (93%)
of the respondents indicated that they had undergraduate training
in the physiotherapeutic management of PU, but not all were
implementing it for varying reasons. CONCLUSIONS: The results
of this survey indicate that most physiotherapists in this sample
do not treat pressure ulcers for various reasons. IMPLICATIONS:
The results cannot be generalized to all the physiotherapists in the
Gauteng province due to the low response rate. The results however
highlight an important gap in the holistic management of pressure
ulcers in the South African context. South African Physiotherapists
need to market their adjunctive role in the management of
pressure ulcers for the benefit of the patients. KEYWORDS:
Pressure ulcers, physiotherapy modalities, rehabilitation. FUNDING
ACKNOWLEDGEMENTS: There was no external funding for this
project. CONTACT: joyce.mothabeng@up.ac.za
ETHICS COMMITTEE: The Faculty of Health Scinces Research and
Ethics committee of the University of Pretoria
Research Report Poster Display
36-21 Tuesday 5 June 14:00
VCEC Exhibit Hall B & C
DEVELOPMENT OF A FRAMEWORK FOR EVIDENCE-BASED
CHOICE OF OUTCOME MEASURES IN NEUROLOGICAL
PHYSIOTHERAPY
Watson A1 , Tyson S1,2 , Moss S1,3 , Troop H4 , Dean-Lofthouse G5 ,
Jorritsma S6 , Shannon M7 ; 1 Physiotherapy Directorate, University
of Salford, UK; 2 Centre for Rehabilitation and Human Performance
Research, University of Salford, UK; 3 Salford Primary Care Trust,
UK; 4 Tameside National Health Service Trust, UK; 5 Physiotherapy
Private Practice, UK; 6 Trafford National Health Service Trust, UK;
7 Salford Royal Hospital Trust, UK
PURPOSE: This paper reports on the first stage of a project
to identify the most robust outcome measures (OMs) for use in
neurological physiotherapy. The aim of this stage of the project
was to identify the domains that physiotherapists need to measure
during a neurological assessment. RELEVANCE: Neurological
physiotherapists recognise the need to include standardised OMs
in clinical practice but lack of information about the OMs available
Poster Displays, Tuesday 5 June
hampers utilisation. DESCRIPTION: Focus groups were held using 3
patient vignettes to represent the acute, rehabilitation and community
settings. Thirty senior neurological physiotherapists participated
and were asked “what would you observe, test or measure if
assessing this patient” . Each of the authors analysed the data
using independent thematic content analysis to identify and define
the items and domains. Internal and external member checking
ensured validity. EVALUATION: Items from the data collection
were classified in to 17 domains that physiotherapists need to
measure: weakness; range of movement / contracture; pain; muscle
tone / spasticity; sensation; ataxia / co-ordination; personal fatigue;
oedema; subluxation; postural impairment; balance impairment;
walking impairment; upper limb; balance disability; walking disability;
mobility disability and falls. CONCLUSIONS: The 17 domains that
physiotherapists need to measure during clinical assessment were
identified. IMPLICATIONS: In the second stage of the project these
domains will instruct systematic reviews to identify the most robust
outcome measures for use in clinical practice. KEYWORDS: neu-
rological physiotherapy, outcome measures, assessment. FUNDING
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:
a.watson@salford.ac.uk
Research Report Poster Display
37-01 Tuesday 5 June 14:00
VCEC Exhibit Hall B & C
SITTING BALANCE IN PATIENTS WITH SUB-ACUTE STROKE
UNDERGOING REHABILITATION: COMPARISON OF TWO
OUTCOME MEASURES
Amusat N; Rehabilitation Center, Two Hills Health Centre, Two
Hills, East Central Health, Alberta, Canada
PURPOSE: Independent sitting is a prerequisite for most functional
activities and a determinant of recovery from stroke. A primary
goal of physical therapy during the early phases of rehabilitation
is to facilitate static and dynamic sitting balance. Accurate clinical
assessment of sitting is required to develop appropriate treatment
program and evaluate functional outcomes. No widely accepted
outcome tool for assessing sitting balance exists. But often
therapists based treatment on sitting balance components of other
standardized outcome measures. The purpose of this study was
to examine some evaluative properties of the sitting balance items
of Berg Balance (BBS) and the Clinical Outcome Variables Scales
(COVS) among patients with stroke who are receiving rehabilitation.
RELEVANCE: The BBS and the COVS have sitting balance items
which are commonly used in stroke rehabilitation. Information
gained from this study will provide further information on some
measurement properties of BBS and COVS to assess sitting balance.
PARTICIPANTS: Fifty-one stroke patients admitted for rehabilitation
in a Canadian rural health region between January 2003 and June
2005. METHODS: A retrospective study of patients with stroke, with
complete admission and discharge BBS and COVS records, was
conducted. Admission and discharge BBS and COVS assessments
were components of standardized evaluative process for all patients
admitted for rehabilitation. ANALYSIS: Frequency distribution was
used to evaluate ceiling and floor effects of the sitting balance scores
(ordinal). Change was evaluated using Wilcoxon test to compare
admission and discharge sitting balance scores and responsiveness
assessed using effect sizes for the BBS and COVS. Sign test was
used to compare the COVS sitting scores of patients with maximum
score on the BBS sitting item. RESULTS: The mean age of the
sample was 72 (SD = 11.3) years, 57% were males; 86% of the
strokes were due to infarction. The median length of stay was
41days and 52% had strokes within 30 days of admission to the
centre. The mean total BBS and COVS scores were 25.0 (SD
15.9) and 56.6 (SD 15.8). There was significant ceiling effect only
for the BBS sitting balance item with >90% of the patients having
S459
the maximum scores at admission and discharge. There was a
significant change (discharge minus admission) in the COVS sitting
scores (P < 0.001), but not for the BBS scores (P>0.05). The effect
sizes were small and moderate respectively for the BBS and the
COVS sitting items. Patients with maximum scores on the BBS
sitting balance showed that they had more sitting ability going by
their scores on COVS (P < 0.001). CONCLUSIONS: Sitting balance
item of the BBS exhibits ceiling effect compared to the COVS. The
BBS sitting item did not show any change in sitting ability from
admission to discharge despite evidence to the contrary for the
COVS sitting item. IMPLICATIONS: The COVS may be a more
appropriate choice for evaluating sitting balance in patients with
sub-acute stroke undergoing rehabilitation. KEYWORDS: Stroke,
Berg Balance Scale, Clinical Outcome Variables Scale, Sitting
balance. FUNDING ACKNOWLEDGEMENTS: Paid time of the
Health Records officer was supported by the East Central Health.
CONTACT: sepet69@hotmail.com
ETHICS COMMITTEE: Community Research Ethics Board of
Alberta, Canada.
Research Report Poster Display
37-05 Tuesday 5 June 14:00
VCEC Exhibit Hall B & C
PSYCHOMETRIC EVALUATION OF WORK DISABILITY
OUTCOME MEASURES FOR INDIVIDUALS WITH
MUSCULOSKELETAL INJURIES: A SYSTEMATIC REVIEW
Williams R1 , Allwood S, Sanchez M, Shea R, Wang J, Wark G;
1 School of Rehabilitation Science, McMaster University, Hamilton,
Ontario. Canada
PURPOSE: This systematic review evaluated the psychometric
properties of outcome measures used to assess work disability
in individuals with musculoskeletal injuries. RELEVANCE: Although
there are several measures of work disability, they have not been
adequately evaluated. PARTICIPANTS: Three pairs of reviewers
evaluated the articles. METHODS: MEDLINE, CINAHL (Cumulative
Index to Nursing and Allied Health Literature), EMBASE, AMED
(Allied and Complementary Medicine), and PsycINFO between
1980 to March 2006 were searched for peer-reviewed studies that
evaluated self-administered instruments that assessed work disability
for individuals with musculoskeletal injuries. Examples of key words
were “work disability”, “worker role”, “return to work”, “instrument
validation”, “validity”, and “reliability”. The eligibility criteria were
articles that: (1) were peer-reviewed, (2) were published in English,
(3) involved an evaluative component of a work disability outcome
measure, and (4) were conducted with individuals who had sustained
musculoskeletal injuries. References cited in the retrieved articles
also were screened for possible inclusion. ANALYSIS: The reviewers
independently evaluated the outcome measures for the following
psychometric properties: (1) content validity, (2) construct validity,
(3) internal consistency, (4) test-retest reliability, (5) responsiveness,
(6) time to administer, and (7) ease of scoring. A modified rating
form was used to assess the instruments. A scoring method was
developed whereby a value was assigned for each psychometric
property evaluated (e.g., “1” was given for a “+” (adequate
methods/results); “0.5” for a “±” (doubtful methods/results); and
“0” for either a “−” (inadequate methods/results) or “?” (no data
available)). The total possible score was 7. When discrepancies
occurred between reviewers in the rating of the article, the reasons
for the discrepancies were identified and consensus between
reviewers was reached. If consensus could not be obtained, a third
reviewer independently evaluated the article until agreement was
determined. RESULTS: Of the 767 articles that were identified, 12
measures met the inclusion criteria. Most studies were found for
the Work Limitations Questionnaire (WLQ). None of the instruments
demonstrated satisfactory results for all properties. Five instruments
had data on content validity with the methodology being questionable
for two of the Instruments. Eleven studies reported on construct
S460
validity, however, the methodology was doubtful for three of the
measures. Internal consistency was addressed for eight instruments.
Test-retest reliability was reported for five instruments, with only one
instrument achieving an intra-class correlation coefficient greater than
0.7. Responsiveness was addressed for only two questionnaires.
Instruments with an administration time of less than 10 minutes
included the Functional Abilities Confidence Scale (FACS) and the
Stanford Presenteeism Scale (SPS). Scoring was considered easy
for the WLQ and the SPS. Overall, the highest ratings (total scores of
greater than 4 out of 7) were given to the FACS, the WLQ-25, and the
Occupational Role Questionnaire. CONCLUSIONS: Further studies
should be conducted that evaluate the psychometric properties and
clinical practicality of outcome measures for assessing work disability.
IMPLICATIONS: There is a need to continue to validate work
disability outcome measures and to make them more meaningful for
physical therapists. KEYWORDS: work disability, outcome measures,
systematic review. FUNDING ACKNOWLEDGEMENTS: unfunded.
CONTACT: rwilliam@mcmaster.ca
Research Report Poster Display
38-09 Tuesday 5 June 14:00
VCEC Exhibit Hall B & C
TRAUMATIC KNEE INJURY – IS KNEE ANTERIOR LAXITY A
RISK FACTOR?
Vauhnik R1,2 , Morrissey M1 , Rutherford O1 , Turk Z3 , Pilih I2,4 ;
1 Division of Applied Biomedical Research, GKT School of
Biomedical Sciences, King’s College London, UK; 2 Arthron –
Institute for Joint and Sports Injuries, Celje, Slovenia; 3 Department
of Rehabilitation Sciences, General Hospital Maribor, Slovenia;
4 Department of Traumatology, General Hospital Maribor, Slovenia
PURPOSE: Traumatic knee injuries occur far more often in female
compared to male athletes. These findings are of particular impor-
tance as knee injuries are one of the most seriously disabling injuries
in sports with short- and long-term disabilities being prevalent.
Preventive measures begin with an investigation of possible risk
factors that may contribute to an athlete’s susceptibility to injury.
The purpose of this study was to investigate if knee anterior laxity,
measured with an arthrometer, is a risk factor for traumatic knee injury
in sportswomen. To allow a more rounded analysis, other, easily
measured variables such as anthropometry, lower leg characteristics,
sport exposure and menstrual cycle characteristics were also
evaluated as possible risk factors. RELEVANCE: Prevention has
become a focal point for researchers and clinicians. However, before
meaningful prevention studies can be conducted, the risk factors
for injury must be clearly established and defined. PARTICIPANTS:
In the 2003/2004 preseason, 55 (70%) out of 79 women teams
in basketball, team handball and volleyball registered in Slovenia
were tested. In Slovenia, women’s basketball is played in one
division, team handball is played in two divisions and volleyball is
played in three divisions. For each sport, testing occurred at all
divisions. In total, 43 teams (54% of the total number of teams
targeted) finished the study. Sportswomen were aged between
11 and 41 years (N = 585). Sportswomen were tested in the
preseason and followed for one season. METHODS: It was a cohort
study and the data collection included: written informed consent,
background questionnaire, anthropometric tests, leg dominance
assessment, navicular drop test (measurement of foot pronation),
passive knee extension assessment and measurement of knee
anterior laxity with the KT arthrometer. ANALYSIS: Several sets of
data analysis were performed including logistic regression analysis
in order to build a model for predicting traumatic knee injury
among sportswomen. RESULTS: Height and average hours of
training per week were found to differ significantly (p < 0.05) between
sportswomen who had an injury in the target season vs those who
did not. Logistic regression indicated that height and knee anterior
laxity are significant risk factors for traumatic knee injuries among
sportswomen. CONCLUSIONS: Traumatic knee injuries among
WCPT 2007, Research Reports
Slovenian sportswomen participating in basketball, team handball
and volleyball are associated with higher amounts of training, greater
body height and a larger knee anterior laxity. The odds ratios and
significant relationships are rather small and therefore, there are
more important factors that need to be investigated. IMPLICATIONS:
As female participation in sports continues to grow and there is
an increased knee injury rate reported among female athletes, it is
crucial for clinicians and researches in the field of sports medicine to
determine the risk factors for traumatic knee injury. With increasing
knowledge of risk factors, more effective and appropriate prevention
strategies might be offered to female athletes at risk. KEYWORDS:
injury prevention, female athletes, logistic regression;. FUNDING
ACKNOWLEDGEMENTS: Funded by Ministry of Science, Slovenia.
CONTACT: r_vauhnik@yahoo.com or rvauhnik@arthron.si
ETHICS COMMITTEE: Ethics committee approval has been gained
from the Committee for Medical Ethics at University of Ljubljana,
Slovenia
Research Report Poster Display
38-13 Tuesday 5 June 14:00
VCEC Exhibit Hall B & C
PASSIVE VISCOELASTIC CHARACTERISTICS OF THE CALF
MUSCLE-TENDON UNIT IN FORMER INTERNATIONAL FEMALE
GYMNASTS
Maı̈setti O1,2 , Stutz I2 , Lecompte J1 , Portero P1,2 ; 1 Service de
Rééducation Neuro-Orthopédique, INSERM UMR 731, Hôpital
Rothschild, 33 boulevard de Picpus, 75571 Paris Cedex 12, France;
2 Département STAPS, Université Paris 12, 94000 Créteil, France
PURPOSE: The purpose of this study was to examine the
difference in passive viscoelastic characteristics of the calf muscle-
tendon unit between former international female gymnasts and
controls. RELEVANCE: Gymnasts usually start intensive training
from early childhood. The impact of such strenuous training on the
musculoskeletal system is not clear and needs to be investigated.
PARTICIPANTS: Six former international female gymnasts that have
stopped intensive training for 5 to 17 years and 6 sedentary subjects
participated to the study. METHODS: An isokinetic dynamometer
was used to passively stretch the right calf muscle-tendon unit from
relaxed plantar flexion to the maximal angle of dorsiflexion (ROM)
at 5º.s-1. The maximal passive resistive torque was measured and
average passive stiffness was calculated between 15 and 25º of dor-
siflexion and for the final 10% of ROM. The area under the moment-
angle curve was calculated as the averaged absorbed passive-elastic
energy. In addition, the maximal voluntary torques of the plantar
flexors and extensors were also measured. ANALYSIS: Unpaired
Student test was performed to compare ROM, passive resistive
torque and passive elastic energy. For stiffness indexes comparison
an ANOVA (group x stiffness indexes) was performed. RESULTS:
Despite similar maximal voluntary plantar flexion and dorsiflexion
torques, former international gymnasts exhibited higher maximal
passive dorsiflexion ROM (+35%, P < 0.05), maximal passive resistive
torque (+48%, P < 0.05) and passive-elastic energy (+63%, P < 0.01).
Furthermore, former gymnasts showed lower passive stiffness within
the 15-25º of dorsiflexion (−33%, P < 0.01) and higher for the last 10%
of ROM (+41%, P < 0.05). CONCLUSIONS: Although speculative,
these results suggest that long term loading during childhood
have modified passive properties of the calf muscle-tendon unit
of former international female gymnasts that persist several years
after the cessation of sport practice. IMPLICATIONS: Longitudinal
follow up would assist in determining whether or not passive
properties of plantar flexors is genetically determined and/or able
to be modified with further gymnastic training. KEYWORDS: former
female gymnasts, viscoelasticity, muscle-tendon unit. FUNDING
ACKNOWLEDGEMENTS: This study was supported by the Institute
of Myology – AFM, Paris, France. CONTACT: o.maisetti@rth.aphp.fr
Poster Displays, Tuesday 5 June
Research Report Poster Display
38-17 Tuesday 5 June 14:00
VCEC Exhibit Hall B & C
EFFECT OF TAPING ON KNEE ROTATIONAL KINEMATICS
DURING SINGLE LEG SQUAT AND DROP LANDING
Kawabata M1 , Kagaya Y1 , Shiba Y2 , Nishizono H1 ; 1 National
Institute of Fitness and Sports; 2 Kitasato University, School of
Allied Health Sciences
PURPOSE: The purpose of this study is to examine quantitatively of
the restricting taping on a knee rotational kinematics during dynamic
movement with a three-dimensional rigid body model. RELEVANCE:
Taping is ordinary used to relieve pain and to improve joint looseness.
The effect of taping tends to be judged subjectively, and there are
few studies on the influence of taping for a knee joint objectively.
PARTICIPANTS: The subjects were 15 normal women (age 21.6±0.9
years, height 157.0±4.3cm, body mass 50.7±6.6kg). METHODS:
Subjects performed the single leg squat and the single leg drop
landing with inside spiral taping, outside spiral taping and without
taping. A 3D motion detection system (OPTOTRAK; Northern Digital)
was used for measuring the knee rotational angle. The taping was
carried out equally by the same expert with 50mm width elasticity
tape (ELASTIKON; Johnson & Johnson). We defined the relative
rotational angle as 0 degrees in both limbs standing. ANALYSIS:
Paired t-test comparisons were made to examine the rotational
angle without taping and with the taping during squat and landing.
RESULTS: As for the squat of starting position, the leg was located
in 0.47±2.5 degrees external rotation without taping. The outside
spiral taping guided the leg to 15.9±3.5 degrees external rotation,
and the inside spiral taping guided it to 12.4±3.8 degrees internal
rotation. As for the maximum rotational shift during squat, the leg was
located in 2.6±2.3 degrees external rotation without taping. With the
outside spiral taping, the leg was located in 5.1±2.3 degrees external
rotation, and with the inside spiral taping, it was located in 0.3±2.1
degrees internal rotation. The rotational angle with each taping was
significantly shifted as compared to without taping (p < 0.05). As for
the pre-landing, the leg was located in 6.9±3.4 degrees external
rotation without taping. With the outside spiral taping, the leg was
located in 19.1±4.3 degrees external rotation, and with the inside
spiral taping, it was located in 7.6±5.2 degrees internal rotation.
As for the post-landing, the leg was located in 2.3±5.7 degrees
internal rotation without taping. With the outside spiral taping, the
leg was located in 4.5±6.7 degrees external rotation, and with
the inside spiral taping, it was located in 7.3±6.4 degrees internal
rotation. In pre- and post-landing, the leg of rotational angle with the
taping shifted statistically better than that without taping (p < 0.01).
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
angle with the inside spiral taping was always located to internal
rotation. That is, the spiral taping affected the static and the dynamic
alignment. IMPLICATIONS: We considered that the conventional
experiential evaluations or treatments were showed objectively.
KEYWORDS: Taping, knee rotation, rigid body model. FUNDING
ACKNOWLEDGEMENTS: The spiral taping affected the static and
the dynamic alignment. CONTACT: kawaba_chan@yahoo.co.jp
ETHICS COMMITTEE: We do not have an ethics system. We
obtained subject’s approval.
Research Report Poster Display
02-03 Tuesday 5 June 15:30
VCEC Exhibit Hall B & C
A CRITICAL EXPLORATION OF THE RELATIONSHIP BETWEEN
PERSONAL SUPPORT WORKERS AND VENTILATOR-USERS
Gibson B, DeMatteo D, Brooks D; Department of Physical Therapy,
University of Toronto, Toronto, Canada
PURPOSE: This study examined the relationship between persons
dependent on home mechanical ventilation (ventilator-users) and
S461
paid personal support workers (PSWs) addressing the following
research questions: 1) How do ventilator-users and PSWs describe
and evaluate their relationships? 2) What are the relevant social and
material conditions that are brought to bear on the relationship?
RELEVANCE: Technical advancement has facilitated community
living for “severely” disabled persons including ventilator-users. Many
require several hours per day of assistance that is provided by
PSWs who work under difficult conditions with low pay and minimal
training. The frequent intimate contact between ventilator-users
and PSWs has the potential to have considerable effects on the
well-being of each. Physiotherapists and other health providers
who work with these individuals, often over the course of many
years, need to have adequate information regarding non-professional
care arrangements in order to maximize care effectiveness and
build successful teams. In addition, information about ventilator-
user/PSW relationships, including barriers and facilitators to success,
has relevance for educational programs for PSWs and persons
with disabilities. PARTICIPANTS: 10 ventilator-users and 10 of
their PSW’s in supported housing environments located in Toronto,
Canada METHODS: One-on-one qualitative interviews with all
participants. ANALYSIS: The data was analyzed using a flexible
coding system consistent with the research purposes and grounded
in a critical social science approach. RESULTS: The accounts
revealed that PSWs and ventilator-users were generally highly
adaptable, finding ways to make relationships work despite significant
variability in interpersonal and official (management) expectations.
Both groups struggled with defining the relationship that was often
perceived as different from either a “friendship” or “professional”
relationship. In addition, considerable variability existed amongst
participants on what it means to “‘direct care” and how it affected the
success of relationships. Participants “worked” their relationships by
alternately drawing from and resisting the policies and philosophies of
management and unions in order to support their individual styles and
commitments. CONCLUSIONS: The considerable variability in how
PSWs and ventilator- users interpret their relationships and “work
the system” suggests that “independent living” and what it means
to “direct care” are not univers IMPLICATIONS: The study informs
the practice of physiotherapists and other health professionals by
providing insight into the most significant health care relationship
in the lives of persons who require daily supportive care and the
implications for health care within an “independent living” model.
KEYWORDS: Disability, personal support workers, home mechanical
ventilation. FUNDING ACKNOWLEDGEMENTS: The study was
supported by a grant from the Ontario Lung Association. CONTACT:
barbara.gibson@utoronto.ca
ETHICS COMMITTEE: University of Toronto Research Ethics Board
Research Report Poster Display
02-07 Tuesday 5 June 15:30
VCEC Exhibit Hall B & C
INTERVAL VERSUS CONTINUOUS EXERCISE FOR PATIENTS
WITH SEVERE COPD
Puhan M1 , Büsching G2 , Schünemann H3,5 , vanOort E2 , Zaugg C4 ,
Frey M2 ; 1 Horten Centre, University of Zurich, Switzerland; 2 Klinik
Barmelweid, Barmelweid, Switzerland; 3 Department of Clinical
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
and Information Translation (INFORMA) Unit, Department of
Epidemiology, Italian National Cancer Institute Regina Elena, Rome,
Italy
PURPOSE: Guidelines recommend continuous exercise at high
intensity to reduce peripheral muscle dysfunction in patients with
Chronic Obstructive Pulmonary Disease (COPD), but patients may
tolerate equally effective alternatives better. RELEVANCE: The
aim of our trial was to assess whether interval exercise is not
S462
less effective than high intensity continuous exercise, but tolerated
better by patients with severe COPD. PARTICIPANTS: 98 patients
with severe COPD. Publicly funded inpatient rehabilitation. COPD
as defined by FEV1/FVC < 70% predicted, FEV1 < 50% predicted
after bronchodilation corresponding to Global Initiative for Chronic
Obstructive Lung Disease (GOLD) stage III-IV and German as first
or daily language. Exclusion criteria included cardiovascular, mus-
culoskelettal or neurological disorders that inhibit physical exercise
or the performance of exercise tests, as described previously. We
also excluded patients who had a diagnosis of cancer (excluding
skin cancers) within the last two years and were undergoing current
treatment. METHODS: Randomized, blinded (outcome assessment)
non-inferiority trial. 12-15 supervised interval exercise or high
intensity continuous exercise sessions followed by home exercise.
All patients followed an inpatient respiratory rehabilitation for three
weeks followed by individually prescribed home-based exercise.
Apart from the exercise program, the rehabilitation program was
identical for both groups and included breathing therapy, relaxation
therapy, guided walking tours and patient education. Primary
outcomes were health-related quality of life using the Chronic
Respiratory Questionnaire (CRQ, summary scores from 1 [most
severe impairment] to 7 by domain) after five weeks and adherence
to protocols. Secondary outcomes included exercise tests such
as Six-minute walking distance (SMWD). ANALYSIS: We used
the confidence interval approach as recommended for equivalence
and non-inferiority trials. We established non-inferiority of interval
exercise if the point estimates and their 95% confidence intervals for
differences between change scores of the continuous and interval
exercise group was smaller than the a priori determined boundary
of clinical equivalence, which we set around the minimal important
difference (0.5 for CRQ31, 45 meters for SMWD39 and 8 for
FT40). We used both intention-to-treat and per-protocol analysis.
We analysed exercise tolerance by comparing the number of breaks
between groups using the Mann-Whitney U-test and the proportion
of patients achieving target exercise using the chi square test.
RESULTS: Both groups experienced large improvements in HRQL
(increase of CRQ scores of 1.00 [0.98 SD] for interval and 1.02
[1.05 SD] for continuous exercise group). Adjusted between-group
differences (−0.05 [95% CI −0.42-0.32] for CRQ total scores and
3.4 meters [95% CI −21.7–28.6] for six-minute walking distance)
were within the a priori defined boundaries of non-inferiority (0.5
for CRQ and 45 meters for six-minute walking distance). 47.9% of
patients with interval exercise were able to adhere to the protocol
versus 24.0% with continuous exercise (difference 23.9%, 95% CI
5.0-42.8%, P = 0.014). The median number of unintended breaks
 1 minute during supervised rehabilitation was 2 (interquartile
range 0-16) for the interval exercise and 11 (2-26) for the
continuous exercise group (P = 0.023). CONCLUSIONS: Interval is
not less effective than continuous exercise, but tolerated better.
Clinicians and patients can choose either of the two exercise
modalities to initiate physical exercise. IMPLICATIONS: For physical
therapy practice KEYWORDS: COPD, interval exercise, non-
inferiority trial,. FUNDING ACKNOWLEDGEMENTS: Astra/Zeneca
Switzerland (unrestricted grant), BoehringerIngelheim Switzerland
(unrestricted grant) and Klinik Barmelweid. The funding sources
provided unrestricted grants and did not influence the planning,
conduct and analyses of the trial or the preparation of the manuscript.
CONTACT: bgbuesching@freesurf.ch
ETHICS COMMITTEE: The ethics committee of the Kantonsspital
Aarau (Aargau, Switzerland) approved the study protocol.
WCPT 2007, Research Reports
Research Report Poster Display
02-11 Tuesday 5 June 15:30
VCEC Exhibit Hall B & C
NEUROMUSCULAR ELECTRICAL STIMULATION TO
THE LOWER EXTREMITY AFTER CARDIAC SURGERY:
A RANDOMIZED CONTROLLED TRIAL
Kamiya M1 , Yamada S2 , Yagi R1 , Nakagawa M1 , Ohno O1 ,
Watanabe T1 ; 1 Toyohashi Municipal Hospital; 2 Nagoya University
PURPOSE: The purpose of this study was to investigate the muscle
strengthening effect of neuromuscular electrical stimulation (ES) to
the lower extremity (L/E) muscles in patients after cardiac surgery.
RELEVANCE: In the acute phase of rehabilitation of the patients
after cardiac surgery, they occasionally complain of fatigue in the
L/E or unstable walking, although they have no trouble in the chest.
Then we considered that a muscle strengthening exercise (M.S.E)
might be effective for these symptoms. However, methods of a
M.S.E for these patients have not been reported. PARTICIPANTS: 19
patients who had undergone cardiac surgery at Toyohashi municipal
hospital (8 females and 11 males; mean age of 63.1±8.6 y/o; 12
CABG surgery, 6 valve replacement, 1 left atrial myxoma extraction)
were included in this study. METHODS: We studied the patients
in a single-blind, randomized controlled trial. The patients were
assigned either to the control group (standard cardiac rehabilitation
program)or to the ES group (standard cardiac rehabilitation program
plus ES). As to the ES protocol, a biphasic symmetric pulsatile
current, 200 msec pulse width, and a 20-pps frequency were used.
The amplitude was increased to the maximum value tolerated by
each of the patients. The muscle contraction/relaxation time ratio
was 1/1. The treatment time was 60 minutes/day, and performed 5
days a week. In the ES group, quadriceps (Q) and gastrocnemius
(G) muscles of both legs were stimulated. The maximum isometric
muscle forces were evaluated pre and post the hospital cardiac
rehabilitation program by using a hand held dynamometer. Vital
signs such as electrocardiogram (ECG), heart rate (HR), and blood
pressure (BP) were monitored during ES and analyzed. This study
design was approved by the Toyohashi municipal hospital ethics
committee, and written informed consent was obtained from the
patients. ANALYSIS: Values are expressed as mean±SD. Normally
distributed paired data were compared using a paired t-test. A value
of p < 0.05 was considered statistically significant. RESULTS: In the
ES group, small increases were observed for the maximum Q force,
but the values did not reach statistical significance from 4.2±0.3 to
4.4±0.2[N/Kg]. The maximum G force increased significantly from
4.0±0.4 to 5.5±0.4[N/Kg]. On the other hand, in the control group,
a significant decrease was seen in both the maximum Q force from
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]
(p < 0.05). There were no remarkable changes in the vital signs of the
patients during ES. CONCLUSIONS: This study showed that ES to
the L/E muscles in combination with a standard cardiac rehabilitation
program was feasible and might be effective in speeding recovery
of the muscle forces in the short term. As to the side effects of
ES to the cardiac function, it was conceivable that an excessive
load was not imposed on the heart during ES. IMPLICATIONS:
ES to the L/E muscles might be beneficial and safe in the
acute phase of rehabilitation in the patients after cardiac surgery.
KEYWORDS: cardiac surgery, neuromuscular electrical stimulation,
cardiac rehabilitation. FUNDING ACKNOWLEDGEMENTS: The
work was unfunded. CONTACT: kmy-m@smile.ocn.ne.jp
ETHICS COMMITTEE: This study design was approved by the
Toyohashi municipal hospital ethics committee.
Poster Displays, Tuesday 5 June
Research Report Poster Display
03-23 Tuesday 5 June 15:30
VCEC Exhibit Hall B & C
CLINICAL EDUCATOR AND STUDENT EXPERIENCES OF
PAIRED AND NON-PAIRED CLINICAL PLACEMENTS
O’Connor A, Sainsbury D, Coote S; Department of Physiotherapy,
School of Health Sciences, University of Limerick, Limerick, Ireland
PURPOSE: Paired clinical placements have been strongly en-
couraged by educational institutions in Ireland recently due to
a shortage of student placements. Evidence for the success
of paired placements in the Irish system is limited due to the
relatively recent introduction of this model. The purpose of this
study was to investigate differences perceived by students and
clinical educators between paired and non-paired placements using
satisfaction questionnaires completed at the end of placement.
RELEVANCE: Reported advantages in current literature relating to
paired placements include reduced staff and resources required
for supervison of students, and decreased supervision time for
clinical educators due to fewer superficial questions from students
as these are resolved through peer learning sessions. The value of
shared learning experiences have been reported by students who
have experienced paired placements. The results of this study will
provide more insight about clinical placement models as well as
increasing the existing database of knowledge. PARTICIPANTS: 222
completed student feedback questionnaires (131 paired and 91 non-
paired) and 133 completed clinical educator feedback questionnaires
(42 from paired model, 91 from non-paired model) were included
for analysis. METHODS: The satisfaction questionnaires were
essentially designed by the University Clinical Placement Co-
ordinator as satisfaction questionnaires relating to several aspects of
the clinical placement. This questionnaire was routinely administered
to all student and clinical educators at the end of placement
regardless of which placement model was used and then returned to
the university for analysis. Each statement on the questionnaire was
scored from zero to ten, where zero represented disagreement with
the statement and ten represented agreement with the statement.
Statements chosen for analysis related to personal enjoyment of
the placement for both student and clinical educator, whether the
placement provided a beneficial learning experience for the clinical
educator and topics regarding supervision provision and time devoted
to problem solving for the students. ANALYSIS: The independent
sample T-test was used to determine any differences between
paired and non-paired placements from the selected responses of
the clinical educator questionnaire and the student questionnaire.
RESULTS: Analysis of student and clinical educator feedback
showed no significant differences between paired and non-paired
clinical placement model experiences. Furthermore there was no
significant difference between paired and non-paired experiences
in outpatient settings (adult and paediatrics) and no difference
between paired and unpaired in a mixed inpatient/ outpatient setting.
CONCLUSIONS: More collaborative research is needed in this area
of clinical education to determine which teaching model is superior.
A comprehensive questionnaire including all pertinent educational
issues relating to clinical placements would assist this process.
Results of this study may have been influenced by some paired
placement sites that conducted placements as a 1:1 model although
theoretically offering a 2:1 placement. In other words, students
continued to work independently of each other and did not experience
the shared learning opportunities of a paired placement model.
IMPLICATIONS: The results found have highlighted the need for
more research related to clinical education models and also that, for
analysis of these models to be valid, then both clinicians and students
must follow the guidelines of that model. KEYWORDS: Clinical
placement, Physiotherapy education,teaching models. FUNDING
ACKNOWLEDGEMENTS: None. CONTACT: anne.oconnor@ul.ie
S463
Research Report Poster Display
08-03 Tuesday 5 June 15:30
VCEC Exhibit Hall B & C
EFFECTS OF HEAT STRESS ON MUSCLE FIBERS DAMAGE IN
RELOADING AFTER IMMOBILIZED RAT SOLEUS MUSCLE
Banno Y1 , Okita M1 , Inoue T2 , Suzuki S2 ; 1 Faculty of Care and
Rehabilitaion, Seijoh University, Tokai, Japan; 2 Program in Physical
and Occupational Therapy Graduate School of Health Sciences
Nagoya University, Nagoya, Japan
PURPOSE: The purpose of this study was to determine whether
heat stress is preventive for muscle fiber injury induced by reloading
after immobilized rat soleus muscle. RELEVANCE: One of the
main programs of physical therapy is thermotherapy, but its efficacy
is still not clear. This study provides new information on the
effects of thermotherapy on muscle tissue. PARTICIPANTS: Twenty
male Wistar rats, aged 8-week-old, were used. Rats were divided
randomly into the control (C, n=5), control with heat stress (CH,
n=5), immobilized followed by normal recovery (IR, n=5), and
immobilized followed by heat stress before reloading (IH, n=5)
groups. METHODS: The experimental protocol was approved by
the Ethics Review Committee for Animal Experimentation at our
institution. Bilateral ankles of each rat in the IR and IH group were
fixed in full planter flexion with a plaster cast for 4 weeks. Immediately
after the 4 weeks immobilized, reloading was allowed to the rats in
the IR group. The rats in the CH and IH group were first exposed to
heat stress (41ºC for 60 min) in an incubator under anesthesia 2 days
before the reloading. ANALYSIS: In all groups, both soleus muscles
were extracted and weighed. Frozen sections of these muscles
were stained with hematoxylin-eosin, the number of necrotic muscle
fibers was counted, and muscle fiber diameters were measured.
Moreover, Hsp70 contents in muscle tissue were measured by using
the Western blot method. RESULTS: The number of necrotic muscle
fibers was significantly increased in IR compared with C and CH
groups. In IH group, however, the number of necrotic fibers was
less than IR group. The mean muscle fiber diameter in IH group
decreased significantly compared with C, CH, and IR groups. HSP70
levels were significantly greater in CH and IH groups compared
with C and IR groups. CONCLUSIONS: These finding suggest that
heat stress prior to reloading induces expression of HSP70 and
leads to protective effect against soleus muscle injury induced by
reloading after immobilization. IMPLICATIONS: The results of the
present study may be provided new information on the effects of
thermotherapy on muscle injury. KEYWORDS: Reloading, Muscle
fibers injury, Heat stress. FUNDING ACKNOWLEDGEMENTS: This
research was supported in part a grant-in-aid for Scientific Research
from the Ministry of Education, Science, Sports and Culture of Japan
(grant no. 16700409). CONTACT: banno@seijoh-u.ac.jp
ETHICS COMMITTEE: The experimental protocol was approved by
the Ethics Review Committee for Animal Experimentation at Seijoh
University.
Research Report Poster Display
08-11 Tuesday 5 June 15:30
VCEC Exhibit Hall B & C
INFLUENCE OF PULSE DURATION IN SENSORIAL
DISCOMFORT DURING THE NEUROMUSCULAR ELECTRICAL
STIMULATION
Murazawa M1 , Rodrigues T1 , Liebano R1,2 ; 1 Physical Therapy
Department, Universidade Cidade de São Paulo, Brazil; 2 Plastic
Surgery Division, Surgery Department, Universidade Federal de
São Paulo, Escola Paulista de Medicina, São Paulo, Brazil
PURPOSE: The aim of this study was to evaluate the sensorial
discomfort during the Neuromuscular Electrical Stimulation (NMES)
with different pulse durations through of the NMES in the peak
torque of the quadriceps muscle. RELEVANCE: Check the relation
of pulse duration and the sensorial discomfort of NMES to optimize
S464
the parameters utilized in this type of stimulation. PARTICIPANTS:
Twenty healthy women were included as volunteers with age
between 18 and 22 years old, without any history of neuromuscular
disease, cardiovascular disease or knee disorders participated in
the study. METHODS: The maximum voluntary isometric contraction
(MVIC) test of the quadriceps femoris muscle was performed in all
volunteers at an angle of 60 degrees of knee flexion in an isokinetic
computerized dynamometer. After that, each one was subjected to
NMES in three different pulse durations (400, 700 and 1000ms)
in order to reach 40% of the peak torque of a MVIC then the
subjects were asked to express their perceived discomfort on a Visual
Analog Scale (VAS) 10 cm. ANALYSIS: To determine which pulse
duration were more comfort, the score of sensorial discomfort were
subjected to a repeated measures Analysis of Variance (ANOVA)
followed by Tukey-Kramer Multiple Comparisons Test RESULTS: The
sensorial discomfort with the different pulse duration of 400, 700
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
with 400 and 700ms. There was no significant statistic difference
between 400 and 700ms. IMPLICATIONS: When the comfort is the
main factor to be considered it is suggested to use lower pulse
duration. KEYWORDS: NMES, Peak torque, Quadriceps muscle.
FUNDING ACKNOWLEDGEMENTS: Universidade Cidade de São
Paulo (UNICID). CONTACT: marthinha_titi@hotmail.com
ETHICS COMMITTEE: It was approved by Universidade Cidade de
São Paulo ethics committee
Research Report Poster Display
09-15 Tuesday 5 June 15:30
VCEC Exhibit Hall B & C
EFFECT OF THE NUMBER OF WEEKLY REPETITIONS OF
STATIC STRETCHING ONTO ISCHIOTIBIAL AND TRICEPS
SURAE ELECTROMYOGRAPHY AND FLEXIBILITY
Marques A, Cabral C, Vasconcelos A, Sacco I; School of Medicine
of the University of São Paulo, São Paulo, Brazil
PURPOSE: To compare the effect of the number of weekly repetitions
of a static segment stretch program on electromyography activity
and flexibility of shortened ischiotibials and triceps surae muscles.
RELEVANCE: Stretching exercises are always applied in the physical
rehabilitation to achieve the best results, but there are few studies
to compare static segment stretch program. Though duration and
number of daily repetitions of stretching have been extensively
studied, weekly frequencies have not; also, electromyography (EMG)
activity has seldom if ever been measured during stretching
PARTICIPANTS: Thirty one healthy subjects (18-30 years old), with
shortened ischiotibials and triceps surae, were randomly distributed
into three groups: Group1 (G1) performed the stretch exercises once
a week, Group 3 (G3) three times a week, and Group 5 (G5), five
times a week. given by the University of São Paulo. METHODS:
Flexibility was assessed by the finger tip-to-floor test before and
after the stretching program. Electromyography data were collected
before and after the program during stretching and during maximum
isometric contraction (MIC). Before its realization, this study had the
ethics approval given by the University of São Paulo. ANALYSIS:
All variables were analysed as to normality using Shapiro-Wilk’s
test. When data distribution was normal, variables between groups
were compared using one-way analysis of variance (ANOVA) with
post hoc Scheffé tests; and that of data pre and post-stretching
program, by the paired t-test. For non-parametric data, a Kruskal-
Wallis test (followed by a post hoc Mann-Whitney U test) was used
to compare variables between the groups, and Wilcoxon’s for pre
and post-program data (a<0.05). RESULTS: Group 3 obtained larger
flexibility gain than Group 1 (p = 0.018) and similar to that of Group
5 (p = 0.3). EMG during stretching tended to decrease in Group
3 and Group 5 after the program. EMG during MIC showed a
WCPT 2007, Research Reports
trend to increase in all groups CONCLUSIONS: All groups showed
significant gains in flexibility after the four-week program; the group
who did the stretch exercises three times a week showed statistically
significant greater improvement in flexibility than the group who did
the exercises once a week; and showed a trend to obtain greater
flexibility gain when compared to the group who did the stretching
5 times a week; during maximum isometric contraction after the
stretching program there was a trend to increased EMG activity
in all groups. IMPLICATIONS: Global stretching exercises may be
added in the physical therapy treatments, especially to improve
the range of motion and flexibility. KEYWORDS: static stretching,
electromyography, flexibility. FUNDING ACKNOWLEDGEMENTS:
FAPESP. CONTACT: pasqual@usp.br
ETHICS COMMITTEE: Comitê de Ética para Análise de Projetos de
Pesquisa (CAPPesq, Ethics Committee for the Analysis of Research
Projects)
Research Report Poster Display
09-19 Tuesday 5 June 15:30
VCEC Exhibit Hall B & C
ESTIMATION AND SEPARATION OF JOINT TORQUE USING
SURFACE ELECTROMYOGRAMS
Tsurusaki T1 , Nishimura H2 , Shitani Y3 , Kajiki M4 ; 1 Graduate
School of Health Sciences, Nagasaki University; 2 NagasakiYurino
Hospital; 3 Nagasaki KITA Hospital; 4 Osaka Rehabilitation Hospital
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
antagonist muscle generative torque. The purpose of this study was
to estimate JTQ and MTQ from surface electromyograms (SEMG).
RELEVANCE: Muscle strength assessment is critical to the outcome
of physical therapy. However, the measured power is JTQ and
not MTQ. The results of the present study will enable muscle
strength assessment under conditions of uncontrolled behavior by
estimating JTQ and MTQ from SEMG. PARTICIPANTS: Five healthy
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
the dominant arm of all the participants. METHODS: The volunteers
performed (1) maximum voluntary contractions (MVCs), (2) isometric
contraction of the elbow joint to flexion/extension to a target (20%,
40%, 60% and 80% MVC) and (3) isometric contraction of the elbow
joint to flexion/extension with extensor/flexor contraction. All tasks
were executed with the spine and shoulder joint abducted 90º, the
elbow joint flexed 90º and the forearm fully supinated. Fourteen
SEMGs from superficial muscles of the upper extremity and JTQ
were recorded in a personal computer (sampled at 1 kHz) using
the BIO-amp system (NF Corporation, JAPAN). ANALYSIS: Data
were analyzed off-line using MATLAB with the Wavelet toolbox (The
MathWorks Inc., Natick, MA, USA). Parameters of SEMG signals are
based on scalograms (the square of the discrete wavelet transform)
estimated using the Daubechies 5 wavelet (DB5) at decomposition
level 5. Prediction equations for JTQ estimation were calculated
by multi-regression analysis of data from each of tasks 2 and 3.
The dependent variable was JTQ and SEMG parameters were
independent variables. One prediction equation was selected for
each task as follows: (a) statistical significance, (b) the SEMG from
the same muscle, (c) sign of coefficient and (d) one or more flexor
and extensor muscles. Thereafter, the correlation between the actual
value of task 2/task 3 and the assessed value of task 3/task 2
was examined. RESULTS: We found that JTQ can be estimated
from SEMG (p < 0.001), the actual and assessed values significantly
correlated (R2 = 0.831) and prediction equations can be expressed by
factors generated by flexor and extensor muscles. CONCLUSIONS:
To measure tension generated by muscle in vivo and to measure
muscular strength under uncontrolled behavior is difficult. Not only
can JTQ be estimated by SEMG, it can be separated into some
MTQs. Further study is required to establish this analysis method.
Poster Displays, Tuesday 5 June
IMPLICATIONS: The SEMG is useful for physical therapy, and it
also has a much broader range of applications such as muscle
strength assessment under conditions of uncontrolled behavior.
KEYWORDS: Joint Torque, Surface Electromyograms, Prediction
Equation. FUNDING ACKNOWLEDGEMENTS: The funding source
of this study was the General Research Fund of Nagasaki University
(Nagasaki, JAPAN). CONTACT: toshiya@nagasaki-u.ac.jp
Research Report Poster Display
09-23 Tuesday 5 June 15:30
VCEC Exhibit Hall B & C
CARDIAC AUTONOMIC FUNCTION AT REST AND PHYSICAL
CAPACITY OF INDIVIDUALS WITH PROFESSIONAL ACTIVITY
OF LOW AND HIGH ENERGY EXPENSE
Paschoal M, Junqueira M, Trevizan P, Bloes M; Pontifı́cia
Universidade Católica de Campinas
PURPOSE: Different professional activities are recognized for
demanding high and low energy expense to be performed, and
also to promote cardiac and metabolic changes with possible
health interferences. RELEVANCE: This study it evaluated if the
normal activity of professional work could promote cardiac autonomic
adaptative changes that could be detected in rest condition by heart
rate variability (HRV) analysis, and during effort, by cardiorrespiratory
effort tests. PARTICIPANTS: Healthy individuals (n=20) were studied:
ten mailmen – M (5 men and 5 women, with mean age of 38.1
+/− 4.8 years old), that walk about 3 to 4 hour per day, and 10
secretaries – S (5 men and 5 women, with mean age of 36.1+/−
5.1 years old). All of them have worked for at least 5 years in the
same professional activity, and they haven’t performed any regular
physical activity despite work in the last six months. METHODS: To
study the cardiac autonomic contidions at rest, the cardiac beats
were recorded (Polar Heart Rate Monitor S810) at morning, during
10min after a regular night of sleep, and the HRV was analysed at
time and frequency domains using the Polar Precision Performance
software. The Bruce’s modified protocol test (Inbrasport Super ATL
treadmil) was applied to study the volunteer’s physical capacity
and performed from rest until 80% of HRmax. ANALYSIS: The
Student T test was used with significance of p < 0.05. RESULTS:
There was no difference among the two groups’ HRV analysis.
Otherwise, all variables obtained during Bruce’s protocol showed
significative differences between the values of the groups. The
time to reach 80% of HRmax was 19:00min (M) and 15:03min
(S) with p = 0.006, also with a significative difference (p < 0.05) to
total distance from rest until 80%HRmax: 1365.0 and 895.0 meters,
respectively to M and S groups. The VO2 peak was also different
(p < 0.05) between the groups, with 56.0 ml/O2/Kg/min for M and
45.5 ml/O2/Kg/min for S group. CONCLUSIONS: We can conclude
that the adaptative differences in the cardiovascular system resultant
of the professional activity could not be demonstrated when the
volunteers were in rest, however they could be easily shown when
they were submitted to an effort test. IMPLICATIONS: Precocious
detention of reduction of the decurrent cardiorrespiratória functional
capacity of the professional activity, making possible that injunctions
and therapeutical are carried through. KEYWORDS: effort test, heart
rate variability, physical activity. FUNDING ACKNOWLEDGEMENTS:
The funding acknowledgements was support by CNPq. CONTACT:
marioap@directnet.com.br
ETHICS COMMITTEE: Ethics committee of Pontifı́cia Universidade
Católica de Campinas.Protocol number:413/05
S465
Research Report Poster Display
11-03 Tuesday 5 June 15:30
VCEC Exhibit Hall B & C
RELATIONSHIP BETWEEN A ROUTINE WALKING PROGRAM
AND EYE HEALTH IN INDIVIDUALS WITH TYPE 2 DIABETES
Stern D, Nof L; Nova Southeastern University, Ft. Lauderdale,
FL, USA
PURPOSE: The purpose was to investigate whether there is a
relationship between a walking program and eye health in individuals
with Diabetes Type 2. Diabetes is a multi-system disease, impacting
all body systems including the eye and vision. No studies could be
identified in the literature that examined this relationship. A routine
walking program was hypothesized as a prevention tool for contin-
uous deterioration of eye health in type 2 diabetes. RELEVANCE:
Physical therapy guidance and monitoring as preventive and disease
management strategies for individuals with diabetes are consistent
with the APTA Guide to Physical Therapist Practice. PARTICIPANTS:
The 20 subjects were 40 years of age or older, had history of Type
2 diabetes, were: English speaking and read at 20/60 or less in the
best corrected eye, willing to participate for 9 months, independent
ambulators with or without a device and had physician permission
to participate. Exclusion criteria: oxygen dependency, history of MI,
angina, intermittent claudication. METHODS: This pilot study used
a one group pre and post-test design. Walking tolerance levels and
eye health were assessed at entry and at nine months. Participants
were instructed in walking programs based on a history and
completion of the SF 36, Rate of Perceived Exertion (RPE),Timed
Up and Go (TUG), vital signs, BMI, lower extremity sensory
assessment and 6-minute walk test. Eye health was determined
through history and opthalmic examination. Subjects were instructed
in appropriate walking programs and used pedometers to track
performance and compliance throughout the 9 months. ANALYSIS:
Logistic regression analyses were conducted separately on change
of walking tolerance and eye health. To explore the strength and
direction of relationship between the two major outcomes (change
of fitness level and change of eye health), Spearman correlational
analysis was used. A correlation coefficient r = 0.4 was considered
statistical significant for this study. Wilcoxin Signed – Ranks test
compared pre and post-test SF-36 scores to measure perceived
sense of well-being. Paired t- tests compared TUG results, six-
minute walk test, and anthropometric measurements. Opthalmic
results were recorded using the appropriate units of measure for
each test. Diabetic retinopathy severity was graded according to
a protocol similar to that used in the Early Treatment Diabetic
Retinopathy Study (ETDRS). For all analyses, significance was
determined at the p  0.05 level. Correlation analysis was used
to compare the pre and posttest findings for exercise tolerance
and fitness tolerance and ophthalmic findings. RESULTS: Routine
walking was found to be effective in management of Type 2
diabetes. Based on self report, HgAIC levels were better controlled,
TUG speeds decreased, distance and speed on the 6 minute
walk test increased, RPE decreased, individuals with a history
of falls reported a decrease, and there was improvement in self
perceived quality of life, although not statistically significant. While
participants improved in walking tolerance, ophthalmic results were
inclusive. CONCLUSIONS: Further research with a larger population
is recommended over a longer period of time. IMPLICATIONS:
Physical Therapy is effective in the management of diabetes Type
2. KEYWORDS: Diabetes; Physical therapy; Walking. FUNDING
ACKNOWLEDGEMENTS: President’s Grant, Nova Southeastern
University, Ft. Lauderdale, FL. CONTACT: debras@nova.edu
S466
Research Report Poster Display
12-15 Tuesday 5 June 15:30
VCEC Exhibit Hall B & C
TEST-RETEST RELIABILITY OF THE STAR EXCURSION
BALANCE TEST IN A GERIATRIC POPULATION
Stockert B, Barakatt E; Department of Physical Therapy, California
State University, Sacramento, California, United States
PURPOSE: The purpose of this study was to: 1) determine the
test-retest reliability of the Star Excursion Balance (Star)Test in
subjects>59 years old; 2) compare the findings to data collected
on 20-39 yo subjects; and 3) determine the impact of subject
height on test performance. RELEVANCE: The ability to maintain
balance during activities of daily living is essential for mantaining
an independent lifestyle. The Star Test examines balance in single
leg stance. The reliability and validity of the Star Test has not
been established in a geriatric population. PARTICIPANTS: All
subjects were community dwelling adults able to stand and walk
independently. Subjects were excluded if they had a condition or took
a medication known to impair balance. Subjects in the “Geriatric”
group (n=42; 28 females, 14 males) were 60-92 years old (x=73.3)
and ranged in height from 60-75 inches (x=65.7). Subjects in the
“Young” group (n=25; 16 females, 9 males) were 23-38 years old
(x=26.3) and ranged in height from 61-76 inches (x=67.0). The data
on the Young Group were collected in a previous study. METHODS:
Informed consent was obtained from all subjects. They were placed
in the center of the Star Grid and stood on one lower extremity
(LE). Subjects reached as far as possible in 5 specific directions
with the opposite LE. Both LEs were tested (10 movements; 3 trials
each). Reach was quantified by measuring the furthest excursion of
the great toe. At least 1 week separated the first and second test
sessions. ANALYSIS: Data were analyzed using SPSS v14.0. The 3
trials for each movement were converted to a mean for each subject.
Test-retest reliability was estimated with an Intraclass Correlation
Coefficient (ICC) calculated for each movement and the test overall.
A t-test was used to compare mean reach between the Young and
Geriatric groups. The relationship between subject height, reach
and normalized reach (reach expressed as a percentage of subject
height) was examined using a Pearson product-moment coefficient of
correlation. RESULTS: Test-retest reliability estimates (ICCs) ranged
from 0.91-0.95. Reach and normalized reach were significantly lower
in the Geriatric group for each movement (p < 0.001). Subject height
was correlated to reach for all movements (p < 0.05). However,
subject height was not correlated with normalized reach for any
movement. CONCLUSIONS: The Star Test has excellent test-
retest reliability in a geriatric population. Reach and normalized
reach in the Geriatric group were significantly less than in the
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
data were normalized to subject height. IMPLICATIONS: The Star
Excursion Balance Test has excellent test-retest reliability for use
as a clinical instrument. Subject height does not predict test
performance when data are normalized to subject height. These
findings may allow for the development of performance standards
for the Star Test, regardless of subject height or age. The validity
of the Star Test has not been established. KEYWORDS: dynamic
balance, Star Excursion Balance Test; geriatric; screening. FUNDING
ACKNOWLEDGEMENTS: none. CONTACT: bstockert@csus.edu
ETHICS COMMITTEE: Commmittee for the Protection of Human
Subjects; California State University, Sacrmento, CA., US.
WCPT 2007, Research Reports
Research Report Poster Display
12-19 Tuesday 5 June 15:30
VCEC Exhibit Hall B & C
DETERMINATION OF SWAY AREA BY FOURIER ANALYSIS
Sevsek F, Rugelj D, Bartol M; University of Ljubljana, University
College of Health Studies, Ljubljana, Slovenia
PURPOSE: To establish the best method to calculate the sway
area for impeded stability conditions. RELEVANCE: Measurement
of the centre of pressure (COP) movement with a force platform
is a standard procedure for assessment of postural stability during
rehabilitation. However, for given conditions, it is very important
to select the most appropriate analysis of the trajectory – from
measured data sway area, total trajectory length, velocity, principal
axes etc. are usually calculated. PARTICIPANTS: 25 healthy females
aged 21.4±1.7 years. METHODS: On force platform (Kistler 9286AA)
each participant performed six tests: standing with feet together
on a hard and on a soft (compliant) surface, with open and
closed eyes and watching projection of randomly moving objects
on a screen. ANALYSIS: Data were analysed with a specially
developed software (computer programmes written in Fortran, C
and PHP). After optional smoothing, the outline of the data points
of each measurement was determined. It was expressed in polar
coordinates to which Fourier series was fitted by solving (using
LU decomposition) the linear system obtained from the normal
equations. From the resulting Fourier coefficients the sway area, its
shape and principal axes were determined. All other parameters,
including the area obtained by the principal component analysis,
were determined by well established procedures. T-test was used to
compare the results of different experimental conditions. RESULTS:
The area of the calculated sway trajectories statistically significantly
(p < 0.001) increased when closing the eyes while standing on a
hard surface. Compliant surface and visual disturbances resulted
in additional increase in all cases, whereas the influence of the
former was much larger. Similar dependence was also recorded
in the length of COP trajectory. Paired t-test showed no significant
changes in principal directions. CONCLUSIONS: Our results show
that the sway area, as calculated from the Fourier coefficients
of its outline, discriminates well different stability conditions. The
procedure seems to be best in cases where a small number of large
COP movements are important. IMPLICATIONS: When stability is
disturbed by external or internal factors, the Fourier analysis of the
outline of measured COP data shows good discriminative power
and gives additional information. KEYWORDS: force platform, sway
area, Fourier analysis. FUNDING ACKNOWLEDGEMENTS: ARRS
contract J3-6423-0382-06. CONTACT: france.sevsek@vsz.uni-lj.si
ETHICS COMMITTEE: State commitee for medical ethics of Slovenia
Research Report Poster Display
12-23 Tuesday 5 June 15:30
VCEC Exhibit Hall B & C
MUSCLE RECRUITMENT PATTERNS IN RESPONSE TO
BALANCE CHALLENGE: A COMPARATIVE STUDY
Hrka-Nikolic B1 , Anderson G; 1 Departments of Kinesiology and
Physical Education, University College of the Fraser Valley,
Abbotsfod BC, Canada
PURPOSE: Prescription of exercise performed on unstable surfaces
is common practice in the rehabilitation of many musculoskeletal
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
Poster Displays, Tuesday 5 June
lower body injury. PARTICIPANTS: 15 highly trained and 15 untrained
individuals held static balanced positions for five seconds in four
conditions (two-foot stance/eyes open; one-foot stance/eyes open;
two-foot stance/eyes closed; one-foot stance/eyes closed) without
aid, on three different stability surfaces (floor, BOSU dome, and
BOSU platform). METHODS: Muscle electrical activity (EMG) was
recorded using surface electromyography as measured using a Grass
Model 10A evoked potential system. EMG recordings were obtained
from each of the soleus, biceps femoris, erector spinae, internal
oblique and rectus abdominis muscles. ANALYSIS: Descriptive
statistics and graphical representations were used to compare
the muscle response to each condition for each of the highly
trained and untrained subjects because of the large numbers of
contrasts. For exploratory purposes, uncorrected, simple T-tests
were used to examine differences between trained and untrained
subjects. RESULTS: EMG activity increased across both groups
in response to increased instability when moving from the floor,
to BOSU dome, to BOSU platform, and in response to reduced
base of support (moving from two feet to one foot stance).
Reduction in base of support increased core muscle activation in
the untrained, while increasing the lower body stabilizing muscles
in the trained subjects. Visual input was only a factor on unstable
surfaces with increased muscle activity in the untrained when moving
to 2 feet, eyes closed on the BOSU dome, while the trained
subjects increased muscle activity only after reducing the base of
support to one foot with eyes closed. CONCLUSIONS: Evidence
of co-activation of core stabilizing and prime mover muscles were
evident in the untrained population demonstrating inefficient muscle
coordination and motor control. Highly trained individuals responded
with evidence of a bottom up pattern utilizing an ankle strategy
with high soleus and biceps femoris activity, suggesting a proper
neurological stimulus and muscle response. Untrained individuals
demonstrated increased core muscle activation and a top-down
strategy that is less effective. Balance training should include all
combinations of conditions starting with a stable surface with a wide
base of support and with full visual feedback. Progress in balance
training should include narrowing of the base of support initially
with eyes open and then with eyes closed, progressing to two feet,
eyes open on an unstable surface, such as the dome side of a
BOSU ball. IMPLICATIONS: Ethical approval was obtained from the
Research Ethics Committee of the University College of the Fraser
Valley. KEYWORDS: Progressive overload, vision, base of support,
instability. FUNDING ACKNOWLEDGEMENTS: None. CONTACT:
Gregory.Anderson@ucfv.ca
ETHICS COMMITTEE: Ethical approval was obtained from the
Research Ethics Committee of the University College of the Fraser
Valley, BC, Canada.
Research Report Poster Display
14-03 Tuesday 5 June 15:30
VCEC Exhibit Hall B & C
RELIABILITY AND SENSITIVITY OF LOWER LIMB
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 ,
Goyette M1 , Fuentes A3,5 , De Guise J3,5,6 , Forget R1,4 ; 1 Centre
de recherche Interdisciplinaire en Réadaptation (CRIR) du Montréal
métropolitain, Institut de réadaptation de Montréal (IRM), Québec,
Canada; 2 Universidade Tuiuti do Paraná, Faculdade de Fisioterapia,
Curitiba, Brazil; 3 Faculté de Médecine – Programme Sciences
biomédicales – Université de Montréal; 4 Ecole de réadaptation,
Faculté de Médecine – Université de Montréal; 5 Laboratoire
de recherche en imagerie et orthopédie, CRCHUM pavillon
Notre-Dame – Canada; 6 École de Technologie Supérieure – Canada
PURPOSE: This study aims at improving the measurement of
proprioception. The detection of the direction of passive movement
is widely used in clinical settings. On the other hand, the threshold
S467
of the direction of passive movement (TDDPM) has been proposed
for research purposes in experimental environments (McCloskey,
1978). RELEVANCE: However, both approaches lack a precise,
reliable and sensitive tool for the quantification of proprioception.
In addition, at the lower limb, the tests usually performed in non
weight bearing condition, should also be performed during weight
bearing to be representative of a more functional position such as
standing. The objectives were (1) to evaluate the test-retest reliability
of the TDDPM of the knee, with and without weight bearing, using
an apparatus especially designed by our research team and (2) to
compare these measurements during slow movements in both flexion
and extension at different starting angles. PARTICIPANTS: Fifteen
healthy young subjects (mean±SD: 26±4years) were evaluated at
0.3º/s in two sessions (2 to 4 days interval) in two conditions (sitting
and standing). METHODS: The subjects had to press a button as
soon as they felt the direction of the movement of the knee. The joint
excursion between the initiation of motion and subject perception
was expressed in degrees. The starting angles for assessment of
TDDPM were 15º, 30º and 45º of knee flexion sitting and 15º and
30º of knee flexion standing. Each movement was evaluated 4 times
in a counterbalanced random order for the direction of movement and
starting angles for a total of 24 trials in sitting and 16 trials standing
for each session. ANALYSIS: Test-retest reliability between the two
sessions was determined by calculating the intraclass correlation
coefficients (ICC). A three-way ANOVA (knee angle, direction of
movement and side) was used for each condition, followed by
Tukey’s Post-hoc test. RESULTS: Similar and reliable measurements
were found for the two sessions, whether the condition was without
(ICC=0.78±0.16) or with (ICC=0.78±0.12) weight bearing. Moreover,
the TDDPM was similar in both legs. In sitting, the TDDPM towards
extension was smaller (p < 0.05) for the starting position at 15º
(0.50º±0.20) compared to the 45º starting position (0.84º±0.62). In
standing, the TDDPM towards extension was also smaller (p < 0.05)
for the starting position at 15º (1.00º±0.64) compared to the
30º starting position (1.28º±0.57). Inversely, when the knee was
displaced towards flexion in standing, the TDDPM was smaller
(p < 0.05) at 30º (0.76º±0.27) compared to 15º starting position
(0.91º±0.50). CONCLUSIONS: The TDDPM measured with this
new apparatus is reliable and sensitive to the starting angle of
the movement for both sitting and standing conditions. Indeed, the
TDDPM towards extension was smaller when the starting position
of the knee was at the maximum extension tested. In a similar way,
the TDDPM towards flexion was smaller when the starting position of
the knee was at the maximum flexion tested. IMPLICATIONS: This
reveals that the proprioceptive sensitivity at slow speed is optimal
when the joint and muscular structures are under tension during
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
sur les troubles de la mobilité et de la posture. CONTACT:
nandorequiao@gmail.com
ETHICS COMMITTEE: CRIR
Research Report Poster Display
14-07 Tuesday 5 June 15:30
VCEC Exhibit Hall B & C
OBJECTIVE EVALUATION OF FINE MOTOR DEXTERITY OF
THE HAND IN NORMAL HUMAN PARTICIPANTS
Hammond E1 , Stzurm T1 , Otto C2 , Shay B1 ; 1 Department of Physical
Therapy, University of Manitoba, Winnipeg, Canada; 2 Electrical
Engineering Department, University of Manitoba, Winnipeg, Canada
PURPOSE: To develop a reliable test protocol and valid objective
measure that can accurately and precisely quantify finger/hand
function during manipulation of any object, independent of geometric
and surface properties. RELEVANCE: Providing effective and
objective ways to document manual dexterity and hand function
S468
is a critical part of evidence-based practice in Physical Therapy.
Clinical measures of finger-hand functions measure time to perform
movements but do not directly measure the accuracy of movements
or grade movement performance or skill level. These tests while
helpful cannot evaluate motor control beyond simple insertion tasks.
PARTICIPANTS: Twenty right handed participants, aged 20-50 were
recruited. Participants were excluded if there was a history of
upper extremity pathology with residual deficits, recent injury to the
right arm, cognitive impairment or neurological impairment affecting
balance, vision or coordination. METHODS: The Minnesota Rate of
Manipulation Test (MRMT), Purdue Pegboard, O’Connor Tweezer
Dexterity test and Nine Hole Peg test were administered to each
subject without the use of the index finger to simulate an amputation.
Motor performance was then quantified during manipulation of a set
of test objects using a computerized visual guided tracking task. Five
objects, ranging in weight and size which required the use of 2 or
3 fingers were selected for this study. Subjects performed the test
with and without the use of the index finger. A cursor set into motion
on the computer screen cued participants to move the object in a
predetermined direction with the amplitude and frequency selected to
match normal function. The cursor moved in a predictable sinusoidal
trajectory for 12 cycles. The miniBird (Ascension Technology)
miniature motion tracking sensor was attached to each object to
measure and record the 3D linear and angular motion of each object
at 100Hz. An electro-goniometer (Biometrics Ltd.) was attached to
record wrist motion. To establish the test-retest reliability all tests
were repeated one week later. ANALYSIS: A cross correlation
analysis of the actual sinusoidal object movement and reference
cursor trajectory (10 cycles) was performed using MatLab 7.0 to
obtain the peak r-value and phase for each object and test period.
These values were used as the index of motor performance. Pearson
r correlation and paired t-tests were used to determine test-retest
reliability. Spearman rho correlation was used to evaluate concurrent
validity between the clinical timed dexterity tests as well as the new
object manipulation task protocol. Results p < 0.05 are considered
significant. RESULTS: The visual-guided object manipulation test
protocol was found to be reproducible to quantify movement accuracy
at both time periods. Low concurrent validity was found between all of
the tests r = 0.22-0.44. CONCLUSIONS: Evaluation with the motion
sensor is a more accurate and precise tool for the measurement
of fine motor manipulation than the current commonly used clinical
tests. IMPLICATIONS: An objective outcome measure that quantifies
performance of the hand to manipulate virtually any object is not
currently available. Development of this tool will prove invaluable to
hand therapists not only as an assessment tool, but also as an
outcome measurement for treatment and research. KEYWORDS:
Hand Function, Motion Analysis, Fine motor manipulation. FUNDING
ACKNOWLEDGEMENTS: unfunded.
ETHICS COMMITTEE: Health Research Ethics Board, University of
Manitoba
Research Report Poster Display
14-11 Tuesday 5 June 15:30
VCEC Exhibit Hall B & C
RELIABILITY OF MEASURING ACTIVE LOWER LIMB JOINT
RANGE OF MOTION USING FLEXIBLE ELECTROGONIOMETERS
Bryant E1 ,Trew M1 ,Bruce A2 ; 1 Clinical
Research Centre for Health
Professions, University of Brighton, Eastbourne, UK; 2 School of
Engineering, University of Brighton, Brighton, UK
PURPOSE: To assess the intra-rater reliability of using flexible
electrogoniometers to measure full, active, lower limb joint range
of motion. RELEVANCE: No previous studies have reported using
electrogoniometers to measure the full active ROM of the hip,
knee and ankle joints. PARTICIPANTS: Ten healthy participants
had measurements of full, lower limb ROM assessed bilaterally on
three different attendances within a 10 day period. All participants
were aged between 29 and 59. METHODS: The relevant flexible
WCPT 2007, Research Reports
electrogoniometers (Biometrics Ltd, Blackwood, Gwent, UK) were
used to assess joint ROM: ankle joint (type XM110A) knee flexion
(type XM180) and hip flexion (type XM180). The testing procedure
was standardised including the testing sequence, limb position,
participant instructions, stabilization, ambient room temperature and
time of day of repeat measurements. The electrogoniometers were
attached following the manufacturer’s guidelines. ANALYSIS: At each
attendance and for each limb movement, the mean value from
three repetitions was used for statistical analysis. All data sets were
checked for normality using the Kolmogorov-Smirnov normality test
using SPSS (v10.1). The reliability of the results was calculated
using intraclass correction coefficients (ICC) to assess the between
visit repeatability. The standard error of measurement (SEM) was
also calculated. RESULTS: Measurements of total ankle ROM (from
full plantar flexion to full dorsiflexion) revealed excellent levels of
test retest reliability (ICC 0.97, SEM 3º). However, a preliminary
pilot study revealed problems in assessing end of range knee
flexion and hip flexion, where large measurement errors (>20º) were
observed. To accurately record end of range measurement of knee
flexion it proved necessary to re-align the electrogoniometer when
the participants were in full flexion. Using this method excellent
levels of test retest reliability were produced for the full, active,
range of knee flexion (ICC 0.91, SEM 4º). For the hip flexion, the
measurement error could not be reduced below 20º and therefore
this measurement was excluded. CONCLUSIONS: Excellent test
retest reliability was found when using flexible electrogoniometers
to assess lower limb joint ROM. However, the measurements
observed at both the knee and hip joints were not valid. Problems
were experienced in measuring full knee flexion and hip flexion,
where the electrogoniometers consistently underestimated the actual
ROM achieved. As the participant moved through the full ROM,
soft tissue distortions and skin movement caused one or both
of the electrogoniometer end-blocks to rotate out of alignment
with the underlying bones. This introduced substantial error, and
accurate measurements of full, active, knee flexion ROM were only
achieved by re-aligning the electrogoniometer during full flexion.
IMPLICATIONS: The results show that flexible electrogoniometers
offer a reliable and accurate measurement of dynamic, full ROM
only for the ankle joint. The effect of skin and soft tissue distortion
around the hip and knee joints at full flexion introduced substantial
errors rendering this measurement technique invalid for dynamic
full range movements. The need to re-align the electrogoniometer
at the end of full range knee flexion means it has no advantage
over the simple universal goniometer, and is not a feasible tool for
measuring dynamic large range movements of the hip and knee.
KEYWORDS: Electrogoniometer, range of motion (ROM), lower limb.
FUNDING ACKNOWLEDGEMENTS: E.Bryant was supported with a
studentship from the Engineering and Physical Sciences Research
Council (EPSRC). CONTACT: e.bryant@brighton.ac.uk
ETHICS COMMITTEE: University of Brighton Research Ethics
Committee
Research Report Poster Display
15-15 Tuesday 5 June 15:30
VCEC Exhibit Hall B & C
EFFECT OF TRAINING THE UPPER LIMBS FOR PARTIAL
WEIGHT BEARING GAIT WITH CRUTCHES
Shimatani K1 , Shimizu M1 , Miyamoto A2 ; 1 Prefectural University
of Hiroshima, Mihara city, Japan; 2 Graduate School of Nihon
University, Tokorozawa city, Japan
PURPOSE: The purpose of this study was to try to enable a person
to learn to perform lower limb partial weight bearing (1/3 body
weight) through learning to bear 2/3 of the body weight on the upper
limbs. RELEVANCE: The amount of time it takes to learn how to
partially weight bear with crutches differs for each person. It has
been reported that constant reexamination of the methods used and
frequent confirmation of the patient’s ability are necessary, which can
Poster Displays, Tuesday 5 June
be very time consuming. Many of the studies report on the exercise
methods for the lower limbs used to begin partial and non-weight
bearing, but no reports on the use of the upper limbs were found.
PARTICIPANTS: The subjects included 40 normal young adult men
and women, who were divided equally into an upper limb group
(UG) and a lower limb group (LG). The average age of the UG was
25.5±3.7 years, and the average age of the LG was 26.2±3.3 years.
METHODS: We used bilateral crutches and 4 scales to measure
the weight applied to each crutch and leg. The UG performed 10
trials learning to support 2/3 of their body weight on their hands, to
become able to partially weight bear on one of the lower limbs. The
LG performed 10 trials to learn to support 1/3 of their body weight on
one of the lower limbs. Feedback on the amount of weight put on the
crutches or leg (“knowledge of results”) was given on alternate trials
to facilitate the learning. ANALYSIS: The average constant error for
each group was analyzed with the Post Hoc Bonferroni test. Statistical
significance was established at the p = 0.05 level. RESULTS: In the
beginning, both groups showed the same rate of error, indicating
that little learning occurred. However, at the end of the trials, the UG
showed fewer errors than the LG, indicating that they were better able
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
bearing on the upper limbs to learn partial weight bearing is more
effective than training weight bearing through the lower limbs. Also,
the retention of the learned knowledge is better when training is done
through the upper limbs. We believe that the cause may be that the
upper limbs have a larger area in the brain available for sensation
and function than do the lower limbs. Also, as noted in studies in
psychophysics, it is easier to make minute weight adjustments when
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:
If a person can learn to perform lower limb partial weight bearing
through learning automatically to bear weight on the upper limbs,
it will be clinically significant. KEYWORDS: motor learning, partial
weight bearing, upper limbs. FUNDING ACKNOWLEDGEMENTS:
Unfunded. CONTACT: shimatani@pu-hiroshima.ac.jp
Research Report Poster Display
15-19 Tuesday 5 June 15:30
VCEC Exhibit Hall B & C
SENSORIMOTOR CORTEX ACTIVATION DURING THE MIRROR
THERAPY IN HEALTHY RIGHT-HANDED SUBJECTS: A STUDY
OF NEAR-INFRARED SPECTROSCOPY (NIRS)
Imai I1 , Shiomi T2,3 , Takeda K2,3 , Taniguchi T2 , Kato H2,3 ;
1 Department of Physical Therapy, Nasu Neurosurgical Center;
2 International University of Health and Welfare; 3 CREST, Japan
Science and Technology Agency
PURPOSE: Clinical studies show that functional motor recovery
after stroke can be beneficial by mirror therapy (MT). However,
its underlying mechanism is uncertain. The purpose of present
study was to investigate whether MT can always cause motor
illusion. Furthermore, we examined the MT-related concentration
change of oxygenated hemoglobin (oxy-Hb) and total hemoglobin
(total-Hb) in and around the primary sensorimotor cortex (SMC)
of both hemispheres during MT (right or left hand grasping)
by using near-infrared spectroscopy (NIRS). RELEVANCE: It is
necessary for physical therapy to investigate the effects of MT
on the cerebral activation and to explain the role of recovery
from stroke. PARTICIPANTS: Eight right-handed healthy subjects
(6 women and 2 men) were recruited for measurement by NIRS
during MT. The subjects were each informed of the purpose and
the method of the study before the experiment began. METHODS:
The MT-related changes in concentrations of oxy-Hb and deoxy-
Hb were measured using NIRS (Hitachi ETG-4000) placing the
probes on the scalp overlying SMC in both hemispheres. A cycle
S469
of 25 s rest–15 s right hand grasping task while seeing a mirror
which reflected the right hand was repeated for 5 times. In addition,
we obtained the answer to presence in motor illusion after NIRS
measurement. ANALYSIS: Local brain activation during MT was
considered significant when the elevation of oxy-Hb and total-Hb
change was above 2SD against the baseline. RESULTS: Six of
subjects were caused motor illusion by MT. The concentration of
oxy-Hb and total-Hb around the SMC significantly increased in
response to MT with right hand grasping and returned to baseline
after termination of the motor task. CONCLUSIONS: The present
study suggests that not all of the subjects can be caused motor
illusion by MT. Moreover, these results demonstrate that MT with right
hand grasping activates the ipsilateral SMC. IMPLICATIONS: For
this reason, MT with right hand movement may enhance functional
motor recovery from affected left hand (injured right hemisphere; left
hemiplegia) via the ipsilateral SMC activation. KEYWORDS: Mirror
therapy, near-infrared spectroscopy, sensorimotor cortex. FUNDING
ACKNOWLEDGEMENTS: None. CONTACT: itsuki.imai@gmail.com
ETHICS COMMITTEE: The ethics committee of international
university of health and welfare
Research Report Poster Display
15-23 Tuesday 5 June 15:30
VCEC Exhibit Hall B & C
FACTORS INVOLVED IN THE DEVELOPMENT OF
OSTEOARTHRITIS FOLLOWING ANTERIOR CRUCIATE
LIGAMENT RECONSTRUCTION
Keays S1 , Bullock-Saxton J2 , Newcombe P, Bullock M, Keays A;
1 Nambour Selangor Hospital; 2 University of Queensland, Brisbane,
Australia
PURPOSE: This study aimed to determine the factors involved in
the development of osteoarthritis (OA)of the knee following anterior
cruciate ligament (ACL) reconstruction. RELEVANCE: OA is a very
common condition and the knee is the most frequently affected
weight bearing joint. Any knowledge of predisposing factors for
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
followed from pre-surgery to six years post surgery. Patients with
pre-existing OA were excluded. METHODS: Assessment before and
after surgery included strength testing (Cybex 11 dynamometer)
and stability testing (KT1000 arthometer). Six-year assessment
also addressed injury-surgery and musculoskeletal factors that
may have contributed to the development of OA: Injury-surgery
factors included time delay between injury and surgery, age at
the time of surgery, family history, meniscectomy,chondral/bony
injury, and type of graft used. Musculoskeletal factors included
quadriceps and hamstring strength and anteroposterior stability.
Tibiofemoral (TF)OA and patellofemoral (PF)OA were assessed by
an independent radiologist. ANALYSIS: Discriminant analyses were
performed separately on the injury-surgery and musculoskeletal
factors in order to assess which were relevant in the development
of OA. RESULTS: Forty eight percent of patients developed TF
OA and 36% developed PF OA. Analysis found a group of three
injury-surgery variables that would reliably discriminate TF OA,
Chi-square(6,n=56)=22.6;p < 0.001. These included the presence of
bony or chondral damage, meniscectomy, and use of the PT as
a graft. Overall this would allow a 76.8% correct classification.
Older age at the time of surgery as well as meniscectomy and
the presence of chondral or bony damage were predictors of PF
OA, Chi-square(6,n=56)=14.4,p = 0.013. These three factors again
allowing a 76.8% correct classification. In addition a lower quadriceps
to hamstring strength ratio were found to be musculoskeletal
discriminator for TFOA. CONCLUSIONS: Five factors were found to
be involved in the development of OA: The presence of chondral or
bony injury, meniscectomy and reconstruction using the PT. Older
S470
age at the time of surgery was predictive of PF OA. A lower
quadriceps to hamstring strength ratio was also associated with
OA. IMPLICATIONS: In order to reduce the incidence of OA post
ACL reconstruction, it is important to avoid undue delay in surgery
which may result in further injury to menisci or chondral surfaces.
Physiotherapy has an important role to play in patient education and
in restoring balance between quadriceps and hamstrings strength
both before and after surgery. Finally the use of STG tendons as
a graft seem to be associated with a lower risk of OA in the long
term. KEYWORDS: knee reconstruction osteoarthritis. FUNDING
ACKNOWLEDGEMENTS: No funding was received. CONTACT:
skeays@bigpond.com
ETHICS COMMITTEE: University of Queensland
Research Report Poster Display
17-03 Tuesday 5 June 15:30
VCEC Exhibit Hall B & C
THE RELEASE OF CALCIUM FROM SARCOPLASMIC RETIC-
ULUM IS ESSENTIAL FOR STRETCH-STIMULATED GLUCOSE
TRANSPORT IN CULTURED SKELETAL MUSCLE CELLS
Iwata M1 , Hayakawa K2 , Murakami T3 , Naruse K4 , Kawakami K1 ,
Inoue-Miyazu M1 , Suzuki S1 ; 1 Program in Physical and
Occupational Therapy, Nagoya University Graduate School of
Medicine, 1-1-20 Daikominami, Higashi-ku, Nagoya 461-8673,
Japan; 2 ICORP/SORST Cell Mechanosensing, Japan Science
and Technology Agency, 65 Tsurumai-cho, Showa-ku, Nagoya
466-8550, Japan; 3 Department of Nutrition, Faculty of Wellness,
Chukyo Women’s University, 55 Nadakayama Yokone-cho, Ohbu
474-8651, Japan; 4 Department of Cardiovascular Physiology,
Okayama University Graduate School of Medicine, Dentistry and
Pharmaceutical Sciences, 2-5-1 Shikata-cho, Okayama 700-8558,
Japan
PURPOSE: It is now generally accepted that physical exercise
or skeletal muscle contraction activates cell surface expression
of glucose transporter 4 in skeletal muscle cells, and that this
expression induces glucose uptake and subsequent events, including
glycogen metabolism. When a muscle contracts, it not only receives
electrical stimulation but it is also subjected to mechanical stimuli
such as stretch or deformation loaded to its own cells and tissues.
Interestingly, passive stretching per se has been reported to increase
glucose uptake in skeletal muscle without force-producing contraction
and in cultured muscle cells. However, the signal transduction
pathway leading to glucose transport following mechanical stretch
in skeletal muscle remained to be elucidated. In the current study,
we sought to determine whether the signaling mechanism leading
to cyclic mechanical stretch-stimulated glucose transport is similar
to, or distinct from, the signaling mechanisms leading to insulin-
stimulated glucose transport in cultured muscle cells. RELEVANCE:
Skeletal muscle is the main tissue involved in glucose disposal in
vivo, and this function is enormously regulated by physical exercise
and insulin. Most interestingly, in insulin-resistant diseases such
as Type 2 diabetes, the effects of contraction on glucose uptake
are unchanged. Thus, efforts have been made to understand the
molecular mechanisms involved in contraction-stimulated glucose
transport. PARTICIPANTS: A subclone of the mouse myogenic
(myoblastic) cell line, C2C12 was used in this study. METHODS:
We first determined whether glucose uptake increased in response
to uniaxial cyclic stretch in 7-day-old myotube cells cultured from
mouse myogenic (myoblastic) cell line C2C12. Furthermore, to
determine whether stretch and insulin stimulate glucose uptake via
different signaling mechanisms, C2C12 myotubes were stretched
or insulin treated for 30 min in the absence or presence of the
phosphatidylinositol 3-kinase inhibitor, wortmannin, or sarcoplasmic
reticulum (SR) Ca2+ release inhibitor, dantrolene, after which 2-
deoxy-D-glucose (2-DG) uptake was measured. ANALYSIS: Results
are expressed as the mean ± standard deviation. Statistical analysis
was undertaken using one-way analysis of variance (ANOVA).
WCPT 2007, Research Reports
When ANOVA revealed significant differences, further analysis was
performed using Tukey’s post hoc test for multiple comparisons.
Differences between groups were considered statistically significant
when p < 0.05. RESULTS: Following cyclic stretch, the myotubes
showed a significant increase in 2-DG uptake. The stretch-stimulated
2-DG uptake was unaffected by wortmannin, whereas the insulin
effect was completely inhibited by wortmannin. These results
demonstrate that at least part of the mechanism by which stretch
and insulin stimulate glucose uptake is distinct. By contrast, the
pretreatment of cells with dantrolene completely inhibited stretch-
stimulated 2-DG uptake, suggesting that Ca2+ release from intra-
cellular stores is required to induce the glucose transport response.
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
a pivotal role in eliciting cyclic stretch-stimulated glucose transport.
IMPLICATIONS: Especially in cases involving obligate immobility
due to illness or physical disability, passive stretching may be
a good alternative to exercise for improving glucose metabolism.
KEYWORDS: mechanical stretch, glucose uptake, intracellular Ca2+
concentration. FUNDING ACKNOWLEDGEMENTS: This work was
supported in part by a grant from the Techno Link Science
Foundation. CONTACT: masa1080@gf7.so-net.ne.jp
ETHICS COMMITTEE: Nagoya University Graduate School of
Medicine
Research Report Poster Display
17-07 Tuesday 5 June 15:30
VCEC Exhibit Hall B & C
ORAL ADMINISTRATION OF GERANYLGERANYLACETONE
INDUCE EXPRESSION OF HEAT SHOCK PROTEIN 70 IN MICE
SOLEUS MUSCLE
Okita M1 , Banno Y1 , Hibino I2 , Inoue T3 , Suzuki S3 ; 1 Faculty
of Care and Rehabilitation, Seijoh University, Tokai, Japan;
2 Department of Physical Therapy, Japan College of Medical
Care and Welfare, Nagoya, Japan; 3 Program in Physical and
Occupational Therapy Graduate School of Health Sciences Nagoya
University, Nagoya, Japan
PURPOSE: It is known that heat or several other types of
stresses induce expression of heat shock protein 70 (HSP70) in
myocytes. HSP70 plays an important role in chaperoning nascent
peptides during translation, and it has been assumed that the
elevation of cellular HSP70 levels can serve as a countermeasure
to attenuate the disuse-induced muscular atrophy. On the other
hand, geranylgeranylacetone (GGA), known as teprenone, is widely
used as an anti-ulcer drug. Recent information suggests that GGA
increases HSP70 expression in various tissues (e.g. stomach and
liver). Little is known, however, whether GGA administration induced
expression of HSP70 in skeletal muscles. The purposes of the
present study were to evaluate the induction of HSP70 expression in
mice soleus muscle by GGA administration. RELEVANCE: If GGA
administration has such effects on muscle cells, it may be able to
use for the treatment of disuse muscle atrophy. This study provides
new information on the effects of GGA administration on muscle
cells in mice. PARTICIPANTS: Twenty-eight male ddy mice, 8 weeks
old, were used, and divided randomly into the control (n=8), heat
stress (Heat, n=8), and GGA administration (GGA, n=12) groups.
METHODS: The experimental protocol was approved by the Ethics
Review Committee for Animal Experimentation at our institution.
Heat group was exposed to heat stress (41 degrees for 60 min)
in an incubator without anesthesia. Mice in the GGA group were
divided into three subgroups (GGA concentrations 600, 900, or 1200
mg/kg), saline solution of GGA was orally administered. Western
blot analysis using soleus muscle homogenates obtained from all
groups determined that HSP70 expression at 24hrs after treatment.
ANALYSIS: Results were analyzed by one-way analysis of variance
Poster Displays, Tuesday 5 June
(ANOVA). If significance was obtained (p < 0.05) by ANOVA, pair
wise comparisons were made by Fisher’s PLSD method. RESULTS:
HSP70 content was significantly greater in Heat than control groups.
Similarly, at GGA groups in 600 and 900 mg/kg, HSP70 content
was significantly increased than control group. HSP70 content in
the 1200 mg/kg of GGA group, however, was significantly decreased
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.
High concentration GGA has the possibility to give it a bad influence
to the myocyte. IMPLICATIONS: Orally administered GGA can be
used as the treatment of disuse muscle atrophy like heat stress.
KEYWORDS: Geranylgeranylacetone (GGA), Heat shock protein
70 (HSP70), Skeletal muscle. FUNDING ACKNOWLEDGEMENTS:
This study was supported in part by a Grant-in-Aid for Scientific
Research from the Ministry of Education, Science, Sports and Culture
of Japan (Grant no. 18500428). CONTACT: okita@seijoh-u.ac.jp
ETHICS COMMITTEE: The experimental protocol was approved by
the Ethics Review Committee for Animal Experimentation at Seijoh
University.
Research Report Poster Display
17-11 Tuesday 5 June 15:30
VCEC Exhibit Hall B & C
HISTPATHOLOGICAL EFFECTS OF THE RANGE OF MOTION
EXERCISE ON JOINT CONTRACTURE. AN EXPERIMENTAL
STUDY USING RATS
Matsuzaki T1 , Hoso M1 , Takemura K2 , Tachino K1 ; 1 Division of
Rehabilitation Science, Department of Health Science, Graduate
School of Medical Science, Kanazawa University; 2 Yamanaka-spa
Medical Center
PURPOSE: The Range Of Motion (ROM) exercise is thought to be
effective in the treatment of the joint contracture, though its medical
evidence is obscure. We investigated the histopathological findings
of treated and non-treated rat’s joint components after two-week
knee joint immobilization. RELEVANCE: For physical therapists, it
is important to demonstrate the efficacy of ROM exercise against
contracture, especially with medical evidences. PARTICIPANTS:
Referring to the precedent reports, sixteen adults, nine-week-old
male Wistar rats (body weight 240-280g) were used for this study.
METHODS: The rats were randomly divided into four groups;
normal group (n=4), contracture group (n=4), treatment group (n=4),
and non-treatment group (n=4). Normal group rats were raised in
separates cages for 2 weeks. Contracture group rat’s right hind limb
was immobilized by plaster cast for 2 weeks. Treatment group rats
were treated with ROM exercise after 2 weeks immobilization of
the right hind limb. Non-treatment group rats were left free for f2
weeks after 2 week immobilization of the right hind limb. ANALYSIS:
Tissue specimens from each group were stained with hematoxylin
and eosin, and examined under a light microscope. RESULTS: The
2-week immobilization caused a limitation of extension about 30
degrees. After that, the ROM limitation of about 10 degrees was left
when both the non-treatment group and the treatment group finished
the experiment, though recovery was seen early after the fixation
was released. Compared with the normal group, the atrophy of the
synovial intimal cells, the fibrosis of the subsynovial layer, the dilation
and the congestion of the small blood vessels were recognized
histologically. These changes showed a tendency to be recovered
with the treatment group to the condition close to the normal group.
The recovery tendency observed in the treatment group was not seen
with the non-treatment group. Inflammatory cell infiltration into the
synovial tissue was not recognized in each group. CONCLUSIONS: It
was demonstrated that the ROM exercise is effective in the treatment
of the joint contracture. Further histopathological investigation and
elucidation of the evidence based effective treatments against
the joint contracture is necessary. IMPLICATIONS: The results of
S471
the present study provide new evidences on the histopathological
findings of the joint contracture. KEYWORDS: joint contracture, ROM
exercise, Pathology. FUNDING ACKNOWLEDGEMENTS: None.
CONTACT: tarosan@mhs.mp.kanazawa-u.ac.jp
ETHICS COMMITTEE: Guideline for the care and use of laboratory
animals in Kanazawa University including ethical codes.
Research Report Poster Display
18-15 Tuesday 5 June 15:30
VCEC Exhibit Hall B & C
DISTRESS AND HEALTH BELIEFS IN PEOPLE WITH CHRONIC
LOW BACK PAIN FOLLOWING DIFFERENT KINDS OF
PHYSIOTHERAPY
Critchley D1 , Dore C2 , Noonan S3 , Jones R4 , Hurley M1 ;
1 Academic Department of Physiotherapy, King’s College London,
London, UK; 2 Clinical Trials Unit, Medical Research Council,
London, UK; 3 3Department of Physiotherapy, Guy’s and St Thomas’
Hospitals, London, UK; 4 School of Medicine, King’s College
London, London, UK
PURPOSE: To compare distress and health beliefs in people
with chronic low-back pain (cLBP) following usual individual
physiotherapy, spinal stabilisation classes, or physiotherapist-led
outpatient pain management. RELEVANCE: Psychological factors
(distress, health beliefs) play an important role in chronic pain
disability. Physiotherapist-led pain management using a cognitive-
behavioural approach combining education with paced exercises
is advocated as reducing distress and unhelpful beliefs (Fear-
avoidance, Catastrophising, Praying/hoping) and encouraging helpful
coping strategies. Other forms of physiotherapy may have inadvertent
effects on psychological factors. PARTICIPANTS: 212 people with
non-specific cLBP. Participants were 44 (range 18-76) years old,
136 (64%) female with a 7.4 (range 0.25-52) years history
of LBP. METHODS: Participants were randomised to individual
physiotherapy (n=71), spinal stabilisation (n=72) or outpatient pain
management (n=69). Outcomes measured were distress [General
Health Questionnaire (GHQ-28), including Anxiety and Depres-
sion sub-scales], Fear-avoidance [Tampa Scale of Kinesiophobia
(TSK)], and pain coping strategies [Coping Strategies Questionnaire
(CSQ)] including Catastrophising and Praying/hoping. ANALYSIS:
Outcomes were compared with ANCOVA with baseline as covariate.
RESULTS: Values are mean(SD) at baseline, 6, 12, 18 months
respectively. GHQ-28 (Distress) Individual physiotherapy: 7.46(6.96),
3.93(5.52), 3.23 (4.88), 2.93(4.26). Spinal stabilisation: 8.80(6.84),
3.98(5.71), 3.84(5.58), 4.71(5.58). Pain management: 6.30(5.19),
4.84(6.07), 4.53(5.48), 4.45(5.88). Reduction from baseline distress
was significant in all arms (P < 0.001); differences between arms
were non-significant. Anxiety and Depression subscales results
were similar. TSK (Fear-avoidance) Individual physiotherapy:
39.89(7.97), 36.51(7.72), 33.40(10.21), 35.55(8.60). Spinal stabil-
isation: 40.13(8.15), 35.69(6.83), 35.55(9.18), 34.66,(8.15). Pain
management: 38.65(7.66), 31.02(7.82), 31.63(8.13), 31.46(8.46).
Fear-avoidance reduced significantly at all follow-ups in all arms
(P < 0.001). Pain management participants exhibited least Fear-
avoidance at all follow-ups; differences between arms were significant
at 6 months (P = 0.001), not significant at 12 (P = 0.2) or 18
months (P = 0.14). CSQ (Catastrophising) Individual physiotherapy:
11.24(7.66), 8.49(6.81), 7.52(6.56), 7.73(7.16). Spinal stabilisation:
9.92(8.35), 7.27(8.59), 8.18(7.19), 7.20(7.86). Pain management:
9.31(7.05), 6.18 (5.19), 6.27 (5.81), 5.70 (5.91), Catastrophising
reduced in all arms for all follow-up points (P = 0.0001); there
were no significant differences between arms, but Catastrophis-
ing tended to occur least in pain management participants
(P = 0.206 at 6/12). CSQ (Praying/hoping) Individual physiotherapy:
17.20(9.26), 12.00(8.18), 12.69(8.58), 13.02(8.29). Spinal stabili-
sation: 17.38(9.77), 16.06(10.64), 17.76(9.83), 15.39(10.12). Pain
management: 15.88(11.13), 13.75(11.62), 12.86(9.88), 10.88(9.85).
Praying/hoping decreased in all arms at all follow-up points
S472
(P = 0.0001), remaining greatest in the Spinal Stabilisation arm,
significantly at 6 (P = 0.029) and 12 months (P = 0.013) but not at 18
months (P = 0.141). Helpful coping strategies showed inconsistent,
non-significant, changes. CONCLUSIONS: Considerable distress
and unhelpful health beliefs were found before intervention. All three
arms showed reductions in distress and unhelpful beliefs but changes
in helpful coping strategies were inconsistent. Physiotherapist-led
pain management was most effective in reducing unhelpful beliefs but
no more effective at reducing distress or encouraging positive coping
strategies than other interventions. Spinal stabilisation was least
effective in reducing unhelpful beliefs. Differences, if any, between
interventions reduced in the longer-term. IMPLICATIONS: These
results support guidelines advocating physiotherapists acknowledge
and address the marked psychological factors commonly found in
people with cLBP. Further research is needed to find the most
effective strategies for physiotherapists to reduce cLBP-associated
distress and promote helpful coping strategies. KEYWORDS:
low back pain, psychology. FUNDING ACKNOWLEDGEMENTS:
This research was funded by the Arthritis Research Campaign.
CONTACT: duncan.critchley@kcl.ac.uk
ETHICS COMMITTEE: Guy’s and St thomas’ Local Research Ethics
Committee
Research Report Poster Display
18-19 Tuesday 5 June 15:30
VCEC Exhibit Hall B & C
THE USE OF EXPERTISE-BASED RANDOMIZED CONTROLLED
TRIALS TO ASSESS SPINAL MANIPULATION AND
ACUPUNCTURE FOR LOW BACK PAIN: A SYSTEMATIC REVIEW
Johnston B1 , da Costa B2 , Busse J3 , Akl E4 , Mills E3 ,
Devereaux P3 ; 1 1) Complementary and Alternative Research
and Education (CARE) Program, University of Alberta, Edmonton,
Alberta, Canada; 2 2) Department of Physical Therapy, Faculty
of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta,
Canada; 3 3) Department of Clinical Epidemiology and Biostatistics,
McMaster University, Hamilton, Ontario, Canada; 4 4) Department
of Medicine, State University of New York, Buffalo, New York, USA
PURPOSE: The use of randomized controlled trials (RCTs) has
become the ‘gold standard’ for evaluating the efficacy of clinical
interventions. Patients are typically randomized according to in-
tervention; however, when treatment is influenced by the skill-set
of the provider it is advisable to randomize patients to therapists
skilled in the procedures under evaluation. This is known as an
expertise-based RCT. RELEVANCE: Because it takes training and
experience to develop expertise in different acupuncture and spinal
manipulation (SMT) techniques, RCTs comparing different forms of
these complementary and alternative therapies would benefit from an
expertise-based randomization scheme. Randomization of patients
to clinicians with defined expertise in intervention A or B will also
reduce the potential for differential expertise-bias, and may be more
ethical if the intervention has been proven superior to placebo or
sham for the study population under investigation. PARTICIPANTS:
Patients with low back pain from previously conducted RCTs.
METHODS: We conducted a comprehensive search of six relevant
electronic databases (i.e. MEDLINE, CENTRAL, EMBASE, AMED,
PEDro, ICL) from inception to December 2005, and a grey literature
search (i.e. reference lists, and contact with authors, experts in
the field, and relevant governing organizations). Search terms
included extensive controlled vocabulary and keyword searches
for (acupuncture OR spinal manipulation) AND (low back pain)
AND (randomized controlled trials). Two reviewers independently
screened titles/abstracts and titles of identified citations by applying
pre-specified eligibility criteria. We retrieved the full text of all
titles/abstracts that appeared to report an RCT of either SMT or
acupuncture for low back pain. Two reviewers then independently
screened full text articles for RCTs using an expertise-based design
for allocating patients to competing forms of SMT or acupuncture.
WCPT 2007, Research Reports
ANALYSIS: 1) To determine the number of RCTs that have compared
the efficacy of different forms of SMT or acupuncture for low back
pain and have used an expertise-based RCT design; 2) To extract the
parameters around the characteristics of these trials. RESULTS: Our
electronic search yielded 3592 references, and after screening, 265
articles were identified for full-text review. An additional 31 articles
were identified from the grey literature. One hundred and seventy-
seven RCTs of acupuncture or spinal manipulation for low back pain
were identified, with 18 exploring the effect of competing techniques;
however, none of these trials used an expertise-based design.
CONCLUSIONS: Use of expertise-based RCT design to evaluate
acupuncture and spinal manipulation for low back pain is non-
existent. IMPLICATIONS: Expertise-based RCTs offer advantages
over conventional RCTs when exploring the effect of competing
techniques in either SMT of acupuncture for low back pain; however,
trialists are not currently making use of this design. KEYWORDS:
acupuncture, spinal manipulation, low back pain, expertise-based
randomized controlled trial. FUNDING ACKNOWLEDGEMENTS:
BCJ holds a Duncan L. Gordon Research Fellowship. JWB is funded
by a Canadian Institutes of Health Research Fellowship Award. PJD
is holds a Canadian Institute of Health Research New Investigator
Award. CONTACT: costa@ualberta.ca
Research Report Poster Display
20-07 Tuesday 5 June 15:30
VCEC Exhibit Hall B & C
INTEGRATED PROPRIOCEPTIVE TRAINING REDUCED THE
SELF-REPORTED NECK DISABILITY IN PATIENTS WITH HIGH
FREQUENCY OF NECK PAIN
Lee H1 , Wang S2 , Wang J3 ; 1 1. Institute of Occupational Medicine
and Industrial Hygiene, College of Public Health, National Taiwan
University, Taipei, Taiwan; 2 2. School and Graduate Institute of
Physical Therapy, College of Medicine, National Taiwan University,
Taipei, Taiwan; 3 3. Department of Internal Medicine, National
Taiwan University Hospital, Taipei, Taiwan
PURPOSE: To determine the effectiveness of a proprioceptive
training program on the perceived disability for subjects with
different frequency of neck pain, as compared with a control group.
RELEVANCE: This study invesitgated the association between
neck proprioception and neck disability.Its results could be helpful
in the identification of target population for future proprioceptive
training. PARTICIPANTS: Eighty-six subjects with current neck
pain were recruited from the bank employees and divided into
6-week proprioceptive training group and control group. In the
follow-up assessment, there were 39 subjects of training group
and 33 subjects of control group completed the study. METHODS:
The intervention integrated the proprioceptive training and deep
neck muscle training.Outcome measurements included neck pain
frequency, head repositioning errors, and neck disability index.
ANALYSIS: A general linear model was used to investigate the
interaction between pain frequency and neck proprioception on
the determination of NDI. After the intervention, change in head
repositioning errors and neck disability was assessed by paired t
test for subjects with different pain frequency. RESULTS: There
exist a significant interaction between pain frequency and neck
proprioception on the measure of NDI (p < 0.01). A positive correlation
between head repositioning errors and NDI was found in subjects
with weekly and daily pain, but not in those with monthly pain.
After six-week proprioceptive training, all the subjects demonstrated a
significant improvement in head repositioning task while a significant
decrease of NDI was only found in subjects with weekly and
daily pain (p < 0.05). CONCLUSIONS: The association between
neck proprioception and neck disability became evident in the
patients with high neck pain frequency.Proprioceptive training was
effective in reducing the neck disability for subjects with higher pain
frequency. IMPLICATIONS: Pain frequency should be included in the
assessment of neck pain perception, particularly for those studies
Poster Displays, Tuesday 5 June
interested to investigate the role of neck proprioception during the
development of neck pain. These results also indicate that following
6-weeks of neck proprioceptive training, people with high frequency
of neck pain can get improvement in their disability level. By contrast,
for those with infrequent neck pain, the same exercise may not
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
91-H122). CONTACT: hsinyilee.lee@gmail.com
ETHICS COMMITTEE: Institutional Human Study and Ethics Review
Board of college of Publich Health in National Taiwan Unversity
Research Report Poster Display
20-11 Tuesday 5 June 15:30
VCEC Exhibit Hall B & C
THE RELATION BETWEEN PREVIOUS VERTEBRAL FRACTURE
AND PHYSICAL FUNCTION IN PATIENTS WITH OSTEOPOROSIS
Kamide N1 , Sumida S2 , Watanabe T3 , Imura T3 , Shiba Y1 ,
Sato H1 , Maeda Y4 ; 1 Kitasato University, School of Allied Health
Sciences; 2 Kitasato University East Hospital, Department of
rehabilitation; 3 Kitasato University East Hospital, Department of
orthopedic; 4 Kanto Rehabilitation College
PURPOSE: It has been reported that previous vertebral fracture
in patients with osteoporosis lowers quality of life (QOL) and
raises mortality (Kado, et al.1999 & Lips, et al.2005). But, the
relation between previous vertebral fracture and physical function
has not yet been thoroughly investigated. Therefore, the purpose
of this study was to investigate the relation between previous
vertebral fracture and physical function in patients with osteoporosis.
RELEVANCE: To understand whether previous vertebral fracture
affect physical function is very important for physical therapists who
treat osteoporotic patients, because occurrence rate of vertebral
fracture is higher than other osteoporotic fractures (ex. hip fracture,
humerus fracture, wrist fracture). PARTICIPANTS: Subjects were
thirty five out-patients who had undergone medication treatment
for postmenopausal osteoporosis by orthopedists. Exclusion criteria
were as follows: severe pain, cancer, neuromuscular disease,
articular rheumatism, hyperthyroidism, history of fracture within one-
year, history of gastrectomy and history of taking steroid. METHODS:
Height, weight, BMI, bone mineral density (BMD) of heel, and fall
history were recorded as a character of subjects. Previous vertebral
fracture was assessed by radiographs of thoracic and lumber region,
which was recorded as diagnosis and treatment. Vertebral fracture
was defined by criterion of the japanese society for bone and
mineral research. Lower limb muscle strength, grip strength, gait
speed, Timed Up & Go test (TUGT), Tokyo Metropolitan Institute
of Gerontology Index of Competence (TMIG-IC), and Modified Fall
Efficacy Scale (MFES) were measured to evaluate the physical
function. ANALYSIS: Based on existence of previous vertebral
fracture, subjects was divided into two groups (group one: patients
with fracture, group two: patients without fracture). And, unpaired
t-test, Mann-Whitney U test, and Fisher’s exact probability test
were used for comparison of physical functions of two groups.
Statistical significance was set at 5%. RESULTS: Sixteen of thirty-five
patients (45.7%) had vertebral fracture. When it was compared with
patients without fracture, both maximum gait speed and effectance
were lower in patients with fracture (p < 0.05). In addition, the
number who experienced fall in patients with fracture was higher
than that in patients without fracture (p < 0.05). CONCLUSIONS:
It was suggested that osteoporotic vertebral fracture was related
to deterioration of gait speed and effectance, and higher fall-
tendency. These factors are also reported that they are risk factors
that cause deterioration of ADL, IADL, and raises frequency of
hip fracture (Shinkai, et al. 2000 & Dargent-Molina, et al.1996).
Therefore, vertebral fracture may disturb the functional independent
life in elderly. IMPLICATIONS: It is thought that the exercises
S473
prescribed by physical therapists are necessary for patients with
vertebral fracture to improve motor function and prevent fall.
KEYWORDS: Osteoporosis, Previous vertebral fracture, Physical
function. FUNDING ACKNOWLEDGEMENTS: This study was no
funded. CONTACT: naokami@kitasato-u.ac.jp
Research Report Poster Display
20-15 Tuesday 5 June 15:30
VCEC Exhibit Hall B & C
RELIABILITY TESTING OF THE PATELLOFEMORAL JOINT
REACTION FORCE (PFJRF) MEASUREMENT DURING
DOUBLE-LEGGED SQUATTING: A PILOT STUDY
Mostamand J, Bader D, Hudson Z; Queen Mary University of London
PURPOSE: Reliability of patellofemoral joint reaction force (PFJRF)
measurement during a range of activities for different patient groups
has not yet been reported. Such information is critical in future
research on patients with patellofemoral pain syndrome (PFPS). As
an example,these patients might experience pain due to alterations
in PFJRF during a wide range of physical activities.The present
pilot study was designed to examine the reliability of PFJRF mea-
surements during double-legged squatting. RELEVANCE: PFJRF,as
an important outcome measure may explain the mechanism of
producing pain during different activities in patients with PFPS.This
study identifies the reliability of the PFJRF measurements before
performance of further studies. PARTICIPANTS: Five volunteers
without any disorders in lower extremities and spinal column were
included in the pilot study. METHODS: A complete kinematic and
kinetic analysis of the right leg of each subject during three
sets of three repetitions were performed using a motion analysis
system (SIMI Reality Motion Systems,Germany) and single force
plate (Kistler Switzerland),respectively. Knee extensor moments were
subsequently calculated using inverse dynamics (Winter,1990) and
combined with a biomechanical model of the patellofemoral joint
(Salem and Powers 2001) to estimate PFJRF for each measurement.
All data were analysed in the eccentric phase of double-legged
squatting at 30 degrees of the knee flexion. ANALYSIS: The
coefficient of variation (CV) was used to obtain the repeatability of
the PFJRF measurements. The correlation coefficient (r) was used
to find the intratester reliability of pair measurements. The standard
error of measurements (SEM) was calculated for PFJRF to evaluate
the precision of these measurements. The least significant difference
(LSD) was used to detect the minimum significant level of the PFJRF
measurements. RESULTS: The coefficient of variations showed that
the repeatability of the PFJRF measurements was good (ranged
from 1.10% to 10.89%). The correlation coefficient revealed relatively
moderate to high significant intratester reliability (0.95 > r > 0.65,
P < 0.05) and poor to moderate significant intratester reliability
(0.67 > r > 0.38, P < 0.05) during second and first sets of 3 repetitions
respectively. The extent of SEM values during the first and second
sets of 3 repetitions of the tests (16.54-51.85 N) showed the high
reliability of the measurements. LSD values showed that there was
insufficient evidence to conclude that the obtained values are different
during the 3 sets of 3 repetitions. CONCLUSIONS: The reliability data
associated with this pilot study on normal subjects have indicated that
PFJRF can be used to as a parameter to examine biomechanical
changes in the patellofemoral joint in patients with varying degrees
of PFPS. IMPLICATIONS: For physical therapy practice/Education.
KEYWORDS: Patellofemoral pain syndrome, patellofemoral joint
reaction force. FUNDING ACKNOWLEDGEMENTS: This study has
been funded by the Ministry of Health and Medical Education of
the Islamic Republic of Iran and Queen Mary University of London.
CONTACT: j.mostamand@qmul.ac.uk
ETHICS COMMITTEE: East London and The City Research Ethics
Committee
S474
Research Report Poster Display
20-19 Tuesday 5 June 15:30
VCEC Exhibit Hall B & C
COMPARISON OF THE PATELLAR MOBILITY IN FEMALE
ADULTS WITH AND WITHOUT PATELLOFEMORAL PAIN
Ota S1,2 , Nakashima T1 , Morisaka F1 , Yagi R1 , Oishi Y1 , Ida K3 ,
Kawamura M2 ; 1 Toyohashi Municipal Hospital; 2 Nagoya University;
3 Asahi Hospital
PURPOSE: The purpose of this study was to compare the patellar
mobility of the subjects, using the Patellaofemoral Arthrometer (PFA),
with and without patellofemoral pain (PFP). RELEVANCE: One
of the causes of PFP is tightness of the retinaculam. This has
been attributed to abnormal patellar mobility such as decreased
lateral and/or medial patellar mobility. Quantification of patellar
mobility is important for providing health professionals with reliable
objective data for selection of the optimal treatment method, that
is, the evidence-based medicine. PARTICIPANTS: Forty four of the
subjects, consisting of 44 females (68 knees) between the ages of
21 and 41, participated in this study. Twenty two participants, (34
knees-PFP group) had a history of PFP. Each control subject (control
group: 22 females, 34 knees) was matched with each of the PFP
subjects using parameters such as the measured side of the knees,
age (±3 years), height (±5%) and weight (±10%). This research was
approved by the Institutional Review Board of Toyohashi municipal
hospital and Nagoya university. METHODS: Patellar mobility on
subjects with PFP and the control group was measured by the
modified reported PFA (in press). The maximal lateral and medial
displacement of the patella at knee flexion angles of 0 degrees
was obtained by manual force pushing the patella laterally and
medially until it stopped. Patellar mobility index (PMI), is calculated
with the formula: PMI = (patellar mobility/patellar width) × 100, to
normalize patellar mobility. Lateral patellar mobility, medial patellar
mobility, total side patellar mobility (lateral mobility plus medial
mobility), side patellar mobility balance ratio (log. lateral mobility/
log. medial mobility), the difference of lateral and medial patellar
mobility (lateral mobility – medial mobility), and the same parameters
of the PMI were used in the final analysis. ANALYSIS: Differences
of patellar mobility between the PFP and the control group were
compared using paired t-tests and F-tests. Significant levels were
set at P < 0.05. RESULTS: Lateral patellar mobility, lateral PMI,
total side patellar mobility, and total PMI of the PFP group were
significantly decreased. On the other hand, those deviations of the
side patellar mobility balance of the PFP group were significantly
different from the balance of the control group (p < 0.01). Seven
knees with PFP showed decreased lateral (3 knees) or medial
patellar mobility (4 knees) based on 2 SD of the patellar mobility of
the control group (6.9 and 6.7 mm, respectively). CONCLUSIONS:
Significant differences in decreased lateral patellar mobility and
lateral PMI are shown, when patellar mobility is compared between
both of the groups. The raw data shows, however, 79% of the
participants with PFP have a normal range of patellar mobility. On
the other hand, 21% of the participants with PFP have deceased
lateral (9%) and medial patellar mobility (12%). IMPLICATIONS: The
effect of the physical therapy intervention, based on these criteria,
is evident from these results, although a normal range of patellar
mobility could be shown more clearly through a large subject group.
KEYWORDS: Patellar mobility, Patellofemoral pain, Knee. FUNDING
ACKNOWLEDGEMENTS: The authors acknowledge the technical
support of Matsumoto Prosthetics and Orthotics Manufacturing
CO.LTD. CONTACT: s-ota@mx3.tees.ne.jp
ETHICS COMMITTEE: Toyohashi Municipal Hospital and Nagoya
University
WCPT 2007, Research Reports
Research Report Poster Display
21-23 Tuesday 5 June 15:30
VCEC Exhibit Hall B & C
EFFECT OF TREADMILL AND BEAM-WALKING EXERCISE ON
FUNCTIONAL RECOVERY AND EXPRESSION OF GDNF AFTER
CEREBRAL INFARCTION IN RATS
Ohwatashi A1,2 , Ikeda S2 , Horinouchi K2 , Harada K2 , Kamikawa Y2 ,
Yoshida A2 , Nomoto Y2 , Sakae K1 , Kawahira K2 ; 1 School of
Medical Sciences, Faculty of Medicine, Kagoshima University,
Kagoshima, Japan; 2 Department of Rehabilitation and Physical
Medicine, Graduate School of Medical and Dental Sciences,
Kagoshima University, Kagoshima, Japan
PURPOSE: This study evaluated differences in the recovery of motor
function by different exercises and the relationship between functional
recovery and the expression of GDNF (Glial cell line-derived
neurotrophic factor) was examined. RELEVANCE: There is limited
evidence regarding the effects of rehabilitation on functional recovery
on stroke patients. In particular, there are few studies focusing on
differences in exercise. Therefore, we investigated the effects of
treadmill and beam-walking exercise on functional recovery in a rat
experimental model of hemiplegia. PARTICIPANTS: In this study, a
total of 59 adult Wistar rats (231±11 g) were used. METHODS: This
study involved the following two procedures. In the first experiment,
34 adult Wistar rats (231±12 g) were used. These animals were
divided into three groups: non-exercise (n = 11), treadmill exercise
(n = 12) and beam-walking exercise (n = 11). All rats underwent
surgical photochemical infarction at the age of 7 weeks. Rats in the
treadmill exercise group were made to run on a treadmill for 20 min
everyday for 14 days. In the beam-walking exercise group, beam-
walking exercises were performed for 20 min everyday for 14 days
and non-exercise group were left to follow a natural course. In the
second experiment, 25 adult Wistar rats (231±10 g) were used. At
various time points (1 day, 3 days, 5 days and 7 days) after photo-
chemical infarction, the brains were removed under deep anesthesia.
The expression of GDNF was examined by immunohistochemical
analyses. The Committee of Research Facilities for Laboratory
Animal Sciences, Kagoshima University, approved the experimental
procedures. ANALYSIS: Hindlimb function was evaluated with beam-
walking task using a narrow beam (122cm long x 2.5 cm wide).
Performance was rated on a seven-point scale. The number of
GDNF-like immunoreactive cells was counted. RESULTS: Functional
recovery in beam-walking exercise group occurred significantly earlier
than that in the other groups. Abundant expression of GDNF-
like immunoreactive cells was observed at the early time points
examined. CONCLUSIONS: In this study, beam-walking exercise
showed the greatest enhancement of functional recovery in the rat
hemiplegic model. Immunohistochemical analysis of brain sections
showed abundant expressions of GDNF-like immunoreactive cells at
the early time points examined. IMPLICATIONS: The beam-walking
exercise was the same as the task used for evaluation of functional
recovery. So this finding suggested that it might be more effective
to perform an exercise suitable for the purpose. There was limited
expression at 7 days. The functional recovery of paralysis was
remarkable until 7 days, and thereafter improved gradually. Therefore,
it is considered that expression of GDNF protein is related in some
manner with functional recovery of paralysis. KEYWORDS: cerebral
infarction, functional recovery, Glial cell line-derived neurotrophic fac-
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.
CONTACT: akihiko@health.nop.kagoshima-u.ac.jp
ETHICS COMMITTEE: The Committee of Research Facilities for
Laboratory Animal Sciences, Kagoshima University, approved the
experimental procedures.
Poster Displays, Tuesday 5 June
Research Report Poster Display
22-03 Tuesday 5 June 15:30
VCEC Exhibit Hall B & C
VASOMOTOR INNERVATION PATTERNS BY PERIPHERAL
NERVES SUPPLYING THE UPPER AND LOWER EXTREMITIES
Allen R, Jefferson E, Bhangu V; University of Puget Sound,
Tacoma, WA, USA
PURPOSE: The purpose was to map vasomotor innervation
fields for peripheral nerves supplying the upper and lower ex-
tremities and compare these surface neurovascular patterns to
somatosensory distributions. RELEVANCE: Knowledge of sensory
nerve distribution topography is essential to diagnosing peripheral
complaints with neurologic origins. Existing innervation maps present
only somatosensory fields. When complaints do not fit known
patterns, nonorganic etiology is sometimes erroneously suspected.
Variations in sympathetic nerve activity to limb arterioles may
result in symptoms of ischemic pain, numbness, or paresthesias
following neurovascular rather than somatosensory distributions.
PARTICIPANTS: Participants included 31 female and 13 male
volunteers, ages ranging from 27 to 64 years (x = 35.7), reporting
no history of amine-type anesthetic hypersensitivity, peripheral
neuropathy, vascular pathology or insufficiency, chronic limb pain, or
hypertension. Upper extremity mapping involved 32 participants and
12 participated in mapping the lower extremity. METHODS: Nerves
investigated were the median, radial, ulnar, musculocutaneous,
lateral antebrachial cutaneous, axillary, femoral, lateral femoral
cutaneous, obturator, tibial, saphenous, deep and superficial fibulars,
medial calcaneal, and medial and lateral plantars. The procedure
involved blockade of each nerve via tissue infiltration of Carbocaine
hydrochloride to the nerve’s most proximal selective location, followed
by infrared digital thermographic imaging of the resultant region of
superficial hyperemia. Neural blockade temporarily interrupted local
sympathetic innervation to arteries supplied by the nerve, resulting
in vasodilation and hyperemia. Hyperemia regions represented the
vascular innervation field of the nerve. Manual muscle testing
and Semmes Weinstein monofilaments were used to validate
success and selectivity of each block. ANALYSIS: Pre-blockade
thermographic stabilization images were digitally compared to post-
blockade thermograms for changes in surface temperature. Areas
with increases of >3 degrees centigrade were assembled to represent
the vasomotor innervation field for the blocked peripheral nerve.
Innervation fields for the nerves under investigation were compiled
to produce a map of vasomotor innervation patterns for each
extremity. RESULTS: In many cases, vasomotor innervation fields
corresponded to established somatosensory patterns, with several
clinically relevant differences revealed in both limbs. No evidence
was found for vasomotor innervation by the radial nerve distal
to the wrist, with innervation to the hand supplied solely by the
median and ulnar nerves. In the lower extremity, no hyperemia
was observed following lateral femoral cutaneous or obturator nerve
blockades, leaving the entire anteromedial to anterolateral thigh
innervated by the femoral nerve. Post-blockade hyperemia patterns
of the deep fibular nerve indicated that it innervates arterioles of
the anterior leg and dorsum of the foot. CONCLUSIONS: Peripheral
nerves supplying the hand, anterior thigh and leg, and foot’s
dorsum display vasomotor innervation patterns notably different
from somatosensory distributions. These findings are consistent
with the hypothesis that peripheral nerves innervate adjacent
principal arteries. IMPLICATIONS: Since vasomotor innervation
fields differ from those of somatosensation, neuropathies involving
sympathetic efferents may produce symptom patterns that do not
match somatosensory distributions. Resulting symptoms should not
lead therapists to suppose the pathology is nonorganic. Sample size
and subject consistency now affords presentation of a vasomotor
innervation map of the extremities for clinical use. KEYWORDS: Neu-
rovascular, vasomotor innervation, peripheral neuropathy. FUNDING
ACKNOWLEDGEMENTS: Release time for the principal investigator
to complete this study was funded by a John Lantz Senior Research
S475
Fellowship from the University of Puget Sound, Tacoma, WA, USA.
CONTACT: rallen@ups.edu
ETHICS COMMITTEE: Institutional Review Board, University of
Puget Sound, Tacoma, WA, USA
Research Report Poster Display
22-07 Tuesday 5 June 15:30
VCEC Exhibit Hall B & C
LOWER LIMB SENSORIMOTOR NETWORK: AN FMRI STUDY
Kapreli E1,2 , Athanasopoulos S1 , Strimpakos N2 ,
Papathanasiou M3 , Gliatis I4 , Van Hecke P5 , Gouliamos A3 ,
Peters R5 , Sunaert S5 ; 1 Department of Sports Medicine and
Biology of Exercise, Sports Physiotherapy Laboratory, National &
Kapodistrian University of Athens, Greece; 2 Department of
Physiotherapy, T.E.I of Lamia, Greece; 3 2nd Department of
Radiology, Medical School, National & Kapodistrian University
of Athens, Greece; 4 Department of Orthopedics and Traumatology,
University Hospital of Patras, Rio-Patras, Greece; 5 Department
of Radiology, University Hospitals of K.U. Leuven, Belgium
PURPOSE: The purpose of the current study was 1) to describe
the pattern of whole brain activity during motion of isolated joints
of the lower limb, 2) to examine the somatotopic organization
of lower limb joint representations in the primary sensorimotor
cortex and the anterior lobe of the cerebellum, and 3) to quantify
the degree of overlap between these lower limb joint activations.
RELEVANCE: The better understanding of central nervous system
function during lower limb motion could enhance rehabilitation,
formatting new aspects and purposes. PARTICIPANTS: Eighteen,
right-leg dominant volunteers (n = 18, males, aged 27±5 years)
participated in this study after giving written informed consent
in accordance with Helsinki Declaration. The study protocol was
approved by the Scientific Committee of Attikon University Hospital of
Athens, Greece. METHODS: The fMRI measurements were carried
out on a 1.5 T MR scanner (Gyroscan ACS-NT; Phillips) using a
quadrate head coil. All subjects performed repetitive knee, ankle,
and toes flexion/extension movements. In order to relate lower limb
joints activation to the well described patterns of finger movement,
serial finger-to-thumb opposition was assessed also. All movements
were auditory paced at 72 beats/min (1.2 Hz). ANALYSIS: Statistical
analysis was performed using SPM99 package implemented in
Matlab. Statistical parametric mapping was used to analyze functional
and anatomical data. The SPM activation maps of the different
isolated joint movements were mapped on Caret 5.1 Atlas flat
map. A statistical evaluation of somatotopy in contralateral SM1
and ipsilateral cerebellum (anterior lobe) during right-sided and
left-sided movements was performed using one-way analysis of
variance (ANOVA) and conditional on a significant main effect,
Tukey’s least square difference tests were calculated for post-hoc
identification of significantly different locations of individual joints
representations. The significant threshold adopted throughout was
p < 0.05. RESULTS: Isolated lower limbs movement activated a
distributed sensorimotor network, including primary and nonprimary
sensorimotor areas. Although a large overlap was evident in primary
sensorimotor cortex (SM1) and cerebellum representations of the
three lower limb joints, a somatotopic arrangement was recognizable
with reference to center of mass coordinates of each individual joint
in the above areas. CONCLUSIONS: A somatotopic arrangement
was recognizable with reference to center- of-mass coordinates of
each individual joint in SM1 and cerebellum, although ankle and
toes presented a close neighboring position. The activated areas
differed for the different joints of upper and lower limbs, not only
considering the somatotopy but also the activation pattern of specific
areas, implying the functional variation of the corresponding joints.
IMPLICATIONS: Detection of active brain regions during movement
of the lower limb joints is feasible with fMRI, encouraging future
studies especially on neurological patients. However, a carefully
optimized methodology protocol is required. KEYWORDS: primary
S476
sensorimotor cortex; cerebellum; somatotopy; brain activation; fMRI;
lower limb. FUNDING ACKNOWLEDGEMENTS: The current study
was supported by Marie Curie Training Fellowship (QLK2-CT-2000-
60057). CONTACT: ekapreli@teilam.gr
ETHICS COMMITTEE: The study protocol was approved by the
Scientific Committee of Attikon University Hospital of Athens, Greece.
Research Report Poster Display
23-11 Tuesday 5 June 15:30
VCEC Exhibit Hall B & C
MEASURING WALKING ABILITY AFTER STROKE: A
SYSTEMATIC REVIEW OF THE EVIDENCE
Fulk G1 , Mirelman A2 , Deutsch J2 ; 1 Clarkson University, Physical
Therapy Department, Potsdam, NY, USA; 2 University of Medicine
and Dentistry New Jersey, School of Health Related Professions,
Newark, NJ, USA
PURPOSE: The purpose of this systematic review was to evaluate
the validity and reliability of clinically based patient oriented outcome
measures for assessing walking ability after stroke. RELEVANCE:
The recovery of walking ability is a primary goal for individuals with
stroke and the rehabilitation team. Approximately one third of all
people who experience a stroke are not able to walk independently
or require assistance. There are a variety of outcome measures that
assess gait in people with stroke undergoing rehabilitation. In order
to determine the effectiveness of evidence based interventions and
to document change clinicians should use outcome measures with
established reliability and validity. PARTICIPANTS: N/A METHODS:
Medline and CINHAL databases were searched in April 2006
using the following MeSH terms and CINAHL headings: “stroke”,
“cerebrovascular disorders”, “cerebrovascular accident”, “ischemic
attack”, “hemiplegia”, “gait”, “gait analysis”, “ambulation”, “walking”,
“locomotion”, “validity”, and “reliability”. Articles whose main purpose
was to explore reliability and validity were identified and reviewed.
The quality of the studies was rated using the Standards of
Tests and Measurements in Physical Therapy Practice. ANALYSIS:
N/A RESULTS: Thirty-four articles met inclusion criteria and were
grouped into 5 categories: independence, distance, speed, appear-
ance, and composite. Independence was most frequently measured
using the Functional Ambulation Categories (FAC). It demonstrated
fair reliability and was strongly related to other measures of
gait. Measures of distance demonstrated high test retest reliability
(reliability coefficients ranged from 0.95 to 0.99) and were moderately
to strongly correlated with measures of body structure/function
and level of activity. Speed, measured over a 10m walk, was the
most common method of measuring walking ability. It demonstrated
strong reliability, (reliability coefficients ranged from 1.0 to 0.60)
and was strongly to moderately related to other measures of body
structure/function and level of activity. Gait speed was sensitive to
change and was able to predict discharge destination and community
walking ability. Observational gait analysis demonstrated moderate to
good intra and inter rater reliability (reliability coefficients ranged from
0.75 to 0.95) and was fairly to strongly correlated with measures
of body function/structure and level of activity. CONCLUSIONS:
Choosing an appropriate method of measuring walking ability after
stroke is important for clinicians and will be dependent on the
setting and level of recovery of the patient. Measures of gait
speed, distance walked, and level of independence have strong
psychometric properties and together provide a comprehensive
picture of walking ability that is clinically useful and important to the
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
WCPT 2007, Research Reports
for patients with stroke at all levels of ability and throughout their
recovery. It is reliable, valid, and sensitive to change. KEYWORDS:
gait, stroke. FUNDING ACKNOWLEDGEMENTS: N/A. CONTACT:
gfulk@clarkson.edu
Research Report Poster Display
23-15 Tuesday 5 June 15:30
VCEC Exhibit Hall B & C
CONSTRAINT-INDUCED MOVEMENT THERAPY (CIMT):
SHORT-AND LONG TERM OUTCOME OF AN INPATIENT
REHABILITATION PROGRAM
Mey S, Jann B, Rutz-LaPitz L; Rheinburg-Klinik, Walzenhausen,
Switzerland
PURPOSE: CIMT is a well-established intervention for treatment of
the upper extremity in patients with hemiplegia. We looked at short
and long term changes on the Wolf Motor Function Test (WMFT)
and the Motor Activity Log (MAL) that occurred when CIMT was
offered in an inpatient rehabilitation program. RELEVANCE: World-
wide, the annual incidence of cerebro vascular accident (CVA) is
700,000 persons. Of these, 30% die within one year and another 25%
remain severely disabled. Disability is associated with high costs and
restricted quality of life. This study addresses the question if CIMT
can improve the use of upper extremity and result in more frequent
use. PARTICIPANTS: 8 patients were recruited who met motor and
cognitive inclusion criteria, agreed to participate in a rehabilitation
program at our center. METHODS: Participants were required to
wear a mitt for max. 90% of waking hours and to participate in at
least 6 hours therapy per day over a minimum of 8 days during 2
consecutive weeks. Objective functional assessment was performed
using the WMFT at the beginning, at the end of the program and
in a follow-up. The MAL was administered at the same time to
assess the subjective and objective quality and quantity of use of
the affected arm. ANALYSIS: Statistical analysis was done using
SPSS version 11.5. The Wilcoxon-Test was used to compare pre-test,
post-test and follow-up data. RESULTS: Statistical analysis showed
significant changes in 15 out of 17 items in the functional part of
WMFT and in 2 items in the timed section between the first and
second test (95% CI). The MAL showed significant differences in
13 out of 30 items between first and second test in both quality
of use (QOU) and amount of use (AOU). After 15 months (6 SD)
3 items from the WMFT functional ability and 9 QOU respective 5
AOU tasks from the MAL differed significantly from the original exam.
CONCLUSIONS: Objective outcomes indicate that CIMT, in selected
patients after stroke or severe brain damage, is a valuable addition to
the established therapy. Results show a small lasting effect.Further
research is needed to address the questions as to whether 8 days of
CIMT are sufficient to cause lasting improvement or whether this
could be achieved by either another session of CIMT at a later
date or an initial program of longer duration. IMPLICATIONS: At
this time reasonable evidence exists that patients with a hemiparesis
can profit from a CIMT program. Rehabilitation specialists should
consider that a short but intensive program can improve the patients
abilities. A clearly defined CIMT inpatient program is recommended.
The question of cost effectiveness compared to benefit for the
patient is mentioned but not conclusively answered. KEYWORDS:
Constraint-Induced Movement Therapy; stroke; physical therapy,
rehabilitation. FUNDING ACKNOWLEDGEMENTS: The work was
not funded. Support was given by the Rheinburg-Klinik. CONTACT:
stefanie.mey@rheinburg.ch
Poster Displays, Tuesday 5 June
Research Report Poster Display
23-19 Tuesday 5 June 15:30
VCEC Exhibit Hall B & C
LOSS OF TRUNK REPOSITIONING SENSE AND ITS RELATION
TO POSTURAL FUNCTIONS IN PEOPLE POST STROKE
Ryerson S1 , Byl N2 , Brown D3 , Wong R4 , Hidler J1,5 ; 1 National
Rehabilitation Hospital, Center for Applied Biomechanics and
Rehabilitation Research, Washington DC, USA; 2 University of
California San Francisco, San Francisco CA, USA; 3 Northwestern
University, Chicago IL, USA; 4 Marymount University, Arlington
VA, USA; 5 Catholic University of America, Washington DC, USA
PURPOSE: To determine whether trunk repositioning sense is
impaired and related to loss of postural control functions in people
post stroke RELEVANCE: Good trunk control is essential for
functional activities. Deficits of trunk anticipatory postural control
have been identified in people post stroke. One conceptual model
suggests that postural control requires an internal model for accurate
orientation. Proprioceptive feedback provides part of the information
for internal modeling. Trunk repositioning sense is one aspect of
proprioception. If trunk repositioning sense is impaired post stroke, it
may be an underlying contributing element of altered trunk postural
control. Altered trunk postural control would adversely affect trunk-
limb linked movement sequences and ultimately interfere with the
performance of daily activities. PARTICIPANTS: 21 subjects with
chronic stroke and 21 age/sex matched non-neurologically impaired
subjects. METHODS: Trunk repositioning error was assessed in
sitting while subjects performed a forward flexion movement. Subjects
were instructed to move to a prespecified flexion position during
which trunk position was recorded from a tracking marker placed
on the skin over the spinous process of T1. An electromagnetic
movement analysis system, ‘Flock of Birds’, was used to track the
position of the trunk and to document errors. ANALYSIS: Mean
repositioning error in people post-stroke and non-neurologically
impaired people was compared using a two-tailed independent t-test.
Spearman correlation coefficient analyses were used to determine
the strength of the relationship between absolute repositioning
error and clincial measures of balance (Berg Balance Scale),
postural control (Postural Assessment Scale for Stroke), and stroke
severity (Fugl-Meyer). RESULTS: There were significant differences
in absolute repositioning error between stroke and control groups in
both the sagittal(p = 0.0001)and transverse(p = 0.012)planes. There
was a significant correlation between sagittal plane absolute
repositioning error and Berg Balance score (r = −0.487, p = 0.029)
transverse plane absolute repositioning error and Berg Balance score
(r = −0.484, p = 0.031; and transverse plane repositioning error and
PASS score (r = −0.518, p = 0.019). CONCLUSIONS: This study is
an important first step towards a more complete understanding
of the role of trunk repositioning sense in people with post
stroke hemiparesis. IMPLICATIONS: Trunk position sense, with an
emphasis on sagittal and transverse plane movements should be
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.
CONTACT: Ryersu@aol.com
ETHICS COMMITTEE: MedStar Research Institute, National Reha-
bilitation Hospital, Washington, DC
Research Report Poster Display
24-23 Tuesday 5 June 15:30
VCEC Exhibit Hall B & C
PREVENTION OF SUBLUXATION OF THE SHOULDER IN PA-
TIENTS AFTER STROKE: A THAI PHYSICAL THERAPY SURVEY
Foongchomcheay A, Chamonchant D, Atichatmanee U;
Department of Physical Therapy, Faculty of Allied Health Sciences,
Chulalongkorn University, Bangkok, Thailand
PURPOSE: Supportive devices such as slings, wheelchair/chair
attachments and orthoses as well as electrical stimulation have been
S477
used by physical therapists to treat shoulder subluxation in patients
after stroke. The aim of this study was to investigate the prevalence
of and rationale for the methods used by physical therapists for
the prevention of subluxation within Thai hospitals. RELEVANCE:
Shoulder subluxation can hinder the recovery of upper arm function
and when it occurs, may be irreversible. Therefore, prevention of
shoulder subluxation is crucial for neurological rehabilitation. This
study will provide essential information of current practice of physical
therapy on the prevention of subluxation of the shoulder in Thailand.
PARTICIPANTS: Three hundred and fourteen hospitals across
Thailand were invited. These hospitals provided neurological physical
therapy services to stroke patients and were chosen to ensure all
major institutions treating stroke patients were surveyed. METHODS:
A self administered questionnaire was mailed to physical therapy
departments. A representative physical therapist from each hospital
was asked about methods used to prevent subluxation, who perform
them, the criteria for using, the criteria for discontinuing their use and
when they were used. The institutional ethics committee approved the
procedures for the survey and consent was assumed by return of the
questionnaire. ANALYSIS: The data was analysed descriptively to
determine the percentage of respondents. RESULTS: Two hundred
and twenty-six questionnaires were returned, ie, a 72% response
rate. 98% of the respondents used assisted exercise, 51% used
electrical stimulation and 31% used shoulder sling for the prevention
of subluxation. The most frequently prescribed assisted exercise
was shoulder exercise (45% of those who prescribed exercise). The
exercise was performed 30 minutes a day, 5 days/week. The most
frequently prescribed electrical stimulation was electrical stimulation
that applied to supraspinatus muscle (38% of those who prescribed
electrical stimulation). The stimulation frequencies used were greater
than 30 Hz and stimulation time of 20 minutes a day, 5 days/week.
The most frequently prescribed shoulder sling was Bobath sling
(87% of those who prescribed slings). The sling was worn all
day time. Inadequate muscle strength was the most frequently-
cited criterion used to prescribe assisted exercise and electrical
stimulation (27% and 31% of those who prescribed) and continued
the use until full recovery of arm function was obtained. Shoulder
subluxation was the most frequently-cited criterion used to prescribe
Bobath sling (31% of those who prescribed slings) and continued
the use until subluxation was repositioned. CONCLUSIONS: Given
that assisted exercises are so commonly selected by Thai physical
therapists as a method to prevent subluxation of the shoulder
after stroke, it is unfortunate that there is so little evidence to
provide guidance for its use. IMPLICATIONS: Therefore, it is
necessary for prescription of assisted exercise to become evidence-
based. KEYWORDS: stroke, shoulder subluxation, questionnaires.
FUNDING ACKNOWLEDGEMENTS: This work was supported by
a grant from the Faculty of Allied Health Sciences, Chulalongkorn
University, Bangkok, Thailand. CONTACT: Anchalee.F@chula.ac.th
ETHICS COMMITTEE: Institute of Health Research Chulalongkorn
University
Research Report Poster Display
25-03 Tuesday 5 June 15:30
VCEC Exhibit Hall B & C
TWO-POINT DISCRIMINATION AND RELATED FACTORS IN
PATIENTS WITH STROKE
Yi S1 , Moon J2 , Ahn S2 , Kim K2 ; 1 Dept. of Physical Therapy,
Andong Science College, Andong city; 2 Dept. of Physical Therapy,
Andong General Hospital, Andong city, Republic of Korea
PURPOSE: The purpose of this study was to investigate two-
point discrimination (TPD) and related factors in patients with
stroke. RELEVANCE: Two-point discrimination is one of the sensory
discriminative modalities, which provides information on the subject’s
spatial acuity. This study provides that physical therapists establish
the treatment plan for physical therapy in these patients with
stroke. PARTICIPANTS: The sample consisted of 40 stroke patients
S478
who had received physical therapy at the physical therapy unit
of Andong General Hospital in Andong city between January and
August 2006 studied. METHODS: Physical therapists measured
TPD for patients with stroke. TPD was measured from the tips of
the thumb, index, middle, ring, and little finger of each hand with
the TPD esthesiometer. The examiner performing the test asked
patients to say “one” if they felt it as one point and “two” if they
felt it as two. The research was designed to be a cross-sectional
measured study. ANALYSIS: SAS statistical software was used for
the analysis. The characteristics of the study sample were described
by mean and standard deviation (SD) for continuous variables and
by frequency and percentage for categorical variables. The Student’s
t-test and analysis of variance (ANOVA) were used to compare
TPD in variables. A Pearson’s correlation analysis was conducted
for relationship among values of 5 fingers. Multiple regression
analysis was performed to determine the factors associated with
TPD. RESULTS: A total of 40 stroke patients were measured,
their average age ± SD was 63.4±10.7 years (range: 34-82
yr). The mean TPD for 5 fingers tips was 8.00±4.31mm (thumb
8.13±4.95mm, index 7.68±4.32mm, middle 7.80±4.21mm, ring
8.08±4.47mm, and little finger 8.33±4.17mm, respectively), while
one for unaffected side was 5.23±1.72mm (thumb 5.13±1.40mm,
index 5.08±2.08mm, middle 5.20±2.04mm, ring 5.08±1.65mm, and
little finger 5.65±2.19mm, respectively). There was a statistically
significant difference in weight (p < 0.05), 10.50±5.58mm for 60–69kg
in the mean TPD for 5 fingers was highest, 8.49±4.62mm for over
70kg, and 6.17±1.96mm for less than 60kg. Value of Stroke patients
with diabetes (10.12±4.71) was statistically higher than patients
without (7.09±3.86) in diabetes mellitus (p < 0.05). Factors related
to TPD by multiple regressions were age (beta=0.18, p < 0.05) and
length of stay (beta=0.06, p < 0.05). CONCLUSIONS: In conclusion,
age and length of stay were significantly associated with TPD. We
recommend that further research should measure TPD by using
larger sample sizes and more sensitive measurement instruments.
IMPLICATIONS: The results of this study provided physical therapists
with information to establish the treatment plan for physical therapy
in the stroke patients. KEYWORDS: Stroke, Two-Point Discrimination
(TPD), Related factors. FUNDING ACKNOWLEDGEMENTS: We
thank Byeong-yeol Chun, MD, PhD, for statistical support with
variable analyses. CONTACT: ysj@andong-c.ac.kr
ETHICS COMMITTEE: Ethics approval was obtained by the hospital
ethics review board.
Research Report Poster Display
25-07 Tuesday 5 June 15:30
VCEC Exhibit Hall B & C
REPETITIVE TRAINING OF ARM POINTING MOVEMENTS IN
PATIENTS WITH HEMIPARESIS IN VIRTUAL VS PHYSICAL
ENVIRONMENTS
Subramanian S1,2 ,Knaut L1,3 ,
Henderson A1,4 ,
Levin M1,2 ;
1 Jewish Rehabilitation Hospital site of Centre For Interdisciplinary
Research in Rehabilitation, Montreal, Canada; 2 School of Physical
and Occupational Therapy, McGill University, Montreal, Canada;
3 School of Rehabilitation, University of Montreal, Montreal, Canada;
4 Department of Neurology and Neurosurgery, McGill University,
Montreal
PURPOSE: Only about 50% of patients with initial arm paresis post
stroke recover arm function. Virtual reality training environments
(VEs) are promising new tools to improve functional recovery level
in chronic stroke patients. Elements essential to maximize motor
learning, such as repetitive and varied task practice, performance
feedback and motivation, can be optimized in VEs.There is
preliminary evidence from several small case studies that virtual
reality in combination with real world therapy may improve functional
and motor outcomes. However evidence is insufficient on whether the
effects of training in a VE differ from training in physical environments
(PEs).This study aimed to answer this question. RELEVANCE:
WCPT 2007, Research Reports
The results of this study will help inform clinical practice of
effective interventions using virtual reality technology for recovery
of arm movements in patients with hemiparesis. PARTICIPANTS:
Subjects aged 19–80 yrs who had a stroke <3 yrs previously and
mild-to-severe motor impairment participated. METHODS: Clinical
evaluations of arm impairment (spasticity – Composite Spasticity
Index, motor impairment – Fugl-Meyer Scale; Reaching Performance
Scale) and function (Box and Blocks Test, Wolf Motor Function Test,
Motor Activity Log) as well as kinematic analysis of a pointing task
(Optotrak, 120Hz, 6 markers) was done before and immediately
after practice. Subjects practiced varied pointing movements (72
trials/session) daily over 10 days during 2wks, in either a PE or a
VE. The task was to point as quickly and accurately as possible to 6
targets (12 trials/target, randomized) placed in different workspace
areas in front of the patient. In PE, the targets consisted of 6
x 6 cm squares placed at 2 heights at a distance just beyond
the subject’s arm’s length. In VE, target size and location were
identical to PE, but viewed in a fully immersive and interactive
visual scene via a head-mounted display. Participants received
feedback about movement outcomes (knowledge of results) and how
they performed the task (knowledge of performance) ANALYSIS:
Three motor performance outcomes (error, trajectory smoothness,
peak arm velocity) and five behavioral movement pattern measures
(elbow extension, shoulder horizontal adduction and flexion, trunk
displacement, trunk rotation) were compared. Two-way ANOVAs with
repeated measures and factors: group (experimental vs control) and
time (pre vs post) were used for each measure. Minimal significance
was set at p < 0.05 RESULTS: After training, movements made by
subjects in both groups improved. Results suggest that participants
who trained in the VE had better performance in terms of movement
accuracy (less errors) and increased velocity. They also had improved
movement pattern measures in terms of increased elbow extension,
shoulder horizontal adduction and shoulder flexion ranges after
training in the VE. Participants expressed satisfaction with and
increased motivation when training in the VE. CONCLUSIONS:
Training in virtual environments may offer a motivating and chal-
lenging environment for rehabilitation interventions. IMPLICATIONS:
Repetative motor retraining performed in a VE with feedback may be
a means of maximising arm motor recovery in patients with stroke.
KEYWORDS: Stroke, Arm motor recovery, Exercise. FUNDING
ACKNOWLEDGEMENTS: We acknowledge Canadian Institutes of
Health Research (CIHR), Canadian Foundation for Innovation (CFI)
and Physiotherapy Foundation of Canada (PFC) for their support.
CONTACT: sandeep.subramanian@mail.mcgill.ca
ETHICS COMMITTEE: Centre For Interdisciplinary Research in
Rehabilitation in Greater Montreal(CRIR), Montreal, Canada.
Research Report Poster Display
26-11 Tuesday 5 June 15:30
VCEC Exhibit Hall B & C
HAMSTRING LENGTH, LUMBAR SPINAL RANGE OF MOTION,
PELVIC TILT, PELVIC MOBILITY AND LOW BACK PAIN AMONG
RACIALLY DIVERSE EMPLOYEES
Kraemer T; A.T. Still University, Arizona School of Health Sciences
PURPOSE: The purpose of this study was to investigate the
relationship of various physical factors (hamstring length, spinal
AROM, pelvic tilt, and pelvic mobility) that result in self-reported low
back pain in racially diverse employees in a physically demanding
job within a university setting. It was hypothesized that decreased
hamstring flexibility and pelvic mobility are contributing factors to low
back pain. RELEVANCE: Back pain is one of the most common
musculoskeletal problems, accounting for 25% of all disabling injuries
in the United States. Previous research on lumbopelvic dysfunction
has focused on a variety of physiological and anatomical parameters
and found that lumbopelvic imbalances produce increased anterior
tilt of the pelvis and exaggerated lumbar lordosis. PARTICIPANTS: A
convenient sample consisting of 30 racially diverse male employees
Poster Displays, Tuesday 5 June
who had been employed by a major research University physical plant
(maintenance, grounds,vehicle repair, custodial) for at least 3 months
were recruited to participate in this study. METHODS: This was a
quasi-experimental, correlational design. Upon independently com-
pleting the informed consent and a general demographic/screening
questionnaire, physical measurements including anthropometrics,
straight leg raise, lumbar spine AROM, pelvic tilt position, and pelvic
mobility utilizing osteopathic spring techniques were obtained via
blinded testers at each station. ANALYSIS: Data analysis included
descriptive analysis and Spearman Correlation using SPSS Version
14.0. RESULTS: Descriptive stats are as follows: BMI (X = 29.0;
df = 6.3); T12-L1 spinal inclination angle (X = 75.4; df = 14.5);
L5-S2 spinal inclination angle (X = 42.2; df = 14.0); pelvic tilt
inclination angle (X = 0.07; df = 0.027); SLR-R (X = 64.1; df
= 14.3); SLR-L (X = 67.6; df = 17.1); osteopathic pelvic spring:
57% hypomobile posterior rotation anterior ilium; 64% hypomobile
inferior stress anterior ilium; 60% hypomobile superior stress to
ischial tuberosity; 57% hypomobile inferior stress to posterior ilium.
Spearman Correlation significant (p < 0.05) for SA-1:SLR-R (.44);
SA-1:SLR-L (.41). CONCLUSIONS: Although the findings indicate
that each variable contributes to lumbopelvic dysfunction and the
resulting report of low back pain, the exact role of each remains
unclear. Reliable interpretation on the source and role of lumbar
lordosis, hamstring tightness, and pelvic immobility is only possible
if additional information on lumbar ROM, pelvic tilt, abdominal
strength, and pelvic mobility (rotation, slide (slip), side bending,
and spring) is available. Future research should focus on the role
and contribution of pelvic mobility combined with neurophysiological
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
dysfunction could considerably reduce worker morbidity and save
billions of dollars. By correctly identifying the contributing factors
to lumbopelvic dysfunction, physical therapists can determine an
accurate differential diagnosis, establish a clincially sound and logical
plan of care, utilize effective treatment intervention strategies, and
provide cost effective quality care thereby enhancing a client’s quality
of life and reducing worker compensation costs and societal medical
expenditures. KEYWORDS: Pelvic mobility, Osteopathic Spring
Techniques, Low back pain. FUNDING ACKNOWLEDGEMENTS:
This research was funded by the Institute on Black Life. CONTACT:
tkraemer@atsu.edu
ETHICS COMMITTEE: The Institutional Review Board (IRB) at the
University of South Florida approved this study.
Research Report Poster Display
26-15 Tuesday 5 June 15:30
VCEC Exhibit Hall B & C
ELDERLY PERSONS PARTICIPATING IN DANCE-WORKSHOP
PROMOTED SENSE OF BODY-MIND CONNECTION
Thornberg K1 , Josephsson S2 ; 1 Karolinska Institute, Dept of
neurobiology, caring sciences and society, division of physiotherapy,
Stockholm, Sweden; 2 Karolinska Institute, Dept of neurobiology,
caring sciences and society, division of occupational therapy,
Stockholm, Sweden
PURPOSE: The purpose of the study was to investigate how
elderly amateurs experienced the participation in a dance-project.
RELEVANCE: To promote health in old age it is important to
investigate activies that are peceived as meaningful for the partic-
ipant. PARTICIPANTS: A choreographer advertised for participants
in a project entitled “Movement as the Memory of the Body”. 145
persons applied to the project and 17 were selected through an
audition process, 6 men and 11 women, aged 66-89. They were
selected from three criterias: different characters, a varied range
of ages and representation of both sexes. When workshops and
performance were finished a letter was sent in which they were
S479
asked to be interviewed about experiences of participating in the
dance-project. METHODS: Data was gathered through semistruc-
tured interviews audiotaped and verbatim transcribed. A qualitative
narrative design was used. ANALYSIS: The data was analysed
according to a qualitative narraive design involving the following
steps: initial reading, identification of significant events, storyline
reconstruction, story/theory juxtaposition, reconstructing narratives.
RESULTS: Results showed that it was a challenge to participate
in the work-shops and in the performance. To do movements that
arouse from a memory made the body-mind connection obvious
for participants in a way they were not previously aware of and a
new understanding of the meaning of bodily movements emerged.
The communicative resources of bodily movements emerged during
the process. Even though it was not found difficult to perform
the movements per se, the challenge consisted in remembering
the sequencing unless there was a clear underlying narrative.
Participants also reported satisfaction with having done something
not expected from than challenging society’s view of what elderly
persons should do. CONCLUSIONS: By expressing memories
through bodily movements these participants formed consiusness of
connection between body-mind. The cartesian dualism separating
body and mind was strongly questioned after the dance experience.
IMPLICATIONS: By transferring the experiences of the project
Movements as the Memory of the Body to rehabilitation settings
new ways of working with elderly to promote mobility and health
can be invented. KEYWORDS: Body-mind, dance, elderly, memory,
rehabilitation. FUNDING ACKNOWLEDGEMENTS: The work was
unfunded. CONTACT: Kerstin.Thornberg@ki.se
Research Report Poster Display
27-23 Tuesday 5 June 15:30
VCEC Exhibit Hall B & C
THE LONG-TERM EFFECTS ON HEALTH-RELATED QUALITY OF
LIFE IN OLDER PEOPLE IN RELATION TO COMPREHENSIVE
GERIATRIC TRAINING
Inaba Y1 , Obuchi S2 , Arai T1,2 , Satake K3 , Sato H4 , Futami T1 ;
1 Graduate school of Medical Science, Kitasato University;
2 Preventive Care, Tokyo Metropolitan Institute of Gerontology;
3 Sapporo Health Promotion Center; 4 School of Allied Science,
Kitasato University
PURPOSE: Interventional research to improve older people’s disuse
have increased, and physical and mental improvements have been
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
not clear whether the changes in HRQOL after intervention are
maintained. The purpose of the present study was to investigate
1) the persistence rate of resistance training with weight training
machines (machines) on subjects after the intervention, and 2) the
long-term changes of HRQOL between a training maintenance group
(one or more days per week after intervention) (TR) and a detraining
group (DT) after the intervention in a progressive resistance and
balance training program named Comprehensive Geriatric Training
(CGT). RELEVANCE: Caring for the expanding elderly population
is an important challenge in Japan as well as in other countries.
Maintenance of physical functioning and a high HRQOL has become
an important goal. Having knowledge of the long-term changes of
a subject’s HRQOL provides information about the psychological
effects of the training and the importance of maintaining training
in the aged. PARTICIPANTS: The study included 167 community-
dwelling persons aged 65 years and older (mean age, 74.0 ±4.9y).
The subjects were recruited through a public relations magazine
and through invitation by public health nurses. Informed consent
was obtained from all persons prior to participation. METHODS: The
subjects’ SF-36 as HRQOL were measured before intervention (T1),
after intervention (T2), and 1 year later (T3). We also interviewed
the subjects about their maintenance of training from T2 to T3.
S480
ANALYSIS: We used two-way ANOVA with repeated measures and
Bonferroni’s multiple comparisons. RESULTS: One-hundred fifty-
three subjects out of 167 completed the CGT, and the HRQOL
were measured in 135 subjects and all data collected. Of the 135
subjects, 58 subjects (43.0%) were in the TR group and 77 (57.0%)
in the DT group. Physical Functioning, Bodily Pain, General Health,
Vitality, and Mental Health subscale scores were changed over time
in both groups. Physical Functioning, Role Physical, General Health,
Vitality, and Mental Health were significantly improved in the TR group
compared to the DT group. In the TR group, the T2 score significantly
improved from T1 in Physical Functioning, Vitality and Mental Health.
Moreover, the T3 scores significantly improved from the T1 scores
in Physical Functioning and Role Physical. In the DT group, the
T2 scores were significantly higher than the T1 scores in Vitality
and Mental Health, while the T3 scores significantly decreased from
the T2 scores in Physical Functioning, General Health, Vitality and
Mental Health. No subscale scores in T3 were significantly lower
than in T1. CONCLUSIONS: The subjects improved and maintained
HRQOL through CGT. Maintaining training led to the maintenance
of a high HRQOL after one year. However, if training is not
maintained, the improvement in HRQOL gained by this program does
not continue after one year. IMPLICATIONS: For physical therapy
practice, these results suggest that for the elderly, doing training
and maintaining training is good not only for physical function, but
for HRQOL. KEYWORDS: HRQOL, Long-term effect, Community-
dwelling older persons. FUNDING ACKNOWLEDGEMENTS: This
work was unfunded. CONTACT: yasuko178@h3.dion.ne.jp
Research Report Poster Display
28-07 Tuesday 5 June 15:30
VCEC Exhibit Hall B & C
PHYSICAL ABILITY ESTIMATION INVOLVEMENT FOR
FALLINGS IN THE ELDERLY
Toshimichi S1 , Mishima S1 , Tanaka M1 , Tsushima E2 ; 1 Yamagata
College Medical Arts & Sciences; 2 Hirosaki University
PURPOSE: In this report we examined the factors regarding falling
related to physical strength awareness in the elderly using the recog-
nized ‘functional reach test’ in clinic. RELEVANCE: This study offers
a new evaluation of falling in elderly people. PARTICIPANTS: The
subjects were 88 healthy elderly who were able to continue the mea-
surement and had no impediments in their daily living. METHODS:
After declaring the estimate values for the ‘functional reach test’ ac-
tual measurements were carried out. Errors were shown in individual
physical strength awareness arising from differences in predicted and
actual measurement values. Three months later, subjects undertook
a survey regarding whether or not falling took place and were
examined on physical strength awareness in falling. ANALYSIS: Mul-
tiple logistic regression analysis and the discriminant characteristic
analysis were used. A p value of <0.05 was considered to be sta-
tistically significant. RESULTS: Of 88 subjects, 21 subjects (23.9%)
experienced fallings during 3 months survey period. As a result of the
multiple logistic regression analysis, the usual functional reach test
result and physical strength awareness error were both chosen as
influences and factors in falling within the 3 month period(p < 0.05).
The recurrence adoption when the two factors were included was
best. Furthermore the discriminant characteristic analysis indicated
that amount of error from measured FRT could judge the possibility of
falling with the border of 8.5cm for the group which overestimate and
−9.5cm for the group which underestimate. CONCLUSIONS: The
result of this study suggested that physical ability estimation is one
of the significant factors in fallings in the elderly. Understanding the
physical ability estimation is meaningful information to predict falling
in the elderly. IMPLICATIONS: primaly health care KEYWORDS:
Physical ability estimation, Falling, Elderly people. FUNDING
ACKNOWLEDGEMENTS: N.A. CONTACT: sugihara@ymisn.ac.jp
ETHICS COMMITTEE: Yamagata College of Medical Arts &
Sciences
WCPT 2007, Research Reports
Research Report Poster Display
29-11 Tuesday 5 June 15:30
VCEC Exhibit Hall B & C
A THREE-MONTH, PILOT, HEALTH PROMOTION AND EXERCISE
PROGRAM IN CANCER SURVIVORS TO IMPROVE ENDURANCE
AND HEALTH-RELATED QUALITY OF LIFE
Pfalzer L, Floros D, Hoppe J, Rexer P, Westover J, Cowdery J,
Fry D, Kincaid C; University of Michigan-Flint, Flint, MI, USA
PURPOSE: To describe the effects of a three-month health promotion
in cancer survivors on aerobic endurance, self-reported fatigue,
physical function of health-related quality of life (HRQOL) and health
beliefs related to physical activity. Cancer-related fatigue (CRF), a
frequent complaint, is reported in as many as 60-70% of survivors.
Although the exact cause of CRF is unknown, decreased physical
activity is proposed as one contributing factor. Fatigue is reported
to negatively impact endurance and HRQOL in cancer survivors.
Several studies have analyzed the effects of exercise on CRF in
cancer survivors; however, none have investigated a combined, high
intensity resistive training protocol for fitness with an aerobic, home
walking program for health in cancer survivors. RELEVANCE: Effec-
tive physical therapy health promotion programs to decrease CRF,
increase endurance and HRQOL are needed for cancer survivors.
PARTICIPANTS: For the purpose of this study, cancer survivors are
persons that have completed all cancer treatments. Thirty-eight can-
cer survivors who ranged in age from 26 to 74 years (mean = 52) and
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
intervention groups, respectively. Twenty-five subjects were assigned
to the three-month health promotion intervention that was an on-line
health education combined with supervised, high-intensity resistance
training and an unsupervised, home walking program based on the
transtheoretical health belief model (TTM) that used constructs such
as motivation, self-efficacy and readiness to change physical activity.
The remaining thirteen subjects were assigned to the non-treatment
control group. METHODS: Outcome measures included six-minute
walk test distance (6-MWT, meters(m)), Fatigue Severity Scale (FSS),
and Short Form-36 version 2 Quality of Life questionnaire (SF-36 v2),
and physical activity motivation, self-efficacy and stages of change
questionnaires developed for this study. Pre- and post-intervention
testing was completed for both, intervention and control groups, by
the same set of investigators who were blinded to the subject’s study
group. ANALYSIS: A two-way MANCOVA between groups*time(type
IV full factorial model with simply contrast with p  0.05) of the
outcome measures (6MWT, FSS, and SF-36v2) while covarying
for age and BMI. Secondary analyses included one-way ANOVAs
between groups on the outcome measures. RESULTS: The 6-MWT
distance before intervention for the intervention and control groups
were 464±84 (mean, standard deviation) and 511±90, and after
intervention 531±109 and 513±116, respectively. MANCOVA results
were not significantly different for the two groups after intervention
(p = 0.11). Endurance (6-MWT distance) in the intervention group
was significantly improved as compared to the control group after
intervention on one-way ANOVA (p = 0.023, observed power 64%).
However, the smaller effect size of the intervention on FSS and
HRQOL indicates a need for a larger study sample or more
sensitive questionnaires to detect change with intervention in the FSS
and HRQOL. CONCLUSIONS: This pilot study demonstrates that
cancer survivors improve endurance (6MWT) with an unsupervised,
home walking program as part of a three-month health promotion
program. IMPLICATIONS: A three-health promotion program is an
effective and safe method of treatment to improve endurance in
cancer survivors. KEYWORDS: cancer; exercise; wellness & health
promotion. FUNDING ACKNOWLEDGEMENTS: This Project was
funded by Research Excellence funds at the University of Michigan-
Flint from the State of Michigan. CONTACT: cpfalzer@umich.edu
ETHICS COMMITTEE: The University of Michigan-Flint’s Instituti-
tional Review Board approved this study.
Poster Displays, Tuesday 5 June
Research Report Poster Display
29-19 Tuesday 5 June 15:30
VCEC Exhibit Hall B & C
ROLES OF PHYSICAL THERAPISTS AND OCCUPATIONAL
THERAPISTS IN SCHOOLS FOR PHYSICALLY HANDICAPPED
CHILDREN: AN ATTITUDE SURVEY ON TEACHERS
Kudo S1 , Takahashi K2 , Naba M3 ; 1 Department of Physical Therapy
at the Akita University Faculty of Allied Medical Sciences. Akita
city, Japan; 2 Department of Occupational Therapy at the Akita
University Faculty of Allied Medical Sciences, Akita city, Japan;
3 Akita Prefectural School for Disabled Children, Akita city, Japan
PURPOSE: To determine the effects of the first adoption of PT (2
individuals) and OT (1 individual) at the Akita Prefectural School
for Disabled Children, and to identify factors facilitating future
cooperation. RELEVANCE: Background: Physical therapists (PT)
and occupational therapists (OT), which have been established as
medical professions in Japan, are legally not allowed to work at
schools for disabled children. PT and OT who wish to work at
schools for disabled children must first obtain a license for teaching
at schools for disabled children, be recruited as teachers (not
as PT or OT) at schools for disabled children, and perform their
functions as teachers. However, due to the increasing severity of
impairment among students at schools for physically handicapped
children in recent years, the Akita Prefectural School for Disabled
Children has adopted PT and OT on a part-time basis, starting in
2006, and received teaching advice and guidance from PT and OT.
So Our research bears some relevance to the discussions under
way at WCPT. PARTICIPANTS: 53 teachers in Akita Prefectural
School for Disabled Children. METHODS: An attitude questionnaire
survey was conducted on 53 teachers in Akita Prefectural School for
Disabled Children. ANALYSIS: Following simple tabulation, results
were analyzed using the chi square goodness of fit test, and
classified by the number of years of teaching experience. RESULTS:
Responses were obtained from 49 (response rate, 92.5%) teachers.
1) The most commonly reported expectations for PT and OT were
needs for positioning and dietary guidance. 2) The most commonly
perceived role of teachers was to nurture the children’s ability to
express themselves. 3) The most commonly reported challenge for
schools for disabled children was improvements in “independent
activities”, 4) In response to the question, “Have you actually seen
the work performed by PT and OT?”, 40 (82%) teachers had seen the
work performed by PT and OT, and had also received guidance from
PT and OT. 5) However, 31 (63%) teachers perceived the cooperation
between education and healthcare/welfare to be inadequate or
somewhat inadequate. 6) In response to a question regarding the
effectiveness of the PT and OT adopted in April, 43 (88%) teachers
evaluated PT and OT as being effective. Thus, considering that 37
(75.5%) teachers commented positively on the effectiveness of PT
and OT adoption, the activities thus far can be thought to have
achieved some degree of success. CONCLUSIONS: The adoption of
PT and OT in schools for physically handicapped children was shown
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
departments, and 3) establishment of a mechanism for cooperation
that enables a mutual and shared sense of accomplishment at work.
IMPLICATIONS: This research make a large contribution to the
development of new working area for Japanese Physical therapist
and the form of new cooperated system for the special education
in Japan. KEYWORDS: Disabled Children,An attitude questionnaire,
cooperation. FUNDING ACKNOWLEDGEMENTS: We obtained the
school master acknowledgment signature to this survey and all
the expenses the this research were covered by my expenditures
on research and development. CONTACT: kudon221@ams.akita-
u.ac.jp
ETHICS COMMITTEE: Our university has an ethics committee.
S481
Research Report Poster Display
30-23 Tuesday 5 June 15:30
VCEC Exhibit Hall B & C
APPLICABILITY OF USING FORMETRIC INSTRUMENT SYSTEM
(FIS) TO ANALYZE POSTURE IN CHILDREN WITH CEREBRAL
PALSY
Abdelazeim F1 , Radwan H2 ; 1 Cairo University, Cairo, Egypt;
2 Winston Salem State University, NC, US
PURPOSE: The purpose of this study was to establish the
applicability of using FIS in postural analysis of children with cerebral
palsy (CP). RELEVANCE: FIS is used to analyze back configurations
and posture in adults with and without spinal problems. The FIS is
relatively easy to use, the anatomical landmarks, vertebral position,
and rotation are automatically detected and there is no need for
manual placement of markers on the vertebrae. However, the FIS is
not used by clinicians to evaluate children with CP. PARTICIPANTS:
This study was conducted at Faculty of Physiotherapy, Cairo
University. Twenty children with spastic diplegic CP were selected
from the outpatient clinic according to preset criteria. The ages
of the children recruited started developmentally from 10 months
according to Denver developmental screening test. They measured
from 1 to 1+ degree of spasticity according to Modified Ashworth
scale. They had no significant perceptual disorders. They were able
to stand alone with heels on the ground (at least five seconds) and
Average height is nearly one meter METHODS: The history of every
child was taken and a primary clinical assessment was done which
included subject’s weight and height. Then each child was prepared
to ensure exposure of the back, to avoid any disturbance of the
image, and to achieve free standing posture as much as possible
with both heels on the ground. The formetric software program was
set to be ready prior to the actual testing to perform the scanning
procedure as soon as the proper position if the chilled achieved to
eliminate any movement artifact. The scanning procedure lasted for
very short time (40 ms). The formetric instrument system was used
to evaluate the spinal geometry in terms of trunk imbalance, pelvic
tilt, pelvic torsion, surface rotation, and lateral deviation based on
dimensional scanning. Full Back Shape three-dimensional analysis
was done, recorded, and printed out for each patient. ANALYSIS:
The data of trunk imbalance, pelvic tilt, pelvic torsion, surface rotation,
and lateral deviation were collected, tabulated and analyzed using
descriptive techniques. RESULTS: The data collected showed that
using FIS to assess the posture of children with spastic diplegic
CP can determine with accuracy the degree of postural deviation in
this population. In this study the trunk imbalance, pelvic tilt, surface
rotation, and lateral deviation were 9.13±3.46, 6.25±2.45, 6.45±2.
22, and 4.64±1.24 respectively. CONCLUSIONS: The FIS can be
used to assess and effectively evaluate posture in children with
CP. IMPLICATIONS: Clinicians will be able to accurately evaluate
and develop an effective plan of care for children with CP when
they use such system. KEYWORDS: Cerebral palsy, Formetric
Instrument System, posture. FUNDING ACKNOWLEDGEMENTS:
N/A. CONTACT: faten.abdelazeim@gmail.com
ETHICS COMMITTEE: Cairo University Research Committee
Research Report Poster Display
31-07 Tuesday 5 June 15:30
VCEC Exhibit Hall B & C
BODY WEIGHT SUPPORT TREADMILL TRAINING WITH
FUNCTIONAL ELECTRICAL STIMULATION FOR A TODDLER
WITH L4/5 SPINDA BIFIDA
Paleg G; Montomery County Infant and Toddler Program Rockville,
Maryland, US
PURPOSE: Recent studies have demostrated the value of Body
Weight Support Treadmill Training in improving functional overground
mobility for people with CVA, TBI and SCI and children with Down
Syndrome. Newer studies have incorporated functional electrical
S482
stimulation and have seen a trend toward improved outcomes. Can
a toddler with L4/5 spina bifida benefit from this intervention? This
study is the first known case to attempt to answer this question.
RELEVANCE: The incidence of spina bifida is estimated at 1-2
per 1000 population, with certain populations having significantly
increased incidence based on genetic predilection. In the past, most
children with L4/5 involvement do not become indep ambulators.
This study seeks a method to improve outcomes for these children.
PARTICIPANTS: This child was born with L4/5 spina bifida. She
began BWS-TT at 12 mos and electrical stimulation was added at
15 mos. At the beginning of the intervention she was unable to sit,
stand, or walk but was able to roll and commando (belly) scoot. She
had absent sensation below her navel and mild increased tone (right
grater than left) of her hamstrings and heelcords. METHODS: Body
Weight Support Gait Therapy (BWS-GT) alone was provided 3x/week
for 10 minutes for 6 weeks. The same subject was then provided 6
weeks of BWSGT with Functional Electrical Stimulation to her hip
and knee extensors 3x/week for 10 minutes per session. ANALYSIS:
During the initial 6 weeks, the child tolerated the treatment well
and gained the ability to get on her knees. During the second
6 weeks she gained the ability to sit, step with HKAFOs with
assistance for weight shifting, and regained sensation to light touch,
pressure, ice and deep touch over her entire lower body. See was
also able to produce a Poor minus contraction of her hamstrings
bilaterally and began to move her toes. RESULTS: Child improved
from Asia A to Asia B, gained the ability to sit and was able to begin
using HKAFO’s. CONCLUSIONS: This study shows that BWSGT
when combined with functional electrical stimulation is a feasible
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
Training Functional Electrical Stimulation; Spina Bifida. FUNDING
ACKNOWLEDGEMENTS: Mobility Research donated the BWSGT
System, Treadmill and harness. CONTACT: ginny@paleg.com
ETHICS COMMITTEE: Ethics was not required as no invasive
procedure was involved
Research Report Poster Display
33-23 Tuesday 5 June 15:30
VCEC Exhibit Hall B & C
PHARMACOLOGY AND PRESCRIPTION: WIDENING THE
SCOPE OF PHYSIOTHERAPY PRACTICE IN SOUTH AFRICA
Unger M1 , Lochner R1 , Eales C2 ; 1 Stellenbosch University; 2 Health
Professions Council of South Africa
PURPOSE: To investigate current practice regarding administration,
recommendation and storage of medication by SA PTs and to
determine their need for the right to prescribe. RELEVANCE:
Inclusion of prescription rights has huge implications regarding
expansion of an already very full undergraduate curriculum and cost
of insurance premiums. However as firstline practitioners and with
the increasing evidence for lack of EBP, the status of physiotherapy
has and is decreasing. Many previously considered PT techniques
are being utilised by other medical and non-medical professionals
and technicians and clients are seeking a one-stop shop for all their
medical requirements. PARTICIPANTS: All 4408 physiotherapists
registered with the HPCSA in Jan 2004 were included in the study.
Motivation: results of this survey had enormous implications for
changing current scope of PT practice. This offered an opportunity
for all to comment. METHODS: Descriptive analytical design.
A self-administered questionnaire was developed in consultation
with the HPCSA. The questionnaire had 3 sections collating
information regarding personal details and demographics; current
practice and knowledge of pharmacology; and attitudes towards
drug administration and prescription respectively. Checklists, yes/no
and open-ended questions for listing and explanation were used.
ANALYSIS: Quantitative data was analysed and correlated with
WCPT 2007, Research Reports
responses relating to work setting and -area, years qualified and
conditions most commonly treated where this was appropriate.
Responses to the open-ended questions were qualitatively processed
and analysed. RESULTS: Responses where received from 461
physiotherapists. 70% of respondents reported a need to legally
administer and 58% reported a need to store certain medicines.
More than 60% of respondents were in favour of the expansion
of the scope of physiotherapy practice to include prescription of
a limited range of medications after training and within certain
areas of specialization or clinical competence. CONCLUSIONS: SA
physiotherapists have a need for legal administration and storage
practice. Physiotherapists are aware of the role in optimal client
management and have recognized the need for pharmacology
knowledge. A need for voluntary limited prescription rights was also
identified. IMPLICATIONS: Several recommendations for inclusion
of a basic pharmacology module as part of the undergraduate
curriculum have been made. The option to expand or update
knowledge and skills via CPD activities and through specialization
was also recommended. Following a report submitted to the Profes-
sional Board for Physiotherapy, a task team has been established
to persue the desicion to expand the scope of PT practice to
include prescription of medicines. Process and successes achieved
to date will also be briefly reported. KEYWORDS: precription rights;
PT status. FUNDING ACKNOWLEDGEMENTS: Harry Crossley
Fund; HPCSA; Stellenbosch University, Faculty of Health Sciences.
CONTACT: munger@sun.ac.za
ETHICS COMMITTEE: Research and Ethics Committee at Stellen-
bosch University, registration no. 2003/147/N
Research Report Poster Display
36-23 Tuesday 5 June 15:30
VCEC Exhibit Hall B & C
VALIDATION OF A PREDICTIVE MODEL FOR LOCOMOTION IN
STROKE PATIENTS: INVESTIGATION USING THE FUNCTIONAL
BALANCE SCALE
Sugimoto S1 , Maruya K2 , Saitoh H3 , Asano S4 ; 1 Health Science
University, Minamitsurugunn Yamanashi, Japan; 2 Musashidai
Hospital, Hidaka Saitama, Japan; 3 Tukuba Memorial Hospital,
Tsukuba Ibaraki, Japan; 4 Tukuba Central Hospital, Ushiku Ibaraki,
Japan
PURPOSE: The Functional Balance Scale [FBS] is a balance test
including not only sitting balance but also higher-level balance
activities such as standing on one leg and stepping. The FBS is
composed of 14 sub-tasks, which are allotted from 0 to 4 points
(0 indicating an inability to complete any aspect of the task) and
the total score is commonly used as the index of balance ability.
Recently, many researchers have reported that the FBS is useful in
predicting locomotive levels in stroke patients and risks of falling in
the elderly. We also previously investigated the relationship between
locomotive levels and the FBS scores in chronic stroke patients
(Sugimoto et al, 2005). Our report emphasized that each sub-task
of the FBS predicted locomotive levels because the point which
was needed to get a good locomotive level was different from
one task to another. However, we couldn’t confirm the validity of
the predictive model in the previous study. Additionally, five-graded
measurements were too many to judge whether the activity of
each sub-task was good or not. The purpose of this study was
to simplify the sub-tasks of the FBS and to investigate the validity
of a predictive model using the simplified sub-tasks for locomotion
in stroke patients. RELEVANCE: This study is useful in order to
clarify methods to easily predict locomotive levels in stroke patients.
PARTICIPANTS: Eighty two chronic stroke patients (34 women and
48 men, 69.5±11.3 years old), who could walk indoors by themselves
consented to participate in this study. METHODS: The subjects
were randomly divided into the predictive group and the verifiable
group after consideration of two locomotive levels (indoors/ outdoors).
After frequency distribution tables were made for locomotive levels
Poster Displays, Tuesday 5 June
and 14 sub-tasks of the FBS, a threshold level to distinguish the
difference between the two locomotive levels was investigated in
each sub-task in the predictive group. ANALYSIS: The predictive
expression for locomotive levels was formulated by discriminant
analysis method using the two-graded sub-tasks. The hitting ratio
of the locomotive level in the verifiable group was calculated with
this predictive expression. RESULTS: The results of the discriminant
analysis using the stepwise selection method indicated that “Turn to
look behind” and “Turn 360 degrees” in the sub-tasks were the most
effective predictors of locomotive levels. In the above two tasks, if a
patient could turn to look behind from both sides and he could turn
360 degrees slowly and safely, then the patient could be predicted
as being in good condition. The hitting ratio of locomotive levels was
80.4% in the predictive group and 68.2% in the verifiable group.
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,
Functional Balance Scale. FUNDING ACKNOWLEDGEMENTS:
N.A. CONTACT: s.sugimoto@kenkoudai.ac.jp
Research Report Poster Display
37-03 Tuesday 5 June 15:30
VCEC Exhibit Hall B & C
A NEW CLINICAL SPASTICITY MEASURE BASED ON EVALU-
ATION OF STRETCH REFLEX THRESHOLD EXCITABILITY
Calota A1 , Feldman A2,3 , Johnstone E3 , Levin M1,3 ; 1 School of
Physical and Occupational Therapy, McGill University, Montreal,
Canada; 2 Department of Physiology, Université de Montréal,
Montreal, Canada; 3 Jewish Rehabiliation Hospital, Laval, Canada
PURPOSE: Spasticity is a motor disorder characterised by a
velocity-dependent increase in tonic stretch reflexes with exaggerated
tendon jerks, resulting from hyperexcitability of the stretch reflex,
as one component of the upper motor neuron syndrome. Common
clinical measures of spasticity are the Ashworth, the modified
Ashworth (MAS) and the Tardieu Scales. The validity of these
measures has been questioned since they focus more on the
quantification of resistance to passive stretch rather than the velocity-
dependence of spasticity. The purpose of this study was to test
the reliability (inter and intra-rater) of a new portable measure
of spasticity based on threshold excitability of the tonic stretch
reflex. RELEVANCE: Evidence-based neurological practice and the
development of physiotherapeutic interventions depend upon valid,
responsive and reliable assessment tools. DESCRIPTION: Patients
with diagnoses of multiple sclerosis, stroke, cerebral palsy, traumatic
brain injury and spinal cord injury presenting with spasticity in the
biceps brachii and/or the gastrocnemius participated in this study. All
patients signed a consent form approved by the Ethics committee of
the Center for Interdisciplinary Research in Rehabilitation. Spasticity
was evaluated by three independent evaluators using the portable
device (MRST) and the MAS on two different days, spaced over
one week. The MRST uses an eletromyographic amplifier and an
electrogoniometer to record stretch reflex thresholds in terms of
joint angles for different velocities of stretch. Up to 20 values of
velocity-dependent stretch reflex thresholds are used by the device
to compute the tonic threshold which is then displayed on a small
computer screen. The degree of spasticity is expressed as the joint
angle at which the threshold response occurs. The MAS is a 5
point scale ranking spasticity from mild to severe based on the
evaluator’s impression of the amount of resistance to stretch of the
passive muscle. EVALUATION: Intra- and inter-rater reliability for
each measure (MRST, MAS) was determined with Kappa and inter-
class correlation analyses (minimal significancelevel p < 0.05). The
relationship between MRST and MAS scores was determined with
Pearson correlations. CONCLUSIONS: Preliminary results suggest
that the intra- and inter-rater reliability of the MRST is moderate
to high while the MAS is less reliable. There was a moderate but
S483
significant relationship between stretch reflex threshold values on the
MRST and resistance to passive stretch as measured on the MAS.
The main factor in improving reliability was better training of clinicians
on the use of the device. The validity and the responsiveness
of the MRST need to be investigated. IMPLICATIONS: The
new measurement tool provides continuous numerical data to
objectively and reliably quantify spasticity. It is the first portable
device that provides accurate measurement of spasticity for both
the rehabilitation researcher and clinician. KEYWORDS: spasticity,
stretch reflex, neurological. FUNDING ACKNOWLEDGEMENTS:
The study was supported by Univalor and OPPQ-REPAR. CONTACT:
andra.calota@mail.mcgill.ca
ETHICS COMMITTEE: Center for the interdisciplinary Research in
Rehabilitation of Montreal.
Research Report Poster Display
37-07 Tuesday 5 June 15:30
VCEC Exhibit Hall B & C
HEALTH LOCUS OF CONTROL SCALE IN PATIENTS WITH
CHRONIC LOW BACK PAIN: PSYCHOMETRIC PROPERTIES OF
THE BRAZILIAN-PORTUGUESE VERSION
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,
Brazil; 3 Centro Universitario de Belo Horizonte, Belo Horizonte, Brazil
PURPOSE: Low Back Pain (LBP) is a common cause of disability in
the Brazilian population, affecting mainly those who are economically
active. The aim of this study was to translate and adapt the
Multidimensional Health Locus of Control (MHLC) scale to Brazilian-
Portuguese, and to investigate its psychometric properties in
Brazilian patients suffering with chronic LBP. RELEVANCE: There
is evidence that psychosocial factors such as health locus of
control affect prognosis in LBP. Although the MHLC questionnaire
is widely used in LBP, the Brazilian-Portuguese version has not been
validated. PARTICIPANTS: The sample consisted of 40 Brazilians
with non-specific chronic LBP, of both sexes, from various social-
economic backgrounds. Individuals with tumours, traumas, infections,
inflammatory disorders and compromised nerve roots were excluded.
METHODS: In the first phase, we translated and adapted the
questionaire as specified by Beaton et al (2000). In the second
phase, the translated and adapted questionnaire was applied on
the sample in order to evaluate the psychometric properties of
reliability (n=20), concurrent validity and internal consistency (n=40).
To evaluate concurrent validity, we used the Roland Morris (RM)
disability questionnaire. The research project was approved by the
Pontificia Universidade Católica ethics committee. ANALYSIS: We
used intra-class correlation coefficients (ICCs), Minimal detectable
change scores (MDCs), and Standard Error of the measurement
(SEM) to analyse reliability, Pearson’s r for concurrent validity and
Cronbach’s alpha for internal consistency. The statistical analyses
were done by a blinded statistician. RESULTS: ICC values for
reliability were of 0.75 for the external subscale (p < 0.01), 0.87 for
the internal subscale (p < 0.01) and 0.90 for the chance subscale
(p < 0.01). The MDC values were 6.84, 6.77 and 5.59 for the
external, internal and chance subscales respectively. The SEM
values were 2.96, 2.92 and 2.42 for the same subscales respectively.
With regard to the concurrent validity, the external and chance
subscales correlated positively with disability (r = 0.58; p < 0.01 for
external and r = 0.35; p < 0.05 for chance respectively) whilst the
internal subscale correlated negatively (r = −0.33; p < 0.05). The
Alpha-Cronback value for the scale was 0.75 and when each
item was excluded it varied between 0.71-0.75. CONCLUSIONS:
The Brazilian-Portuguese version of the MHLC scale for individuals
with non-specific chronic LBP in Brazil showed excellent reliability,
no problematic items and good internal consistency. Individuals
with higher scores for the internal subscale demonstrated lower
disability levels whilst those with higher scores on the external
S484
and chance subscales showed greater disability. IMPLICATIONS:
The Brazilian-portuguese version of the MHLC scale is a useful
tool for clinicians to evaluate Brazilians suffering with LBP. Future
research should investigate whether physiotherapy interventions alter
the health locus of control of Brazilians suffering with chronic
LBP and the impact of these changes on clinical outcomes
such as disability. KEYWORDS: Low back pain, health locus of
control, scales. FUNDING ACKNOWLEDGEMENTS: This work was
unfunded. CONTACT: viniciuscunhaoliveira@yahoo.com.br
ETHICS COMMITTEE: Pontificia Universidade Católica ethics
committee
Research Report Poster Display
38-11 Tuesday 5 June 15:30
VCEC Exhibit Hall B & C
THE EFFECTS OF KINESIO TAPING ON SCAPULAR
KINEMATICS IN BASEBALL PLAYERS WITH SHOULDER
IMPINGEMENT SYNDROME
Shih Y1,2 , Hsu Y1 , Chen W1,2 ; 1 Faculty and Institute of Physical
Therapy, National Yang-Ming University, Taipei, Taiwan; 2 Research
and Education Department, Taipei City Hospital, Taiwan
PURPOSE: Scapular dysfunction often occurs with shoulder im-
pingement. The resultant alternations in scapular kinematics may
lead to further shoulder injury and pain. Although Kinesio taping
techniques are commonly used in treating this type of dysfunction
in the Asia Pacific region, no research has ever been conducted to
investigate the effects of Kinesio taping on the scapular kinematics.
This study aimed to assess the immediate effects of Kinesio taping on
scapular kinematics in baseball players with shoulder impingement.
RELEVANCE: With the growing use of therapeutic taping in the
sports injury management, we would like to establish the therapeutic
effect of Kinesio taping on the scapular dysfunction and to explore
the mechanism of the treatment effect. The results of this study could
provide an evidence-based clinical practice when treating athletes
with shoulder pain. PARTICIPANTS: Twenty baseball players with
shoulder impingement were recruited from amateur baseball teams
in the Taipei area, and were randomized into an experimental-first
or a placebo-first group. Seventeen subjects finished the study.
METHODS: Subjects received both types of taping with at least three
days in between. The Kinesio tape was used in the experimental
session, and the 3M Micropore tape in the placebo session. The
tape was applied to wrap around the lower trapezius muscle.
The testing tasks included three trials of shoulder elevation in the
scapular plane (scaption) with a 2 kg load in the testing hand.
During scaption, the data of the 3-dimensional motion of the scapula
were collected using Liberty electromagnetic tracking system before
and after taping application. ANALYSIS: The raw data of the 3-
dimensional scapular movement were transformed into anatomically
bound coordinate systems according to the recommendations from
ISB (International Society of Biomechanics). The six components
of scapular movement, upward/downward rotation, internal/external
rotation, anterior/posterior tilt, superior/inferior displacement, me-
dial/lateral displacement, and anterior/posterior displacement were
described in relation to the arm elevation angle. Analyses of
variance (ANOVA) with repeated measures were used to compare
the differences in the scapular kinematics between the two types of
taping. RESULTS: With increased arm elevation, the scapula rotated
upward and internally, tilted posteriorly, and moves superiorly and
medially. Compared to the placebo taping, Kinesio taping significantly
increased the scapular posterior tilt at 30º and 60º of scaption
(p < 0.05). CONCLUSIONS: This is the first study conducted to
examine the effect of Kinesio taping on the scapular kinematics
in baseball players with shoulder impingement. The results of this
investigation proved that use of Kinesio taping improve the scapular
movement in baseball players with shoulder impingement syndrome.
Further research should be carried out to promote the understanding
of the taping mechanisms and its long-term treatment effect on
WCPT 2007, Research Reports
the shoulder and scapular dysfunction, injury prevention and sports
performance. IMPLICATIONS: The application of Kinesio taping
resulted in positive changes in the scapular motion and could be
used as a treatment aid in managing baseball players with shoulder
impingement problems. KEYWORDS: taping, scapular kinematics,
shoulder impingement. FUNDING ACKNOWLEDGEMENTS: This
study was partly sponsored by the National Science Council, Taipei
City Hospital, and China Medical University, Taiwan. CONTACT:
yfshih@ym.edu.tw
ETHICS COMMITTEE: Institutional Review Board (IRB) National
Yang Ming University
Research Report Poster Display
38-15 Tuesday 5 June 15:30
VCEC Exhibit Hall B & C
THE EFFECTS OF SPORTS PHYSICAL THERAPY ON NATIONAL
COMPETITIVE SWIMMERS
Kimura T1 , Sakai Y2 , Uchida Y3 ; 1 Department of Physical Therapy,
School of Health Sciences, Shinshu University; 2 Department
of Physical Therapy, College of Medical and Human Services in
Toyama; 3 San·ai Hospital
PURPOSE: The purpose of this study was to clarify the effects of
sports physical therapy on the athletes of the national Japanese
swimming team. RELEVANCE: This study is useful for providing
guidelines in the clinical decision making process for physical therapy
intervention programs, by clarifying the effects of sports physical ther-
apy such as physical modalities and manual therapy on the athletes
in the national swimming team. PARTICIPANTS: The subjects in this
study were forty-two swimmers (17 female, 25 male; mean age ±
SD, 21.3±2.7 years; range, 16-27 years) from the Japanese national
swimming team at an international swimming competition in 2006.
METHODS: Physical modalities consisting of therapeutic ultrasound
and direct current stimulation, and manual therapy consisting of
mobilization, massage, and stretching, were executed to improve
the local muscle fatigue and muscle pain in swimmers during pre-
competition and competition phases. To determine the effects of
these interventions, a numeric rating scale (NRS) was analyzed
before and after all interventions. ANALYSIS: Mann-Whitney U test
was used for analysis of the changes in NRS in the local muscle
fatigue and muscle pain between pre and post-intervention periods.
Statistical significance level was set at 0.05. RESULTS: During
sixteen-day study period which included a pre-competition phase
(twelve days) and competition phase (four days), a total of eighty-
two swimmers utilized the sports physical therapy service provided.
The area of local muscle fatigue where the swimmers complained
the most (in descending order) included the low back (20.6%),
thigh (14.1%), shoulder, upper back and buttocks (11.3%), calf
(10.7%), neck (8.2%), upper arm (5.5%), and others (6.9%). The
area of muscle pain where the swimmers complained the most (in
descending order) included the low back (53.8%), neck (17.9%),
shoulder (7.7%), buttocks and thigh (5.1%), and others (10.3%). With
regards to local muscle fatigue, the mean (±SD) values of NRS
pre and post-intervention were 5.5 (±1.5) and 2.2 (±0.9), and this
was significantly different (p < 0.01). With regards to muscle pain, the
mean (±SD) values of NRS pre and post-intervention were 5.5 (±2.1)
and 2.6 (±1.1), and this was also significantly different (p < 0.01).
CONCLUSIONS: From the results of this study, it is believed that the
comprehensive intervention to the local muscle fatigue and muscle
pain were important in improving the performance of the swimmers.
Since it was observed that intervention by physical modalities and
manual therapy demonstrated significant effects for local muscle
fatigue and muscle pain, it is believed that these interventions should
be available for prevention and treatment of sports disorders such as
low back pain in swimmers. However, since outcome evaluation in
this study was analyzed based on the interactive effects of physical
modalities and manual therapy, it is thought that further studies are
needed to clarify the individual effects of sports physical therapy.
Platform Presentations, Wednesday 6 June
IMPLICATIONS: The results from this study can be used to guide
clinicians in their decision making process for determining the most
appropriate physical therapy treatment for competitive swimmers.
KEYWORDS: Sports physical therapy, Physical modalities, Man-
ual therapy, Swimming. FUNDING ACKNOWLEDGEMENTS: Nil.
CONTACT: tkimura@gipac.shinshu-u.ac.jp
ETHICS COMMITTEE: Japan Swimming Federation
Research Report Poster Display
38-19 Tuesday 5 June 15:30
VCEC Exhibit Hall B & C
THE EFFECTS OF WEARING SPORTS TIGHTS DURING
TRAINING ON LOWER LEG VOLUME IN PROFESSIONAL
RUGBY LEAGUE PLAYERS
Morgan K1,2 , Alonso A1 , Adams R3 ; 1 Bulldogs National Rugby
League Club, Sydney, Australia; 2 Parramatta National Rugby
League Club, Sydney, Australia; 3 School of Physiotherapy,
University of Sydney, Sydney, Australia
PURPOSE: Swelling, or an increase in limb volume, has been found
to occur following high intensity exercise. Swelling has been linked to
muscle damage, which requires a recovery period before maximum
function can be regained. Applying a compression garment is one
possible method of limiting exercise-induced swelling or increased
limb volume. The aim of the present study was to determine if in fact
lower leg volume is increased in professional rugby league players
following a training session, then to determine what effect sports
tights might have on lower leg volume if worn during a similar training
session. RELEVANCE: If the swelling that occurs following high in-
tensity exercise is limited or even prevented then recovery times may
be improved following intense training sessions. PARTICIPANTS:
Twenty four professional first-grade rugby league players volunteered
to take part in the study. METHODS: The players were assigned to
one of three training groups; endurance, sprint and weight training.
Lower leg volume up to the popliteal crease was measured before
and after two separate training sessions using water displacement
volumetry. Thirteen players volunteered to wear sports tights during
training during the second session. All subjects filled out a question-
naire before and after each training session, rating their feelings of
leg fatigue on visual analogue scales. ANALYSIS: Statistical analysis
was performed using SPSS for windows (v10.0). Descriptive statistics
were obtained, including the mean pre and post training lower leg
volumes as well as standard error and standard deviation. Descriptive
data was then analysed using paired samples t tests to determine
if any significant change in volume had occurred. The same method
was used to analyse the self-reported data obtained from the visual
analogue scales. RESULTS: Mean lower leg volume increased signif-
icantly by 30.31ml (p = 0.001) when subjects trained without sports
tights. The endurance group recorded the largest volume increase
(31.15ml).When sports tights were worn lower leg volume was
unchanged following training. The volume increases in the endurance
group coincided with significant increases (p < 0.05) in post training
ratings of leg tiredness, swelling and muscle twitching. When subjects
from the endurance group wore sports tights during training there
were no significant changes to lower leg volume, or to feelings of leg
fatigue. As well, the group reported a significant increase in subjective
ratings of training performance following training with sports tights.
CONCLUSIONS: In this sample of professional rugby league players
lower leg volume was significantly increased following training.
Endurance training resulted in the largest volume increase followed
by sprint training and weight training. Sports tights, when worn during
training, worked to limit the observed lower leg volume increase.
These preliminary data suggest that the compression applied by
sports tights is sufficient to prevent an increase in fluid accumulation
in working limbs, possibly by altering the hydrostatic pressure gradi-
ent. IMPLICATIONS: Sports tights work to limit the lower leg volume
increases seen following training. If the lower leg volume increases
presented here are indicative of muscular damage then sports tights
S485
may work to improve recovery rates following training. KEYWORDS:
Exercise, Recovery, Volumetry. FUNDING ACKNOWLEDGEMENTS:
None. CONTACT: kieren.morgan@parraeels.com.au
ETHICS COMMITTEE: Ethics and Biosafety Committee, University
of Sydney.
Platform Presentations, Wednesday
6 June
Research Report Platform Presentation
777 Wednesday 6 June 08:30
PP Crystal Pavilion A
PROFESSIONAL SOCIALIZATION BEGINS: PERSPECTIVES
FROM FIRST YEAR PHYSIOTHERAPY STUDENTS
Solomon P, Miller P; McMaster University, School of Rehabilitation
Science, Hamilton, Canada
PURPOSE: The purpose of this study was to examine the formal and
informal influences on the professional socialization of physiotherapy
students as they enter their educational programs. RELEVANCE:
Professional socialization is the process through which individuals
acquire the knowledge, skills, values, attitudes and beliefs of the
profession. Little is known about this process in physiotherapists yet
the impact of formal and informal curricula, and role modeling by
faculty and clinicians can have a profound impact on students’ career
goals and aspirations. PARTICIPANTS: Eleven masters-entery level
physiotherapy students with a mean age of 24.4 years volunteered
to participate. There were 8 women and 3 men. Students were
enrolled in a 2 year Canadian program with a problem-based learning
curriculum. METHODS: In a qualitative, phenomenological design,
the students participated in individual semi-structured face-to-face
interviews within the first 6 weeks of their program. The interviewer
was not a faculty member and was not known to the students.The
students answered questions about the roles of physiotherapists,
what it means to be a professional, societal views of the profession,
views on research and future job preferences. ANALYSIS: Interviews
were audiotaped and transcribed verbatim. The insetigators reviewed
2 transcripts together to develop a coding scheme, apply the
scheme to the data and identify themes. Subsequent transcripts were
reviewed independently, then together, with differences in assigned
codes and themes reconciled. RESULTS: Within 6 weeks of their
physiotherapy program, the students had well-developed perceptions
of the knowledge, skills and values of the profession. Six themes
were identified (in brackets). Students perceived the role of the
physiotherapist to be “hands-on” with a focus on improving function
(“A Functional Role”). They had difficulty describing the meaning
of professionalism although they did identify honesty and integrity
as important (“Being Professional”). Students recognized the value
of research and were distressed about the paucity of research in
many areas (“Perceptions of Research”). They felt that there were
conflicting societal views about the value of the profession to society
(“Conflicting Societal Views”). Students spoke of a wide range of
career possibilities, although they did not want to work in geriatrics
or cardiorespiratory practice (“A World of Possibilities”). Student
identified their sincere desire to help others and their interest in
working with people as motivation for entering the profession (“Al-
truistic Motivation”). CONCLUSIONS: Results indicate that students
enter their educational programs with many preconceived ideas
about the profession. IMPLICATIONS: The findings support early
education about the scope of the profession, professionalism and
career opportunities. As students tend to embrace values that are
espoused by their educational programs it is important that faculty
instill professional values through formal curriculum and informal role
modelling. KEYWORDS: professionalism, education, professional
socialization. FUNDING ACKNOWLEDGEMENTS: This project was
funded by an internal grant from the School of Rehabiliation Science
at McMaster University.
ETHICS COMMITTEE: Research Ethics Board McMaster University
S486
Research Report Platform Presentation
1153 Wednesday 6 June 08:30
VCEC Ballroom A
WHAT MAKES A CLINICAL PLACEMENT EXCELLENT? A
SURVEY OF MANITOBAN PHYSIOTHERAPISTS
Stevenson T1,2 , Garrett M2 , Fruehm C2,3 ; 1 St. Boniface General
Hospital, Winnipeg, Canada; 2 School of Medical Rehabilitation,
University of Manitoba, Winnipeg, Canada; 3 Health Sciences
Centre, Winnipeg, Canada
PURPOSE: To examine the factors that registered physiotherapists
(PTs) in Manitoba believe to be important in making entry-to-
practice (ETP) clinical placements excellent. RELEVANCE: The ETP
Physical Therapy curriculum at the University of Manitoba (UofM)
has academic and clinical education (ClinEd) components. In 2004-
2005, the ClinEd component constituted 24% of the credit hours
and 40% of the contact hours. Student feedback has indicated
consistently that ClinEd is valued highly as the major opportunity
in the curriculum to apply and integrate material presented in the
academic component. As such, ongoing effort to optimize ClinEd
experiences is warranted. Our first step was to survey PTs regarding
their opinions of the factors that led to an excellent ClinEd experience.
PARTICIPANTS: All PTs licensed to practice in Manitoba (n=562)
were surveyed. METHODS: A questionnaire requiring respondents
to rate each of 37 statements that reflected factors thought to have
influence on the quality of ClinEd was developed. A final summary
question asked respondents to identify the 3 factors believed to be
most important in making a clinical placement excellent. All potential
respondents were mailed a package containing a questionnaire, a
cover letter, and a postage-paid return envelope. ANALYSIS: The
number of respondents who identified each of the statements in
the summary question was determined. Subgroups were formed
on the basis of various characteristics of respondents thereby
permitting between-group comparisons using Chi Square Tests for
Association. RESULTS: The overall response rate was 55% (n=305).
The vast majority of respondents had obtained their ETP credentials
from the UofM (n=250; 82%) an average of 15.7 years prior to
this project (range: 0-40 years); 50% (n=152) had served as a
Clinical Instructor (CI) in the past year. The summary question
was completed by 292 respondents (96% of respondents). The
following 5 statements were identified most often: “The student’s
initiative in taking responsibility for their own learning” (n=113, 39%);
“Availability of suitable clients during the placement” (n=104, 36%);
“The CI provides constructive feedback” (n=69, 24%); “The CI enjoys
supervising students” (n=53, 18%); and, “The student’s enthusiasm
about working with the client population” (n=52, 18%). Respondents
who had supervised a student in the previous year (n=149) did not
differ from those who had not (n=135) in the statements listed in
the summary question (c2 = 1.099, df=4, p = 0.894). Similarly, CIs
who reported supervising fewer than 5 students over their careers
(n=95) seemed to prioritize the same statements as those CIs
who had supervised more than 20 students (n=62) (c2 = 4.817,
df=4, p = 0.307). CONCLUSIONS: There was no clear consensus
among our respondents about what factors were associated with an
excellent clinical placement with only 2 statements being identified
by more than one third of the respondents. The consistency with
which specific statements were prioritized by different subgroups
was remarkable. One reason for this might be that our respondents’
formative experiences for ClinEd were obtained while they are
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:
tstevens@sbgh.mb.ca
ETHICS COMMITTEE: Health Research Ethics Board, Bannatyne
Campus Researcdh Ethics Office, Unviversity of Manitoba
WCPT 2007, Research Reports
Research Report Platform Presentation
1085 Wednesday 6 June 08:30
VCEC Meeting Rooms 1-3
INFLUENCE OF REDUCED PRACTICE ON THE RELIABILITY
OF THE STAR EXCURSION BALANCE TEST
Lane J, Varley E; Queen Margaret University College, Edinburgh, UK
PURPOSE: To determine whether reliability of the Star Excursion
Balance Test (SEBT) is influenced by the type of practice undertaken.
RELEVANCE: The SEBT is a method of assessing dynamic
balance particularly following musculoskeletal injury. Previous studies
concluded that at least 6 trials of the test in all 8 directions (i.e.
48 reaches) are required before reliable results are achieved. Such
practice may limit the clinical usefulness of the test due to the time
required and the potential for patient fatigue. This study therefore
aimed to determine whether practice could be reduced without
negatively influencing the reliability of the SEBT. PARTICIPANTS:
A convenience sample of 30 healthy volunteers (median age 24.5
years) was recruited by word of mouth, emails and posters, from
a student population. METHODS: Ethical approval was provided by
Queen Margaret University College. Participants were randomised
to either: reduced trial practice, reduced direction practice or control.
The reduced trial practice group completed 3 practice trials in all 8
directions. The reduced direction practice group undertook 6 practice
trials in only the antero-medial, antero-lateral, postero-lateral and
postero-medial directions. The control group undertook no practice.
Both practice groups completed 24 reaches in total in order to
control for differences between groups due to fatigue. Following
practice, each participant rested for 5 minutes before undertaking
3 master trials in all directions. Reach distances by the dominant
leg were recorded (in cm), by a single researcher. ANALYSIS: Data
were normalised to leg length before analysis. Intra-class correlation
coefficients (2,1) and the standard error of measurement (SEM) were
used to determine the reliability of the three master trials. A mean
of the three trials was also calculated and a one-way ANOVA was
used to test for differences between groups in each direction. The
alpha level was 0.05. RESULTS: ICC’s for the reduced trial group
were >0.82 in all directions. The mean SEM was 2.3cm. ICC’s for
the reduced direction group were >0.9 for all directions including
those that had not been practiced. The mean SEM was 1.8cm.
ICC’s for the control group were >0.7 except for the three medial
directions (0.525-0.686). The mean SEM was 4.6cm. There were
no significant differences between reach distance in any direction
between the three groups (p > 0.05). CONCLUSIONS: Reducing
the overall number of practice trials of the SEBT by either limiting
the number or direction of the practice both results in acceptable
reliability. Both practice groups showed better reliability than the
control group although acceptable reliability in 5 out of 8 directions
was obtained without any practice at all. Results do not support
previous work which suggests that practice of 6 trials in all 8
directions is necessary although the use of healthy participants
limits generalisations to a wider population and further work may
include a patient group. Further work is also required to determine
whether reducing both direction and amount of practice is possible.
IMPLICATIONS: Practice of the SEBT can be reduced to three full
trials or eight reduced direction trials without negatively influencing
reliability of the results. KEYWORDS: SEBT; practice; reliability.
FUNDING ACKNOWLEDGEMENTS: No funding was received in
support of this work. CONTACT: jlane@qmuc.ac.uk
ETHICS COMMITTEE: Subject Area of Physiotherapy Ethics Panel,
Queen Margaret University College
Platform Presentations, Wednesday 6 June
Research Report Platform Presentation
628 Wednesday 6 June 08:30
VCEC Meeting Rooms 11-12
EXERCISE IN THE REHABILITATION OF SUBSTANCE
MISUSERS: A QUALITATIVE STUDY OF SERVICE USERS AND
STAFF PERCEPTIONS AND EXPERIENCES
Dawes J1,2 , Mutrie N1 ; 1 University of Strathclyde, Glasgow, United
Kingdom; 2 Greater Glasgow NHS, Glasgow, United Kingdom
PURPOSE: The purpose of this research was to establish the per-
ceived benefits of exercise in the rehabilitation of substance misusers.
Additionally, barriers to attendance were explored. RELEVANCE:
Substance misuse is a growing health problem both in Scotland
and across the world. Current literature suggests that exercise is
offered in substance misuse rehabilitation facilities, despite limited
evidence supporting the efficacy of this approach. This study will
be of particular interest to physical therapists working in the field of
substance misuse rehabilitation and to those working in a community
or hospital setting with people who suffer from addiction problems.
PARTICIPANTS: Following the completion of a structured exercise
programme, purposeful sampling was used to recruit information rich
cases for interview. Seven people, of an age range 28 years to
43 years were recruited, including: three people who successfully
completed the ten week exercise programme, one person who
started but did not complete and one person who agreed to
participate, but did not attend. A staff member from the community
drugs team and a staff member who provided the exercise sessions
were also interviewed. The structured exercise programme involved
people suffering from substance misuse problems attending a
local authority gym once per week and carrying out an exercise
programme tailored to their physical activity needs by a trained fitness
instructor. METHODS: In depth, semi-structured interviews were
used to collect data. The interview schedules were systematically
created by identification of themes from the research questions,
critically examined by technical experts and piloted. The interviews
were then carried out, recorded with a Dictaphone and transcribed
verbatim. ANALYSIS: Analysis involved the researcher becoming
deeply familiar with the data set to identify direct quotes as “raw
data themes”. These were then compared and contrasted and those
with common threads were clustered to create a collection of first-
order themes. This process was repeated until no further groupings
could be made. The remaining groups were labelled as “general
dimensions”. RESULTS: The results of the investigation were
positive. The group was well received, physical and mental health
benefits were identified and it was felt that exercise could assist in
preventing relapse of substance misuse amongst participants. There
was also the perception that the group facilitated social functioning
of the participants and impacted on their physical activity habits.
However, there was recognition that many barriers to attendance
existed in the lives of participants and that significant support from
the community drugs team staff was required to facilitate attendance.
CONCLUSIONS: This study provides preliminary evidence that
exercise may be of value in the rehabilitation of substance misusers.
Further research is required to establish in greater detail firstly, the
mechanisms of how these benefits are achieved and secondly, to
investigate the types of exercise programmes that promote adher-
ence and provide benefit. IMPLICATIONS: This research suggests
that physical therapists and other health care workers involved
in the rehabilitation of people suffering from substance misuse
problems should consider the use of exercise for this client group and
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: joannadawes@nhs.net
ETHICS COMMITTEE: Faculty of Biomedical and Life Sciences,
University of Glasgow & Department of Sports, Culture & the Arts,
University of Strathclyde
S487
Research Report Platform Presentation
981 Wednesday 6 June 08:30
VCEC Meeting Room 16
AMBULATORY ACTIVITY, QUALITY OF LIFE, AND COMMUNITY
MOBILITY OF STROKE SURVIVORS DURING THE TRANSITION
FROM HOSPITAL TO HOME
Manns T1 , May L1 , Chard G2 , Edney P2 ; 1 Department of Physical
Therapy, University of Alberta; 2 Department of Occupational
Therapy, University of Alberta
PURPOSE: To determine the course of changes in ambulatory
activity, quality of life, and community mobility in stroke survivors
during the transition from hospital to home. RELEVANCE: The scope
of practice of physical therapists is expanding to include a greater
emphasis on services in the community for community dwelling stroke
survivors. PARTICIPANTS: Five participants have been enrolled to
date. Participants were inpatients in a large rehabilitation hospital
where they were receiving treatment for a first stroke. In order to be
included, participants were required to be ambulatory (able to walk at
least 10 m with or without assistance), and have a discharge location
of their own home or an assisted living environment. METHODS:
Participants were seen at three different time periods, once in
the rehabilitation hospital (between 4-10 days prior to discharge –
time 1), and twice after discharge (at 2 weeks [time 2] and 6
weeks post discharge [time 3]). Ambulatory activity was measured
at all three times periods using the step activity monitor (Cyma
Corporation, Mountlake Terrace, WA). Health related quality of life
was measured using the stroke impact scale, at all three time
periods. The life space assessment was used to measure community
mobility during the two week and six week post discharge visits. An
individual interview was conducted with the participants six weeks
post discharge to explore the phenomenom of the hospital to home
transition. ANALYSIS: A repeated measures analysis of variance
was used to determine if there were differences in the dependent
variables (ambulatory activity, quality of life, community mobility)
across the three time periods. Inductive analysis using N-Vivo 7
identified themes and categories of the participants’ perceptions of
the transition from hospital to home. RESULTS: Participants were
62 ±18 years old and 78 ±27 days post stroke. Ambulatory activity
was not different between the 3 times periods (6706 steps/day at
time 1, 5700 steps/day at time 2, 6446 steps/day at time 3)(F=0.708,
p = 0.462). The score on the physical domain of the stroke impact
scale increased from time 1 to time 3 (63 to 76) but was not
significantly different across time periods (F=5.490, p = 0.079). The
participation, memory, communication, and emotional domains on the
stroke impact scale did not change across the three time periods.
Community mobility as measured by the life space questionnaire
increased from 37.9 to 44.7 from time 2 to time 3, and not significantly
different (t=-1.890, p = 0.132). Inductive analysis uncovered themes
related to adjustment, unwanted dependence, new priorities, and
need for services. CONCLUSIONS: There was no change in
ambulatory activity and domains on the stroke impact scale during
the six week transition period. IMPLICATIONS: An understanding
of the course of changes for stroke survivors during the transition
period will assist physical therapists to provide appropriate services
during that transition period. KEYWORDS: community reintegration,
ambulatory activity, transition. FUNDING ACKNOWLEDGEMENTS:
This study was funded by the Physiotherapy Foundation of Canada.
CONTACT: trish.manns@ualberta.ca
ETHICS COMMITTEE: Health research ethics board (Health Panel) –
University of Alberta
S488
Research Report Platform Presentation
1218 Wednesday 6 June 08:30
VCEC Meeting Room 17
THE CONTRIBUTION OF GLUTEUS MAXIMUS AND GLUTEUS
MEDIUS TO FRONTAL PLANE STABILITY OF THE HIP: AN
ANATOMICAL STUDY
Conneely M1 , O Sullivan K2 , Edmondston S3 ; 1 Private Practitioner,
Co. Galway, Ireland; 2 University of Limerick, Ireland; 3 Curtin
University of Technology, Perth
PURPOSE: To evaluate if the functional roles of gluteus maximus
and gluteus medius in hip frontal plane stability, as proposed in the
literature, are supported by their underlying anatomy. RELEVANCE:
Gluteal muscle dysfunction has been implicated in a variety of pelvic
and lower limb disorders. Rehabilitation of gluteus medius, especially
the posterior fibres of gluteus medius, is often advocated in the
rehabilitation of these disorders. It has been suggested, however,
that the proposed importance of gluteus medius in frontal plane
stability does not correlate with its small size. Furthermore, it has
been proposed that the greater size of gluteus maximus, and its
attachment to the iliotibial band (ITB), indicates it may also contribute
significantly to frontal plane stability. PARTICIPANTS: One adult male
cadaver METHODS: All skin and subcutaneous tissue, including
the gluteal fascia, was removed. Gluteus maximus, gluteus medius
and their anatomical relations, particularly the ITB, were identified.
Gluteus maximus was dissected at its ITB insertion and reflected
medially, to facilitate complete observation of gluteus medius and
all anatomical connections. Gluteus medius was then dissected
in an antero-posterior direction across its mid-substance, exposing
all anatomical relations and gluteus minimus. ANALYSIS: Digital
images were taken at each stage of the dissection process. The
angle of muscle fibre orientation for each part of both muscles
was calculated, using the specimen midline as a reference. Muscle
thickness (cm) was calculated, using calipers, for each part of
both muscles. Surface area (cm2 ), of both muscles was calculated
electronically using the digital images. RESULTS: Gluteus maximus
was strongly connected to the iliotibial band, while the insertion of
gluteus medius enveloped the greater trochanter. The surface area of
gluteus maximus was significantly larger than that of gluteus medius.
Average muscle thickness was similar in both (1.3cm), with large
intramuscular variations in thickness (1.1-1.6cm). There were also
major differences in muscle fibre orientation, both between gluteus
maximus and medius, and also between the functional subdivisions of
each muscle. CONCLUSIONS: Fascial connections, and similarities
in muscle fibre orientation, between superior gluteus maximus and
posterior gluteus medius, support a suggested synergistic action in
the control of frontal plane stability. IMPLICATIONS: The synergistic
activation of gluteus maximus and gluteus medius, rather than
the isolated activation of one particular muscle, should be an
important consideration in the assessment and rehabilitation of hip
frontal plane stability. Further research is needed to verify these
findings in larger samples, and to relate any proposed rehabilitation
strategies to improved outcomes. KEYWORDS: Anatomy, dissection,
physiotherapy, gluteal region. FUNDING ACKNOWLEDGEMENTS:
None. CONTACT: kieran.osullivan@ul.ie
ETHICS COMMITTEE: Curtin University Ethics committee
Research Report Platform Presentation
1013 Wednesday 6 June 08:30
VCEC Meeting Room 18
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
WCPT 2007, Research Reports
complaints of the arm, neck or shoulder (CANS). We evaluated
whether conservative interventions have a significant impact on
outcomes for work related CANS. RELEVANCE: The relevance of
this systematic review in contributing to the body of knowledge
concerning the efficacy of interventions in non-specific work related
CANS lies mainly in the fact that it points out a clear lack of evidence
regarding the effectiveness of most often prescribed interventions.
Most important difficulties found here are: lack of a definition of
‘work-relatedness’, the wide variety of interventions used to treat
people with possible CANS, and the overall poor methodological
quality. PARTICIPANTS: not applicable METHODS: A systematic
review. Only (randomised) trials studying conservative interventions,
for patients suffering from work related CANS will be included.
Interventions may include exercises, relaxation, physical applications,
biofeedback, myofeedback and work place adjustments. Two authors
independently selected the trials, assessed methodological quality
and extracted data. ANALYSIS: We pooled data or, in the event
of clinical heterogeneity or lack of data, we used a rating system
to assess levels of evidence. RESULTS: We included 26 studies
(in total 2376 patients), 23 studies included patients with chronic
non-specific neck and shoulder complaints or non-specific upper
extremity disorders. Over 30 interventions were evaluated; seven
main subgroups of interventions could be determined, of which
the subgroup ‘exercises’ was the largest one. Overall, the quality
of the studies appeared to be poor. CONCLUSIONS: There is
limited evidence for the effectiveness of exercises when compared
to massage; adding breaks during computer work; massage as
add-on treatment on manual therapy, manual therapy as add-on
treatment on exercises; and some keyboards in people with carpal
tunnel syndrome when compared to other keyboards or placebo. For
other interventions no clear effectiveness could be demonstrated.
IMPLICATIONS: Implications for practice. In conclusion, this review
shows limited evidence for the efficacy of specific keyboards with
an alternative force-displacement or geometry only for participants
labelled with carpal tunnel syndrome. There is limited evidence
for the efficacy of exercises when compared to massage; adding
breaks during computer work; massage as an add-on treatment on
manual therapy, and manual therapy as an add-on treatment on
exercises in participants with non-specific work-related complaints.
The benefit of (expensive) ergonomic interventions in the workplace
is not clearly demonstrated. Implications for research: 1. There is
a need for an agreed definition of what can be considered as a
’work-related disorder’. This way a clear patient population can be
selected for future studies. 2. Future research should examine clear
and well defined interventions not only in pragmatic trials comparing
various conservative interventions with each other, but also in more
explanatory trials comparing the intervention with a no treatment
control group. 3. Large, adequately powered trials are needed that
focus on appropriate allocation concealment, blinding of at least
outcome assessment and, if possible, patient and therapist and
an adequate data presentation and analysis. 4. The design and
reporting of future trials should conform to the CONSORT statement
(Altman 2001). KEYWORDS: randomised clinical trial, systematic
review, upper extremity disorder, physiotherapy, ergonomics, work
related. FUNDING ACKNOWLEDGEMENTS: This project is funded
by the Dutch Health Insurance Executive Board (CvZ). CONTACT:
a.verhagen@erasmusmc.nl
Platform Presentations, Wednesday 6 June
Research Report Platform Presentation
1261 Wednesday 6 June 08:30
VCEC Meeting Rooms 19-20
EXPERIENCES OF PATIENTS WITH CHRONIC LOW BACK PAIN
OF TREATMENT WITH SPINAL STABILIZATION EXERCISES
Sokunbi O1 , Moore A1 , Watt P2 ; 1 Clinical Research Centre
for Health Professions, University of Brighton, Eastbourne, UK;
2 Department of Sport and Exercise Science, Chelsea School,
University of Brighton, UK
PURPOSE: The aim of this study was to elicit valuable information of
the experiences of patients who participated in a spinal stabilisation
programme within a randomised controlled trial (RCT). This qualita-
tive study was part of a large mixed methods study into the effects
of spinal stabilisation exercises on participants with chronic low back
pain. It was hoped that this study would expose the possible reasons
for the treatment benefit demonstrated in the RCT incorporating
spinal stabilisation exercises. RELEVANCE: The results of many
randomized clinical controlled trials (RCTs) on the efficacy of
commonly utilized therapeutic interventions for chronic back disorder
indicate a clear trend in favour of spinal stabilizing exercises.
However, there is limited evidence on the patients’ perception of this
treatment and their overall experience of the treatment programme.
PARTICIPANTS: Participants were selected (purposive sampling)
from among those who participated in a randomised controlled trial
(RCT) on the use of stabilization exercises in the treatment of chronic
low back pain. Nine participants (male = 3, female = 6) took part in the
study. Four people participated in the first focus group interview while
five participants participated in a second focus group. METHODS:
A semi-structured interview comprising of open ended questions
were used and audio recording was used to record participants’
opinions during the interview process. ANALYSIS: Careful checking,
reading and correction of the transcript from the interviews was
carried out and a thematic content analysis was conducted on
the data. RESULTS: The main themes that emerged from the
data analysis included. 1)Participants perceptions of the causes
and aggravating factors for their low back disorders. 2)Physical
dimensions of participants chronic low back disorder experience.
3)Emotional and psychological dimensions of participants low back
disorders experience. 4)Perceived treatment effects on pain and
functional limitation. 5)The impact of treatment programme on
participants empowerment and self efficacy. 6)Impact of information
on participants attitude to treatment. 7)Relationship with the therapist.
8)Compliance with home exercise programme. 9)Suggestions for
improvement in future studies involving spinal stabilisation exercise
treatment. CONCLUSIONS: Participants appeared to be unequivocal
as regards their satisfaction with the treatment received during
this randomized controlled trial. However, opinions on what were
the major therapeutic benefits of the treatment presentation varied
from one participant to another. Participants’ explanation for the
perceived improvements included major increases in confidence
and formulation of self help strategies. They also reflected on
their ability to exert batter control over their back pain, due to
increase empowerment and self efficacy based on more knowledge
of the spine and how it works. IMPLICATIONS: Empowerment
and self efficacy enabled by increased awareness of what is
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:
o.g.sokunbi@brighton.ac.uk
ETHICS COMMITTEE: University of Brighton Research Ethics
Committee
S489
Research Report Platform Presentation
1102 Wednesday 6 June 08:50
VCEC Meeting Rooms 1-3
THE INFLUENCE OF PROPRIOCEPTIVE NEUROMUSCULAR FA-
CILITATION STABILIZATION TECHNIQUES ON STATIC BALANCE
Rugelj D, Seničar V, Sevšek F; University of Ljubljana/University
College of Health Studies, Ljubljana, Slovenia
PURPOSE: The purpose of the study was to evaluate the effect
of 4-week stabilization training with proprioceptive neuromuscular
facilitation (PNF) stabilization techniques on static balance in
young healthy subjects. RELEVANCE: PNF is a well-established
therapeutic approach. The assumption underlying its techniques is
based on the hierarchical model of neural organization; however,
scientific evidence for its effectiveness is moderate. PARTICIPANTS:
20 young healthy female subjects aged from 16 to 23 years
participated in the study. The participants were assigned into a
treatment and a control group. METHODS: The outcome measures
used were: timed one leg stance with eyes opened (EO) and eyes
closed (EC), tandem stance on compliant surface with EO and
EC, one leg stance on the narrow (2cm) beam with EO and EC.
The center of pressure (CoP) excursions during one leg stance
was measured with the Kistler 9286AA force plate. The sampling
frequency used was 50 Hz. The participants of the treatment group
took part in a 4-week training program, 5 times a week, 10 minutes
per session. The subjects were standing on one leg and the therapist
performed stabilizing reversals. In the first and the second treatment
week, stabilizing reversals on one leg lasted continuously 30 seconds
and than legs changed. In the third and the fourth week of treatment,
the continuous stabilizing reversals on one leg increased to one
minute. Stabilizing reversals were performed in the trunk, pelvic and
knee region in all directions. ANALYSIS: Paired t-Test was used for
the comparison of results within the group and t-Test for comparison
of the results between the two groups. RESULTS: All the participants
in both groups reached the maximum score of 60 seconds in the
initial and final measurements at one leg stance with EO and tandem
stance on the compliant surface with EO. For the treatment group
the difference after practice was statistically significant for one leg
stance with EC (p < 0.01), tandem stance on the compliant surface
with EC (p < 0.02), stance on the narrow (2cm) beam with EO
(p < 0.02), stance on the narrow (2cm) beam with EC (p < 0.004).
There was no statistically significant difference at any assessment
in the control group. Differences between the treatment and control
group reached significant levels for one leg stance (p < 0.02), one leg
stance on the narrow beam with EO (p = 0.002) and EC (p < 0.001).
The treatment protocol did not influence the CoP excursions and
its length of path during one leg stance with EO and EC. There
was no difference before and after treatment and it did not differ
between the two groups. CONCLUSIONS: The results support the
assumption that PNF techniques of stabilizing reversals improve
the subject’s efficacy of balance function as measured with clinical
outcome measures. However, there is no observed difference in the
body steadiness. It remains to be discovered whether we can attribute
these changes to the increase of muscle strength or endurance, or
if the process of motor learning plays the key role in improvement
of balance efficacy. IMPLICATIONS: The results support use of
stabilization techniques as an effective tool for balance retraining.
KEYWORDS: PNF, stabilization techniques, balance. FUNDING
ACKNOWLEDGEMENTS: none.
ETHICS COMMITTEE: State medical ethic commettee of Slovenia
S490
Research Report Platform Presentation
696 Wednesday 6 June 08:50
VCEC Meeting Rooms 11-12
DO VESTIBULAR INPUTS INFLUENCE STANDING BALANCE
IN ADULTS WITH A LOWER LIMB AMPUTATION DUE TO
VASCULAR DISEASE? A PRELIMINARY INVESTIGATION
Hendrie J1,2 , Earl M1,2 ; 1 Capital District Health Authority, Halifax,
Canada; 2 Dalhousie University, Halifax, Nova Scotia, Canada
PURPOSE: Amputation due to PVD is a major cost to health care
in many countries. After prosthetic rehabilitation, individuals often
have difficulty returning to functional independence. Balance control
is a major factor of functional independence. One important facet of
balance control is the ability to interpret sensory inputs for balance
control. These are received from the visual, somatosensory and
vestibular systems. Little literature exists about sensory inputs for
balance control, and none on the vestibular components of balance
in relation to this population. This preliminary project evaluated
the vestibular control of balance in individuals with lower limb
amputations by comparing the Clinical Test of Sensory Interaction
and Balance test 1 (CTSIB1 ) where all three inputs for balance
were available with test 5 (CTSIB5 ) where only vestibular inputs
for balance were accurate. The hypothesis was that CTSIB1 time
would be longer than CTSIB5 time. The influence of vestibular
inputs for balance control on balance confidence and age was
also explored. RELEVANCE: According to the literature, in current
physiotherapy practice, while function and mobility are routinely
assessed, sensory aspects for balance and in particular vestibular
inputs for balance control are not examined or treated in adults with
a lower limb amputation. It may be that if the ability to use vestibular
inputs for balance control were known, treatment of balance control
may be ameliorated in this population. PARTICIPANTS: Ten in-
patients on the rehabilitation ward of a rehabilitation centre in
a Canadian city and within 2 weeks of discharge, volunteered.
They were medically stable men aged 48–83 years with a lower
limb amputation due to Peripheral Vascular Disease and were
able to walk 6m independently with or without a walking aid.
METHODS: Participants performed the CTSIB test, and the Activity-
specific Balance Confidence (ABC) questionnaire was completed.
ANALYSIS: CTSIB1 and CTSIB5 were analysed using the Wilcoxon
signed ranks test. Pearson correlation coefficients were used to
explore the association between vestibular inputs for balance control
(CTSIB5 ) and balance confidence (ABC score) and age. Hypotheses
were evaluated using a = 0.05. RESULTS: The CTSIB5 median score
of 6.0s was significantly shorter than CTSIB1 score of 30.0s. (W
= 45, p < 0.05). The average ABC score was 71.9% ±19.9. The
average age was 62yrs ±13. CTSIB5 scores correlated with ABC
scores (r = 0.651, p < 0.05) and there was a trend towards correlation
with age (r = 0.813, p < 0.1). CONCLUSIONS: Results indicate
that towards the end of prosthetic rehabilitation, participants had
difficulty using vestibular inputs for balance control. Impaired ability
to use vestibular inputs appeared to be associated with decreased
balance confidence. IMPLICATIONS: Assessment and treatment of
the vestibular inputs for balance control by physiotherapists may
improve balance and therefore function in this population. The CTSIB
would be an affordable method of assessment of vestibular inputs
for balance in this population and may be easily reproduced in
different clinical settings. KEYWORDS: amputation, vestibular inputs,
balance. FUNDING ACKNOWLEDGEMENTS: Unfunded.
ETHICS COMMITTEE: Capital District Health Authority Research
Ethics Board approved the work.
WCPT 2007, Research Reports
Research Report Platform Presentation
2607 Wednesday 6 June 08:50
VCEC Meeting Room 16
EFFECTS OF TASK-SPECIFIC LOCOMOTOR AND STRENGTH
TRAINING IN AMBULATORY STROKE SURVIVORS
Sullivan K1 , Brown D2 , Klassen T1 , Mulroy S3 , Ge T1 , Azen S1 ,
Winstein C1 ; 1 University of Southern California, Los Angeles,
California, USA; 2 Northwestern University, Chicago, Illinois,
USA; 3 Rancho Los Amigos National Rehabilitation Center, Downey,
California, USA
PURPOSE: A phase II, multi-site, single-blinded, randomized clinical
trial (RCT) was conducted to determine the independent and
combined effects of task-specific and LE strength training on walking
outcomes post-stroke. RELEVANCE: Impaired walking ability is a
hallmark residual deficit that contributes to post-stroke walking dis-
ability. Impairment in lower extremity muscle strength is a significant
contributor to decreased walking speed after stroke. No studies
have combined task-specific locomotor training in combination with
lower extremity strength training programs designed to improve post-
stroke walking outcomes. PARTICIPANTS: Participants included
80 individuals (mean age 61±12.4 years) who were ambulatory,
but walked slower than 1.0 m/sec and were at least 6 months
post unilateral stroke (stroke onset 25±16.2 months). METHODS:
Participants were stratified by initial comfortable walking speed
(moderate>0.5 m/sec; severe 0.5 m/sec) and randomized to one
of four exercise pairs: 1) body-weight supported treadmill training
(BWST) and locomotor-based strength training (resistive cycling task,
LBST), 2) BWST and LE muscle-specific strength training (MSST),
3) BWST and upper extremity ergometry (SHAM), and 4) LBST and
SHAM.Training occurred 4 times per week for 6 weeks (24 total
sessions). Exercise type in each exercise pair was alternated daily.
Primary outcomes were comfortable and fast overground walking
speed, and distance walked in 6-minutes measured at baseline,
after 12 and 24 treatment sessions and at a 6-month follow-up.
ANALYSIS: Interactions between severity, treatment group, and time
were assessed by using a repeated measures ANOVA model for each
of the primary outcome measures. RESULTS: The BWST/SHAM
group had significantly greater increases in walking speed compared
to the LBST/SHAM group (pre-post change in comfortable velocity =
0.12 +/− 0.14 m/sec vs. 0.01 +/− 0.07 m/sec, p = .004), change in fast
velocity = 0.09 +/− 0.14 m/sec vs. 0.01 +/− 0.09 m/sec, p = .03), but
improvement in 6 min walk distance was comparable between the
two groups. All BWST groups made similar significant improvements
in walking speed and distance with training (p < 0.0001) that were
evident regardless of whether LE strength training (LBST, MSST)
was combined or not (SHAM). Walking improvements for the BWST
groups were maintained at the 6-month follow-up. CONCLUSIONS:
After stroke, task-specific training using body-weight support during
treadmill walking is more effective in improving walking speed than
resisted cycling. Furthermore, a moderate intensity LE progressive
resistive training program alternated daily with task-specific treadmill
walking did not provide an added benefit to walking outcomes.
IMPLICATIONS: The findings provide strong evidence for the
effectiveness of intense, task-specific training to improve walking
outcomes after stroke. Further work is necessary to determine how
exercise programs that combine muscle strengthening protocols
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
Platform Presentations, Wednesday 6 June
Research Report Platform Presentation
1389 Wednesday 6 June 08:50
VCEC Meeting Room 17
PASSIVE MECHANICAL PROPERTIES OF HUMAN
GASTROCNEMIUS MUSCLE-TENDON UNITS, MUSCLE
FASCICLES AND TENDONS IN VIVO
Hoang P1 , Herbert R1 , Gandevia S2 ; 1 University of Sydney,
Sydney, Australia; 2 Prince of Wales Medical Research Institute,
Sydney, Australia
PURPOSE: To develop a method for measuring mechanical
properties of muscle fascicles and tendons in resting humans
muscles in vivo, and to describe mechanical properties of resting
muscle fascicles and tendons of gastrocnemius in healthy adults.
RELEVANCE: Measurement of mechanical properties of resting
muscle fascicles and tendons on humans in vivo makes it possible to
investigate mechanisms of contracture in humans. PARTICIPANTS:
9 healthy adults. METHODS: The method described by Hoang et
al (J Biomechanics 2005;38:1333-41) was used to measure length-
tension properties of human gastrocnemius. The method involves
measurement of ankle torque-angle relations at 8 knee angles
under passive condition. These measures were combined with
ultrasonographic measures of muscle fascicle lengths to determine
passive length-tension properties, slack lengths and strains of
the whole muscle-tendon unit, its muscle fascicles and tendons.
ANALYSIS: Descriptive (means and SDs). RESULTS: Mean slack
lengths of the gastrocnemius fascicles, tendons and whole muscle-
tendon units were 3.4 +/− 0.6 cm, 39 +/− 1.7 cm and 42.4
+/− 1.5 cm respectively (mean +/− SD, n = 6, slack lengths
not calculable for 3 of 9 subjects). With combined changes of
knee and ankle angles, the maximal change in length of the
gastrocnemius muscle-tendon unit was 6.7 +/− 2 cm, to which the
muscle fascicles and the tendon contributed almost equal length
changes. Muscle fascicles and the tendon undergo strains of 93.2
+/− 41% and 8.8 +/− 5.9% respectively across the physiological
range of lengths. CONCLUSIONS: The muscle-tendon unit of
gastrocnemius falls slack at close to its shortest physiological
length. The tendon is quite extensible even at low forces and can
contribute substantially to the total compliance of resting muscle-
tendon units. IMPLICATIONS: It is now possible to investigate
mechanisms of contracture in human muscles in vivo. KEYWORDS:
Muscle, tendon, contracture. FUNDING ACKNOWLEDGEMENTS:
Professor Gandevia is supported by the Australian National Health &
Medical Research Council. CONTACT: r.herbert@fhs.usyd.edu.au
ETHICS COMMITTEE: University of Sydney, University of New South
Wales
Research Report Platform Presentation
1342 Wednesday 6 June 08:50
VCEC Meeting Room 18
MOTIVATING DISABILITY PENSIONERS WITH BACK PAIN TO
RETURN TO WORK- A RANDOMIZED CONTROLLED TRIAL
Magnussen L1 , Strand L2 , Skouen J3 , Eriksen H4 ; 1 Department
of Physiotherapy, Faculty of Health and Social Sciences, Bergen
University College and Department of Education and Health
Promotion, University of Bergen, Bergen, Norway; 2 Department of
Public Health and Primary Health Care, Section for Physiotherapy
Science, University of Bergen, Bergen, Norway; 3 Outpatient Spine
Clinic, Haukeland University Hospital, Bergen, Norway; 4 Unifob
Health and Department of Education and Health Promotion,
University of Bergen, Bergen, Norway
PURPOSE: The purpose of the present study was to investigate the
effect of a brief vocational-oriented intervention on return to work
or having entered a return to work process in disability pensioners
with back pain, and to examine whether physical performance, self-
assessed work ability, emotional distress, fear avoidance beliefs and
expectancy could predict return to work. RELEVANCE: Throughout
S491
the western world, disability pension (DP) has become an increasing
economical and social concern, and low back pain (LBP) is one
of the most common conditions leading to DP. Therefore, efforts of
returning disability pensioners to work have become a key target for
health policy in most western countries. PARTICIPANTS: Eighty-nine
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
to 56 years. Eligible for the study were all individuals on DP due
to back pain in the county of Hordaland, Norway (n=431), being
under 56 years of age and having received full DP for more than
one year. The disability pensioners (n=431) were identified through
the National Insurance Administration. METHODS: The participants
were randomised into an intervention group (n=45) or a control
group (n=44) to evaluate the effect of a brief vocational-oriented
intervention. The intervention consisted of two group sessions of
information,lectures related to spinal problems, fear reduction and
a motivational course. After the group sessions the participants were
offered individual follow-up by a physician and a nurse including a
medical examination and assessment of their work ability. Primary
outcome measures were return to work or having entered a return to
work process. Secondary outcome measures were life satisfaction,
physical functioning, fear avoidance behaviour and expectancy.
Prognostic factors for having entered a return to work process were
evaluated. ANALYSIS: Comparisons of change between intervention
and control groups were examined by t-test for independent samples.
Relative Risk (RR) for having entered a return to work process was
calculated. Logistic regression analysis was used to identify possible
predictors at baseline for having entered a process of returning to
work (dependent variable) after 1 year. RESULTS: The intervention
had no statistically significant effect on return to work or having
entered a return to work process at 1-year follow-up. Twice as many
in the intervention group (n=10, 22%) had entered a return to work
process compared to the controls (n=5, 11%). The number needed to
treat was 9. Only minor differences in secondary outcome measures
were demonstrated. Positive expectancy, better physical performance
and less pain were related to return to work. CONCLUSIONS:
despite lack of statistically significant results, the effort of returning
disability pensioners back to work by a brief vocational-oriented
intervention may have practical relevance. The effect needs to
be further explored in larger samples of disability pensioners.
IMPLICATIONS: The vocational intervention offered in this study
might still be cost-effective if carefully selecting participants most
likely to succeed. KEYWORDS: Randomized controlled trial, return
to work, disability pensioners, low back pain, vocational-oriented
rehabilitation. FUNDING ACKNOWLEDGEMENTS: The authors
thank the Norwegian Foundation for Health and Rehabilitation for
funding. CONTACT: liv.magnussen@hib.no
ETHICS COMMITTEE: The study was approved by the Norwegian
Ethics Committee for Medical Research, Health Region west
Research Report Platform Presentation
1819 Wednesday 6 June 08:50
VCEC Meeting Rooms 19-20
RANDOMIZED TRIAL COMPARING GENERAL EXERCISE,
MOTOR CONTROL EXERCISE AND SPINAL MANUAL THERAPY
FOR CHRONIC LOW BACK PAIN
Ferreira P1,2 , Ferreira M1,3 , Latimer J1 , Herbert R1 , Hodges P4 ,
Jennings M5 , Maher C1 , Refshauge K1 ; 1 School of Physiotherapy,
The University of Sydney, Sydney, Australia; 2 Departamento de
Fisioterapia, Universidade Federal de Minas Gerais, Belo Horizonte,
Brazil; 3 Departamento de Fisioterapia, Pontifı́cie Universidade
Católica de Minas Gerais, Belo Horizonte, Brazil; 4 Division of
Physiotherapy, The University of Queensland, Brisbane, Australia;
5 Outpatient Physiotherapy department, Liverpool Hospital, Sydney,
Australia
PURPOSE: To compare the effects of general exercise, motor control
exercise, and spinal manual therapy on disability and global perceived
S492
effect of intervention in patients with chronic non-specific low back
pain. RELEVANCE: Evidence-based clinical practice guidelines
recommend exercise and spinal manual therapy for management
of chronic non-specific low back pain. PARTICIPANTS: 240 adults
with non-specific low back pain of at least 3 months duration.
METHODS: Setting: Three physical therapy clinics in Australian
hospitals. Intervention: Each participant was allocated to either a
general exercise group, a motor control exercise group, or a spinal
manual therapy group. The general exercise included strengthening
and stretching exercises and light aerobic exercises. The motor
control exercise involved retraining of specific trunk muscles using
ultrasound feedback of muscle contraction. Spinal manual therapy
included joint mobilization and manipulation. Participants in all three
groups were treated for 8 weeks. Measurements: The primary
outcomes were patient-specific function (PSFS, 3 to 30 scale) and
global perceived effect of treatment (GPE, −5 to 5 scale) measured
at 8 weeks. These outcomes were also measured at 6 and 12
months. Other secondary outcomes were pain intensity and disability
measured at 8 weeks, 6 months and 12 months. The study was
approved by the University of Sydney Ethics Committee. ANALYSIS:
The primary measures of treatment effect were measures of function
and global perceived effect of therapy at 8 weeks. Data were analyzed
according to a protocol specified a priori. The statistician was blinded
to which group received each intervention. Analysis was by intention-
to-treat. The emphasis in the analysis was on estimation rather
than hypothesis testing. To maximise precision we used analysis of
covariance to adjust the between-group differences in each outcome
for baseline values of that outcome. RESULTS: Follow-up was 93%
at 8 weeks and 88% at 6 and 12 months. The motor control exercise
group had substantially better outcomes than the general exercise
group at 8 weeks (between-group difference in PSFS: 2.9, 95% CI:
0.9 to 4.8; GPE: 1.7, 95% CI: 0.9 to 2.4), as did the spinal manual
therapy group (PSFS: 2.3, 95% CI: 0.4 to 4.2; GPE: 1.2, 95% CI: 0.4
to 2.0). The three groups had similar outcomes at 6 and 12 month
follow-ups. No adverse events were reported. CONCLUSIONS:
Motor control exercise and spinal manual therapy produce better
short-term function and perceptions of global effect than general
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
patient requires faster short-term improvement in symptoms. General
exercises are likely to be more suitable when there is a high patient
to health professional ratio and when physical space is available.
Future research should analyze and compare the cost effect of these
interventions. KEYWORDS: Low back pain; randomized controlled
trial; exercises. FUNDING ACKNOWLEDGEMENTS: The study was
funded by The Arthritis fundation, Motor Authority Association and the
University of Sydney SESQUI grant. CONTACT: pferreira@ufmg.br
ETHICS COMMITTEE: The University of Sydney Ethics Committee
Research Report Platform Presentation
1111 Wednesday 6 June 09:10
PP Crystal Pavilion A
AN EVALUATION OF FACTORS INLFUENCING UNDERGRAD-
UATE BSC PHSYIOTHERAPY ACADEMIC PERFORMANCE
Horgan T; Kingston University/St George’s University of London
London. England
PURPOSE: To consider the influence of gender, age, and entrance
qualification on the academic award of undergraduate physiotherapy
students. To investigate relationships between university performance
and performance whilst on assessed clincal practice. RELEVANCE:
Populations of students entering higher education and health care
professions are from diverse backgrounds and experiences. This
diversity maybe assocaited with changes in the national curriculum
in the UK and initiatives to widen participation to inclde non-
traditional applicants. It is important to consider changes in the
WCPT 2007, Research Reports
make up of students in the light of final award. PARTICIPANTS:
Two cohorts of students were randomly selected using a research
randomizer. A total of 110 students were investigated, 31 males.
The age range was from 18-42 years with a median 23.5 years.
METHODS: This was retrospective study. Data were collected from
the national database for university entry and collated relating to
age, gender and entrance profile. Examination performance data was
collected from 2001 to Sept 2005. ANALYSIS: Data was classifed
into categories, chi square statistics were used to assess differences
in degree classification according to age, gender and entry profile.
Significance taken as p  0.05. All academic marks were normally
distributed therefore a Spearmans correlation coefficient was used
to look at relationships between marks awarded whilst at university
and whilst on clincal practice. RESULTS: Staistically significant
differences were observed (p < 0.05) for entrance qualification and
age when compared with final award. A first class award was
achieved only by those students aged over 21 (and <31) and only
by students who entered the course via A’levles(36.4%) or held
previous degrees (30%). Those who accessed the course via other
qualifications access degrees (25%) or other route (8.2%) achieved
lower final awards (p  0.05). We observed statistically significant
relationship between results awarded in year 1 at University and
year 2 clinical(p = 0.05) (r = 0.319). Year 2 university results and year
2 clinical results (p  0.01) (r = 0.648). Year 2 university results and
year 3 clinical (p  0.01) (r = 0.541). CONCLUSIONS: Older age and
qualification on entry to Physiotherapy appear to be associatd with
degree classification. There is a good relationship between results
of university based work and clinical work suggesting that those
who do well academically are also those who do well clinically.
IMPLICATIONS: With the current trend in the UK of widening
participation to encourage a more diverse background in the student
population we need to be aware that achievement on th BSc degree
may be influenced by other factors. Universities need to monitor these
factors and see if additonal support or resources need to be offered to
students. Are the current delivery mechanisms of our degrees limiting
the non-traditional students? KEYWORDS: Education. FUNDING
ACKNOWLEDGEMENTS: None.
Research Report Platform Presentation
1906 Wednesday 6 June 09:10
PP Crystal Pavilion B & C
RELIABILITY OF AN ASSESSMENT OF CONTINUING
COMPETENCE THROUGH PEER REVIEW
Miller P1 , Nayer M2 , Eva K1 ; 1 McMaster University, Hamilton,
Ontario, Canada; 2 College of Physiotherapists of Ontario, Toronto,
Ontario, Canada
PURPOSE: This study was undertaken to examine: 1. the relation-
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,
Canada (CPO); 2. the relationship among the various components
of the Onsite Assessment; and 3. the reliability of the Onsite
Assessment. RELEVANCE: A key mandate of a professional
regulatory board is to ensure that practitioners provide competent
care. The challenge is to develop a competency assessment program
that is reliable, valid, and feasible. CPO developed a competency
assessment program to evaluate its registrants in their workplace.
PARTICIPANTS: 106 registrants completed an Onsite Assessment,
conducted by peer assessors. The mean age of the registrants
was 42 years (SD 9.5) and the mean years since graduation
was 18 (SD 10.7). The majority had a professional bachelor’s
degree (73%). METHODS: An assessor visited the registrant in
his/her workplace. In 53 instances, the registrant was examined by
two assessors simultaneously. The assessment included: Practice
Issues Evaluation, Record Keeping Evaluation, Billing Practices
Evaluation (if applicable), Portfolio Review (formative feedback only),
and a Chart Stimulated Recall process (CSR) using six to eight
Platform Presentations, Wednesday 6 June
patient records. One mandatory component of the Portfolio was the
Professional Issues Self Assessment (PISA). The assessor provided
Summary Report to the Quality Management (QM)Committee, which
reviewed the Summary Report and made a final decision regarding
the registrant’s overall performance. ANALYSIS: Pearson correla-
tion coefficients and regression analyses were used to examine
the relationships between demographic factors and performance.
Generalizability theory analyses were used to examine the inter-
rater reliability of the various performance measures and the inter-
case reliability of the CSR. RESULTS: 88% of registrants (n=93)
completed the program successfully while 11% (n=12) required a
remediation program with 1 registrant requiring reassessment. There
was no relationship between the final decision and age, years since
graduation, or educational program (p < 0.05 in all cases). Record
keeping was found to be the most significant contributor to both
the QM Committee’s final decision and the Summary Report (R2 =
0.385 and 0.474 respectively). The inter-rater reliability ranged from
0.74 (Summary Report, n=52) to 0.48 (PISA, n=53). The inter-
case reliability of the CSR was 0.65 which rose to 0.92 when
ratings were averaged across 6 cases. The review of 3 medical
records is sufficient to achieve acceptable reliability (ICC =.85) in
the CSR component. CONCLUSIONS: The majority of registrants
assessed in the Program were considered to be providing competent
care and adhering to professional standards of practice. Unlike
similar studies with physicians, this sample did not find a decline in
competency associated with increasing age. The inter-rater reliability
of the various components ranged from fair to good. IMPLICATIONS:
These results indicate that it is possible to implement a reliable
evaluation of clinical competency through an Onsite Assessment
using peer assessors. This study can inform the QM Committee
on the number of patient records to be reviewed during the
assessment. These results can provide valuable information to
similar agencies considering the assessment of competency of
physiotherapists. KEYWORDS: Peer Review, Quality Management,
Continuing Competence. FUNDING ACKNOWLEDGEMENTS: This
work was supported from a Strategic Training Fellowship in
Rehabilitation Research from the CIHR Musculoskeletal and Arthritis
Institute to PM. CONTACT: pmiller@mcmaster.ca
ETHICS COMMITTEE: McMaster University Research Ethics Board
Research Report Platform Presentation
1562 Wednesday 6 June 09:10
VCEC Meeting Rooms 1-3
CHANGES IN KNEE ARTICULAR CARTILAGE IN RESPONSE
TO RUNNING AND ITS RELATIONSHIP TO BIOMECHANICAL
LOADING
Boocock M1 , McNair P1 , Cicuttini F2 , Stuart A3 , Sinclair T3 ;
1 Physical Rehabilitation Research Centre, AUT University,
Auckland, New Zealand; 2 Monash University Medical School,
Alfred Hospital, Prahran, Victoria, Australia; 3 The Radiology Group,
Auckland, New Zealand
PURPOSE: The purpose of this study was to investigate the
relationship between knee joint loading and changes in the volume
of knee articular cartilage following a 30 minute recreational run.
RELEVANCE: Osteoarthritis (OA) is a leading cause of morbidity and
disability internationally, costing billions in health-care expenditure
and lost earnings. In addition to the economic costs, patients often
suffer considerable pain, loss of function, disability and impaired
quality of life. Understanding the mechanical characteristics of knee
articular cartilage in response to activities of daily living may provide
important insights into the aetiology of knee OA. PARTICIPANTS:
Ten healthy male subjects with a mean age of 33.4 years (SD=
±2.3) and no medical history of a lower limb musculoskeletal
condition. METHODS: Magnetic Resonance Imaging (MRI) (T1-
weighted) scans of the right knee were taken in the sagittal plane
(1.5 mm slices) prior-to and directly following a: 1) 30 minute period
of relaxed sitting; and 2) a 30 minute run. During the run participants
S493
were required to complete 2500 steps (impacts) at a self-selected
running speed. The number of steps taken by participants was
recorded using a pedometer and running speed was measured at
regular intervals throughout the run. Tibial and femoral knee articular
cartilage volumes were measured for each MRI scan using computer
imaging software (OSIRIS). Within the laboratory, three-dimensional
(3D) motion analysis was used to capture lower limb kinematics
and a force platform provided information on 3D ground reaction
forces during the right foot stance of the running gait. A simplified
muscle model of the knee incorporating the patella ligament and
biceps femoris tendon was used to estimate knee compression
and shear forces. ANALYSIS: To test for the main effects of
activity (sitting versus running) a repeated measures ANOVA with
Bonferroni correction was performed. Pearson correlation coefficients
and linear regression analysis were used to examine the relationship
between knee cartilage volume changes and compression and
shear forces at the knee. The significant level was set at 0.05.
RESULTS: Thirty minutes of relaxed sitting resulted in no significant
change in femoral and tibial (medial and lateral) cartilage volumes.
A significant decrease in the volume of femoral (4.4%, p < 0.05)
and lateral tibial cartilage (6.7%, p < 0.05) was found following
the 30 minute run. None of the biomechanical parameters (i.e.
joint compression and shear forces) was found to be significantly
related to changes in articular cartilage. CONCLUSIONS: Knee joint
loading associated with recreational running was shown to lead to
decreases in knee articular cartilage volumes, most noticeably in
the femoral and lateral tibial aspects of the knee joint. Observed
changes due to the cyclic loading of knee joint could not be
explained by the individualised joint compression and shear forces
measured by this study. IMPLICATIONS: Volumetric changes in knee
articular cartilage may have an important role in maintaining healthy
knee cartilage. Further work is needed to investigate similar cyclic
loading responses of knee cartilage in a group of OA patients.
KEYWORDS: Knee articular cartilage, MRI, running. FUNDING
ACKNOWLEDGEMENTS: Arthritis New Zealand, The Decade of
Bone and Joint in New Zealand and Countrywomens Institute.
CONTACT: mark.boocock@aut.ac.nz
ETHICS COMMITTEE: AUT University Ethics Committee
Research Report Platform Presentation
2490 Wednesday 6 June 09:10
VCEC Meeting Rooms 11-12
MEASUREMENT OF PHYSICAL PERFORMANCE, QUALITY OF
LIFE AND NUTRITIONAL STATUS OUTCOMES FOLLOWING
IMPLEMENTATION OF AN EXERCISE PROGRAM FOR
HAEMODIALYSIS PATIENTS
Heck C1 , Darling P2 , Kerby J3 , Lee-Yu N4 , Lee S5 , Frazer J6 ,
Cook D7 , Hardy D8 , Yang C9 , Kareem J10 , Saunderson R11 ,
Cochrane N12 ; 1 University Health Network, Toronto Canada;
2 St. Michael’s Hospital, Toronto Canada; 3 St. Michael’s Hospital,
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
Hospital, Toronto Canada; 9 St. Michael’s Hospital, Toronto Canada;
10 St. Michael’s Hospital, Toronto Canada; 11 St. Michael’s Hospital,
Toronto Canada; 12 St. Michael’s Hospital, Toronto Canada
PURPOSE: To evaluate physical performance, quality of life and
nutritional status of end stage renal disease (ESRD) patients on
haemodialysis following implementation of an exercise program.
RELEVANCE: Patients with ESRD have high mortality, high morbidity
and a low quality of life which has been shown to be related to mal-
nutrition and compromised physical functioning. Physical functioning
is an important predictor of an individual’s ability to perform activities
of daily living, which in turn is important for participation in social,
vocational and recreational activities. PARTICIPANTS: The thirty
nine subjects included met the following criteria: interested/motivated
to exercise, deemed medical stable and suitable for exercise,
S494
received hemodialysis for at least 3 months and currently were not
physically active METHODS: Subjects were randomized to either an
exercise or attention placebo (non-exercise control) group. Exercisers
(n=21) were prescribed an individualized bicycle exercise program,
performed three times/week for up to 30 minutes during hemodialysis.
Controls (n=18) were offered attention placebo up to 30 minutes,
three times a week during hemodialysis. Data was collected at three
time periods: baseline, 6 weeks and 12 weeks after initiation of
the intervention. Outcomes measured included physical performance
[six minute walk tests (6MWT), timed-up-and-go (TUG)]; quality of
life [SF-36 Health Survey (SF36)and Illness Intrusiveness Rating
Scale (IIRS)]; measures of nutritional status [estimated dry weight,
Subjective Global Assessment score (SGA), lean body mass, dietary
energy and protein intake]; biochemical values from routine blood
work, and functional measures [Human Activity Profile (HAP)and
functional autonomy (SMAF)]. ANALYSIS: Analyses were performed
using difference from baseline and percent change from baseline.
The comparisons between the 2 groups for continuous variables
was performed with Wilcoxon Rank Sum test; and the comparisons
within each group compared with baseline was performed with
Wilcoxon Signed Rank test. Comparisons for categorical variables
was performed with Pearson Chi Square test. For cases where the
number of observations was small Fisher’s exact test was used.
RESULTS: Participants were primarily male (59%), aged 51.6±15.2
years, whose primary cause of renal failure was attributed to diabetes
(14%) and/or hypertension. (25.6%). The majority had been on HD
45.8±50.72 months (range 3 to 104). There were no significant
between group differences on these demographic variables. The
following changes were noted in the exercise group only. TUG scores
had significantly improved (p = 0.00) from 11.9 +/−10.4 at baseline
to 8.3 +/− 3.8 seconds by 12 weeks. Also the 6MWT distance
significantly (p = 0.00) improved from 407.0 +/− 136.8 metres at
baseline to 469.4 +/− 136.3 metres by 12 weeks. Other changes
noted included a significant between group difference on HAP at
6 weeks and the instrumental activities of daily living subscore on
SMAF at 6 and 12 weeks. There were no significant improvements in
the quality of life measures or changes in nutritional status in either
group over the course of the study. CONCLUSIONS: The results
of this study provide evidence that exercise had a positive impact
on the physical performance and functional measures for ESRD
patients on hemodialysis. IMPLICATIONS: Physical exercise should
be incorporated as an integral component of ESRD management.
KEYWORDS: physical exercise; hemodialysis; end stage renal
disease; physical performance; nutritional status; quality of life.
FUNDING ACKNOWLEDGEMENTS: The investigators would like to
acknowledge the funding received from The Kidney Foundation of
Canada. CONTACT: carol.heck@uhn.on.ca
ETHICS COMMITTEE: Research Ethics Board, St. Michael’s
Hospital, Toronto, Canada
Research Report Platform Presentation
3159 Wednesday 6 June 09:10
VCEC Meeting Room 16
MAINTENANCE OF ACHIEVED GAINS FOLLOWING TASK-
ORIENTED INTERVENTIONS TARGETING WALKING AND ARM
FUNCTION IN PERSONS WITH STROKE: A RANDOMIZED
CONTROLLED TRIAL
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
WCPT 2007, Research Reports
ability and arm function in persons within one year of stroke onset, are
maintained 6 months later. RELEVANCE: Existing evidence supports
the efficacy of a task-oriented approach in improving walking ability
and arm function. In previous publications, we showed that a walking
intervention was effective in the short term while an upper extremity
(UE) intervention was not. This study focuses on what happened
after the intervention ended and subjects were left to their own
devices and were no longer followed by a therapist. PARTICIPANTS:
Ninety-one individuals within one year of a first or recurrent stroke
agreed to participate and provided written, informed consent; 44
subjects were randomized to the walking intervention and 47 to
the UE intervention. Both groups were similar in terms of their
baseline characteristics. Follow-up was immediately after the 6-
week intervention (previously published) and 6 months later, the
results to be presented here. METHODS: The walking intervention
consisted of walking on different surfaces, on a treadmill. The UE
intervention involved practice of functional, unilateral and bilateral
tasks designed to improve gross and fine manual dexterity. Persons
in both groups attended three times a week for 6 weeks. Evaluations
were conducted by trained and blind evaluators at baseline, on
completion of the intervention and 6 months after the completion of
the intervention. The Six Minute Walk Test (6MWT) was the primary
outcome measure for the walking intervention. Secondary walking
outcomes were the 5-m walk, the Timed ‘Up and Go’ (TUG) and
the Berg Balance Scale. The Box and Block Test (BBT) was the
primary outcome measure for the UE intervention. Secondary UE
outcomes were the Nine-Hole Peg Test (NHPT), the Test d’Evaluation
du Membre Supérieur pour Personnes Agées (TEMPA) and grip
strength. ANALYSIS: Data were analyzed on the basis of intention to
treat. Group comparisons were made using a t-test for independent
samples for variables measured on a continuous scale and the
Wilcoxon Rank Sum Test for variables measured on an ordinal
scale. T-tests and Wilcoxon rank sum test were also done on the
change scores between groups. RESULTS: Six months after the
intervention ended, the walking group lost what they had gained
from the interventions (6MWT= −35m; SD=46) while the UE group
stayed relatively stable (6MWT= −8 m; SD=64). There were no
meaningful changes observed in Box and Block scores for either
group. CONCLUSIONS: Gains observed in walking as assessed
immediately after a 6-intervention were not maintained after a period
of 6-month when no intervention took place. UE function did not
improve nor deteriorate during this same time. IMPLICATIONS:
Results indicates that once patients are discharged from therapy
and no longer being followed and encouraged to exercise, the
gains obtained during rehabilitation are mostly lost. Development
of community programs focusing on exercises for post-rehabilitation
stroke persons may be a solution to maintaining physical gains and
function in society KEYWORDS: Stroke, Efficacy, Therapy. FUNDING
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
Stroke Network. Johanne Higgins was supported by a fellowship from
the Canadian Stroke Network, McGill University Research Institute
and the Fonds de Recherche en Santé du Québec. Nancy M.
Salbach received a fellowship from the Canadian Institutes of Health
Research.
ETHICS COMMITTEE: Faculty of Medicine, Mcgill University
Institutional Review board and Institut de Réadaptation en déficience
physique du Québec Review Board
Platform Presentations, Wednesday 6 June
Research Report Platform Presentation
2155 Wednesday 6 June 09:10
VCEC Meeting Room 17
KNEE JOINT ROTATION IN VIVO MEASUREMENTS –
DEVELOPMENT OF AN EXTERNAL CLINICAL DEVICE AND
CLINICAL STUDIES
Almquist P1 , Fridén T2 , Zätterström R3 , Ekdahl C1 ; 1 Department
of Health Sciences, Division of Physiotherapy, Lund University,
Lund, Sweden; 2 Department of Orthopedics, Lund University,
Lund, Sweden; 3 Department of Physical Medicine, Lund University
Hospital, Lund, Sweden
PURPOSE: Knee joint rotation is important for most weightbearing
movements. During the stance phase of walking, the foot is
fixed to the ground, this causes internal rotation of the tibia with
ankle dorsiflexion and external tibial rotation with plantar flexion
of the ankle. Excessive forces in the knee may tear ligamentous
structures, resulting in defects in the envelope of passive motion,
including rotatory motions. However, no clinical knee joint rotation
measurement instrument, evaluated regarding validity and reliability
exists, and tibio-femural rotation is hardly ever measured and
evaluated in clinical works. The aim of this study was to develop
a clinical external cevice for measuring knee joint rotation range of
motion, as well as establish age and gender differences in a knee
healthy reference population. RELEVANCE: The normal range of
rotation of the knee in various healthy population in vivo is not known,
age and gender differences are not established, and rotation is
hardly ever estimated in clinical works. A device measuring knee joint
rotation could be of great value as a complement to existing clinical
tools and examination equipment. PARTICIPANTS: The knee healthy
reference population was constituted of 120 persons, 60 females and
60 males, divided into four different age groups, 15-30, 31-45, 46-
60 and>61 years old. The four age groups were divided to match
different age related knee dysfunction problems in future studies.
METHODS: The newly developed measurement instrument was
used in the present study. It’s validity was evaluated by simultaneous
measurements with Roentgen Stereometric Analysis on five male
subjects. The intra- and intertester reliability were evaluated with 10
knee healthy subjects each. 120 knee healthy subjects, divided into
genders and four different age groups, were used to represent a
reference population, with the purpose to establish normal knee joint
rotation and variations due to age and gender. The subjects were
examined in 90, 60 and 30 degrees of knee flexion angle, with 6 and
9 Nm as well as the examiners apprehension of end-feel. ANALYSIS:
Pearson’s coefficient of correlation, Five way analysis of variance,
Anova and T-test were used for statistic analysis. RESULTS: The
external device showed high validity (r2 0.83-0.90) and intra- and
intertester reliability (r2 0.74-0.95). The females in the reference
population showed significant larger (p < 0.001) range of knee joint
rotation than the males. Knee joint rotation decreased significantly
due to age in both genders (p < 0.001), and no differences between
the right and left knees were found. CONCLUSIONS: The newly
developed device was a valid and reliable measurement instrument.
In the knee healthy reference population, the females showed
significant larger range of rotation than the males, the knee joint
rotation decreased significantly due to age in both genders and
no differences between the right and left knees were found.
IMPLICATIONS: Further knowledge about normal knee joint rotation
and variations due to age and genders, which maybe could have
an influence in different knee joint disorders. KEYWORDS: Knee,
rotation, measurements. FUNDING ACKNOWLEDGEMENTS: This
work was funded by County Council of Halland foundation, Sweden
and Bertil Hemborgs foundation.
ETHICS COMMITTEE: The study was approved by the Ethics
Committee of Lund University
S495
Research Report Platform Presentation
1743 Wednesday 6 June 09:10
VCEC Meeting Room 18
EFFECTIVENESS OF A WORKPLACE PHYSICAL EXERCISE
INTERVENTION ON THE FUNCTIONING, WORK ABILITY, AND
WELL-BEING – A CLUSTER RANDOMISED CROSS-OVER TRIAL
Sjögren T1 , Nissinen K2 , Järvenpää S2 , Ojanen M3 , Vanharanta H4 ,
Mälkiä E1 ; 1 Department of Health Sciences, University of Jyväskylä,
Finland; 2 Department of Mathematics and Statistics, University
of Jyväskylä, Finland; 3 Department of Psychology, University of
Tampere, Finland; 4 Leeds Musculoskeletal Service, Leeds England
PURPOSE: The purpose of this study was to investigate the
effects of a workplace physical exercise intervention on physical
and psychosocial functioning, work ability, and general subjective
well-being. RELEVANCE: The chronic outcome effects of the
intervention were evaluated within the framework of the International
Classification of Functioning, Disability and Health (ICF). During the
physical exercise intervention dose of exercise and other physical
activity outside the intervention were controlled for. PARTICIPANTS:
The volunteer study population of 124 office workers was drawn
from four municipal administrative departments. 90 workers (73%)
from this population took part in a cluster randomized cross-over
designed physical exercise intervention. METHODS: The intervention
consisted 15 weeks’ light resistance training (30%1RM) with air
resistance equipment and guidance. The no-intervention period was
also 15 weeks. During the first five-week intervention period a specific
training programme (6 minutes x 5 times a week x 5 weeks=
435 metabolic equivalent (MET) minutes) was to be performed
once each working day and during the second and third 5-week
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
CR10 pain scales, modified version of the Nordic questionnaire
on musculoskeletal symptoms, descriptive visual rating scales on
psychosocial functioning and well-being, and a work ability index
questionnaire. Muscle strength was measured with the 5 repetition
maximum (RM) test. Physical activity was measured by a diary
and the MetPro questionnaire, and then converted to MET values.
The study was approved by the ethical committee of the University
of Kuopio and the University Hospital of Kuopio. ANALYSIS: The
statistical analysis was based on linear mixed model. RESULTS:
Specific physical exercise during the working day, with a mean
training time of 5 minutes per working day (average 363 MET
minutes during 5 week), improved the subjects’ physical functioning,
especially in the components of body function and structures. The
intervention alleviated the intensity of headache (p = 0.001) and
intensity of neck (p = 0.002) and low back (p = 0.020) symptoms
as well as reduced the prevalence of headache (p = 0.41-0.47)
and neck (p = 0.003), shoulder (p = 0.007) and low back (p = 0.000)
symptoms. The intervention improved subjective physical well-being
(p = 0.015), but it had no effect on the other psychosocial functioning,
work ability or general well-being variables. CONCLUSIONS: The
intervention benefited in physical functioning and the component of
body functions and structures, especially musculoskeletal symptoms,
more than psychological functioning or the components of activities
and participation or social environmental factors. IMPLICATIONS:
The physical exercise intervention partly created evidence-based
practices for use in occupational heath. Physiotherapists can
adapt these practices in seeking to maintain physical functioning
among persons in sedentary occupations. More studies need to
be carried out among wider range of working populations or
among populations with different levels of functioning to learn
more about the effectiveness of physical exercise interventions on
physical and psychosocial functioning, work ability and general
subjective well-being. KEYWORDS: Occupational health, exercise,
evidence based practice. FUNDING ACKNOWLEDGEMENTS: The
study was supported by the Chydenius Institute and University of
Jyväskylä, and personal grants from the Finnish Work Environment
S496
Fund, Juho Vainio Foundation and Academy of Finland. CONTACT:
tuulikki.sjogren@sport.jyu.fi
ETHICS COMMITTEE: The study was approved by the ethical
committee of the University of Kuopio and the University Hospital
of Kuopio.
Research Report Platform Presentation
2126 Wednesday 6 June 09:10
VCEC Meeting Rooms 19-20
EFFECTIVENESS AND COST-EFFECTIVENESS OF THREE
PHYSIOTHERAPY REGIMES COMMONLY USED TO REDUCE
DISABILITY IN PATIENTS WITH CHRONIC LOW BACK PAIN
Critchley D1 , Ratcliffe J2 , Noonan S3 , Jones R4 , Hurley M1 ;
1 Academic Department of Physiotherapy, King’s College London,
London, UK; 2 School of Health and Related Research, Sheffield
University, Sheffield, UK; 3 Department of Physiotherapy, Guy’s
and St Thomas’ Hospitals, London, UK; 4 School of Medicine, King’s
College London, London, UK
PURPOSE: To compare the effectiveness and cost-effectiveness of
usual individual physiotherapy, spinal stabilisation, or physiotherapist-
led pain management in managing chronic low-back pain (cLBP).
RELEVANCE: cLBP is common, disabling and a costly problem
for health-care providers. Exercise-based physiotherapy reduces
disability in cLBP, but it is unclear if one form of physiotherapy
is most effective or cost effective. PARTICIPANTS: 212 people
with non-specific cLBP already referred to physiotherapy and able
to participate in group exercises. Participants were 44 (range 18-
76) years old, 136 (64%) female with a 7.4 (range 0.25-52) years
history of LBP. Their socio-economic profile was representative
of the trial location, inner-city south London: 48% self-described
non-white ethnicities, 58% lived in social housing. METHODS:
Participants were randomised to individual physiotherapy (n=71),
spinal stabilisation classes (n=72) or outpatient pain management
(education and paced exercise)(n=69). Primary outcome was
Roland-Morris disability score 18 months from baseline. Secondary
measures were pain (NAS), quality of life (EQ-5D) and time off-
work. Economic measures were UK National Health Service (NHS)
costs associated with low-back pain and quality adjusted life years
(QALYs) over trial period. ANALYSIS: Clinical outcomes were
compared on an intention-to-treat basis with ANCOVA with baseline
as covariate; economic outcomes were compared with ANOVA and
results confirmed with bootstrapping. Cost-effectiveness acceptability
curves were constructed and will be presented. RESULTS: 160
(75%) participants provided clinical follow-up data at 18 months.
Mean(CI) Roland-Morris disability score at baseline, 6, 12, and 18
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-
8.4) respectively for individual physiotherapy; 12.8(11.4 −14.2),
7.0(5.6-8.5), 7.6(5.9-9.2), and 6.8(4.9-8.6) for spinal stabilisation;
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
pain management. Improvements from baseline were significant
in all arms at all times (P < 0.001). There were similar significant
improvements in pain, quality of life and days off-work. Differences
between treatments were not significant for any clinical outcomes
at any follow-ups. Pain management participants had far fewer
secondary care visits, inpatient procedures, and investigations
than individual physiotherapy or spinal stabilisation participants.
Mean(SD) LBP-related NHS costs and QALY gain over the eighteen-
month trial period were £474(840) and 0.99(0.27) respectively
for individual physiotherapy, £379(1040) and 0.90(0.37) for spinal
stabilisation and £165(202) and 1.00(0.28) for pain management.
Excluding three patients who received costly spinal surgery did
not change the result that functional restoration was most cost-
effective. CONCLUSIONS: Physiotherapist-led pain management
offers a cost-effective alternative to usual individual physiotherapy for
cLBP and promotes more effective self-management. Improvements
in disability and pain were clinically important and maintained for
more than one year following treatment. IMPLICATIONS: Economic
WCPT 2007, Research Reports
analysis is unusual in physiotherapy studies at present, yet in this trial
it reveals important differences between interventions not apparent
from clinical outcomes. Mean LBP-related NHS costs were £206
less per year per patient in functional restoration compared with
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
(2003-4 prices). Given the prevalence of cLBP and its personal
and socio-economic costs these findings have important implications
for primary care management. KEYWORDS: Low back pain,
economic analysis, exercise. FUNDING ACKNOWLEDGEMENTS:
This study was funded by Arthritis Research Campaign. CONTACT:
duncan.critchley@kcl.ac.uk
ETHICS COMMITTEE: Guy’s and St Thomas Local Research Ethics
committee
Research Report Platform Presentation
1167 Wednesday 6 June 09:30
PP Crystal Pavilion A
PROFESSIONAL IDENTITY FORMATION IN CLINICAL
EDUCATION
Webb G
PURPOSE: This research was concerned with the professional
identity formation of physiotherapy students in clinical practice
and the development of a theoretical model that can underpin
pedagogical partnerships in clinical education between students,
supervisors and academics. RELEVANCE: The aims of the research
were to explore the issues of professional identity formation in un-
dergraduate physiotherapy students; how they and their supervisors
position themselves in conversations and use reflexive positioning
to create new knowledge and develop professional competency.
It explores how language and interpretations of language during
conversations form a critical part of the professionalisation of
physiotherapy students in clinical practice. PARTICIPANTS: Third
year students and clinicians involved in the clinical program at the
School of Physiotherapy at the University of Melbourne. METHODS:
This qualitative research used interpretative techniques within a
phenomenological account of the social world of clinical education
in physiotherapy, social agency and the institutions and artifacts
with which the participants are dealing. For this study six students
were interviewed three times in the third year of their physiotherapy
degree; before their first major clinical experience, after their first
clinic and at the end of their third year clinics. All students wrote
a reflective essay at the end. ANALYSIS: Themes were developed
from the student interviews.Positioning theory, cultural psychology
and professional identity formation form the conceptual framework
around which this data was interpreted. Crucial moments in becoming
a professional are often couched in successful or unsuccessful
relationships during the experiential learning encountered in clinical
settings. All of the students showed differences in how they
engaged in their learning in the clinics and the development of
an understanding of what it means to be a physiotherapist. The
use of indexical grammer demostrated the lack of ownership of
their learning and responsibility for patient outcomes. RESULTS:
Curricula goals, which recognise the importance of the dynamic
interplay between public /private and individual /collective dimensions
of speech in the enactment of the explicit and informal curriculum,
are important (Richardson 2002) to ensure links between the
micro-world of systematic theoretical learning and an individual’s
experiences in the life world of professional practice setting. The
social-constructivist model for clinical education proposed begins in
the world of physiotherapy practice, constructed by humans, where
the student is encouraged to elaborate, question and debate with
others, the ontological constructions being placed on ‘’things’ and
shared experiences in clinical settings. The supervisors’ role is to
interpret these dialogues against their own cultural agency. Their
Platform Presentations, Wednesday 6 June
teaching should be inclusive and seen to be so as opposed to
exclusive. CONCLUSIONS: Research and curricula models need
to be developed that attend simultaneously to both the person of
the student and the context of learning. Professional knowledge
creation is a complex concept that has not been sufficiently explained
by available theories of practice. IMPLICATIONS: The research
explores how students are inducted into the profession. It assists
students and clinicians to understand the complex interactions that
take place in conversations in clincal education. It is important in
enabling young students to understand the institutional practices
KEYWORDS: professional identity formation; clinical education.
FUNDING ACKNOWLEDGEMENTS: none.
ETHICS COMMITTEE: The University of Melbourne
Research Report Platform Presentation
2225 Wednesday 6 June 09:30
PP Crystal Pavilion B & C
FACTORS THAT PREDICT SUCCESSS ON THE WRITTEN
COMPONENT OF THE CANADIAN PHYSIOTHERAPY
COMPETENCY EXAM
Miller P1. , Cooper M2 , Eva K1 ; 1 McMaster University, Hamilton,
Ontario, Canada; 2 Canadian Alliance of Physiotherapy Regulators,
Toronto, Ontario, Canada
PURPOSE: The purpose of this study was to examine the
relationship between demographic factors and performance on the
written component of the Canadian Physiotherapy Competency
Exam (PCE). RELEVANCE: The PCE is a requirement for licensure
in most Canadian provinces. As such, it defines the minimum
standard of competency required prior to entering the workforce. Little
is known about factors contributing to successful performance on
the exam or the ability of the exam to assess clinical competency
beyond entry-level. PARTICIPANTS: The sample included results
from 2867 examinations, with Canadian-educated candidates (CEC)
making up 75% of the sample (n=2139). In the sample of CEC, 96%
were first-time candidates, and 96% were writing in their year of
graduation (new graduates). There were 74 CEC candidates with
at least 1 year in practice (CEC-1+). In the sample of internationally-
educated candidates (IEC) (n=728), 73% were first time candidates,
and 5% were new graduates. METHODS: The PCE is comprised of 2
components: written and clinical. The candidate has up to 3 attempts
to pass the written component prior to taking the clinical. The
written component is comprised of approximately 200 questions from
the musculoskeletal, neurosciences, and cardiorespiratory domains,
addressing the functions of assessment, planning, and intervention.
Anonymized data (demographic factors and performance) from the 24
sittings of the written examination for the years 2001-2004 were used
in the analyses. ANALYSIS: Descriptive statistics were calculated
and correlational analysis used. RESULTS: The overall pass rate
was 85%. The pass-rate for the CEC was 94% and for the IEC
was 60%. Pass rate for CEC and IEC repeat-writers was 78%
and 51% respectively. Performance scores declined with increasing
years since graduation when the entire group of candidates was
considered (whole sample: r =-.346, p < 0.01) and whole group
of first-time candidates r=-.311, p < 0.01), however this trend was
not present within the various subgroups (eg. CEC: r =-.043,
IEC: r =-.076, CEC1+: r = −0.057). The 3 domain scores were
highly correlated (p < 0.01) as were the 3 function scores for the
CEC, IEC, Canadian new graduates, and the CEC1+ subgroups.
CONCLUSIONS: Canadian-educated candidates, candidates writing
for the first time, and new graduates perform better on the written
component of the PCE. The decline in performance with increasing
years in practice seen in the whole group appears to be driven
by the lower scores and greater years post-graduation in the IEC.
The decline in performance with increasing years post-graduation
seen in other professional groups was not evident when the various
subgroups were considered. None of the subgroups appeared to
perform better in any one domain or any one function, suggesting
S497
that candidates come equally prepared in domains and functions.
IMPLICATIONS: Information about potential performance and the
influence of time since graduation on examination results is now
available for candidates. Future research should address the barriers
to success encountered by the IEC, and the relationship between
exam performance and clinical practice. KEYWORDS: licensure,
examination, competency. FUNDING ACKNOWLEDGEMENTS: This
research was supported by the Ann Collins Whitmore Memorial
Award from the Physiotherapy Foundation of Canada and from a
Strategic Training Fellowship in Rehabilitation Research from the
CIHR Musculoskeletal and Arthritis Institute to PM. CONTACT:
pmiller@mcmaster.ca
ETHICS COMMITTEE: McMaster University Ethics Review Board
Research Report Platform Presentation
2108 Wednesday 6 June 09:30
VCEC Ballroom A
CARRY OVER OF LEARNING PROCESS AND SKILLS FROM
PROBLEM-BASED LEARNING TUTORIALS TO THE PRACTICE
SETTING: A STUDENT PERSPECTIVE
Quilter J, Dawson L; University of Brighton, Brighton, UK
PURPOSE: The aim of the study was to uncover physiotherapy
students’ perspectives on how the learning process and skills
gained from problem-based learning (PBL) carried over into the
practice setting by asking students to reflect on their experiences
of clinical placement after completing a year of PBL. RELEVANCE:
The evolving health care environment demands that educational
programmes graduate clinicians whose focus is directed to the
holistic needs of the patient and are capable of adapting to the
ever changing nature of clinical practice. It has been argued that
traditional didactic pedagogy is deficient in preparing students
for holistic practice and that student-centred learning, such as
PBL, facilitates students to make the transition to clinical practice.
PARTICIPANTS: Fourteen second year students on an entry-level
accelerated master’s programme in physiotherapy were selected
because they had experienced the “phenomena” of PBL and clinical
education. The study was approved by the School of Health
Professions Ethics Panel at the University of Brighton. METHODS:
The research design used a qualitative, phenomenological approach.
Data were collected by means of focus group interviews, facilitated
by the researcher and moderated by a colleague, after undertaking
a pilot study focus group. Focus groups were audio taped and
transcribed verbatim. A transcribed debrief was undertaken by the
researcher and moderator in order to identify emerging themes and
reflect on potential bias. ANALYSIS: A thematic content approach
to data analysis was taken. The researcher invited one participant
from each focus group to verify the accuracy of the transcripts and a
colleague, familiar with qualitative research, to verify the categories
and themes generated from the raw data. RESULTS: Five themes
emerged from the the categories generated through sequential
analysis of the focus group data; group functioning in learning,
self-directed learning, physiotherapy-specific knowledge and skills,
health care professional skills and extrinsic factors to the learning
environment. CONCLUSIONS: PBL was viewed as a pedagogical
approach, whose group based process enabled students to learn
team work skills necessary for work in practice. Reflecting on the
the PBL experience,students felt that group dynamics developed
their team working skills which eased their transition into the
clinical setting and increased their confidence in interprofessional
working. IMPLICATIONS: The qualitative nature of the study does
not permit the author to suggest curricula changes based on its
findings. However,in light of the body of literature on PBL and
students perspectives on professional education, it would seem that
collaborative work in the form of PBL can enhance team working,
confidence, self-directed learning and holistic attitudes, all of which
are desirable attributes for physiotherapy graduates. KEYWORDS:
Problem-based learning; education; clinical education. FUNDING
S498
ACKNOWLEDGEMENTS: The work was unfunded. CONTACT:
joequilter@hotmail.com; l.dawson@bton.ac.uk
ETHICS COMMITTEE: School of Health Professions Ethics Panel,
University of Brighton, UK.
Research Report Platform Presentation
2635 Wednesday 6 June 09:30
VCEC Meeting Rooms 11-12
THE INFLUENCE OF FULL FIELD OPTOKINETIC STIMULATION
WITH AND WITHOUT A CUSTOM EXERCISE PROGRAM ON
VISUAL VERTIGO
Winkler P, Koch A, Limoges A, Perez D, Schrey P, Smith J; Regis
University, Denver, CO, USA
PURPOSE: Some individuals with vestibular impairments become
dizzy and unstable in response to movement of the visual
environment, a symptom called visual vertigo (VV). Optokinetic
visual stimulation (OPK) is effective in treating visual vertigo,
however no studies have explored whether it is more effective
when combined with a traditional vestibular rehabilitation program.
A secondary purpose was to demonstrate the effectiveness of a
moderately priced, commercially available system for providing OPK
stimulation. RELEVANCE: This research addresses the need for
custom exercises for people with VV. Additionally, OPK stimulation
systems used in published experiments are expensive or not
commercially available PARTICIPANTS: The seventeen participants,
ages 20-65 years old, included individuals with peripheral or
central vestibulopathy diagnosed by neuro-otology. A questionnaire
determined sensitivity to movement in the visual environment (VV).
All subjects had previously received vestibular rehabilitation without
resolution of symptoms. METHODS: The study randomly assigned
subjects. One group (8 subjects) received OPK stimulation for 10
minutes 3 times weekly for 3 weeks. The 2nd group (9 subjects)
received the same intervention plus a customized home exercise
program upgraded weekly. Outcome measures included sway (force
platform), Dynamic Gait Index (DGI), and gait characteristics
measured by Gaitrite. The Dizziness Handicap Inventory (DHI) and a
visual analog scale (VAS) assessed level of dizziness. Measurements
were performed at the first, 9th and at a 1 month follow up visit. A
global outcome questionnaire asked the subjects to rate the benefits
of the intervention on dizziness, balance, ADLs and overall life
improvement. ANALYSIS: Force platform, DGI and GaitRite scores
were analyzed in one-factor repeated measures ANOVA and Tukey
post hoc test. To analyze the VAS scores (pre-test, post-test at
each session), a 2x2x3 design was used. Scores from the DHI
were analyzed using a Kruskal-Wallis test. RESULTS: No significant
differences were found between groups on any of the measures.
Data analyzed by session showed significant improvements in
both groups in sway and total length of movement on the force
platform at 9th visit and 1 month follow up. There were significant
improvements in single leg stance time, velocity of gait and step
length. The level of dizziness on the VAS was significantly less
immediately post intervention when compared to the initial and
1 mo follow up visit. Seventy one percent of subjects reported
less dizziness and improved balance, 65% felt they improved in
IADLs, and 65% said the study had made an important improvement
in their life on the global questionnaire. CONCLUSIONS: These
findings indicate that a home exercise program may not provide
additional benefits for subjects with VV when compared to OPK
stimulation alone. Nine 10 minute intervention sessions were effective
in improving gait, balance, and decreasing dizziness. A larger sample
size should be tested to confirm these results. An inexpensive
($100.), commercially available (Starball II) OPK system was effective
for intervention. IMPLICATIONS: OPK alone effectively reduces
symptoms of VV without exercises and may decrease the cost of
rehabilitation. The Starball II provides a widely available and cost-
effective means of providing the OPK intervention in the clinic or
at home KEYWORDS: vestibular, optokinetic stimulation, dizziness.
WCPT 2007, Research Reports
FUNDING ACKNOWLEDGEMENTS: Partially funded by a SPARC
grant from Regis University, Denver, Co.
ETHICS COMMITTEE: Regis University IRB, Denver, Co, USA
Research Report Platform Presentation
3226 Wednesday 6 June 09:30
VCEC Meeting Room 16
EXECUTIVE FUNCTION IS INDEPENDENTLY ASSOCIATED
WITH PERFORMANCES OF BALANCE AND MOBILITY IN
OLDER ADULTS WITH MILD CHRONIC STROKE
Liu-Ambrose T1,4 , Pang M2 , Eng J1,3 ; 1 School of Rehabilitation
Sciences, Department of Physical Therapy, University of British
Columbia,; 2 Department of Rehabilitation Sciences, Hong Kong
Polytechnic University, Hong Kong; 3 Rehabilitation Research
Laboratory, GF Strong Rehabilitation Center, Vancouver, BC,
Canada; 4 Department of Psychology, University of British Columbia,
Vancouver, BC, Canada
PURPOSE: We examined the independent association of executive-
controlled processes (ECPs) with performances of balance and
mobility in community-dwelling older adults with mild chronic
stroke. RELEVANCE: Stroke survivors have a high incidence of
falls. Impaired ECPS are frequent in stroke survivors and are
associated with falls in this population. Better understanding of
the independent association between ECPs and physiological fall
risk (i.e., performances of balance and mobility) could enhance
future interventions that aim to prevent falls and to promote an
independent lifestyle among stroke survivors. PARTICIPANTS: The
sample consisted of 63 men and women with mild chronic stroke,
aged 50 years and older. We included those who: 1) had a single
stroke greater >1 year onset; 2) were aged 50 years; 3) were able
to walk >10 meters independently (with or without walking aids); and
4) lived in their own home. We excluded those who: 1) had a history of
serious cardiac disease (e.g., myocardial infarction); 2) uncontrolled
blood pressure; 3) had neurological conditions in addition to stroke;
or 4) obtained a score less than 22 on the Mini-Mental State
Examination. METHODS: Measures of balance and mobility were:
Berg Balance Scale, Timed Up and Go Test, 6-Minute Walk Test,
gait velocity, and stair climbing time. Measures of cognitive function
were the specific ECPs of cognitive flexibility (Stroop Test) and
working memory (digit span backwards). We also assessed bilateral
quadriceps strength and current physical activity level (PASIPD
questionnaire). The study was approved by the relevant University
and Hospital ethics boards. All participants gave written informed
consent prior to participating in the study. ANALYSIS: The five
performances of balance and mobility were entered into a principal
component analysis (PCA). We set the eigenvalues to be greater
than 1 in the analysis. One hierarchical linear regression model
was constructed to determine the independent association of ECPs
with the first principal component extracted from the PCA. In this
model, age, normalized quadriceps strength of the paretic side,
and the PASIPD score were statistically controlled by forcing these
three variables into the regression model first. Executive-controlled
processes, specifically, performance on the interference condition
of the Stroop Test, was then entered into the regression model.
RESULTS: Cognitive flexibility, specifically response inhibition, was
independently associated with the balance and mobility principal
component in the final model, even after adjusting for age, normalized
quadriceps strength of the paretic side, and the PASIPD score.
Age, normalized quadriceps strength of the paretic side, and the
PASIPD score together accounted for 21.5% of the total variance.
Adding cognitive flexibility resulted in an R-square change of 6.3%
and significantly improved the model (F Change (1, 53) = 4.59,
P = 0.04). The total variance accounted by the final model was
27.8%. CONCLUSIONS: our study highlights that cognitive flexibility,
specifically response inhibition, was independently associated with
performances of balance and mobility in community-dwelling older
adults with mild chronic stroke. IMPLICATIONS: Clinicians may
Platform Presentations, Wednesday 6 June
need to consider cognitive function when assessing and treating
impaired balance and mobility in older adults with mild chronic
stroke. KEYWORDS: executive function, balance, mobility, older
adults, chronic stroke. FUNDING ACKNOWLEDGEMENTS: Teresa
Liu-Ambrose: Supported by a post-doctoral fellowship from the
Michael Smith Foundation for Health Research and the Canadian
Institutes for Health Research (CIHR). Marco YC Pang: Supported
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:
tambrose@interchange.ubc.ca
ETHICS COMMITTEE: Clinical Ethics Board of the University of
British Columbia and the Ethics Board of GF Strong Rehabilitation
Centre
Research Report Platform Presentation
3030 Wednesday 6 June 09:30
VCEC Meeting Room 17
GENDER DIFFERENCES IN TYPE-1 AND TYPE-3 COLLAGEN
MRNA EXPRESSION IN THE RAT ANTERIOR CRUCIATE
LIGAMENT
Romani W, Witherspoon J; University of maryland School of
Medicine Department of Physical Therapy and Rehabilitation
Science, Baltimore, Maryland, USA
PURPOSE: The purpose of this study was to determine the gender
differences in type-1 and type-3 collagen mRNA expression in
skeletally mature Sprague Dawley rats. RELEVANCE: Women are
between 2 and 10 times more likely to injure their anterior cruciate
ligament (ACL) than men participating in similar military and athletic
activities. Gender specific differences in the hormonal milieu and
response to specific steroid sex hormones have been suggested as
potential causes for this disparate injury rate. Type-I alpha-1 (T1C)
and type-3 collagen (T3C) are the crucial structural components that
define the ligament’s ability to withstand tensile loads. Synthesis and
remodeling of collagen follows the transcription of T1C and T3C
mRNA and conversion of procollagen into collagen fibers. If sex
hormones influence ACL strength in a gender specific manner they
must do so by mediating the transcription that regulates the collagen
essential to the ligament’s mechanical strength. PARTICIPANTS:
Two groups of male (N= 10, 11) and of female (N= 11, 10) 13
week old Sprague-Dawley rats were used in this study. METHODS:
Female rats were cycled daily and euthanized when they were in
the diestrous phase of their estrous cycle. One ACL was harvested,
the mRNA isolated, and reverse transcribed. Quantitative polymerase
chain reaction analysis was carried out with an MJ SYBR green
kit and an MJ Chromo 4 Real Time Detector. 18S was used as
an internal control. ANALYSIS: Two separate one-way ANOVAs
were used to determine differences in mRNA expression between
hormone treated and control groups. Significance was set at p < 0.05.
RESULTS: As expected female rats had higher mRNA expression of
T3C than males (P = 0.001). Males had higher expression of T1C
but these differences were not statistically significant (P = 0.191).
CONCLUSIONS: These results indicated that gender differences in
collagen mRNA expression existed in our rat model. Although T1C
and T3C likely play a role in the tensile strength of the ACL, changes
in the expression of mRNA do not necessarily indicate a change in
protein content or ligament strength. However, higher concentrations
of the more elastic T3C in may result in a down stream reduction in
the relative strength of the ACL while increases of T1C may increase
tensile strength. Further studies are needed to determine the gender
specific mechanism of collagen remodeling and the role of steroid
sex hormones on metabolism, matrix metalloproteinases and ACL
strength IMPLICATIONS: Understanding of the mechanism by which
sex hormones influence collagen content and ACL strength will fur-
ther explain the gender disparities in ACL injury rate. These findings
are important as they will help direct future studies to identify women
S499
at risk for ACL injury and develop novel strategies to prevent their
occurrence KEYWORDS: Gender Disparity, ACL, Ligament, Knee,
Womens Health. FUNDING ACKNOWLEDGEMENTS: Supported in
part by USPHS Health Disparities Program MD00532-02. CONTACT:
wromani@som.umaryland.edu
ETHICS COMMITTEE: University of Maryland School of Medicine
Institutional Animal Care and Use Committee
Research Report Platform Presentation
3079 Wednesday 6 June 09:30
VCEC Meeting Room 18
VALIDATION OF A SHORT-FORM FUNCTIONAL CAPACITY
EVALUATION: RESULTS FROM A CLUSTER RANDOMIZED
CONTROLLED TRIAL
Gross D1,2 , Battie M1 , Asante A3 ; 1 Department of Physical
Therapy, University of Alberta, Edmonton, Canada; 2 Workers’
Compensation Board Alberta/ Millard Health, Edmonton, Canada;
3 Foothills Hospital, Calgary, Canada
PURPOSE: Functional Capacity Evaluations (FCE) are used for
making return-to-work decisions. FCE is a burdensome clinical tool
in terms of time and cost, yet predictive validity is modest. A short-
form FCE with comparable predictive accuracy would be beneficial.
Our objective was to evaluate a short-form FCE. RELEVANCE:
Physical Therapists often perform fitness-for-work assessments
using FCE, however, it is unknown which form of assessment is
most effective or efficient for promoting return-to-work and making
clinical decisions. PARTICIPANTS: Participants included twenty-
six Physical, Occupational and Exercise Therapists employed at
the Workers’ Compensation Board-Alberta’s rehabilitation facility
who were trained and experienced with FCE administration. Data
was collected on all workers’ compensation claimants undergoing
FCE at the rehabilitation facility over the trial period. Subjects
included 552 claimants (265 tested with short-form FCE) who
were predominantly employed (58%) males (72%) with chronic
musculoskeletal conditions (mean duration 709 days). METHODS:
Four region-specific FCE protocols were created from items within
the full Isernhagen Work Systems’ FCE protocol. To test the
utility and effectiveness of the short-form FCE protocols, a cluster
randomized controlled trial was conducted. Fourteen FCE clinicians
were randomized to an intervention group while the remainder
formed a control group. Clinicians in the intervention group were
trained to conduct the short-form FCE and used these protocols
through the trial’s duration. Clinicians in the control group continued
routine FCE procedures. All injured workers seen for FCE at the
rehabilitation facility were therefore entered into clusters based
on whether they were assessed using the short-form or routine
FCE. Data on subject characteristics, return-to-work outcomes and
claimant satisfaction with care were extracted from the WCB-Alberta
computer databases. Clinicians logged amount of time during the
assessment. Focus groups were held with clinicians using the
short-form to determine their satisfaction with the protocol’s clinical
utility. ANALYSIS: Analysis included examining differences between
groups on baseline characteristics and on indicators of fitness-to-
work, efficiency, and claimant and clinician satisfaction. Multivariable
regression was used to evaluate differences in outcomes between
groups while controlling for potential confounders. We accounted for
within-cluster dependence using a small inflation factor (intra-cluster
correlation = 0.05) as claimants were assigned to therapists in a
non-systematic, relatively random fashion. RESULTS: No significant
differences were observed between the intervention and control
groups on baseline characteristics including age, sex, duration of
injury, employment status, pain intensity, or self-rated disability. No
adverse consequences or complications from FCE testing were ob-
served. The distribution of return-to-work determinations were similar
between groups as were claimant satisfaction ratings (~90% satisfied
with the process). Focus groups with participating clinicians indicated
adequate satisfaction with the short-form FCE’s clinical utility. A 57%
S500
efficiency gain in time of functional assessment was seen, whereas
overall efficiency gain was 24%. One-year follow-up on administrative
return-to-work outcomes is nearing completion. CONCLUSIONS: A
short-form FCE appears to have adequate clinical utility while not
affecting clinician return-to-work decisions when compared to routine
FCE administration. Further evaluation of return-to-work outcomes
is underway. IMPLICATIONS: Short-form FCEs may be a cost-
effective option for Physical Therapists performing fitness-for-work
assessments. KEYWORDS: Occupational Health; Musculoskeletal;
Measurement in Practice. FUNDING ACKNOWLEDGEMENTS:
Funding was received from the Clinical Research Partnership Fund
sponsored by the Alberta Physiotherapy Association and University
of Alberta’s Department of Physical Therapy. WCB-Alberta assisted
with data acquisition. CONTACT: dgross@ualberta.ca
ETHICS COMMITTEE: University of Alberta’s Health Research
Ethics Board
Research Report Platform Presentation
2422 Wednesday 6 June 09:30
VCEC Meeting Rooms 19-20
USE OF VIDEOTAPES IN DETERMINING OUTCOME AFTER
INTENSIVE REHABILITATION FOR CHRONIC BACK PAIN
Barker K1 , Allen A1 , Frost H2 ; 1 Physiotherapy Research Unit,
Nuffield Orthopaedic Centre NHS Trust, Oxford, UK; 2 Department
of Public Health, University of Warwick, Warwick, UK
PURPOSE: To investigate using videotaped recordings of patients
performing functional tasks to evaluate change following a pain
rehabilitation programme. RELEVANCE: There is a need to assess
the benefit derived from treatment programmes. Currently a number
of self-report questionnaires and timed performance tests are used.
These are effective at documenting changes in the quantity of move-
ment and in patient reported function. However, they do not reflect
changes in the quality of movement. This study presents a method of
recording this information. PARTICIPANTS: 120 patients with chronic
back pain attending a rehabilitation programme. METHODS: Video-
tapes were recorded of patients performing two standard tasks, walk-
ing and sitting down on a chair, 3 weeks apart at the beginning and
end of a rehabilitation programme. Two experienced physiotherapists
scored the videos using observational grids. Walking was scored us-
ing the modified Rivermead Mobility Index; sit to stand based on devi-
ation from an ideal normalised posture and observed pain behaviour
using the system of Keefe (1). Changes in observed performance
were compared with changes in other standard outcome measures,
Oswestry Disability Index (ODI), Pain Self Efficacy (PSE) and Tampa
Kinesiphobia Scale (TKS); and three timed performance measures:
the shuttle walking test, stairs climbed and sit to stand in 60 seconds.
ANALYSIS: Inter-rater reliability was calculated using ICC. Changes
after treatment by students paired t- test. Associations between the
observational and other outcome measures were analysed using
Pearson’s Correlation coefficient. RESULTS: The inter-rater agree-
ment for walking was I.C.C. 0.969 (C.I. 0.954–0.979); p < 0.001; sit to
stand 0.785 (C.I. 0.686–0.853) p < 0.001 and pain behaviour 0.870
(CI 0.811-0.911), p < 0.001. There were significant improvements
in the measures between baseline and end of the programme for
observed gait, sit to stand and pain behaviour (p < 0.001). There were
only weak associations between the observed function and perfor-
mance in timed tests (observed gait and shuttle walking test p < 0.01;
observed and timed sit to stand p < 0.05). There was no correlation
between pain behaviour and performance in timed tests, nor with the
ODI, PSE or TKS. CONCLUSIONS: The interrater reliability of the
observational grids was high and they were sensitive to changes over
time. The percentage improvement measured by observation was
similar to those measured using timed tests; indicating that the grids
have good criterion-related validity. The lack of any strong association
between the observed and timed measures indicates that improved
quality of movement did not correlate with improvements in the speed
or quantity of physical performance. IMPLICATIONS: The use of
WCPT 2007, Research Reports
observational grids to measure changes in the quality of movement
can provide a useful alternative indicator of outcome in the field of
low back pain rehabilitation. It may be more relevant to the goals of a
rehabilitation programme than some of the timed measures that are
currently used. KEYWORDS: Back pain, video, outcome. FUNDING
ACKNOWLEDGEMENTS: The study was supported by a project
grant from the OHSRC. CONTACT: karen.barker@noc.anglox.nhs.uk
ETHICS COMMITTEE: Oxford LREC
Research Report Platform Presentation
2459 Wednesday 6 June 09:50
PP Crystal Pavilion A
RELIABILITY OF A COGNITIVE ADMISSION TEST FOR THE
STUDIES IN PHYSIO-/OCCUPATIONAL THERAPY
Genucchi R; Schule für Physiotherapie am UniversitätsSpital,
Zürich, Switzerland
PURPOSE: For the new established Swiss studies in physio-
/occupational therapy (BSc), starting in autumn 2006, 180 study
places (120 PT, 60 OT) are provided in Zurich and 44 (PT) in
Berne. A two-stage admission test has been developed based on
job specification, which describes important attributes and skills for
the studies and later occupational activity. In the first part (written test)
primarily cognitive skills are tested and in the second part (practical
test/interview) primarily communicative and sensomotor skills. Is the
difficulty level and selectivity of test items of the written test good
enough for reliable differentiation of the performance? Is the reliability
(internal consistency) of the written test good enough to examine the
required attributes of the candidates? RELEVANCE: The results of
the written test are used as selection criterion for participation in the
second part of the admission procedure. In order to select suitable
candidates, the test items should dispose of good selectivity, item
difficulty and internal consistency. A literature search found similar
tests for admission to medical studies but not for physiotherapy
studies. DESCRIPTION: The four parts of the written test (80
multiple-choice questions) should examine the following cognitive
attributes: 1. capacity for observation/remembering (COR), 2. basic
understanding of science (BUS), 3. interpretation of diagrams/tables
(IDT), and 4. spatial sense (SPS). BUS, IDT, SPS follow the Swiss
admission test for medical studies in their methodology sections, but
the content is adapted for physiotherapy purposes. The COR section
was newly developed. In order to economize costs, the four-hour test
was held jointly by two universities of applied sciences (Zurich, Berne)
and included the study courses physio- and occupational therapy.
The second stage of the admission test was planned separately by
each course. EVALUATION: 787 applicants (Zurich: 316 PT, 179
OT, Berne: 291 PT) attended the written test. A maximum of 20
points in each section could be achieved. The mean results of the
three groups did not differ significantly (PT Zurich: 41.62, PT Berne:
41.48, OT Zurich: 39.90). Internal consistency (cronbach a) was
0.62, sections COR/IDT display clearly lower reliability (0.22/0.30).
Cronbach a remains 0.61 when COR section is omitted. 58% of test
items display sufficient selectivity (R>0.10), 62% display adequate
item difficulty (P=40-90). CONCLUSIONS: The attribute COR cannot
be assessed by this test. Item difficulty of the BUS/IDT sections
was too high. Reliability is weak for a test with drastic personal
consequences. To obtain reliability of 0.80 the test with similar
item quality should theoretically consist of 190 items and would
be uneconomical. The same result is found when test items with
insufficient selectivity are analyzed and eliminated and replaced
with qualitative better items. The test is thus expanded to 84
questions (reliability improvement after G. Lienert). IMPLICATIONS:
Further research is necessary to bring the quality of test items to a
standardized level and develop an adequate test for the COR section.
KEYWORDS: Physiotherapy Studies, Admission Test, Reliability.
FUNDING ACKNOWLEDGEMENTS: No funding was received for
this work. CONTACT: reto.genucchi@usz.ch
Platform Presentations, Wednesday 6 June
Research Report Platform Presentation
2946 Wednesday 6 June 09:50
VCEC Meeting Rooms 11-12
EVALUATION OF VISUAL VERTIGO WITH 2-DIMENSIONAL
VIDEO-OCULOGRAPHY
Dannenbaum E1 , Ip A2 , Stuart R3 , Paquette C1,4 , Fung J1,4 ;
1 Jewish Rehabilitation Hospital Research Site of the Montreal
Center for Interdisciplinary Research in Rehabilitation, Laval, QC,
Canada; 2 Faculty of Medicine, McGill University, Montreal, QC,
Canada; 3 Department of Biology, Western Washington University,
Washington, USA; 4 School of Physical and Occupational Therapy,
McGill University, Montreal, QC, Canada
PURPOSE: Visual vertigo (VV) is induced by exposure to visually
moving environments. Quantitative assessments of clients with VV
are not yet available. The goal of this study was to investigate
eye movements generated by viewing a moving target or a moving
background in clients with VV. RELEVANCE: In vestibular rehabili-
tation, VV is a debilitating symptom frequently reported by clients.
Objective outcome measures are lacking. An accurate evaluation of
VV will contribute towards more efficient treatment. PARTICIPANTS:
Ten clients with VV were recruited from a vestibular rehabilitation
program. The inclusion criteria were that the client’s symptoms were
provoked by performing at least 5 of these 6 activities: television,
movie, grocery shopping, malls, traffic, escalators, and checkered
floor. A convenience sample of 10 age- and gender-matched controls
also participated. METHODS: In a controlled experiment, subjects
tracked a horizontally moving target (covering 30 deg of visual angle),
projected on a screen 2m in front of them. Two velocities at 10 and 20
deg/sec were tested. In a second series, subjects viewed a moving
background (alternating colored bars moving across the screen) at
the same velocities. Stimuli of 20-s durations were generated with
an infrared camera-based 2D video-oculography (2D VOG) system.
Both protocols were tested in sitting, standing and standing on
foam. ANALYSIS: The main outcome variables for the respective
paradigms were (1) Proportion of smooth pursuit eye movements
generated by subjects (Amplitude of Smooth Pursuit / [Amplitude
of Smooth Pursuit + Amplitude of Saccadic Movement] * 100) and
(2) gain of the nystagtmus slow phase velocity (SPV) relative to the
stimulus velocity (SPV / stimulus velocity * 100). Three-way mixed
effects analyses of variances were performed to test the effects
due to group (VV vs. control), stimulus velocity (10 deg/s vs. 20
deg/s) and testing position (sit vs. stand vs. foam). A p-value of less
than 0.01 was accepted as significant, after adjusting for multiple
comparisons (Bonferoni’s test). RESULTS: In the smooth pursuit
paradigm, the clients with VV used significantly more saccades.
Stimulus velocity however, did not affect smooth pursuit control. The
moving background induced significant main effects due to group
and stimulus velocity such that clients with VV showed a significantly
higher gain than controls and that gain significantly decreased with
increasing stimulus velocity. In both paradigms the testing position
has no significant effect on eye movements CONCLUSIONS: Clients
with VV generated more saccades during smooth pursuit than control
subjects in tracking a moving target, reflecting either an inability to
anticipate movement of the target or control gaze smoothly. With the
moving background stimulus, many of the controls were able to inhibit
eye movements at will while clients with VV constantly responded to
the stimulus. The fact that testing position did not affect oculomotor
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.
CONTACT: Edannenbaum_hjr@ssss.gouv.qc.ca
ETHICS COMMITTEE: Centre de recherche interdisciplinaire en
réadaptation du Montréal métropolitain
S501
Research Report Platform Presentation
3258 Wednesday 6 June 09:50
VCEC Meeting Room 16
A PILOT RANDOMIZED CONTROLLED TRIAL TO EVALUATE
THE SAFETY AND FEASIBILITY OF VERY EARLY MOBILIZATION
IN ACUTE STROKE UNITS (AVERT)
Bernhardt J1,2 , Dewey H1,3 , Collier J1,3 , Thrift A1 , Donnan G1,3 ;
1 National Stroke Research Institute, Melbourne, Australia; 2 School
of Physiotherapy, La Trobe University, Melbourne, Australia;
3 Department of Neurology, Austin Health, Melbourne, Australia
PURPOSE: Very early mobilization may be an important component
of effective stroke unit care. Identifying effective components of
stroke unit care can improve standards of care and outcomes
for stroke survivors. RELEVANCE: Physiotherapy research trials
commonly fail to evaluate the implimentation of new intervention
protocols and the potential for patient harm. Prior to commencement
of a large randomized controlled trial of very early mobilization
(VEM), we aimed to investigate both the safety and feasibility
of a VEM protocol. PARTICIPANTS: Patients were recruited from
two Melbourne metropolitan stroke units. We included people
admitted to hospital within 24 hours of confirmed stroke, whose
physiological parameters fell within set limits. Patients with severe
premorbid disability, severe comorbidities or requiring palliative care
were excluded. METHODS: Patients were randomized to VEM or
standard care (SC). Patients in the control group received SC.
Patients receiving VEM commenced mobilisation within 24 hours
post stroke and were provide frequent daily mobilizations for 14
days or until discharge (whichever was sooner). VEM was provided
by a physiotherapist and nurse team. Assessments at days 7,
14 and 3 months were conducted by a blinded assessor. The
primary safety outcome was death at 3 months. Secondary safety
outcomes included the number of falls, number of serious adverse
events (SAEs), deterioration in the first 14 days, excessive fatigue
after treatment and failure to mobilize due to blood pressure drops
of >30 mmHg. The main feasibility outcome was the total “dose”,
measured in minutes of mobilization. Secondary feasibility outcomes
included the time from stroke to first mobilisation, and whether
contamination of SC occurred. ANALYSIS: Analyses were intention
to treat. Fischer’s exact test was used for analyses. RESULTS:
Seventy one patients were recruited between March 2004 and
February 2006. Patient mean age was 74.7 years, 54% were male,
87% had infarcts, and 58% had an admission National Institute
Health Stroke Score >7. More patients in the VEM group died
(8/38 VEM; 3/33 SC). The risk difference was 12% (95% CI −4–
28%, p = 0.16), and was in the expected range. There were no
severe falls, no failures to mobilize due to postural BP drop and the
number of SAEs was similar (35/38 VEM; 27/33 SC). Total dose
was 255.6 minutes for VEM and 125.4 minutes for SC (p = 0.011).
Median time to first mobilization was 18.5 (IQR 13.7-21.9) hours for
VEM and 30.8 (IQR 23.0-39.9) for SC (p < 0.0001). There was no
evidence of contamination of SC. CONCLUSIONS: VEM appears
safe and feasible. IMPLICATIONS: Given these findings, a phase
III trial to test efficacy is underway. KEYWORDS: safety, feasability,
randomized controlled trial. FUNDING ACKNOWLEDGEMENTS:
Affinity Health and National Heart Foundation (Australia). CONTACT:
j.bernhardt@unimelb.edu.au
ETHICS COMMITTEE: Human Research Ethics Committee, Austin
Health; Human Research Ethics Committee, St. Vincents Hospital
S502
Research Report Platform Presentation
3035 Wednesday 6 June 09:50
VCEC Meeting Room 17
ACOUSTIC STIFFNESS INDEX OF ARTICULAR CARTILAGE
AFTER AUTOLOGOUS OSTEOCHONDRAL TRANSPLANTATION
SURGERY AND CARE FOR PHYSICAL THERAPY
Kuroki H1 , Nakagawa Y2 , Mori K3 , Kobayashi M2 , Okamoto Y2 ,
Yasura K2 , Nishitani K2 , Sakakima H1 , Nakamura T2 ; 1 Department
of Physical Therapy, School of Health Sciences, Faculty of
Medicine, Kyoto University; 2 Department of Orthopaedic Surgery,
Graduate School of Medicine, Kyoto University; 3 Department
of Applied Medical Engineering Science, Graduate School of
Medicine, Yamaguchi University
PURPOSE: Autologous osteochondral transplantation (AOT) is the
surgery to reconstruct focal cartilage lesion. Although reports on the
surgery state that AOT successfully reconstructs the lesion, no report
focuses on physical therapy (PT) after AOT. We have demonstrated
and published cartilage acoustic stiffness index in animal experiments
using ultrasound. The purpose of study, therefore, is to investigate
the cartilage acoustic stiffness index after AOT and to discuss when
care for PT should be taken. RELEVANCE: For successful PT and
for evidence based PT after AOT it is important to understand
acoustic stiffness index of articular cartilage because cartilage
with low acoustic stiffness index that suggests decreased collagen
cartilage is affected by repeated mechanical stress and is easy
to deteriorate. PARTICIPANTS: Thirty-six Japanese white rabbits
were used (Approval number: Med Kyo 04202). METHODS: In 36
rabbits, an osteochondral plug, 6 mm in diameter, was removed from
the right patellar groove and grafted into a recipient hole, 5 mm
in diameter, in the left patellar groove. Specimens at 2, 4, 8, 12,
24 and 52 weeks postoperatively were assessed by macroscopic
and histological observation and by an ultrasound system. Using
ultrasound, acoustic stiffness index of plug cartilage and percentage
acoustic stiffness index (ratio to adjacent intact cartilage) after AOT
was examined. ANALYSIS: Acoustic stiffness index and percentage
acoustic stiffness index was analyzed using the non-parametric
Kruskal-Wallis test and the post-hoc Holm’s test. RESULTS: Acoustic
stiffness index of control knee cartilage was 3.18 (relative value,
unitless). Acoustic stiffness index of plug cartilage of AOT knees
at weeks 2, 4, 8, 12, 24 and 52 postoperatively was 2.17, 2.04,
1.23, 1.01, 1.95 and 3.94, respectively. Acoustic stiffness index of
plug cartilage decreased up to 12 weeks but then increased at
24 and 52 weeks after AOT. The acoustic stiffness index at 52
weeks postoperatively was significantly higher than that at 8 or 12
weeks (P < 0.01). Percentage acoustic stiffness index decreased up
to 8 weeks (58.7%) but then recovered to 83.9% at 12 weeks and
102.7% at 24 weeks and increased to 196.3% at 52 weeks after
the surgery. CONCLUSIONS: Although percentage acoustic stiffness
index decreased up to 8 weeks postoperatively, it recovered well
at 52 weeks after AOT. After 8 weeks postoperatively, menu for
PT can be able to be increased. IMPLICATIONS: Postoperative
care in physical therapy up to 8 weeks should be taken after AOT.
KEYWORDS: autologous osteochondral transplantation, ultrasound,
acoustic stiffness index. FUNDING ACKNOWLEDGEMENTS: This
study was supported in part by a grant from the Grant-in-Aid for
Scientific Research, Japan. CONTACT: kuro@hs.med.kyoto-u.ac.jp
ETHICS COMMITTEE: The Animal Research Committee of Kyoto
University Graduate School of Medicine (approval number; Med Kyo
04202).
WCPT 2007, Research Reports
Research Report Platform Presentation
3089 Wednesday 6 June 09:50
VCEC Meeting Room 18
THE INFLUENCE OF A CONTINUUM OF CARE MODEL ON THE
REHABILITATION OF CLAIMANTS WITH SOFT TISSUE INJURY
Stephens B1 , Gross D1,2 ; 1 Workers’ Compensation Board Alberta,
Edmonton, Canada; 2 Department of Physical Therapy, University
of Alberta, Edmonton, Canada
PURPOSE: Soft tissue musculoskeletal conditions continue to
be leading causes of disability and work loss in Canada and
internationally. From 1996 through 1997, the Workers’ Compensation
Board of Alberta (WCB-Alberta) implemented a soft tissue injury
continuum of care model to guide physical therapy and rehabilitation
service delivery. The model was designed as a high-level decision-
making tool to promote a consistent, evidence-based approach to
care provision within the jurisdiction. The model involved three main
components: 1) staged application of various rehabilitation services
depending on progress of recovery; 2) case management protocols
and checkpoints integrated into case planning; and 3) contracted
services with rehabilitation providers (physical therapy, chiropractic,
multidisciplinary assessment and rehabilitation centres). As contin-
uums of care have been little studied, we evaluated the impact of
the WCB-Alberta model on sustained return-to-work. RELEVANCE:
This study is important for physical therapy practice as little is known
about the effectiveness of funder-based models (i.e. continuums of
care) or rehabilitation provider networks. PARTICIPANTS: The model
was implemented province-wide, therefore, the entire population of
workers ensured by the WCB-Alberta was the object of investigation.
The model was directed at workers with uncomplicated soft tissue
injuries (i.e. injury claims for strain, sprain or tear to muscles,
tendons or ligaments involving only one body part). An intervention
group was created from all claimants with soft tissue injuries to
the low back, ankle, knee, elbow, and shoulder identified using
ICD-9 and National Work Injury Statistics Program coding. The
comparison group was formed of workers experiencing fractures or
other traumatic non-soft tissue injuries. METHODS: A population-
based before-and-after design with concurrent control group was
used. Data was extracted from the WCB-Alberta administrative
database from two years prior to model implementation to five
years after. Information on potential confounders was obtained
including age, gender, wage, industrial sector and occupation, past
claim history, employer size, and employment status at time of
claim acceptance. Primary outcome measure was a surrogate
indicator of sustained return to work, cumulative days receiving wage
replacement benefits. Cost savings were also estimated. ANALYSIS:
To determine the impact of model implementation while controlling
for potential confounders, survival analytic techniques including Cox
regression were used. Data was censored at one year. RESULTS:
Over the entire study period, 70,116 claimants experienced soft
tissue injuries (14,217 pre-implementation) while 101,620 claimants
experienced non-soft tissue injuries (12,236 pre-implementation).
In the intervention group, significant improvement in outcome was
observed after implementation (adjusted Hazard Ratio 1.54(1.50-
1.58). Median duration of wage replacement benefits decreased
from 13 days to 8 days while mean duration lowered from 39 to
20 days. Little change was seen in the control group’s disability
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
Platform Presentations, Wednesday 6 June
received in support of this research. WCB-Alberta assisted with data
extraction. CONTACT: dgross@ualberta.ca
ETHICS COMMITTEE: Approval was given by the WCB-Alberta’s
Strategic Management Council.
Research Report Platform Presentation
2585 Wednesday 6 June 09:50
VCEC Meeting Rooms 19-20
RELATIONSHIP BETWEEN SPINAL STIFFNESS AND OUTCOME
IN PATIENTS WITH CHRONIC LOW BACK PAIN
Ferreira M1,2 , Ferreira P1,3 , Latimer J1 , Herbert R1,4 , Maher C1,4 ,
Refshauge K1 ; 1 School of Physiotherapy, The University of Sydney,
Sydney, Australia; 2 Departamento de Fisioterapia, Pontifı́cie
Universidade Católica de Minas Gerais, Belo Horizonte, Brazil;
3 Departamento de Fisioterapia, Universidade Federal de Minas
Gerais, Belo Horizonte, Brazil; 4 Center for Evidence-Based
Physiotherapy, The University of Sydney, Sydney, Australia
PURPOSE: (i) To investigate whether spinal joint stiffness changes
after treatment, or if it is changed by treatment; (ii) to investigate
the relationship between pre-treatment spinal stiffness and change
in stiffness with treatment; (iii) to assess the relationship between
stiffness, pain, disability and Global Perceived Effect scores (iv)
to investigate whether stiffness predicts response to treatment
in chronic low back pain patients. RELEVANCE: Posteroanterior
pressure is commonly used by manipulative therapists to assess
the extent and quality of spinal stiffness in people with spinal
pain. However, only few studies have investigated the influence of
treatment on spinal joint stiffness and the relationship between spinal
stiffness and outcomes such as pain, disability and health status.
PARTICIPANTS: 191 subjects with chronic low back pain (CLBP)
were randomly allocated to groups that received either spinal manip-
ulative therapy, specific segmental exercise, or a general exercise
program. METHODS: Before and after receiving the intervention
subjects were manually assessed for spinal stiffness. Spinal stiffness
assessments were performed using a reference-based protocol.
ANALYSIS: Paired samples t-tests were used to test change in
stiffness with treatment. Differences between the three treatment
groups’ mean changes were analyzed using independent samples
t-tests. Pearson’s correlation was used to analyze the relationship
between pre-treatment stiffness scores and change in stiffness with
treatment and to analyze the relationship between stiffness change
and change in clinical outcome measures. Multiple linear regression
was used to determine if stiffness predicted outcome. RESULTS: All
three intervention groups showed a significant decrease in stiffness
following treatment (p < 0.001). No difference between groups was
observed. There was a significant negative correlation between pre-
treatment stiffness scores and change in stiffness scores for all
subjects (r = −0.61, p < 0.001) and for each group (r = −0.40, p = 0.02
for the Specific Stabilisation Group, r = −0.77, p < 0.001 for the Spinal
Manipulative Therapy Group, and r = −0.62, p < 0.001 for the General
Exercise Group). There was a significant but low correlation of
0.18 (p = 0.02) between stiffness change and change in Global
Perceived Effect of treatment for all subjects, and a significant
but low correlation between stiffness change and Patient Specific
Functional Scale change for subjects in the Spinal Manipulative
Therapy Group (−0.28; p = 0.02). No significant association was
observed between initial stiffness score and any of the final outcome
measures following treatment. CONCLUSIONS: Spinal stiffness has
been considered an important factor in the assessment and treatment
planning of patients with low back pain. Stiffness decreases over
the course of an episode of treatment, more so in those with the
stiffest spines, but the decrease is not dependent on treatment
and is not generally related to outcome. Measures of stiffness
cannot be used to assess outcomes. IMPLICATIONS: Our results
suggest that clinicians might be overestimating the usefulness of the
information gathered from spinal stiffness assessment. KEYWORDS:
Low back pain, spinal stiffness, exercise, spinal manipulative therapy.
S503
FUNDING ACKNOWLEDGEMENTS: The study was funded by The
Arthritis fundation, Motor Authority Association and the University of
Sydney SESQUI grant. CONTACT: m.ferreira@pucminas.br
ETHICS COMMITTEE: The University of Sydney Ethics Committee
Research Report Platform Presentation
2730 Wednesday 6 June 10:10
VCEC Meeting Rooms 1-3
TRUNK POSTURE AFFECTS REGIONAL CHEST WALL
MOVEMENT DURING BREATHING
Lee L, Coppieters M, Hodges P; Division of Physiotherapy, School
of Health and Rehabilitation Sciences, University of Queensland,
Brisbane, Australia
PURPOSE: Changes in spinal alignment are likely to influence rib
mechanics, which in turn impact ventilation. Although it is known that
gross changes in posture (eg. scoliosis) lead to regional changes
in ventilation and chest wall movement, whether subtle postural
changes influence chest wall motion is unclear. This study aimed
to investigate the influence of subtle changes in spinal curvature on
chest wall motion and adaptation of breathing pattern to increased
respiratory demand. RELEVANCE: Assessment and treatment of
breathing pattern and capacity is an important component of
cardiovascular and musculoskeletal physical therapy. Commonly,
people present with subtle variations in spinal posture, which
may affect accurate assessment, treatment, and research design.
PARTICIPANTS: Seven volunteers (three males, four females)
with no history of spinal pain or scoliosis, any neurological
condition, or any respiratory condition participated. METHODS:
Three-dimensional (3D) motion of the chest wall was recorded using
an electromagnetic tracking device. Sensors placed over landmarks
on the upper and lower ribcage, spine, and abdomen measured
spinal alignment and chest wall motion. Subjects breathed through
a mouthpiece; flow was measured with an pneumotachometer and
volume calculated by integrating the flow signal. Seated subjects
adopted seven postures: self selected, neutral, slump, thoracolumbar
extension (military), half trunk rotation, full trunk rotation, and
lateral ribcage shift. In each position subjects breathed quietly
(QB) and with an increased dead-space to increase respiratory
demand. ANALYSIS: Times of end-inspiration and expiration were
identified from the volume data. Displacement of the movement
sensors in three planes between inspiration and expiration was
calculated and diameter changes for chest wall and abdomen
were determined. Movement data were normalised to that recorded
during a vital capacity maneuver. Spinal angles in the sagittal
plane were calculated. Repeated-measures ANOVAs were used
to compare differences in spinal angles between postures and
differences in chest wall movement between postures and different
levels of respiratory demand. RESULTS: Subjects successfully
attained the target postures, evidenced by differences in thoracic,
thoracolumbar, and lumbar spine angles between postures in the
sagittal plane(p < 0.001). Chest wall motion was different between
postures. In mililtary posture there was more lateral movement
of the lower ribcage compared to all other postures(p < 0.002). In
slump posture there was greater upper chest movement in both
lateral and anteroposterior (AP) planes compared to the neutral
position(p < 0.004), and in full rotation there was decreased upper
ribcage movement in the lateral direction(p < 0.05) and increased
AP abdominal movement(p < 0.02) compared to the neutral position.
CONCLUSIONS: Subtle changes in postural alignment in both
the sagittal and transverse planes affect chest wall motion, both
during quiet breathing and when respiratory demand is increased.
Further studies are required to determine whether the underlying
mechanisms are mechanical or muscular, and to determine if these
changes in chest wall motion impact distribution of ventilation.
IMPLICATIONS: Physical therapists involved in both clinical as-
sessment and treatment of respiratory function and in respiratory
research need to consider that spinal alignment has the potential to
S504
affect diagnostic measures, treatment efficacy, and standardization
of research protocols. KEYWORDS: thorax, respiration, chest
wall motion. FUNDING ACKNOWLEDGEMENTS: Linda-Joy Lee is
supported by the Canadian Institutes of Health Research (CIHR).
Paul Hodges is supported by the National Health and Medical
Research Council of Australia. Michel Coppieters is supported by
the University of Queensland. CONTACT: ljlee@alumni.ubc.ca
ETHICS COMMITTEE: Medical Research Ethics Committee of the
University of Queensland
Research Report Platform Presentation
3155 Wednesday 6 June 10:10
VCEC Meeting Room 18
THE EFFECT OF AN EXERCISE PROGRAM AND ERGONOMIC
ADVICES IN LOW BACK PAIN: A RANDOMISED CLINICAL
TRIAL IN NURSING POPULATION
Mohseni Bandpei M1 , Fakhri M2 , Bagheri Nessami M2 , Ahmad
Shirvani M2 , Khalilian A1 , Shayesteh Azar M1 ; 1 School of Medicine,
Mazandaran University of Medical Sciences; 2 School of Nursing
and Midwifery, Mazandaran University of Medical Sciences
PURPOSE: Annually, one third of work related injuries belongs to the
musculoskeletal disorders and low back pain is the most commonly
reported injury. There are many therapeutic interventions available
in the treatment of low back pain, but the most effective treatment
is yet to be demonstrated. The present study was designed to
compare the effect of an exercise program and ergonomic advices
in the treatment of chronic low back pain with adequate long term
follow up. RELEVANCE: Back injuries are a major category of
occupational injuries and nursing personnel have a higher prevalence
and incidence rate of back injuries than most occupational groups
in the healthcare sector as well as in all industries. This study
determines how effective exercise programs and ergonomic advices
could be in reducing the impact of low back pain in nursing staff.
PARTICIPANTS: 236 registered nurses matched by age, gender
and body mass index were randomly recruited for the purpose of
this study. METHODS: Following ethical approval, a randomised
controlled clinical trial was carried out to assess the effect of an
exercise program and ergonomic advices in the treatment of low
back pain. Participants were randomly divided into four groups.
The first three groups were received different intervention (group
1, therapeutic exercise combined with ergonomic advices; group 2,
therapeutic exercise only; and group 3, ergonomic advices only). The
fourth group was given no intervention. Pain on visual analogue scale
and disability on Oswestry low back disability questionnaire were
measured at 1, 3, 6 and 12 months after intervention. ANALYSIS:
Descriptive analysis, a Repeated Measurements test, ANOVA and
Dunet test were used to analyze data. RESULTS: Statistical analysis
indicated that there was significant differences on pain and disability
measurements in all instances using ANOVA (p < 0.001). A Repeated
Measurements test showed significant improvements in the first three
groups both on pain and disability following intervention (p < 0.01). No
significant changes were found in the fourth group (control group)
neither on pain nor disability scores at different period of follow
up. Dunnet test revealed a significant difference between each first
three group (group 1, 2 and 3) and the fourth group on pain and
disability (p < 0.001 in both instances). CONCLUSIONS: The results
demonstrate that therapeutic exercise and ergonomic advices could
be considered as effective approaches in the treatment of low back
pain in nursing population. Therefore, more emphasis should be put
on regular exercise and ergonomic advices in nursing population
in order to prevent and control such a common and costly health
problem. IMPLICATIONS: Exercise program and ergonomic advices
may play an important role to reduce the prevalence and incidence
of low back pain in nursing profession. KEYWORDS: Occupational
injury; low back pain; nurses; ergonomic advice; exercise. FUNDING
ACKNOWLEDGEMENTS: We would like to express our sincere
appreciation to the Mazandaran Province Management and Planning
WCPT 2007, Research Reports
Organisation for the financial support of this study. We would also like
to thank the Vice-Chancellor for Research Affairs of the Mazandaran
University of Medical Sciences for his contribution and kind support.
CONTACT: Mohseni_bandpei@yahoo.com
ETHICS COMMITTEE: Medical Ethics Board at the Mazandaran
University of Medical Sciences
Research Report Platform Presentation
2926 Wednesday 6 June 10:10
VCEC Meeting Rooms 19-20
PREDICTIVE FACTORS FOR DISABILITY AFTER 1 AND 5 YEAR
IN PATIENTS SEEKING PRIMARY CARE FOR LOW BACK PAIN
Enthoven P1 , Skargren E1 , Carstensen J2 , Öberg B1 ; 1 Department
of Health and Society Phyriotherapy, Linköpings universitet;
2 Department of Health and Society Tema Health and Society,
Linköpings universitet
PURPOSE: To assess the independent predictive value of a
number of potential predictive factors for disability at the 1-year
and 5-year follow-ups, and to examine whether prediction models
were improved by replacing baseline health-state-related variables
with corresponding variables after treatment. A further aim was
to describe possible differences between those on sick leave,
early retirement or disability pension, and those who were not.
RELEVANCE: Many patients seeking primary care for low back
pain continue to report disability several years after their initial
visit, and about one third of the patients seek care again every
six months. PARTICIPANTS: The study sample comprised 148
participants in a previous randomized trial in primary care who
were eligible for sick leave benefits. METHODS: Prospective cohort
study. Baseline factors for the prediction of future disability were
age, gender, self-reported physical-activity-related and work-related
factors, expectations of treatment, similar problems previously,
duration of episode, more than one localization, sick leave, pain
frequency, disability and well-being. ANALYSIS: Simple and multiple
logistic regression analyses were used to identify predictive factors.
RESULTS: At the 5-year follow-up, 37% (n=19/52) of the patients
with disability were on sick leave or were receiving early retirement
or disability pension. For those without disability the corresponding
figure was 9% (n=8/92). Being a woman, duration of the current
episode, similar problems during the previous 5 years, exercise level
before the current episode, pain frequency at baseline, and disability
after treatment emerged as predictive factors for disability at the
5-year follow-up. Replacing baseline health-state-related measures
with corresponding measures after the treatment period as well as
adding physical-activity-related and work-related factors improved
prediction of future disability. CONCLUSIONS: At the 5-year follow-
up patients with disability were more often on sick leave or receiving
early retirement or disability pension than patients without disability.
Predictive factors for disability after 5 years were partly different
from predictive factors for disability after 1 year. Replacing baseline
health-state-related measures with corresponding measures after the
treatment period, and adding physical-activity-related and possibly
work-related factors might improve the likelihood of predicting future
disability. Confidence intervals were wide in several cases, and
the results must be interpreted with caution. IMPLICATIONS: Early
identification of factors predicting different health outcome may
improve treatment management, avoid unnecessary treatments and
improve information to the patients about the course of their condition.
KEYWORDS: Low back pain; Prognostic factors, physical activity.
FUNDING ACKNOWLEDGEMENTS: The study was supported
by the County Council of Östergötland and Linköping University,
Sweden. CONTACT: elisabeth.skargren@ihs.liu.se
ETHICS COMMITTEE: The research ethic committee at Linköping
University, Sweden
Platform Presentations, Wednesday 6 June
Research Report Platform Presentation
1433 Wednesday 6 June 10:45
PP Crystal Pavilion A
CATASTROPHIZING, FEAR-AVOIDANCE BELIEFS, PHYSICAL
ABILITY AND HEALTH-RELATED QUALITY OF LIFE AMONG
WOMEN WITH AND WITHOUT LUMBOPELVIC PAIN IN EARLY
PREGNANCY
Olsson C1,4 , Buer N2 , Holm K3 , Harms-Ringdahl K4 , Nilsson-
Wikmar L4 ; 1 Center for Family and Community Medicine (CeFAM),
Huddinge, Sweden; 2 Department of Health Sciences, Örebro
University, Örebro, Sweden; 3 Team Aktiv, Hässelby, Stockholm,
Sweden; 4 Department of Neurobiology, Care Sciences and Society,
Division of Physiotherapy, Karolinska Institutet, Stockholm, Sweden
PURPOSE: It seems that there is a relationship between fear-
avoidance beliefs and activity level as well as between catastrophiz-
ing and pain, and it seems that these relationships play an active
role in the transition from acute to chronic pain. About 50% of all
pregnant women report lumbopelvic pain which is also the most
common reason for sick leave during pregnancy. Many women state
that their back problems started during pregnancy. The purpose of
the study was to compare catastrophizing, fear-avoidance beliefs,
physical ability and health-related quality of life in pregnant women
with and without lumbopelvic pain in early pregnancy. RELEVANCE:
In order to form effective treatment and prevent future pain and
disability more knowledge is needed about the significance of
catastrophizing and fear-avoidance beliefs in the development of
pregnancy-related lumbopelvic pain. These variables might also be
helpful in the early identification of women at risk of developing
chronic problems. Increased knowledge about how women’s lives
are affected if they suffer from pregnancy-related lumbopelvic pain is
of great importance for the whole society. PARTICIPANTS: Three
hundred and four women in the 19th-21th week of pregnancy,
attending five specific midwife receptions filled out questionnaires.
METHODS: The questionnaires included: general questions about
background factors, the Pain Catastrophizing Scale (PCS)(0-52) for
exaggerated negative thoughts about pain experiences, the Fear-
Avoidance Beliefes Questionnaire (FABQ)(0-24) for beliefs about
how physical activity affect back pain, the Disability Rating Index
(DRI)(0-100) to score the physical ability, and The Nottingham
Health Profile (NHP)(0-100) for assessing health-related quality
of life. ANALYSIS: For comparison between the two groups the
Mann-Whitney U-test was used. RESULTS: The 304 women who
answered the questionnaires were divided into women with (LP;
n=135) and without (NLP; n=169) lumbopelvic pain. The women with
lumbopelvic pain rated significantly (p < 0.05) higher catastrophizing
(PCS; Md, (range) LP 15.0(0-48), NLP 10.0(0-43), higher level of
fear-avoidance beliefs (FABQ; Md, (range) LP 12.0(0-23), NLP 6.0(0-
24, lower physical ability (DRI; Md, (range) LP 26.3(0-89.5), NLP
9.6(0-98.4) and lower health-related quality of life (NHP; Md, (range)
LP 17.4(0-83.3), NLP 3.3(0-73.8), compared to women without
lumbopelvic pain. CONCLUSIONS: Even during early pregnancy
many women suffer from pregnancy-related lumbopelvic pain and
it seems that catastrophizing and fear-avoidance beliefs are involved
in the development of such pain. The women with pregnancy-
related lumbopelvic pain had more exaggerated negative thoughts
about pain experiences and more fear-avoidance beliefs than those
without lumbopelvic pain. They also had a lower physical ability
and a lower health-related quality of life compared to women
without lumbopelvic pain. More knowledge should be acquired in
this area, in early pregnancy and also in other occasions like
later during pregnancy and after delivery. IMPLICATIONS: To form
effective treatment strategies for pregnancy-related lumbopelvic pain
it’s important to consider catastrophizing and fear-avoidance beliefs
and not only the intensity and duration of pain. The effect pregnancy-
related lumbopelvic pain has on womens lives should be taken
into account by general health care and society whenever there
is a discussions about sick-leave. KEYWORDS: women’s health,
disability, pain,. FUNDING ACKNOWLEDGEMENTS: This study was
S505
supported by grants from The Research and Development Unit,
Beställare Vård, Stockholm County Council, Sweden. CONTACT:
christina.b.olsson@sll.se
ETHICS COMMITTEE: The Local Ethic’s Committee, The Karolinska
Hospital, Solna, Sweden.
Research Report Platform Presentation
1571 Wednesday 6 June 10:45
VCEC Ballroom A
CLOSED KINETIC CHAIN EXERCISE RESTORES MUSCULO-
SKELETAL REFLEX FUNCTION IN QUADRICEPS FEMORIS IN
THE JOINT HYPERMOBILITY SYNDROME
Tennant N1 , Ferrell W2 , Baxendale R3 , Kusel M3 , Sturrock R2 ;
1 Physiotherapy Department, Royal Infirmary Glasgow, Scotland,
UK; 2 Centre for Rheumatic Diseases Royal Infirmary, Glasgow,
Scotland, UK; 3 Institute of Biomedical and Life Sciences, University
of Glasgow, Scotland, UK
PURPOSE: We previously observed impaired proprioception in
patients with Joint Hypermobility Syndrome (JHS) compared to a
control group. We then demonstrated that a closed kinetic chain
(CKC) exercise program enhanced knee joint proprioception and
in addition reduced pain and improved function. Patients with JHS
often report instability (’giving way’) at the knee joint. The purpose
of this study was therefore to investigate whether reflex function at
the knee is impaired in patients with JHS and if so whether this
can be improved by exercise. Further to this we investigated the
consequences of hyperextension of the knee joint on reflex function
RELEVANCE: This group of patients have been traditionally difficult
to manage responsding poorly to conventional physiotherapy. In
addition it is crucial for our profession to investigate interventions
at physiological level thereby providing objective evidence of our
efficacy. PARTICIPANTS: Fifteen patients diagnosed with JHS
were recruited from the Hypermobility Clinic at Glasgow Royal
Infirmary. Diagnosis of JHS was based on the revised Brighton
criteria which includes the Beighton scoring system. Eleven healthy
normomobile individuals with no history of joint disease, were
recruited from the university student and staff population. METHODS:
Electromyographic (EMG) recordings were obtained via surface
electrodes from the quadriceps femoris muscle while brief electrical
pulses (1.3 times motor threshold) were applied to the common
peroneal nerve. A reflex was considred to have occurred if the
average signal exceeded two standard deviations from the baseline,
(average of the 30msec period preceeding the elctrical stimulus).
Reflex status was confirmed by repeat testing. An eight week
home-based exercise program was delivered via a diary after initial
demonstration. Final testing was performed on program completion.
ANALYSIS: Data analysis was performed using ANOVA and t-tests
(Sigmastat, SPSS Inc, USA), all tests being two-tailed with P less
than 0.05 being considered significant. RESULTS: Electrical activity
consistent with a segmental spinal reflex (~26msec) was present
in quadriceps femoris in all normomobile subjects but in only half
the JHS group, the difference being significant (P < 0.01). Following
the exercise program the reflex could be elicited in all patients in
whom it was previously absent. Joint position affected the magnitude
of the reflex, diminishing significantly both on flexion (P < 0.05) and
hyperextension (P < 0.03)of the knee. CONCLUSIONS: Musculo-
skeletal reflex function is compromised in some patients with JHS
but can be restored by an eight week CKC exercise program. This
provides objective evidence of the effect of exercise on physiological
function. In addition hyperextension of the knee joint apart from
being biomechanically unsound has adverse neurophysiological
consequences in terms of facilitation of quadriceps femoris function.
IMPLICATIONS: As a significant number of patients with JHS are
compromised neurophysiologically and this can be rectified with a
CKC exercise program the management of this patient group has
been significantly improved. Demonstration of impairment and then
restoration of function at physiological level is not only exciting but
S506
critical to the standing of our profession in the scientific world. Further
research could be directed at investigating the absence of the reflex
in patients with JHS and the reflex status of other patient populations.
KEYWORDS: Reflex, Exercise, Joint Hypermobility Syndrome.
FUNDING ACKNOWLEDGEMENTS: The Arthritis Research Cam-
paign (ARC). CONTACT: nicola.tennant@northglasgow.scot.nhs
ETHICS COMMITTEE: Glasgow Royal Infirmary Research Ethics
Committee
Research Report Platform Presentation
1270 Wednesday 6 June 10:45
VCEC Meeting Rooms 1-3
VALIDITY AND RELIABILITY TEST OF OPTOELECTRONIC
MOTION ANALYSIS AND ULTRASONOGRAPHY OF CHEST
WALL MOTION AND DIAPHRAGMATIC EXCURSION
Liing R1 , Lin K1 , Lu T2 , Wang H1 ; 1 School and Graduate Institute of
Physical Therapy, College of Medicine, National Taiwan University,
Taipei, Taiwan; 2 Institute of Biomedical Engineering, College of
Medicine, National Taiwan University, Taipei, Taiwan
PURPOSE: The purposes of this study were to investigate the
test-retest reliability and validity of lung volume estimated by chest
wall motion and diaphragmatic excursion. RELEVANCE: It has
been suggested that optoelectronic motion analysis system and
ultrasonography (USD) were good evaluation tools to describe the
volume changes of chest wall and diaphragmatic excursion, but
there is lack of reliability and validity analysis. PARTICIPANTS:
Seven healthy male subjects (age: 21.43±1.13 yrs; mean body
height: 180.57±2.64 cm; mean body weight: 69.57±6.92 kg) were
recruited in this study. METHODS: All subjects were asked to
take deep inspiration and expiration with mouth obtaining lung
volume by spirometry (Microspiro HI-601, Janpan) in sitting position
synchronously. Meanwhile, right diaphragmatic movement was mea-
sured by USD (Sonosite, USA). Totally, 86 infrared-reflective markers
were applied on subjects’ body surface to acquire volume changes
of chest wall from optoelectronic motion analysis system (Vicon 250,
UK). The subjects repeated two trials in one session. ANALYSIS:
Matlab program7.01 and SPSS13.0 were used for data analysis.
The intraclass correlation coefficient (ICC) was used to evaluate test-
retest reliability. The concurrent validity was estimated by Pearson
correlation test. The significant level was set at 0.05. RESULTS: The
results showed that the test-retest ICC of diaphragmatic excursion
measurd by USD was 0.99 (p < 0.05), and the test-retest ICC of chest
wall volume changes measured by optoelectronic motion analysis
system was 0.85 (p < 0.05). The relation between diaphragmatic
excursion (3.47±0.97 cm) and spirometry (mean lung volume:
2.14±0.39 liter) was 0.68 (p < 0.05). The relation between chest
wall volume changes and spirometry (mean value of maximum lung
volume: 4.81±0.49 liter) was 0.97 (p < 0.05). CONCLUSIONS: The
results showed high test-retest reliability and moderate to good
validity of USD and optoelectronic motion analysis system in healthy
subjects. Therefore, lung volume can be estimated noninvasively
in healthy subjects, and the application in patients would require
further study. IMPLICATIONS: It is possible that optoelectronic
3-dimensional motion analysis can describe abnormal chest wall
motion and breathing pattern. Furthermore, USD can be used as the
screening test of diaphragmatic weakness. KEYWORDS: Optoelec-
tronic motion analysis system, Ultrasonography, Chest wall motion,
Diaphragmatic excursion. FUNDING ACKNOWLEDGEMENTS: This
study was granted by National Science Council, Taiwan (Grant #
NSC94-2314-B-002-075). Thanks to Yu-Kuang Wu, Sheng-Chang
Chen, Ying-Chen Chen, and Chia-Chieh Chang for their assistance.
CONTACT: khlin@ntu.edu.tw
ETHICS COMMITTEE: Department of Medical research, National
Taiwan University Hospital, Taiwan.
WCPT 2007, Research Reports
Research Report Platform Presentation
599 Wednesday 6 June 10:45
VCEC Meeting Rooms 11-12
AEROBIC EXERCISE TRAINING EFFECTS IN AFRICAN
AMERICAN WOMEN WITH BREAST CANCER
Adams Jr J1 , Kline J1 , Kim S1 , Drouin J1 , Birk T2 ; 1 University
Of Michigan-Flint, United States; 2 Wayne State University-Detroit,
United States
PURPOSE: Early evidence suggests there are physiological and
psychological differences between African Americans (AA) and
Caucasians (CC) during and after treatment for breast cancer.
Although exercise has been found to promote physiological and
psychological factors during breast cancer treatment, no studies
were found that examined the effects of aerobic exercise training
in AA women or that compared training adaptations with Caucasian
women. RELEVANCE: There is limited evidence to support reha-
bilitation practices during treatment for cancer in racial and ethnic
minorities. This study provides physical therapists with evidence on
the efficacy of aerobic exercise training during radiation treatment
for breast cancer in AA women to enable safe and effective
design of rehabilitation interventions. PARTICIPANTS: Following
human subject approvals, 7 AA and 6 CC women were recruited
through oncologists. Participants were between age 35 and 65,
scheduled for radiation for breast cancer [stage 0 (Ductal Carcinoma
Insitu) to III), and sedentary for 3 months prior to the study.
METHODS: Participants performed self monitored walking, 3-5
days per week, at 50-70% of their measured maximum heart
rates, during seven weeks of radiation. Pre and post tests were
administered one week before and one week following the radiation
regimen. Tests included symptom limited graded exercise testing
with oxygen uptake analysis, serum blood draws, Profile of Mood
States, Revised-Piper Fatigue Scales, Kilogram weight, Skin Caliper
measures, and Body Mass Index. ANALYSIS: Wilcoxon Signed
Rank examined pre-post differences and Wilcoxon-Mann-Whitney
U assessed between group differences (p < 0.05). RESULTS: AA
physiologic measures for peak VO2 (p = .001), lactate threshold
(p = .014), treadmill time (p = .014) and maximum pulse oxygen
(p = .014) improved significantly, while resting heart rate (p = .034)
increased significantly. All AA anthropometric measures improved
significantly (p = .014). Compared to CC participants, AA physiologic
measures were significantly lower for peak VO2 (p = .037) and
treadmill time (p = .023), and higher for resting heart rate (p = .025),
and resting (p = .043) and maximum (p = .013) diastolic pressures.
Serum erythrocytes increased non-significantly in both groups, while
serum immune measures declined significantly in both groups. Final
fatigue (p = .058) and psychological (p = .10) measures were better in
AA participants however differences were not statistically significant
between groups. CONCLUSIONS: Results from this study suggest
that AA women experience significant improvements in physiologic
and anthropometric measures from aerobic exercise training during
radiation for breast cancer; however final physiological measures
for fitness, resting heart rates, diastolic blood pressures, and body
composition were poorer than in CC participants. Interestingly,
although having lower fitness, AA women reported less fatigue and
had higher psychological scores than CC women. IMPLICATIONS:
This study provides physical therapists with evidence for the efficacy
of aerobic exercise training during radiation for breast cancer in AA
women. Future study is recommended on whether these changes
positively affect physical function, health, and survival rates in AA
women, as well as reasons for the differences observed between
AA and CC women. KEYWORDS: Breast Cancer; Aerobic Exercise;
African American; Women. FUNDING ACKNOWLEDGEMENTS:
Elsa U Pardee Foundation – Midland, Mi; Max & Victoria Dreyfus
Foundation – White Plains, NY. CONTACT: jeromea@umflint.edu
ETHICS COMMITTEE: Wayne State University and Karmanos
Cancer Institute (Both Detroit, MI, United States)
Platform Presentations, Wednesday 6 June
Research Report Platform Presentation
581 Wednesday 6 June 10:45
VCEC Meeting Room 16
WHOLE BODY VIBRATION EXPOSURE IN ALL TERRAIN
VEHICLE USE IN NEW ZEALAND AGRICULTURE
Milosavljevic S, Carman A, Pal P; School of Physiotherapy,
University of Otago, Dunedin, New Zealand
PURPOSE: Although New Zealand (NZ) farmers have a high
incidence of low back pain (LBP) many of these episodes are
due to unknown causes. Associations have previously been shown
between LBP and whole-body vibration (WBV) in occupational
driving. All Terrain Vehicles (ATVs) are used extensively in rural
NZ potentially exposing farmers to prolonged periods of WBV. The
purpose of this study is to measure the vibration exposure of
daily rural ATV use and compare to vibration exposure guidelines.
RELEVANCE: Evidence for cumulative WBV exposure as a risk
factor for the development of LBP in NZ farmers will allow rural rural
heath practitioners, ergonomists, and rural industry groups to inform
farmers as to appropriate farming practice to reduce WBV exposure
and reduce the risk of developing occupational LBP. PARTICIPANTS:
Following ethical approval from the University of Otago Human Ethics
Committee, 30 experienced male sheep and beef farmers from the
Otago region of New Zealand were recruited. They had a mean age
of 47 years, a mean height of 1.80 metres, a mean weight of 86.0 kgs
and a mean 27 years of farming experience. METHODS: To gather
vehicle and body vibration data tri-axial gravitational accelerometers
were mounted on a helmet, pelvis, and on the ATV chassis of each
farmer. For frequencies of interest between 0-100 Hz, accelerometer
data were recorded at 200Hz, from each participant working on
their farm over the full working day. These data were stored on a
data logger mounted to the ATV. A Global Positioning System (GPS)
recorded position and velocity data. ANALYSIS: The Vibration Dose
Value (VDV) for each farmer was calculated from all driving episodes
over the working day. To determine the frequency spectrum a Fast
Fourier Transform (FFT) was applied to the vibration data from all
driving episodes using a 400 sample window, for 12 Hz resolution
between 0-100 Hz. For each farmer the maximum amplitude at each
discrete frequency across all FFT windows was obtained. Data
were then pooled to obtain average maximum amplitude at each
discrete frequency across the 30 farmers. RESULTS: The total
average daily Vibration Dose Value (23.1 m/s1.75) was above the
maximum recommended limit of 21 m/s1.75. On average 1 hour
of rural ATV use reached VDV limit value. The ATV, pelvis and
helmet experienced substantial vibrations at the lower frequencies
(2-20 Hz). These included the adverse resonant frequencies of the
spine (2–12Hz), with dominant axes being the vertical and anterior
directions. Little ATV vibration above 35 Hz was transmitted to the
pelvis or helmet. CONCLUSIONS: Daily ATV use by NZ farmers
exposes them to cumulative vibration in excess of recommended
limits. Exposure to such vibration provides a plausible explanation for
the high incidence of LBP in New Zealand farmers. IMPLICATIONS:
The results indicate a need for change in ATV use and design to
reduce the exposure to such adverse vibrations. Such information
will be invaluable for those health professionals who work and
advise in the rural occupational health sector. KEYWORDS: Low
back Pain, Vibration, Farming. FUNDING ACKNOWLEDGEMENTS:
University of Otago Research Grants (UORG) 2005. CONTACT:
stephan.milosavljevic@otago.ac.nz
ETHICS COMMITTEE: University of Otago Human Ethics Committee
S507
Research Report Platform Presentation
637 Wednesday 6 June 10:45
VCEC Meeting Room 17
AN EXPLORATION OF HOW PHYSIOTHERAPY AFFECTS THE
SOCIAL INCLUSION OF PERSONS WITH RA
Areskoug-Josefsson K; Värnamo Sjukhus, 331 85 Värnamo, Sweden
PURPOSE: To explore patients opinions of how physiotherapy affects
patients with RA from the perspective of the relational model of
social theory which considers Body, Work, Citizenship, Identity and
Territory to determine if physiotherapy can enhance social inclusion
RELEVANCE: The aim of physiotherapy intervention is to maximise
independence and mobility. An ability to work is a primary concern for
persons with RA. In order to measure the outcome of physiotherapy
and to evaluate treatment effect it is important to bring forward the
view of the patient. PARTICIPANTS: A consecutive selection of 8
persons with a diagnosed RA (ACR criteria) >4 years, who did not
have any other chronic illness and who were permanent residents of
the same geographical region. Each, during their period of illness,
had participated in more than ten physiotherapy treatment sessions.
Each gave written consent to participate in the project. METHODS: A
phenomenological qualitative study design was used which facilitated
data collection to establish views on whether treatment has an
effect on social inclusion. Semi-structured interviews were chosen
to allow the interviewer to probe the experience of the participant.
They were conversational in style and focused onto the participant’s
experience and views of the effect of physiotherapy. ANALYSIS:
Each interview was tape-recorded and transcribed verbatim. The
interviews were analysed within a phenomenological framework
based on the role of physiotherapy concerning social inclusion, the
categories were sorted into the five dimensions of the relational
model of social theory. Data were sorted into categories concerning
the phenomena of “effect of physiotherapy” and “effect of RA” on
social activities. In this process two subgroups of “the role of the
physiotherapist” and “physiotherapy in the future” emerged. Each of
the four perspectives included the five dimensions of the relational
model: body, work, citizenship, identity, and territory, and were
integrated into an explanatory model. RESULTS: These participants
experiences physiotherapy in group training as giving a positive
effect on the perspective of citizenship and on identity, particularly
after physical training, and increase self esteem. Ability to work
was connected with independence. Physiotherapy played an active
and important role in giving self-managing strategies, and providing
social contact in training groups. The role of the physiotherapist was
seen to be a motivator of physical activity and self-management
strategies. CONCLUSIONS: Informants experienced physiotherapy
in a body perspective with effects on participation in their environment
and their work. Physiotherapy can lead to increased quality of life
through increased body function which might increase ability to
work. IMPLICATIONS: The findings from this study could be of
interest to other EU states since the participants of this study are
similar (concerning gender, age, sick leave from work, and duration
of illness) An increased knowledge of how the persons with RA
experience the effect of physiotherapy is of interest concerning
development of physiotherapy treatment strategies. KEYWORDS:
Social inclusion. FUNDING ACKNOWLEDGEMENTS: This project
achieved financial support from the regional organisation for persons
with Rheumatoid Arthritis and from Futurum, Academy of Health,
County of Jönköping, Sweden. CONTACT: kristina.areskoug@lj.se
ETHICS COMMITTEE: Ethical inspection by the standards of the
local county (Jönköpings läns landsting; Sweden) and the University
of Karlstad, Sweden.
S508
Research Report Platform Presentation
1373 Wednesday 6 June 10:45
VCEC Meeting Room 18
PSYCHOLOGICAL DETERMINANTS OF CHRONIC
MUSCULOSKELETAL PAIN AND DAILY FUNCTIONING IN
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
Health Care Sciences – University College Antwerp (HA), Antwerp,
Belgium; 2 2. Department of Human Physiology – Faculty of
Physical Education and Physiotherapy – Vrije Universiteit Brussel
(VUB), Brussels, Belgium
PURPOSE: The present study aims at examining the role of
catastrophising, coping, kinesiophobia and depression in chronic,
widespread, musculoskeletal pain complaints and daily functioning
in patients with Chronic Fatigue Syndrome (CFS) having chronic,
widespread musculoskeletal pain. RELEVANCE: In addition to the
debilitating fatigue, the majority of patients with CFS experience
chronic widespread pain, in particular myalgias and arthralgias.
This chronic pain contributes to self-reported activity limitations
and participation restrictions. Despite the clinical relevance of this
complaint, studies regarding chronic pain in CFS are scarce.
However, evidence for the role of kinesiophobia, depression,
catastrophising and copings strategies in maintaining the chronic pain
complaints has been supported in patients with fibromyalgia (FM),
chronic low back pain, and other disorders associated with chronic
musculoskeletal pain. PARTICIPANTS: One hundred and three CFS
patients with musculoskeletal pain participated in the study. They
were selected following several criteria: all subjects fulfilled the
1994 Centre for Disease Control and Prevention (CDCP) criteria for
CFS, all patients experienced chronic widespread pain, as defined
by the American College of Rheumatology and finally all study
participants had Dutch as their native language, and were within the
age range of 18 to 65 years. METHODS: The participants completed
a battery of standardized and valid questionnaires evaluating pain,
daily functioning and psychological characteristics, such as the
degree of depression, kinesiophobia, pain coping style, and pain
catastrophising. ANALYSIS: In order to examine the associations
between pain and daily functioning on the one hand and cognitive and
behavioural aspects on the other hand, Pearson correlation analyses
were used. For interpreting correlation coefficients and defining
predictors for pain and functioning, multiple regression analysis was
performed. RESULTS: The strongest correlations with pain intensity
and daily functioning were found for catastrophising (respectively r=-
.462 and r=.435; p < 0.001) and depression (respectively r= -.439
and r=.481; p < 0.001). The stepwise multiple regression analysis
revealed that catastrophising was the main predictor for pain (20.2%)
and depression for daily functioning (23.2%). Kinesiophobia and
the coping styles “resting” and “worrying” were also significantly
related to pain intensity and daily functioning. CONCLUSIONS: Pain
catastrophising and depression were associated with pain intensity
and the associated functional disabilities. Kinesiophobia and several
passive coping styles were even so related to pain and functioning,
but catastrophising and depression were the main predictors for pain
and functioning in patients with CFS having chronic widespread
musculoskeletal pain. IMPLICATIONS: These findings give new
insights in the history of chronic pain in CFS. It is shown that there is
a relation between pain and these psychosocial factors. Although
the direction of this relationship remains unclear, it is important
to be aware of the association. Physical therapists, together with
other health care providers, may be able to influence psychosocial
factors and in consequence eventually pain. But this last hypothesis
needs to be investigated in further research projects. KEYWORDS:
Catastrophising, coping, kinesiophobia, depression, daily functioning,
fibromyalgia. FUNDING ACKNOWLEDGEMENTS: Mira Meeus is
financially supported by a PhD grant supplied by the Higher Institute
of Physiotherapy, Department of Health Sciences, University College
Antwerp, Antwerp, Belgium (G 807) and co-financed by Faculty of
WCPT 2007, Research Reports
Physical Education and Physiotherapy – Vrije Universiteit Brussel
(VUB), Brussels, Belgium (OZR project OZ.R. 1234/MFYS Wer2).
CONTACT: mira.meeus@vub.ac.be
ETHICS COMMITTEE: Committee Medical Ethics Academic Hospital
Vrije Universiteit Brussel, Brussels, Belgium
Research Report Platform Presentation
783 Wednesday 6 June 10:45
VCEC Meeting Rooms 19-20
IS ELECTRO-ACUPUNCTURE A USEFUL ADJUNCT IN THE
TREATMENT OF LEG ULCERS? A PILOT STUDY
Tebbutt E; Coventry University, Coventry, United Kingdom
PURPOSE: To investigate the effects of electro-acupuncture, applied
to the upper limb, on leg ulcers, specifically in relation to pain, mobility
and healing. RELEVANCE: Within the UK, prevalence of leg ulcers
in over 65’s is 3-5% and costs the national health service between
£300 and £600 million/year. Leg ulcers are of direct relevance to
physiotherapists who treat elderly people as they have a significant
impact on mobility (due to pain). Some research suggests that
electro-acupuncture at remote sites may be of benefit to ulcer healing,
pain and mobility but it is of poor quality and more research is
warranted. PARTICIPANTS: 6 participants were recruited from a leg
ulcer clinic and elderly rehabilitation wards within South Birmingham
primary care trust. They were aged between 65 and 87, with venous
or mixed venous/arterial leg ulcers. During a 4 month period, all
patients with a leg ulcer and who could give informed consent were
approached. Patients were excluded if: A) any contra-indications for
electro-acupuncture were present B) they were receiving concurrent
treatment that would affect healing. METHODS: Patients received 10
electro-acupuncture treatments over a 5 week period. Treatment was
standardised and 8 needles were inserted into acupoints on the hand
and forearm (LI4, LI11, SJ5, SI3). Outcome measurements were
taken pre-treatment, post-treatment and 3 months after treatment.
The researcher carried out the acupuncture and other therapists
completed the outcome measurements. The faces pain scale was
used to measure pain and patients’ subjective reporting was also
documented. The 10 metre timed walk and elderly mobility scale were
used to measure mobility. Ulcer area was calculated using tracings
and qualitative information regarding the wound was also collected.
ANALYSIS: Descriptive statistics were analysed individually and as
a group, using timeline graphs for visual analysis. Qualitative data
was analysed individually, as a group and in relation to quantitative
results. RESULTS: 5 patients’ ulcers were smaller post-treatment
(between 20-40%) and 1 patient’s ulcer could not be measured due
to diffuse spread. At 3 month follow-up, 1 ulcer was fully healed, 1
had continued to improve, 2 had partially regressed and 1 patient was
not available. A ceiling effect was observed for the mobility scales.
Patients reported subjective improvements in mobility. Faces pain
scale scores were unreliable as they did not correlate with subjective
pain reporting. No adverse effects were observed. CONCLUSIONS:
The study was successful as a pilot as flaws and essential
elements on which to base future research design were identified.
A randomised controlled trial is recommended in order to determine
whether improvements observed were due to acupuncture or other
factors. IMPLICATIONS: electro-acupuncture is a safe, minimally
invasive treatment and could have a useful role in the treatment of
leg ulcers, particularly when applied to acupuncture points outside
the area of compromised skin. Many lessons were learned that
can be shared with other novice researchers, notably in relation
to recruitment and selection of outcome measures. KEYWORDS:
Electro-acupuncture; Leg Ulcers; Outcome Measures. FUNDING
ACKNOWLEDGEMENTS: West Midlands Workforce Development
Confederation; Chartered Society of Physiotherapy Charitable Trust.
CONTACT: emidyem@yahoo.co.uk
ETHICS COMMITTEE: Local Research and Ethics Committee
(LREC)
Platform Presentations, Wednesday 6 June
Research Report Platform Presentation
2006 Wednesday 6 June 11:05
PP Crystal Pavilion A
DOES GROUP TRAINING DURING PREGNANCY PREVENT
LUMBOPELVIC PAIN?
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,
Norwegian University of Science and Technology, Trondheim,
Norway; 3 Department of Obstetrics and Gynaecology, Norwegian
University of Science and Technology, Trondheim, Norway; 4 Unit
for Applied Clinical Research, Department and Cancer Research
and Molecular Medicine, Norwegian University of Science
and Technology, Trondheim, Norway; 5 National Center for Fetal
Medicine, St.Olavs Hospital, Trondheim, Norway; 6 Department of
Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
PURPOSE: Prevention of lumbopelvic pain in pregnancy has been
sparsely studied. One aim of this study was to assess if a 12
week training program during pregnancy can prevent and/or treat
lumbopelvic pain. RELEVANCE: A high percentage of women suffer
from low back and pelvic girdle pain (lumbopelvic pain) during
pregnancy and after delivery. The average prevalence from different
studies of lumbopelvic pain in pregnancy is 45%, and of all women
postpartum 25%. The condition may influence daily activities, cause
withdrawal from social situations and physical activities and lead
to reduced quality of life. Lumbopelvic pain is the most common
reason for sick leave during pregnancy in the Scandinavian countries.
PARTICIPANTS: 301 healthy nulliparous women were included at
20 weeks of pregnancy, and randomly allocated to a training group
(148) or a control group (153). Exclusion criteria were pregnancy
complications,or diseases that could interfere with participation.
METHODS: A randomised controlled trial was conducted at Trond-
heim University Hospital and three outpatient physiotherapy clinics.
The outcome measures were self reported symptoms of lumbopelvic
pain (once per week or more), sick leave and functional status
(Disability Rating Index). Pain drawing was used to document the
painful area of the body. The intervention included daily pelvic
floor muscle training at home, and weekly group training in 12
weeks including aerobic exercises, pelvic floor muscle and additional
exercises, and information related to pregnancy. ANALYSIS: The
main analysis was by intention to treat. Risk differences were
analysed by Pearson’s chi squared test, and by computing 95%
confidence intervals. Possible influences of covariates (age, BMI,
leisure time physical activity and pelvic floor muscle strength) on
risk differences was explored using logistic regression. Students
t-test was used to compare distributions between groups. In an
exploratory analysis of a possible association between pelvic floor
muscle strength and lumbopelvic pain, we grouped women according
to self reports of pain instead of the randomised groups. Two-
sided P-values <0.05 were considered significant. RESULTS: At 36
weeks of gestation women in the training group were significantly
less likely to report lumbopelvic pain: 65/148 (44%) versus 86/153
(56%) (p = 0.03). Three months after delivery the difference was
39/148 (26%) in the training group versus 56/153 (37%) in the
control group (p = 0.06). There was no difference in sick leave during
pregnancy, but women in the training group had significantly (p = 0.01)
higher score on functional status. Analyses of Numbers Needed
to Treat (NNT) demonstrated that this specific training program
prevented lumbopelvic pain in about one in 8.1 women during
pregnancy, and one in 9.8 women after delivery. There was no
association between mean pelvic floor muscle strength at 36 weeks of
pregnancy and 3 months after delivery, or changes in strength, and
lumbopelvic pain CONCLUSIONS: A 12 week specially designed
training program during pregnancy was effective in preventing
lumbopelvic pain in pregnancy. IMPLICATIONS: Physiotherapists
should engage in pre- and postnatal care. However, it is essential
that future service for women during pregnancy is organised – as
far as possible – according to results from controlled clinical trials.
S509
KEYWORDS: Lumbopelvic pain, pregnancy, prevention. FUNDING
ACKNOWLEDGEMENTS: The Norwegian Fund for Postgraduate
Training in Physiotherapy and Norwegian Women’s Public Health
Association. CONTACT: siv.morkved@ntnu.no
ETHICS COMMITTEE: The Regional Committee for Research Ethics
in Sør-Trøndelag,Norway
Research Report Platform Presentation
2175 Wednesday 6 June 11:05
VCEC Ballroom A
CHANGES IN LOWER EXTREMITY MOVEMENT PATTERNS ARE
ACCOMPANIED BY MOTOR CORTEX NEUROPLASTICITY: A
CASE REPORT
Powers C, Fisher B, Lin J, Kantak S, Tan C, Pollard C, Sigward S;
Division of Biokinesiolgy & Physical Therapy, University of Southern
California, Los Angeles, CA, USA
PURPOSE: There is increasing evidence suggesting that changes in
primary motor cortex (M1) play an important role in skill acquisition.
Although M1 changes have been documented in relation to upper
extremity motor learning tasks, there is little evidence demonstrating
M1 changes in response to lower extremity skill acquisition. The
purpose of this case report was to determine whether an intensive
three-week training program aimed at improving lower extremity
kinematics and kinetics would result in changes in M1 excitability as
measured by transcranial magnetic stimulation (TMS). RELEVANCE:
Lower extremity training programs are gaining popularity as a means
to reduce knee injuries, particularly anterior cruciate ligament tears.
Whether or not observed changes in behavior following such training
programs are accompanied by central nervous system changes
has not been examined. PARTICIPANTS: A 28 year old female
with no history of lower extremity injury. METHODS: The subject
underwent two phases of data collection: 1) TMS assessment to
map the representative area of the contralateral vastus lateralis
(VL) in M1, and 2) biomechanical evaluation of the lower extremity
while performing a drop-jump task. First, the optimal spot over
the M1 to elicit motor evoked potentials (MEP) in the VL was
determined. Motor threshold (MT) was defined as the minimal
intensity of stimulation capable of inducing MEPs of >50 mV. The
TMS coil was moved on the scalp in 1 cm increments to identify
all positions that produced VL MEPs. Five TMS pulses with an
intensity 10% above MT were applied at each position. MEPs
were recorded with surface electrodes from the VL. Lower extremity
kinematics (8 camera Vicon motion system; 250 Hz) and kinetics
(2 AMTI force platforms; 1,500 Hz) were measured as the subject
performed a series of 3 drop-jump maneuvers from an 18 inch
box. Following the initial TMS and biomechanical evaluations, the
subject underwent a 3 week plyometric training program designed to
improve sagittal plane deceleration and prevent knee valgus forces.
The subject trained a ANALYSIS: Pre-post training changes in the
size of the cortical motor output map was defined as the number
of positions whose stimulation evoked MEPs >50 mV. Changes in
knee flexion and knee valgus moment were compared pre and
post training. RESULTS: Following the training program, the subject
demonstrated a 40% increase in knee flexion (75º vs. 105º) and
a 40% reduction in the knee valgus moment (0.5 vs. 0.8 Nm/kg-
bwt). The M1 representation of VL was significantly smaller post
training. In addition, the number of active scalp positions was
decreased when compared to baseline. CONCLUSIONS: Behavioral
changes in lower extremity kinematics and kinetics following an
intensive lower extremity training program were accompanied by
decreased M1 excitability. IMPLICATIONS: Our findings suggest that
improved performance in functional tasks following training can be
accomplished with less voluntary effort which is consistent with the
basic principles of skill acquisition and motor learning. KEYWORDS:
Lower extremity, biomechanics, neuroplasticity, transcranial magnetic
stimulation. FUNDING ACKNOWLEDGEMENTS: None.
ETHICS COMMITTEE: Institutional review board, University of
southern california
S510
Research Report Platform Presentation
1388 Wednesday 6 June 11:05
VCEC Meeting Rooms 1-3
EFFECT OF COMBINED INSPIRATORY MUSCLE TRAINING AND
EXERCISE COMPARED WITH EXERCISE ALONE FOR INDIVID-
UALS WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE
O’Brien K1 , Geddes L2 , Reid D3 , Brooks D1 , Crowe J2 ;
1 Department of Physical Therapy, University of Toronto, Toronto,
ON, Canada; 2 Department of Rehabilitation Science, McMaster
University, Hamilton, ON, Canada; 3 School of Rehabilitation
Sciences, Division of Physical Therapy, University of British
Columbia, Vancouver, BC, Canada
PURPOSE: To determine the effect of combined inspiratory muscle
training (IMT) and exercise compared with exercise alone for indi-
viduals with stable chronic obstructive pulmonary disease (COPD).
RELEVANCE: IMT can reduce dyspnea and improve exercise
tolerance; however, the literature has provided conflicting results,
and the effect of co-interventions with IMT are largely unknown.
PARTICIPANTS: Adults (18 years) living with COPD. METHODS:
We conducted an update to a systematic review on IMT and COPD
up to December 2005 according to Cochrane Collaboration protocol.
Inclusion criteria included randomized controlled trials, published in
English comparing IMT or combined IMT and exercise/pulmonary
rehabilitation with other rehabilitation interventions among individuals
with stable COPD. Abstracts were reviewed independently by two
investigators to determine study eligibility. Data were abstracted
from studies that met inclusion criteria using standardized data
abstraction forms. Methodological quality of included studies was
assessed. ANALYSIS: Meta-analyses using random effects models
wherever possible, were performed using RevMan computer soft-
ware. RESULTS: Two new studies met the inclusion criteria and
were included with the 16 studies in the original review. One study
compared combined IMT and pulmonary rehabilitation with education
alone. The other study compared combined IMT plus exercise with
exercise alone. Eight new meta-analyses were performed with the
latter new study and two originally included studies. Meta-analyses
compared targeted/threshold IMT and exercise combined to exercise
alone for outcomes of inspiratory muscle strength (maximum inspi-
ratory pressure), inspiratory muscle endurance (minute ventilation),
exercise capacity/performance (maximum oxygen consumption, work
rate maximum, heart rate maximum, and maximum tidal volume) and
quality of life (dyspnea and fatigue scales of the Chronic Respiratory
Questionnaire (CRQ)). Results showed significant improvements in
maximum inspiratory pressure of 8.60 cmH2 O and maximum tidal
volume of 0.14 L favouring combined IMT and exercise compared
with exercise alone. In contrast, significant greater improvements in
the CRQ Dyspnea Scale of 1.94 points were found favoring exercise
alone compared with combined IMT and exercise. CONCLUSIONS:
Performing a combination of targeted/threshold IMT plus exercise
at least 3X/wk for 8 weeks may lead to significant improvements
in inspiratory muscle strength and endurance for individuals with
COPD. These results should be interpreted cautiously due to a
small number of trials (n=3) and a maximum of 99 participants
in the meta-analyses. Findings are limited to those participants
who continued to carry out the IMT and exercise interventions.
In conclusion, combined IMT and exercise might be beneficial
for adults living with COPD. Results pertaining to quality of life
outcomes, including dyspnea are less clear. IMPLICATIONS: Results
suggest that combining IMT with other exercise interventions may be
beneficial for increasing inspiratory muscle strength and endurance
outcomes for individuals with COPD. Further trials are required to
investigate the effect of IMT or combined IMT plus other rehabilitation
interventions compared to other rehabilitation interventions without
IMT for outcomes of exercise capacity/tolerance, dyspnea and
quality of life. Further research also is needed to determine the
optimal IMT frequency, intensity, and time to maximize outcomes
for individuals with COPD. KEYWORDS: inspiratory muscle training,
exercise, COPD. FUNDING ACKNOWLEDGEMENTS: Funding for
WCPT 2007, Research Reports
this research was provided by the Ontario Lung Association and the
Canadian Lung Association. CONTACT: kelly.obrien@utoronto.ca
Research Report Platform Presentation
768 Wednesday 6 June 11:05
VCEC Meeting Rooms 11-12
IMPACT OF LYMPHOEDEMA ON ARM FUNCTION AND
HEALTH-RELATED QUALITY OF LIFE IN WOMEN FOLLOWING
BREAST CANCER SURGERY
Dawes D1 , Latella J2 , Meterissian S2 , Goldberg M1 , Mayo N1 ;
1 McGill University, Montreal, Canada; 2 McGill University Health
Centre, Montreal, Canada
PURPOSE: To estimate the extent to which the impairments
associated with lymphoedema are linked to arm dysfunction and
sub-optimal health related quality of life. RELEVANCE: Breast
cancer is the most commonly diagnosed malignancy among
Canadian women with over 18,800 new cases per year. Post-
surgical lymphoedema has impact on physical function, psychological
distress and health-related quality of life (HRQL). PARTICIPANTS:
Women surgically treated for stage I or II breast cancer at the
McGill University Health Centre from January 1992 to January 2002.
METHODS: A cross-sectional study within the context of a pilot
study. Phase 1: postal survey including a series of questions on
the presence of signs and symptoms of lymphoedema. Phase 2:
Women who responded positively to any one of these questions
had a comprehensive assessment. Measures used: Tonometer,
water displacement, lymphometer, spring-loaded tape, McGill pain
questionnaire, Box & Block, Nine-hole Peg, TEMPA, JAMAR,
Disabilities of Arm Shoulder & Hand Questionnaire (DASH), SF36 &
EORTC. ANALYSIS: Descriptive statistics were calculated on all
variables and bi-variate associations were calculated between pairs
of variables. A separate regression model was developed for each
outcome. Path analysis was completed using a medical model.
RESULTS: Women with self reported symptoms of lymphoedema
(72 of 204 respondents) had a significantly higher score on the
DASH questionnaire (mean difference = 23.4, 95% CI 19.3 to
27.5) indicating activity limitation and participation restriction. As
the number of positive screening items increased so did the arm
volume with an estimated effect of 66 ml. (p < 0.0001), per additional
positive item. Pain was consistently related to disability as measured
by the DASH and HRQL (SF-36, EORTC) but not volume. Path
analysis provided a close description (Chi-squared probability=0.22,
CFI=0.98) of the relationships between the variables being studied.
No relationship was found between volume increase and disability,
but there is a strong correlation between the number of symptoms
of lymphoedema experienced and the volume difference between
arms (for every additional symptom an increase of 132 ml of
water). There is no significant relationship between the number of
symptoms experienced and level of disability. Pain is related to
disability (for an increase of one unit in McGill pain score there is
an increase in the DASH score of 0.73), and the level of disability,
as measured by the DASH questionnaire is significantly related to
health related quality of life (SF36). CONCLUSIONS: The use of
measurements of pain, activity limitation, participation restriction and
health related quality of life may be more meaningful than volume
measurements alone with this group of women. Further research
needs to be done with a sufficiently large sample size to fully
understand the role of pain and lymphoedema. IMPLICATIONS: For
the majority of women, treatment should be aimed at decreasing pain,
activity limitations and participation restrictions. Success of physio-
therapeutic treatment should be measured by a woman’s ability to
participate in activities of daily life rather than by reduction in volume
alone. KEYWORDS: Lymphoedema, Breast cancer, Measurement.
FUNDING ACKNOWLEDGEMENTS: McGill University Health Re-
search Institute. CONTACT: diana.dawes@clinepi.mcgill.ca
ETHICS COMMITTEE: Research Ethics Board, Surgery, of the
McGill University Health Centre.
Platform Presentations, Wednesday 6 June
Research Report Platform Presentation
807 Wednesday 6 June 11:05
VCEC Meeting Room 17
PARENTING WITH A DISABILITY
Cooper N1,2 , Yoshida K1,2 ; 1 Graduate Department of Rehabilitation
Science, University of Toronto, Toronto, Canada; 2 Department
of Physical Therapy, University of Toronto, Toronto, Canada
PURPOSE: The objective of this project was to describe the
prevalence, frequencies and significant relationships associated
with the parenting phenomena in a large sample of women with
various physical health conditions in Canada. RELEVANCE: Women
living with physical disabilities often face a difficult time fitting into
an ablest society, especially within the roles of motherhood and
parenting. Qualitative studies and narratives report that they may
also experience the additional challenges of receiving appropriate
health care during this time. Physical therapists, working with women
living with physical disabilities, are in the ideal position to help
connect these women with the various resources they may require.
PARTICIPANTS: A convenience sample of women was utilized.
Participants were at least 18 years of age and older, living with a
physical or sensory disability and resided in Canada. Those with
only one health condition who were parenting were selected for
analysis, resulting in 143 participants. Of the 143 parents, 36%
reported a neurological condition, 36% a sensory impairment, 22%
indicated a musculoskeletal condition, with the remaining indicating a
cardio-respiratory, gastro-intestinal, environmental or another health
condition. METHODS: A self-completed mailed survey was used to
gather information from the participants related to general health,
disability and parenting. ANALYSIS: Descriptive statistics were used
to characterize the sample. Bi-variate analysis was run between
the independent and dependent variables for parenting for each
of the parenting dependent variables. All relevant variables were
examined for collinearity after bi-variate analyses and prior to
multivariate analyses. Logistic regressions were used to determine
the proportional odds of having negative parenting experiences.
RESULTS: Looking at the ability to care for children without
assistance from another individual; those who utilized personal
assistance (OR=0.21±0.16, ø  0.05) or those with a musculoskeletal
health condition (OR=0.23±0.16, ø  0.05), were more likely to
require assistance in caring for their children. Conversely those with
household sizes of three or more (OR=5.87±4.19, ø  0.05) were
less likely to need assistance with care. When examining if the
women were worried about dying or becoming too disabled to care
for their children, those with an activity limitation were six times
more likely to worry (OR=6.0±5.11, ø  0.05) than those without a
limitation in their activity. Lastly, when questioned about the ability
to find assistive devices, those without pain were more likely to
be able to find the assistive devices they required (OR=0.09±0.08,
ø  0.05) than those who usually experienced pain. CONCLUSIONS:
Among these women parenting with a disability, those with activity
limitations required more assistance and had greater worries about
being able to care for their children in the future. In addition the
presence of pain made it more difficult to find the necessary assistive
devices that were required during parenting. IMPLICATIONS: The
relationship between pain and finding devices needed for parenting
is one that physical therapists are ideally situated to influence;
through treatments to reduce pain, and by assisting women parenting
with disabilities find the assistive devices they require. Further
research is required to better understand the issues faced by
women living with physical disabilities who are parenting within the
areas examined above. KEYWORDS: women, disability, parenting.
FUNDING ACKNOWLEDGEMENTS: University of Toronto Open
Fellowship. CONTACT: n.cooper@utoronto.ca
ETHICS COMMITTEE: University of Toronto, Health Science II
Research Ethics Board
S511
Research Report Platform Presentation
1398 Wednesday 6 June 11:05
VCEC Meeting Room 18
PHYSIOTHERAPY AND ALTERNATIVE THERAPY: THE SEARCH
FOR PAIN RELIEF IN PEOPLE WITH CHRONIC FATIGUE
SYNDROME (CFS) / MYALGIC ENCEPHALOMYELITIS (ME)
Marshall R, Paul L, Wood L; Glasgow Caledonian University,
Glasgow, Scotland
PURPOSE: It is widely accepted that pain and fatigue are the two
most common symptoms in CFS/ME, but there have been few studies
investigating chronic pain in this condition. Treatment for pain in
CFS/ME relies heavily upon pharmacological intervention and many
people have experienced serious side affects from taking medication.
Therefore, the aim of this study was to investigate the therapies
people have tried to ease painful CFS/ME symptoms. RELEVANCE:
No previous research has explored the variety of therapies that
people with CFS/ME have experienced. This study could provide
valuable knowledge about treatments that could help relieve pain
and suggestions for future Physiotherapy research. PARTICIPANTS:
There were 42 people recruited to this study, including seven people
who were severely affected and were either housebound or bed
bound. The mean age of participants was 47.8 (±9.8) years old.
The duration of illness ranged from 14 months to 26 years and
three months. Participants were recruited via local CFS/ME support
groups and CFS/ME charities. All recruits successfully passed a
diagnostic screening questionnaire that was based on the CDC
criteria (Fukuda, 1994) and the Canadian Guidelines (Carruthers et
al, 2003). METHODS: This study was of a descriptive, cross-sectional
design. All participants were required to complete a structured
subjective interview. Accounts of all previous treatments and the
effects it had upon participants painful CFS/ME symptoms were
documented. ANALYSIS: The data collected from the interviews was
coded and entered in to SPSS 14.0 for analysis. Descriptive statistics
were incorporated to explore pain characteristics. RESULTS: 40.5%
of participants had received physiotherapy treatment for pain
caused by CFS/ME. The treatments and benefits varied; 14.8%
of participants were given graded exercise by Physiotherapists,
all experienced exacerbation of their symptoms. However, 11.1%
of participants were treated with neck and gentle exercises with
positive results. At the time of the interview 14 participants were
currently receiving treatment, four were having acupuncture, and
only one person was receiving physiotherapy. Nineteen variations
of alternative treatment have been sampled by participants, e.g,
reflexology, reiki, massage; The most popular and beneficial was
acupuncture (18.8%). CONCLUSIONS: The results of this study
suggest some physiotherapy and alternative therapy treatments
may help people manage painful symptoms. Furthermore, additional
information from the interview could help towards developing a pain
management programme. This research has emphasized that there
is a poor evidence base and almost no research on the effectiveness
of alternative therapies in CFS/ME. IMPLICATIONS: The implications
of this research suggest that physiotherapy is ideally positioned to
offer an evidence based service to people suffering with CFS/ME.
Numerous Physiotherapists are also licensed to practice alternative
therapies; this would not only reduce the risk of people with CFS/ME
being exposed to unregistered therapists, but also the financial
burden of paying for treatments. KEYWORDS: CFS/ME, Treatment,
Pain. FUNDING ACKNOWLEDGEMENTS: The funding for this
research was jointly provided by Glasgow Caledonian University and
ME Research UK. CONTACT: Rebecca.Marshall@gcal.ac.uk
ETHICS COMMITTEE: The ethics committee from the School of
Health and Social Care at Glasgow Caledonian University approved
this research.
S512
Research Report Platform Presentation
1272 Wednesday 6 June 11:05
VCEC Meeting Rooms 19-20
EFFECT OF ACU-TENS ON FORCED EXPIRATORY FLOW RATE
AND DYSPNOEA IN PATIENTS WITH COPD
Jones A1 , Lau K2 ; 1 Department of Rehabilitation Sciences, The
Hong Kong Polytechnic University, Hong Kong; 2 Department of
Physiotherapy, Kowloon Hospital, Hong Kong
PURPOSE: Traditional acupuncture has been used for thousands
of years in China and international interest in unlocking its secrets
continues. Reports of the efficacy of acupuncture in the management
of breathlessness in patients with Chronic Obstructive Pulmonary
Disease (COPD) have aroused controversy. Manual acupuncture
is invasive and carries risks. Transcutaneous Electrical Nerve
Stimulation (TENS), a non-invasive modality, is widely used for pain
relief in both acute and chronic conditions. It is hypothesized that
application of TENS over specific acupuncture points (Acu-TENS)
associated with the respiratory system will elicit similar respiratory
responses to manual or electro-acupuncture. The effect of Acu-TENS
on respiratory responses has not been reported. This study aimed
to investigate the effect of Acu-TENS on forced expiratory flow rate
in 1 second (FEV1) and on the sensation of dyspnoea in patients
with COPD. RELEVANCE: Unwanted effects of medication have
encouraged alternative approaches to management of patients with
chronic illness. Identification of non-invasive treatment interventions
which assist management of breathlessness is one important role
of a respiratory physical therapist. PARTICIPANTS: Patients aged
60 yrs or over with a medical diagnosis of COPD and members
of elderly community centres within one geographic district were
invited to participate in the study. Forty-six patients (mean age 75
±6.9 yrs) were recruited. METHODS: TENS was randomly applied,
to 23 of the 46 patients, for 45 minutes, bilaterally, to the acupoint
Ex-14 (Ding Chuan) (0.5 cun lateral to the spinous process of C7)
(1 cun= distance between the medial ends of the creases of the
interphalangeal joints of the individual’s middle finger). The other
23 patients had electrodes attached to similar sites but received no
output from the TENS machine, although the output light flashed
(placebo-TENS group). ANALYSIS: FEV1 and subjective sensation
of breathlessness measured by a visual analogue scale (VAS),
before and after TENS intervention, were compared using paired-
t-test analysis. RESULTS: FEV1 increased by 12% after TENS in
the Acu-TENS group (p < 0.005). There was about 1% increase in
FEV1 in the placebo-TENS group after intervention but the result
was not significant (p = 0.81). Similarly, dyspnoea score improved
by 17% in the Acu-TENS group (p < 0.005) and 3.7% (p = 0.08)
in the placebo-TENS group. CONCLUSIONS: Acu-TENS applied
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
of dyspnoea in patients with COPD. KEYWORDS: Acu-TENS,
COPD, FEV1, Dyspnoea. FUNDING ACKNOWLEDGEMENTS: Not
applicable. CONTACT: rsajones@polyu.edu.hk
ETHICS COMMITTEE: Departmental Research Committee, The
Hong Kong Polytechnic University.
Research Report Platform Presentation
2586 Wednesday 6 June 11:25
PP Crystal Pavilion A
AN EVALUATION OF AN EXERCISE & PREGNANCY HELPLINE
Alleyne J1,2 , Farrer C1,2 , Cruz L1,2 , Robinson H1 , Weind K1 ;
1 Women’s College Hospital, Toronto, ON Canada; 2 University of
Toronto
PURPOSE: A pilot study was conducted to evaluate the perceived
usefulness of the information provided by trained health care
professionals given through an existing Exercise and Pregnancy
WCPT 2007, Research Reports
Telephone Helpline. The purpose of the helpline is to disseminate
general exercise and pregnancy guidelines to pregnant and pre-
pregnant women who call requesting information. RELEVANCE:
This evaluation of an innovative care delivery model will result in
enhanced quality of care. The unique needs of pregnant women
are addressed by this telephone helpline service that empowers
women to lead an active lifestyle during pregnancy. PARTICIPANTS:
Pregnant and pre-pregnant women who had questions related to
exercise during pregnancy were the target population for this study.
This included those who were regular exercisers prior to pregnancy
and those who wanted to begin an exercise routine at the time of
pregnancy. METHODS: Twelve consecutive, English speaking callers
to the helpline who agreed to participate in the study were sent
a survey one month following the initial phone call and exercise
prescription. The survey asked about the perceived usefulness
of written materials, the verbal information and the in-person
consultation (if performed) via rating scales. An overall review of
the helpline was surveyed with rating scales. ANALYSIS: Descriptive
statistics were calculated to describe the baseline characteristics of
the study population. Frequencies and percentages were calculated
for the quantitative survey data. RESULTS: The average age of
women calling the helpline was 33±3.87 years. The average length
of pregnancy at the time of the call was 4.3±2.9 weeks, with 3
callers phoning pre-pregnancy. 67% of callers had not received
any advice regarding exercise and pregnancy prior to calling the
helpline. 83% of callers believed their knowledge had improved
by phoning the telephone helpline. 100% of the callers found the
information provided was useful (75% very useful, 25% somewhat
useful). 75% strongly agreed with statement that the information
was easy to understand and that they were given clear directives.
67% thought the information given was specific to their situation.
Overall 75% of callers were very satisfied with the service and
100% would recommend the service to others. CONCLUSIONS:
The results reflect that callers perceived the information provided
through the Exercise and Pregnancy Helpline is relevant although it
did not always fulfill the role of addressing caller’s specific situations.
IMPLICATIONS: Callers to the helpline were satisfied with this model
of service delivery. The Exercise and Pregnancy Telephone Helpline
provides an alternative mode of education dissemination that allows
for global service delivery to a target population. This is relevant as
it brings clinical expertise to outreach communities in a cost effective
manner. KEYWORDS: exercise and pregnancy, service delivery,
women’s health. FUNDING ACKNOWLEDGEMENTS: Sunnybrook
and Women’s College Health Sciences Centre, Practice-based
Research Grant. CONTACT: chandra.farrer@wchospital.ca
ETHICS COMMITTEE: Sunnybrook & Women’s College Health
Sciences Centre Research Ethics Board
Research Report Platform Presentation
2993 Wednesday 6 June 11:25
VCEC Ballroom A
FUNCTIONAL KNEE STABILITY DURING BALANCE
PERTURBATION
Vaes P1 , Barrat D1 , Duquet W1 , Van Gheluwe B1 , Meirhaeghe E1 ,
Pollet V2 , Handelberg F2 ; 1 Physical Education and Physiotherapy
Faculty, Vrije Universiteit Brussel-BELGIUM; 2 Orthopaedics and
Traumatology Department Academic Hospital Vrije Universiteit
Brussel-BELGIUM
PURPOSE: To evaluate and document stability control mechanism
in patients with complaints of knee instability. RELEVANCE: There is
a need for good predictors of functional outcome in patients following
knee trauma. Assessment of reaction patterns of the lower extremity
during a sudden perturbation of the knee in the sagital plane using
a ‘genupulse’ procedure can possibly offer objective evaluation of
patient complaints. PARTICIPANTS: A total of 29 patients and 22
control subjects were recruited for the study. Patients were included
if diagnosed with unilateral anterior cruciate ligament rupture based
Platform Presentations, Wednesday 6 June
on arthroscopic or magnetic resonance imaging. METHODS: An
anteriorly directed force (a constant pressure of 8 bar produced an
impulse force of 353 N) was applied to the proximal upper third
of the posterior aspect of the tibia in monopodal weight bearing
position. Electrogoniometric, accelerometric and electromyographic
registrations were obtained during a ‘genupulse’ antero-posterior
balance disturbance. The data of the genupulse test were examined
for reproducibility and compared with data of healthy subjects.
ANALYSIS: Patients in the experimental group were clustered in
copers and non-copers based on their functional status. Test-retest
evaluations, and t-test comparisons within and between healthy
individuals and patients with invalidating knee joint instability were
carried out. RESULTS: Analysis revealed significant differences
(p < 0.05): 1) patients had higher knee angular displacement and
higher knee angular velocity following perturbation than healthy
subjects. 2) copers decelerated earlier following perturbation in
comparison to non-copers. All of these significant parameters were
shown to be reproducible. CONCLUSIONS: Using this perturbation
device we could differentiate copers from non-copers based on a
reproducible parameter “time of the deceleration point”, whereby non-
copers needed significantly more time to decelerate after perturba-
tion. IMPLICATIONS: With an operationalized balance disturbance
procedure deficiency in joint stability and more specifically complaints
of functional instability can be documented. KEYWORDS: Knee
instability, sensorimotor control, proprioception, joint perturbation,
joint stability, ACL, copers. FUNDING ACKNOWLEDGEMENTS: The
research committee of the Physical Education and Physical Therapy
Faculty of the Vrije Universiteit Brussel funded this research project-
OZR 608. CONTACT: pvaes@vub.ac.be
ETHICS COMMITTEE: Ethics Commission of the Academic Hospital
Vrije Universiteit Brussels-BELGIUM
Research Report Platform Presentation
1627 Wednesday 6 June 11:25
VCEC Meeting Rooms 1-3
REPEATABILITY OF CARDIORESPIRATORY MEASUREMENTS
RECORDED BY THE LIFESHIRT SYSTEM AND COMPARISON
BETWEEN PATIENTS WITH CF AND HEALTHY CONTROLS
Bradley J1,2 , BoyleL2 , Elborn J2,3 ; 1 Health
and Rehabilitation
Sciences Research Institute, School of Health Sciences, University
of Ulster, Belfast, United Kingdom; 2 Adult Cystic Fibrosis Centre,
Belfast City Hospital, Belfast, United Kingdom; 3 Department of
Respiratory Medicine, Queen’s University, Belfast, United Kingdom
PURPOSE: To determine if the LifeShirt system is a repeatable
method of assessing cardiorespiratory responses during exercise
and if the LifeShirt system can distinguish between cardiorespiratory
responses during exercise in patients with cystic fibrosis (CF) and
healthy controls RELEVANCE: The LifeShirt system offers the
possibility to measure the cardiorespiratory responses to activity
outside the laboratory environment. It therefore has the potential to
be an important outcome measure in clinical trials. PARTICIPANTS:
20 stable patients with CF (11M; age 26[9]yrs; FEV1 67[23]%)
and 20 age matched healthy individuals (9M; age 24[5]yrs; FEV1
92[8]%). METHODS: All subjects wore the LifeShirt system during
a 6 minute walk test (6MWT), a stair test, and a modified
shuttle test (MST) on 2 occasions at least one week apart. Data
relating to various cardiorespiratory parameters including: HR (heart
rate) Vt (tidal volume); Ve (minute ventilation); RR (respiratory
rate); phase angle, and SpO2 for the 6MWT (mean values), stair
test (mean values), and the MST (peak values) were analysed.
ANALYSIS: Descriptive statistics, t tests and repeated measures
ANOVA assuming compound symmetry. RESULTS: There was no
difference in mean exercise performance between Day 1 and Day 2
in any of the tests in either patients with CF or healthy controls which
enabled the groups to be combined to determine the repeatability
of cardiorespiratory responses recorded by the LifeShirt system.
There were no differences in mean cardiorespiratory responses to
S513
6MWT between Day 1 and Day 2: HR −1.71[-6.01 to 2.60]beats/min;
Vt 17.21[-117.47 to 51.90]ml; Ve −0.17[-5.05 to 4.70]Lmin−1 ; RR
−0.13[-1.13 to 0.87]breaths/min; phase angle 0.11[-1.01 to 1.22];
SaO2 1.94[-3.49 to 7.38]%. There were no differences in peak
cardiorespiratory responses to MST between Day 1 and Day 2:
HR −0.14[-2.05 to 1.79]; Vt 5.97[-22.22 to 4.16]ml; Ve 2.24[-0.44
to 4.91]Lmin−1 ; RR −0.03[-0.72 to 0.66]; phase angle 0.04[-0.93
to 1.01]; SpO2 1.04[-0.59 to 2.67]%. There were no significant
differences between cardiorespiratory responses to the stair test
between Day 1 and Day 2: HR 1.55[-2.14 to 5.24]beats/min; Vt
−43.72[-162.09 to 4.65]ml; Ve −1.44[-5.94 to 3.06]Lmin−1 ; RR 0.47[-
1.02 to 1.95]; phase angle 0.47[-2.36 to 3.31]; SaO2 −3.44[-13.44
to 6.55]%. On both days exercise performance was significantly
greater in healthy individuals than patients with CF. Ve recorded
during comparable periods of these exercise tests were greater in
CF versus healthy controls although these differences only reached
critical level of significance (p < 0.05) for the stair test and the MST:
mean Ve recorded during the 6MWT: CF 35.31(20.47)Lmin−1 versus
healthy controls 31.74(20.47)Lmin−1 ; mean during 1st minute stair
test CF 37.76(16.62)Lmin−1 versus healthy 26.73(16.20)Lmin−1 ; MST
(mean min 6-9): CF 15.18(23.61)Lmin−1 versus healthy controls
3.55(23.49)Lmin−1 . CONCLUSIONS: This study suggests that the
cardiorespiratory responses recorded by the LifeShirt system during
endurance and peak exercise tests are repeatable and the LifeShirt
is able to distinguish between responses to exercise in patients with
CF and healthy controls IMPLICATIONS: The LifeShirt system offers
a unique opportunity to record multiple cardiorespiratory measures
outside the laboratory in ambulatory patients. This study provides
preliminary evidence for the use of the LifeShirt as an outcome
measure in CF. KEYWORDS: Lifeshirt: Exercise: Cystic Fibrosis.
FUNDING ACKNOWLEDGEMENTS: Research and Development
Office Northern Ireland. CONTACT: jm.bradley@ulster.ac.uk
ETHICS COMMITTEE: Queens University Belfast Northern Ireland
Research Report Platform Presentation
1071 Wednesday 6 June 11:25
VCEC Meeting Rooms 11-12
SURVEY OF ARM ACTIVITY AFTER BREAST CANCER
TREATMENT
Lee T1 , Kilbreath S1 , Sullivan G2 , Refshauge K1 , Beith J3 ; 1 School
of Physiotherapy, University of Sydney, Australia; 2 Faculty of
Education and Social Work, University of Sydney, Australia; 3 Sydney
Cancer Centre, Royal Prince Alfred Hospital, Sydney, Australia
PURPOSE: Women are advised to avoid strenuous arm exercise
in order to avoid lymphedema, while at the same time, they are
advised to perform strenuous arm exercise to regain shoulder range
and strength. There is good evidence that strenuous arm activity is
not related to lymphedema, and that it is beneficial in preventing
musculoskeletal problems which may result from arm disuse. Our
hypothesis is that some of the chronic upper limb impairments found
in breast cancer survivors after surgery may result from women
over-protecting their arm. RELEVANCE: The inability to return to
normal life due to physical restrictions is frustrating and distressing.
It is the primary aim of physical therapists to rehabilitate the upper
limb of breast cancer survivors so that they may resume normal
activities of living. PARTICIPANTS: Women were eligible for the
study if they had surgery 6-15 months ago, had no recurrence since
surgery, and could read and comprehend English. METHODS: A self-
administered, anonymous survey was pre-tested, then distributed to
144 consecutive breast cancer survivors, who completed it in the
waiting room of 2 public hospitals and 2 private treatment facilities.
A reply-paid envelope was supplied in circumstances where the
survey was not finished in the waiting room. ANALYSIS: Bivariate
and multivariate analyses were performed to assess the relationship
between treatment variables, participant demographics, perceptions,
intentions, and arm symptoms/function. Stepwise linear regressions
were conducted to determine perceptions that were likely predictors
S514
of participants’ intentions to use their affected arm. RESULTS: Upper
limb impairments were present in women 6-15 months following
breast cancer surgery. Many of the women (47%) intended to
avoid strenuous arm exercise. In contrast, only 27% of women
intended to perform strenuous exercise. Women who intended to
avoid strenuous arm exercise were twice as likely to have shoulder
restriction, 4.6 times more likely to have arm swelling, and 3.5
times more likely to have arm weakness. Five perceptions explained
75% (F=82, p = 0.000) of the variance in the intention to avoid
strenuous arm activity. These perceptions were that: strenuous
activity exacerbates arm swelling; family encourage rest; confidence
in avoiding strenuous activity; arm swelling affects lifestyle; and health
professionals advised against strenuous exercise. Similarly, 5 percep-
tions explained 65% (F=51, p = 0.000) of the variance in the intention
to perform strenuous arm exercise. These included perceptions
that: strenuous exercise helps resolve shoulder restriction, strenuous
exercise helps resolve weakness; other breast cancer survivors have
problems with shoulder restriction; they will be unhappy to live life
with limited shoulder range; and health professionals’ advised the
performance of strenuous exercise. CONCLUSIONS: Women are
still receiving conflicting information about avoidance of strenuous
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
perception of how vigorously they can use their arm, more emphasis
could be placed on the development of musculoskeletal problems
after surgery. KEYWORDS: Breast Cancer, Lymphedema, Exer-
cise. FUNDING ACKNOWLEDGEMENTS: Not funded. CONTACT:
tlee8503@mail.usyd.edu.au
ETHICS COMMITTEE: Sydney South West Area Health Human
Ethics Committee
Research Report Platform Presentation
871 Wednesday 6 June 11:25
VCEC Meeting Room 16
PREVALENCE OF WORK-RELATED MUSCULO-SKELETAL
INJURIES IN PHYSICAL THERAPISTS
Hill C1 , Bumgardner J1 , Bustos M1 , Hellman M1 ; 1 Nova
Southeastern University; 2 ; 3 ; 4
PURPOSE: The physical demands commonly encountered by
physical therapists during patient treatment pre-disposes clinicians to
work-related musculo-skeletal injuries. The purpose was to identify
the prevalence and long term effects of these injuries in physical
therapists practicing within the state of Florida. We hypothesized that
given the large geriatric population in Florida, our physical therapists
would have a greater percentage of work-related musculo-skeletal
injuries than has been reported in other studies. RELEVANCE:
Attrition from the profession occurs for a number of reasons,
including injuries sustained on the job. Knowing whether the patient
population increases the likelihood of injury is important to know for
injury prevention. PARTICIPANTS: Five hundred physical therapists
were randomly selected from the database of all licensed physical
therapists maintained by the state of Florida. METHODS: A slightly
modified version of the survey used by Holder et a. (1999) was
used to gather work-related musculo-skeletal information from the
respondents. Respondents who indicated they were not currently
practicing or had not practiced in Florida were excluded from the
study. ANALYSIS: Descriptive statistics were used to quantify the
injuries by anatomical area, injuries by activity being performed,
altered work habits after injury, and injuries by practice setting. Chi
square was used to see if there was any difference between the
subjects in this study and other related studies. RESULTS: Fifty-three
percent of respondents indicated they had sustained a work-related
musculo-skeletal injury.There was no higher incidence of injury in our
population that that reported in other studies. In addition, there was
no significant difference in anatomical areas of injury, practice setting,
WCPT 2007, Research Reports
or altered work habits after injury. The anatomical area most often
affected was the low back, and those injuries occurred most often with
patient transfers. Injuries occurred most often in hospital settings, and
the most frequent altered work habit was using additional personnel.
CONCLUSIONS: While there was no significant difference between
our subjects and those in other studies, it is intereting to note
that 31% of those injured chose or had to change work settings
or retired as a result of being injured. It was also interesting to
note that while the practice setting in which most injuries occurred
was the hospital (acute care), the number of injuries in the sub-
acute setting were so few the results fell into the “other” category.
IMPLICATIONS: A high geriatric population does not increase the
risk of getting injured on the job. However, for a profession that
embraces safety and teaches good body mechanics to health care
colleagues and patients, we need to find better and more effective
ways to preserve our bodies while actively engaging in the practice
of physical therapy. KEYWORDS: work-related injuries; musculo-
skeletal injuries. FUNDING ACKNOWLEDGEMENTS: This was a
self-funded study.
ETHICS COMMITTEE: Internal Review Board, Nova Southeastern
University
Research Report Platform Presentation
1275 Wednesday 6 June 11:25
VCEC Meeting Room 17
EXPERIENCES OF THE ENCOUNTERING PROCESS AFTER
TRANSFEMORAL AMPUTATION FROM THE PATIENTS’
PERSPECTIVE
Sjödahl C1,2 , Gard G2 , Jarnlo G2 ; 1 Department of Psychiatry,
Landskrona, Lund University Hospital; 2 Department of Psychiatry,
Landskrona, Lund University Hospital
PURPOSE: To describe, by use of a phenomenological approach,
how transfemoral amputees experience their encounter with health-
care providers in the acute phase and over time. RELEVANCE:
Depression and anxiety are well documented consequences of
trauma and these reactions can cause delay of the rehabilitation
process and have a negative effect on outcome. Understanding
of the encountering process may facilitate communication and
interaction thereby improving patient satisfaction and rehabilitation
outcomes. PARTICIPANTS: Eleven trans-femoral amputees with
trauma or tumour-related amputation, median age 33.5 years, were
interviewed. Amputation was made in median 7.5 years before the
interview. The informants were community dwelling and managed
well indoors. One had a half disablement pension and all the
others were working or studying full time. METHODS: Data was
collected by use of a semi-structured interview for 60 to 90 minutes.
The interviews were tape-recorded and transcribed verbatim. All
gave their written consent. The study was approved by the Ethical
Committee of Lund University (LU 34-95). ANALYSIS: Data was
processed and analyzed by a phenomenological approach to enable
the researchers to gain a deeper understanding of the unique
experience of the individuals. This analysis consisted of the following
steps: a/ All the interviews were read separately several times in
order to get an understanding of the essence of each interview.
b/ The interviews were read to identify and categorize the primary
patterns in the data. c/ Meaning units were formulated to try to
catch the essence and meaning of the statements. d/ Clusters of
different aspects emerged in the coded data and were organised
in categories. e/ These clusters were referred back to the raw
data, which was read through once again. The raw interviews were
coded again and the coded sentences were cut out and placed
in a ‘scrapbook’ arranged by category. This was done to validate
the categories and make sure that no essential aspect had been
left out. f/ The raw data as well as the significant statements
extracted from these transcriptions was read and coded separately
by all the authors. This was done to obtain consensus between
the authors, and to make sure that no further aspects appeared
Platform Presentations, Wednesday 6 June
and that the coding of the data was correct. g/ Three categories
were described. RESULTS: Preliminary results were structured in
three categories, in which the respondents expressed problems
in the encountering process 1) communication/information – lack
of preparation for the new situation 2) empathy and emotional
support and 3) difficulties to meet the need of individually tailored
rehabilitation/training. CONCLUSIONS: Increased awareness of how
communication and interaction influence the rehabilitation process
may further improve patient satisfaction and rehabilitation outcomes.
IMPLICATIONS: Knowledge and understanding of how encountering
processes influence rehabilitation outcomes may lead to use of
a conscious therapeutic approach. KEYWORDS: encountering,
amputation, communication. FUNDING ACKNOWLEDGEMENTS:
This study was supported by grants from the Gyllenstiernska
Krapperups’ Foundation.
ETHICS COMMITTEE: the Ethical Committee of Lund University,
Sweden (LU 34-95)
Research Report Platform Presentation
1980 Wednesday 6 June 11:25
VCEC Meeting Room 18
PREDICTING FUNCTIONAL ABILITY IN PATIENTS WITH
CHRONIC FATIGUE SYNDROME: THE IMPORTANT ROLE OF
COGNITIVE FACTORS
Woby S1,2 , Urmston M1,2 , Oldham J2 ; 1 Department of
Physiotherapy, North Manchester General Hospital, Manchester,
United Kingdom; 2 Centre for Rehabilitation Science, University
of Manchester, Manchester, United Kingdom
PURPOSE: The cognitive behavioral paradigm posits that cognitive
factors are an important determinant of functional ability. Therefore,
the purpose of this study was to determine the extent to which certain
cognitive factors were differentially related to the functional ability
of patients with chronic fatigue syndrome (CFS). RELEVANCE:
Physical therapists often treat patients with chronic fatigue syndrome.
When treating such patients a primary objective is to increase
functional ability. The extent to which cognitive factors influence
the functional ability of patients with CFS within a physical therapy
context is unclear. Delineating the extent to which certain cognitive
factors affect the functional ability of patients with CFS is essential
as these findings would alert practitioners to those cognitive factors
that need to be targeted during treatment. PARTICIPANTS: Data
were collected from 68 patients with chronic fatigue syndrome who
had been referred to a physical therapy department. Eighty percent
were female, the mean age was 41.8 years (SD=10.8) and the mean
duration of symptoms was 6.2 years (SD=4.8). Forty-eight percent
had not been in employment because of their CFS symptoms for
a mean duration of 4.9 years (SD=4.9yrs). METHODS: Prior to
treatment, patients completed a series of measures that assessed
function, pain, fatigue, self-efficacy, catastrophizing, acceptance,
hypervigilance, anxiety and depression. ANALYSIS: The relation
between the cognitive factors and functional ability was initially
explored via partial correlations (covariates were age, sex, fatigue
and pain). Those cognitive factors that were related to functional
ability were subsequently entered into a two step hierarchical multiple
regression analysis to determine their relative importance. Age, sex,
pain intensity and fatigue were entered in Step 1, and the cognitive
factors were entered in Step 2. RESULTS: Age, sex, pain intensity
and fatigue explained 21% of the variance in functional ability
(P < 0.01). Interestingly higher pain intensity (b = 0.28; P < 0.01), but
not fatigue (b = −0.10; P = 0.27), was uniquely related to functional
ability. After controlling for the aforementioned factors, the cognitive
factors explained an additional 33% of the variance. Of the cognitive
factors, only functional self-efficacy explained unique variance (b =
−0.52; P < 0.001). The final model accounted for 58% of the total
variance in functional ability. CONCLUSIONS: Cognitive factors were
related to the functional ability of patients with CFS. Furthermore,
these cognitive factors were a stronger predictor of functional ability
S515
than the combined effect of pain intensity and fatigue. Functional
self-efficacy played a particularly important role, with lower levels of
self-efficacy being related to lower functional ability. IMPLICATIONS:
Physical therapists need to target cognitive factors when treating
patients with CFS. Specifically, increasing a patient’s functional self-
efficacy should be a primary objective. KEYWORDS: Chronic Fatigue
Syndrome, Cognitive Factors. FUNDING ACKNOWLEDGEMENTS:
This study was funded by Pennine Acute NHS Trust. CONTACT:
steve.woby@pat.nhs.uk
ETHICS COMMITTEE: North Manchester Local Research Ethics
Committee
Research Report Platform Presentation
2547 Wednesday 6 June 11:25
VCEC Meeting Rooms 19-20
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 ,
Park J5 ; 1 Health and Rehabilitation Sciences Research Institute,
School of Health Sciences, University of Ulster, Northern Ireland;
2 Public Health, Medicine and Primary Care, Queens University
Belfast, N Ireland; 3 School of Health Sciences, University of
Ulster, N Ireland; 4 Centre for Physiotherapy Research, School
of Physiotherapy, University of Otago, New Zealand; 5 Division
for Research and Education in Complementary and Integrative
Medical Therapies, Harvard Medical School, Osher Institute, USA
PURPOSE: This double-blind, randomized controlled pilot study
assessed the feasibility of a trial to investigate the efficacy of
acupuncture compared to placebo needling for the treatment of acute
low back pain. The study was designed to establish the credibility of
the placebo control, and to provide data to inform a power analysis
to determine numbers for a future trial. RELEVANCE: Increasing
numbers of physical therapists use acupuncture for pain relief but
there is no evidence to support the specific effect of acupuncture
over placebo effects in acute low back pain. PARTICIPANTS: All
consenting patients meeting the inclusion criteria who were referred
to the South and East Trust for physiotherapy were recruited into
the study. METHODS: Patients (n=48) with acute low back pain
were randomized to verum or placebo acupuncture in a double
blind randomised controlled trial. The Roland and Morris Disability
Questionnaire (RMDQ), Visual Analogue Scale (VAS), medication
use and an exit questionnaire were completed at baseline, end
of treatment, and at 3 month follow up. ANALYSIS: Intention-to
treat analysis was carried out by an investigator who was masked
to treatment allocation. Analysis of Covariance (ANCOVA), using
pretreatment value as the covariate, was used to determine any
differences between the two groups at the post-treatment and follow-
up visits RESULTS: 94% of patients completed assigned treatment,
83% completed the 3 month follow-up. The sham needle proved
to be credible with 91.7% in the placebo group and 95.8% in the
verum group believing they had received acupuncture. There was
no significant difference between the groups on the RMDQ over
time. For pain, the only statistically significant difference was at the 3
month follow up (worst VAS, point estimate, 26.95, 95% CI 9.561 to
44.34, p < 0.01). The majority of patients were taking some form of
analgesic medication for LBP at the start of treatment (n=44; 92%)
with the verum acupuncture group taking significantly fewer tablets
(mean (SD): 0.82±1.2) than the placebo group (mean (SD), 3.2±3.2,
p < 0.05) at the end of treatment CONCLUSIONS: Based upon these
data, power analysis indicated that 120 participants (60 per group)
would be needed to complete an adequately powered randomized
controlled trial IMPLICATIONS: These preliminary results support
a specific effect of acupuncture in reducing low back pain and the
requirement for pain relieving medication in an acute episode of
low back pain KEYWORDS: low back pain, acupuncture, placebo.
FUNDING ACKNOWLEDGEMENTS: The Department of Education
S516
in Northern Ireland Strategic Priority fund supported this work.
CONTACT: s.mcdonough@ulster.ac.uk
ETHICS COMMITTEE: Royal Hospitals Research Ethical Committee
Research Report Platform Presentation
3255 Wednesday 6 June 11:45
PP Crystal Pavilion A
PREGNANCY INFLUENCES SPINAL LIGAMENT ENDOCRINE
RECEPTORS
Doschak M, Emami S, Kawchuk G; University of Alberta
PURPOSE: The goal of this project was to characterize the expres-
sion of endocrine receptors in the spinal ligaments of pregnant and
non-pregnant rabbits. RELEVANCE: Low back pain is a significant
cause of maternal distress during pregnancy. While the etiology of
pregnancy-related back pain has not been characterized fully, some
believe an increase in the laxity of spinal ligaments is a potential
cause of pregnancy-related back pain. While increased expression
of progesterone receptors has been shown to occur in peripherial
ligaments during pregnancy (Hart et al., 2002), we are not aware of
any evidence that the stiffness of spinal ligaments is modulated by the
endocrine system. PARTICIPANTS: Primigravida pregnant and virgin
control female New Zealand White rabbits. METHODS: Estrogen
receptor and progesterone receptor expression were assessed using
reverse-transcriptase polymerase chain reaction (RT-PCR). Samples
of the supra-spinous ligament (SSL) were isolated from between
adjacent vertebrae of each rabbit. Ligaments were flash frozen
and pulverized in liquid nitrogen using a ball-bearing dismembrator
(Mikro-Dismembrator S, Sartorius, Germany). ANALYSIS: After
digestion with Trizol reagent, samples of mRNA were extracted using
the Qiagen RNeasy kit and reverse transcribed into copy-DNA for use
with conventional semi-quantitative PCR. Specific oligonucleotide
PCR primers were synthesized against both estrogen receptor and
progesterone receptor, and standardized against housekeeping gene
(GAPDH) expression. RESULTS: Results showed that a 17-fold
increase in progesterone receptor expression was measured in SSL
from pregnant rabbits when compared to that from virgin control
rabbits. In contrast, estrogen receptor expression was relatively
constant, with only a 1.5-fold increase in pregnant rabbits over that
from virgin control rabbits. CONCLUSIONS: We believe that these
data are the first to suggest that hormonal changes during pregnancy
may influence spinal ligament laxity. IMPLICATIONS: In the future,
pharmacologic modulation of spinal ligament progesterone receptor
expression may prove to be important toward the management
of pregnancy-related back pain. KEYWORDS: Pregnancy, Back
pain. FUNDING ACKNOWLEDGEMENTS: Natural Sciences and
Engineering Research Council of Canada (NSERC). CONTACT:
greg.kawchuk@ualberta.ca
Research Report Platform Presentation
2998 Wednesday 6 June 11:45
PP Crystal Pavilion B & C
AN ONLINE COMMUNITY OF PRACTICE AS A PROFESSIONAL
DEVELOPMENT APPROACH TO ADVANCING THE PHYSICAL
THERAPY MANAGEMENT OF OSTEOPOROSIS
Evans C1 , JaglalS2 ; 1 University
of Toronto, Toronto, Canada;
2 University of Toronto and Osteoporosis Research Program,
Women’s College Hospital, Toronto, Canada
PURPOSE: The purpose of this study was to investigate whether
participants in an online community of practice advanced their
knowledge and skills in the management of low trauma fracture
associated with osteoporosis. This research also examined design
innovations used to create and sustain an online community of
practice. RELEVANCE: Osteoporosis is a major health problem char-
acterized by compromised bone strength, leading to an increased risk
of fracture causing significant disability. Despite a substantial body
WCPT 2007, Research Reports
of research supporting physical therapy interventions, this condition
is under diagnosed and under treated. Traditional professional
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
community of practice model based on social learning theory
in which participants are mutually engaged in a joint enterprise
in the context of their practice moving beyond passive learning
to understanding and creating new knowledge to move their
practice forward. PARTICIPANTS: Subjects included physical and
occupational therapists who were recruited and selected from four
sites in northern and southern Ontario, where there was a shortage
of family physicians, high volumes of fractures and limited access to
osteoporosis care. METHODS: A design research approach involving
progressive refinement of processes to develop the community
and advance practice was used. During the four cycles, design
innovations were made to respond to the challenges and facilitators
to inform the next cycle of development. The goal of the community
of practice was to advance practice through the development of
exemplar cases to be used as a learning resource. ANALYSIS:
Qualitative (grounded theory approach) and quantitative analyses
(t tests) were carried out to determine how the multiple variables
and design iterations contributed to knowledge and practice advance-
ment, development of the community and emerging exemplar cases.
Data sources included the Knowledge Forum® database; audio-
taped synchronous discussions and individual feedback interviews.
RESULTS: Participants (n=6)in the online community of practice
progressed through four cycles of innovation shifting from individual
task based activity to collective advancement of practice using
evidence and theories to address authentic clinical problems. The
community created 14 exemplar cases based on practice situations
and identified that their practice had advanced in the assessment
and management of low trauma patients. Multi-medium technology
played an essential role in the development and sustainability of
the community of practice. The use of a design research approach
allowed for “just in time” innovations. CONCLUSIONS: An online
community of practice is an innovative approach to professional
development that allows for the collective creation and distribution
of knowledge in ways that exceed individual capabilities, contributing
to the advancement of practice related to low trauma fracture.
Future research should study how emerging technologies can further
support communities of practice as a professional development
strategy. IMPLICATIONS: Online communities of practice have the
capacity to bring together physical therapists and researchers,
transcending geographical and temporal boundaries to advance
practice which is vital to moving physical therapy forward to create
its future. KEYWORDS: professional development, community of
practice, osteoporosis. FUNDING ACKNOWLEDGEMENTS: This
research was supported by the Physiotherapy Foundation of Canada
and Ontario Ministry of Health Primary Health Care Transition Fund.
CONTACT: cathy.evans@utoronto.ca
ETHICS COMMITTEE: University of Toronto, Education Research
Ethics Review Board
Research Report Platform Presentation
3162 Wednesday 6 June 11:45
VCEC Ballroom A
INTER OBSERVER RELIABILITY OF TWO MEASUREMENTS FOR
DETERMINING SUBTALAR POSITION IN HEALTHY SUBJECTS
Oosterveld F, Niessink P, van der Weit-Seales E, Schoenmaker W;
Saxion University, Enschede, The Netherlands
PURPOSE: The purpose of this study was to investigate the inter
observer reliability of two different methods for assessing subtalar
joint position: the inclino measurement (Rippstein plurimeter) of the
calcaneus position perpendicular to the floor and the analysis of a
standing foot blue print. RELEVANCE: Subtalar joint measurement
Platform Presentations, Wednesday 6 June
is a common procedure in daily practice of physiotherapists with
expertise in foot problems and is clinically used to determine the
position of the calcaneus. According to recent literature, there are
fewer consensuses about the reliability of the tools. In different stud-
ies, poor, moderate or even good reliability was reported. However,
research methods and measurement methods differ, are not quite
comparable and large studies are exceptional. PARTICIPANTS: 102
Healthy subjects, 67 female and 32 male, with a mean age of 24 sd 10
years (median 20 years; range from 17 to 58) were recruited among
students and staff of Saxion University. METHODS: Two second year
bachelor students, blinded for each other’s outcome, performed the
inclino measurements. Results were expressed in degrees and also
transferred to nominal data in varus, neutral or valgus. Subsequently
standing blue prints on the Harris mat of both feet of the subjects were
made. Two experienced physiotherapist-podiatrists examined the
prints determining the subtalar joint position by drawing a rectangular
line on the central transversal axis-line from the os naviculare. Then
the length of the medial (AB) and the lateral (BC) line was measured.
The difference was expressed in mm. ANALYSIS: Cohen’s Kappa
was used for nominal data and Pearson’s correlation coefficient
for continuous data to estimate inter observer agreement. Also,
differences between the measurements were expressed in mean
and standard deviation using T-tests. Based on these SD’s and
correlation coefficients the Smallest Detectable Difference (SSD)
was calculated. RESULTS: Inter observer reliability for inclinometer
measurements was relatively low. The mean difference was 0.2
sd 3.6 (p = 0.62), with a Pearson’s correlation coefficient of 0.33
(p = 0.01), while the SSD as 8.6. In nominal measurements Cohen’s
Kappa’s results also indicates poor agreement (0.13; p = 0.075).
Inter observer reliability of blue print analysis by experienced
physiotherapist-podiatrists is better, regarding the good correlation
coefficients (0.82; p = 0.000) and moderate Cohen’s Kappa’s (0.5;
p = 0.000). Nevertheless, the variance in the measurements between
the two physiotherapist-podiatrists is rather large (1.4 sd 6.3;
p = 0.025), still leading to a relatively big SDD (9.7). CONCLUSIONS:
Reliability of inclino measurements done by students is rather
poor; deviation from the neutral less than approx. 8 degrees
may not have any clinical implications. Experienced professionals
perform better on their analysis of footprints, but the validity of
their diagnosis of the calcaneus positions is questionable in a
range between 5 and 10 mm difference in AB vs. BC line.
IMPLICATIONS: Some caution in the interpretation of this diag-
nostic measure is necessary. KEYWORDS: measurements, validity,
reliability. FUNDING ACKNOWLEDGEMENTS: None. CONTACT:
f.g.j.oosterveld@saxion.nl
Research Report Platform Presentation
1756 Wednesday 6 June 11:45
VCEC Meeting Rooms 1-3
THE RELATIONSHIP BETWEEN AGE AND FORCES APPLIED
DURING CHEST PHYSIOTHERAPY IN MECHANICALLY
VENTILATED CHILDREN
Gregson R1,2,4 , Shannon H2 , Main E1,2 , Dunne C1 , Warner J4 ,
Goldman A3 , Stocks J2 ; 1 Physiotherapy Department, Great Ormond
Street Hospital for Children, London, United Kingdom; 2 Portex
Respiratory Unit, UCL Institute of Child Health, London, United
Kingdom; 3 Intensive Care Units, Great Ormond Street Hospital for
Children, London, United Kingdom; 4 School of Medicine, University
of Southampton, United Kingdom
PURPOSE: To assess, via an innovative new method (Novel
Pliance® ), the variability of forces applied to mechanically ventilated
children during chest wall vibrations, and the extent to which
these vary according to the age of the child. RELEVANCE: Chest
wall vibrations are commonly used during respiratory physiotherapy
treatments. However, this technique remains largely unquantified. In
order to understand its effects, it is essential to measure the force and
characteristics of techniques involving manual contact between the
S517
physiotherapist and child. Moreover, the magnitude of force applied
during physiotherapy in this population may be related to differences
in age and chest wall compliance. PARTICIPANTS: Mechanically
ventilated children (aged 0-16 years) at Great Ormond Street
Hospital for Children were recruited if they were clinically stable,
heavily sedated or paralyzed and required chest physiotherapy
(assessed by the physiotherapist and the medical team). METHODS:
Prior to physiotherapy, a lightweight, flexible, prototype force-
sensing mat (Novel Pliance® ) was placed over the area requiring
treatment, between the child’s chest wall and the therapist’s hand.
Physiotherapists administered treatments in their usual manner and
forces applied through the mat were transmitted to the Pliance®
system. Algorithms and an analysis program were devised in
Labview™ using the Pliance® force system’s summary ASCII format
file (comprising time and force data). Force-time profiles, including
maximum force and duration of vibration, and the amplitude, number
and frequency of oscillations, were calculated for all chest wall
vibrations. ANALYSIS: Average values for the maximum force applied
during each vibration were calculated for every treatment session.
The median and range of these values between treatments were
then reported. The extent to which forces varied according to age
was also examined. RESULTS: Nine senior physiotherapists were
recruited to treat 40 mechanically ventilated children (median age:
1.5 years [range 0.2–14yrs], weight: 10kg [4.7–50kg]). Maximum
applied forces ranged from 21–165 Newtons (N) (median: 40N) and
were strongly associated with age. For every 1 year increase in age
there was a 9N increase in Force applied (P < 0.0001) and these
correlated significantly (r2 =0.72). There was marked variability in the
pattern of force-time profiles between physiotherapists with respect
to the duration of vibration, and amplitude, number and frequency
of oscillations. However this pattern was generally consistent within
individual therapists, regardless of the child’s age. CONCLUSIONS:
There was considerable variation in the magnitude of forces applied
by different physiotherapists and these were significantly related
to the age of the child. It is likely that this association reflects
modification of treatment in response to differences in chest wall
compliance, this being considerably higher during early life. Further
research should examine other factors influencing physiotherapist’s
application of manual techniques, including how applied forces may
differ in the treatment of adults. IMPLICATIONS: The variations
in force patterns between physiotherapists raise questions about
the relative importance of individual components of chest wall
vibrations and how these are anticipated to affect respiratory or
physiological change. Developments to combine force analysis
with airflow data could prove invaluable in future intervention
trials and for training purposes. KEYWORDS: Respiratory Therapy,
Intensive care, Pediatrics. FUNDING ACKNOWLEDGEMENTS:
Sport Aiding Medical Research for Kids (SPARKS); Great Ormond
Street Hospital Physiotherapy Research Fellowship. CONTACT:
r.gregson@qub.ac.uk
ETHICS COMMITTEE: South and West Local Research Ethics
Committee. Great Ormond Street and Institute of Child Health Local
Research Ethics Committee, London.
Research Report Platform Presentation
2165 Wednesday 6 June 11:45
VCEC Meeting Rooms 11-12
BREAST CANCER PATIENTS’ PAIN EXPERIENCES 6 AND 12
MONTHS AFTER OPERATION
Kärki A; Satakunta University of Applied Sciences, Pori, Finland
PURPOSE: The purpose of the study was to describe pain
experiences and intensity of the pain 6 and 12 months after
breast cancer operation. Another purpose was to find out the
impact of pain on activity limitations and participation restrictions.
RELEVANCE: In the review by Rietman et al. (2003) the prevalence
of pain ranged from 12 to 51% among breast cancer patients and
Tengrup et al. (2000) showed that even one third of the patients
S518
experienced pain in the arm as long as five years after operation.
The level of functioning and participation should be major concern
among physiotherapists working with breast cancer patients with
pain experiences. PARTICIPANTS: The population consisted of
110 patients with breast cancer from Satakunta district, Finland.
Mean annual number of new cases in 1996-7 in this area was
149. One hundred and five patients answered the first survey
and 96 (91.4%)the second. METHODS: The prospective survey 6
and 12 months after operation was done by questionnaires. The
questions concerned experienced impairments, activity limitations
and participation restrictions. Pain was examined by SF-MPQ
(Short Form McGill Pain Questionnaire) and severity of pain by
modified VAS. Modified Behavioural Rating Scale for Breast Cancer
Patients was used to find out the possible pain impact on activity
and participation. ANALYSIS: Descriptive statistics were used,
correlations were calculated and the Wilcoxon Signed Rank Test
was used for counting changes of pain, activity limitations and
participation restrictions. One-way Anova was used to determine
differences between operation types. A Paired Samples Test was
used for assessment of changes between VAS-values. Linear
regression analysis was done to determine the effect of pain on
limitations and restrictions. RESULTS: Neck and shoulder pain was
the most common pain experienced by the breast cancer patients,
38.5% at 6-month and 40.6% at 12-month follow-up. VAS-values were
also the highest varying from 27 mm to 28 mm. Modified radical
mastectomy (MRM) patients experienced increasing limb ache in
one year follow-up. Most common pain descriptions at 6-month and
12-month follow-up were sharp 18.8% to 14.6%, shooting 22.9% to
20.8% and tender 45.8% to 38.6%. MRM group described their pain
as fearful more often than breast saving operation (BSO) group.
BSO group experienced more severe axilla pain and breast pain
than MSM group. Axilla pain, breast pain, upper limb ache, neck
and shoulder pain were shown to be the determinants of activity
limitations and sleep impairment together with other determinants
like edema, age, shoulder movement restriction and upper limb
weakness. CONCLUSIONS: Breast cancer patients described their
pain as mostly sharp, shooting and tender. These descriptions
represent the sensory dimension of pain; tender in the sensory
miscellaneous, shooting in the sensory spatial and sharp in the
sensory pressure subclass. The pain values in VAS were less than
30 mm, and should not affect daily activities (Tengrup et al. 2000),
however we found that most of the activities were affected by pain
symptoms. IMPLICATIONS: Pain should be assessed and treated
during rehabilitation process of each patient, while it will cause
suffering, activity limitations and sleep disturbances. KEYWORDS:
Breast cancer, pain, VAS, modified radical mastectomy, breast saving
operation. FUNDING ACKNOWLEDGEMENTS: The study was sup-
ported by the Satakunta Foundation. CONTACT: anne.karki@samk.fi
ETHICS COMMITTEE: The Finnish Social and Health Ministry has
approved the study in 1997.
Research Report Platform Presentation
1453 Wednesday 6 June 11:45
VCEC Meeting Room 17
AFFECT-FOCUSED PSYCHODYNAMIC BODY THERAPY
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.
WCPT 2007, Research Reports
Patients with GAD often seek primary health care because of their
muscular pain caused by anxiety-provoked tension. This is one
reason why patients with GAD often are referred to physiotherapeutic
treatment. The aim of this study was to explore the long-term
effect of Affect- focused Psychodynamic Body Therapy (PBT)for
patients with GAD. RELEVANCE: Patients with GAD is a challenge
for physiotherapists because symptomatic treatment generally only
achieves short-term relief. Affect-focused Body Therapy offers a more
holistic approach by focusing on how the mind/body unity is lived. The
affect-focused psychodynamic body therapy is a physiotherapeutic
treatment method especially suited for patients with psychosomatic
and psychiatric problems. There is empirical support for its use in
the treatment of patients with chronic pain, but it has not been
evaluated for patients with GAD.There is still no state of the art
treatment for GAD patients and recovery rates reported are around
60%. Therefore there is a need to develop and evaluate alternative
treatment strategies. It is also vital to the physiotherapy profession
that new methods such as the PBT are evaluated. PARTICIPANTS:
The patients were recruited consecutively through the first-line
psychiatric outpatient clinics south of Stockholm. The total patient
group consisted of 61 patients with GAD; 42 women and 19 men,
mean age 37 years (range 21-55). METHODS: Of the 61 patients
33 were randomised to PBT and 28 to psychiatric treatment as
usual (TAU). The patients were assessed before treatment and
followed-up one and two years after inclusion. Four physiotherapists
administered the PBT once weekly during one year. Three self report
questionnaires were administered; SCL-90, Beck Anxiety Inventory
(BAI) and the WHO (Ten) Well-being Index (WWB). ANALYSIS: A
repeated measures multivariate analysis of covariance (MANCOVA)
was performed. We also calculated within-group effect sizes, d, on
the raw scores on each outcome variable. Between group effect
sizes, D, were calculated according to Becker. RESULTS: Both
groups improved significantly in all scales and the improvement was
somewhat more pronounced in the PBT group. A MANCOVA with
occasions as a within-subjects factor and groups as a between -
subjects factor, using age, sex and number of personality disorder
diagnosis as covariates gave a significant multivariate effect of
occasions (p < 0.05) with significant univariate effects on BAI and
Global Severity Index of the SCL-90. CONCLUSIONS: PBT seems
to be a viable treatment alternative for patients with GAD. In
terms of general symptom relief it might even be more efficient
than treatment as usual. IMPLICATIONS: As patients with GAD
frequently present bodily symptoms their first treatment contact in
many cases is with a doctor in the somatic health care where
they are examined to exclude any circulatory or endocrinological
problem. A physiotherapist with training in PBT may then offer an
adequate treatment for patients with a predominantly psychological
aetiology. KEYWORDS: Affects, Generalised Anxiety Disorder,
Outcome, Physiotherapy, Psychodynamic Body Therapy. FUNDING
ACKNOWLEDGEMENTS: This study was supported by grants from
Vårdalstiftelsen, Karolinska Institutet, the Boëtius foundation, the
Bror Gadelius foundation and the Psychiatric Clinic and research
department at Karolinska University Hospital – Huddinge. CONTACT:
adrienne.levy-berg@swipnet.se
ETHICS COMMITTEE: The ethical committee at Huddinge hospital
1998
Platform Presentations, Wednesday 6 June
Research Report Platform Presentation
2036 Wednesday 6 June 11:45
VCEC Meeting Room 18
INFLUENCE OF THE KNOWLEDGE OF PAIN NEUROPHYSIOL-
OGY ON COPING, CATASTROPHISING, KINESIOPHOBIA AND
PAIN IN PATIENTS WITH THE CHRONIC FATIGUE SYNDROME
Meeus M1,2 , Nijs J1,2 , Van Oosterwijck J1 , Van Alsenoy V1 ,
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
Physiology – Faculty of Physical Education and Physiotherapy –
Vrije Universiteit Brussel (VUB), Brussels, Belgium
PURPOSE: The present study aimed at investigating whether an
education session on the neurophysiology of pain is capable of
reducing pain catastrophising, kinesiophobia, passive coping and
pain in patients with the Chronic Fatigue Syndrome (CFS), suffering
from chronic widespread pain. RELEVANCE: Besides the debilitating
fatigue, the majority of CFS patients experiences chronic widespread
pain. In patients with chronic low back pain the efficacy of education
sessions on the neurophysiology of pain has already been shown.
The patient education aims at reconceptualising “pain” by providing
correct information on the function and the mechanism of pain. Up
to now, there is no evidence for the efficacy of such education
session in CFS patients suffering from chronic musculoskeletal pain.
PARTICIPANTS: Forty-eight patients fulfilling the 1994 Centre of
Disease Control and Prevention (CDCP) criteria for CFS and the
1990 American College of Rheumatology criteria for widespread pain
were included in the study. All participants had Dutch as native
language and were aged between 18 and 65 years. METHODS:
Participants were subjected to a pain threshold measurement and
filled out a list of Dutch questionnaires evaluating their knowledge
on pain neurophysiology, coping strategies, kinesiophobia and pain
catastrophising. Afterwards patients were randomly assigned to
the experimental group or the control group. The experimental
group (n=24) received a 30 minutes-lasting individual information
session about the neurophysiology of pain: the mechanism, the
function and the modulation of pain. The control group (n=24) had
an individual lesson of 30 minutes on self-management pacing
techniques. Finally the second blind researchers repeated the pain
threshold measurements and patients completed the questionnaires
for the second time. ANALYSIS: Two-way ANOVA was used to
reveal a possible therapy effects on the questionnaire score and pain
thresholds. RESULTS: After the intervention, the experimental group
presented a significant better knowledge on the neurophysiology of
pain, compared to the control group. Secondly, in the experimental
group a significant reduction was found in the passive coping
strategies “worrying” and in the subscale “ruminating” of the Pain
Catastrophising Scale, in comparison to the controls. Furthermore,
a significant increase in the active coping strategy “distraction” was
revealed. Finally, the pain thresholds of the treatment group increased
after the education session, but compared to the control group it
was not a significant therapy effect. CONCLUSIONS: The present
study revealed some interesting therapy effects of an individual
education session on the neurophysiology of pain for CFS patients
experiencing chronic pain. Despite frequently reported concentration
problems, CFS patients are able to understand and learn the
neurophysiology of pain, and this knowledge has immediate effects
on pain behaviour. Reconceptualisation of pain by an education
session on the neurophysiology of pain has an influence on
pain catastrophising and pain coping. Further investigation should
focus on long-term therapy or long-term effects on pain and pain
behaviour. IMPLICATIONS: With these results in mind, physical
therapists could provide education for CFS patients with pain,
in order to influence negative thoughts, pain behaviour and on
long term eventually pain, since catastrophising is known to be a
predictor of chronic pain. KEYWORDS: Chronic Fatigue Syndrome,
chronic pain, catastrophising, coping, kinesiophobia, education, pain
neurophysiology. FUNDING ACKNOWLEDGEMENTS: Mira Meeus
S519
is financially supported by a PhD grant supplied by the Higher
Institute of Physiotherapy, Department of Health Sciences, University
College Antwerp, Antwerp, Belgium (G 807) and co-financed by
Faculty of Physical Education and Physiotherapy – Vrije Universiteit
Brussel (VUB), Brussels, Belgium (OZR project OZ.R. 1234/MFYS
Wer2). CONTACT: mira.meeus@vub.ac.be
ETHICS COMMITTEE: Committee Medical Ethics Academic Hospital
Vrije Universiteit Brussel, Brussels, Belgium
Research Report Platform Presentation
2808 Wednesday 6 June 11:45
VCEC Meeting Rooms 19-20
A PILOT STUDY ON THE EFFECT OF ACU-TENS DURING
EXERCISE ON POST-EXERCISE EXPIRATORY FLOW RATE IN
SUBJECTS WITH ASTHMA
Ngai S, Jones A, Hui-Chan C; Department of Rehabilitation
Sciences, The Hong Kong Polytechnic University
PURPOSE: Exercise can induce asthma in susceptible individuals
and patients with symptoms of asthma may therefore be reluctant
to exercise. Suppression of hyperventilation may reduce stimulus
to asthma and allow patients to perform at a higher workload to
maximize their exercise capacity. Acupuncture stimulation is believed
to promote health by restoring the free flow of energy (qi) along
meridians. Effects of acupuncture stimulation on cardiovascular and
respiratory systems have been reported in literature. Explanations for
acupuncture effect in asthma include suppression of inflammatory
markers and release of endogenous opioids, which may in turn
reduce hyperventilation during exercise, and thereby subdue airway
irritation and alleviate asthmatic symptoms. Acupuncture is however
invasive. Transcutaneous Electrical Nerve Stimulation (TENS) is
a non-invasive modality, which when applied over acupuncture
points (Acu-TENS) may elicit similar responses to acupuncture.
The aim of this study was to investigate the effect of Acu-TENS
applied during exercise, on post-exercise forced expiratory flow
rate, in subjects with asthma. RELEVANCE: TENS is a non-
invasive electrophysical modality commonly employed by physical
therapists. Acu-TENS may permit higher training intensity in patients
with asthma thereby improving musculoskeletal and cardiovascular
fitness. PARTICIPANTS: Patients aged between 18 to 70, diagnosed
with asthma for over 5 years, and attending follow up at a large district
hospital were recruited. Patients were free from musculoskeletal
disorders which could limit their performance in a treadmill exercise
test. Sixteen subjects were recruited. METHODS: Subjects were
randomly assigned into one of the three groups: Group 1 received
TENS over the acupoints: Lieque (LU 7–1.5 cun above transverse
crease of wrist between tendons of brachioradial muscle and
abductor pollicis longus) and Dingchuan (EX 14–0.5 cun lateral to
the spinous process of C7) (1 cun= distance between the medial
ends of the creases of the interphalangeal joints of the individual’s
middle finger) for 45 minutes prior to a submaximal treadmill exercise
test (Naughton protocol). Group 2 similar to Group 1 except that
application of acu-TENS continued during the exercise test. Group
3 (Placebo-TENS) similar to Group 1 but there was no electrical
output from TENS machine despite apparent activation of the output
indicator. ANALYSIS: Percentage of drop in forced expiratory volume
in 1 second (FEV1) after exercise test was compared amongst the
three groups using one way ANOVA. RESULTS: The percentage
drop of FEV1 after exercise was smallest in Group 2 (acu-TENS
before and during the exercise text) (−1.9%) and greatest in the
Group 3 (Placebo-TENS) (−6.9%). However the differences did not
reach statistical significant level (p = 0.53). CONCLUSIONS: This
study did not support the hypothesis that Acu-TENS improves FEV1
in subjects with asthma. Failure to reach significance is probably
related to the small sample size. IMPLICATIONS: Stabilising airway
patency (as reflected by maintenance of FEV1) with Acu-TENS
applied before and during exercise suggests that studies of similar
nature with a larger sample size are indicated. KEYWORDS: Asthma,
S520
TENS, FEV1, Acupuncture. FUNDING ACKNOWLEDGEMENTS:
This project was supported by Area of Strategic Development Grant,
Department of Rehabilitation Sciences, The Hong Kong Polytechnic
University.
ETHICS COMMITTEE: Ethics committee of the Hong Kong
Polytechnic University
Research Report Platform Presentation
3182 Wednesday 6 June 12:05
PP Crystal Pavilion B & C
THE FIRST YEAR OF CLINICAL PRACTICE: AN INVESTIGATION
OF THE PROFESSIONAL DEVELOPMENT OF PROMISING
NOVICE PHYSICAL THERAPISTS
Black L1 , Mostrom E2 , Perkins J2 , Jensen G1 , Hayward L3 ,
Blackmer B3 , Ritzline P4 ; 1 Creighton University; 2 Central Michigan
University; 3 Northeastern University; 4 University of Indianapolis
PURPOSE: This qualitative multiple case study describes the
learning and professional development of promising novice physical
therapists during their first year of clinical practice. RELEVANCE:
While a moderate amount of cross-sectional research has been
conducted on expertise in physical therapy and differences between
novice and expert practitioners, there are few longitudinal studies
of therapists’ development over time or through critical transitions
(student to practitioner; novice to experienced clinician). This study
focuses on the learning and professional development of novice phys-
ical therapist graduates as they progressed through their first year
of clinical practice. PARTICIPANTS: A purposive sample of 12 new
graduates from 4 physical therapist professional education programs
participated in the study. Selection criteria included evidence of
promise as demonstrated by exceptional performance during clinical
internships, engagement in extra-curricular professional activities,
demonstration of characteristics of professionalism as defined in
the American Physical Therapy Association’s Professionalism/Core
Values document, and cumulative GPA of 3.0 or higher. METHODS:
Investigators from 4 universities followed graduates throughout their
first year of practice. Data sources included: (1) semi-structured
interviews conducted at baseline and every 3 months for 1 year
(3, 6, 9 and 12 months); (2) reflective journals completed twice
per month; and (3) review of artifacts such as academic and
clinical education records and resumes. An interview guide was
developed and used by investigators for each interview. Interviews
were audiotaped and transcribed verbatim. Guidelines for journal
writing were provided to participants. ANALYSIS: Data were
analyzed using a qualitative general inductive approach to analysis
employing constant-comparison for within case and cross-case
analysis. RESULTS: Across the twelve cases and four universities,
five primary themes emerged: (1) Therapist learning was on-going
throughout the year and accomplished through a variety of strategies
and via multiple sources; (2) Environmental factors that influenced
learning and development included work place factors (culture of the
clinic, the practice community) and personal factors; (3) Professional
role and identity development occurred in relation to self, PT/patient
relationships, and relationships with other colleagues, although there
was individual variation in identity formation; (4) Recognition of the
vital importance of communication as an essential professional skill
continually grew and expanded over the year; (5) Perspectives varied
on the contribution of the professional education program to learning
and development during the first year of practice. CONCLUSIONS:
For these promising novice therapists, interaction with patients,
caregivers, peers and other professionals were important catalysts
for learning and development during their early years of practice.
Mentorship and the workplace environment/experiences were critical
in shaping the nature and direction of growth. IMPLICATIONS:
There is a need for continued longitudinal inquiry to fully understand
the forces that influence the early professional development of
physical therapists. This study begins to address this gap in our
understanding of development during the early years of practice
WCPT 2007, Research Reports
for graduates who demonstrate professional promise. Exploration
of the professional development of promising novice therapists
during early years to generation of a working grounded theory on
novice development. KEYWORDS: professional development, novice
therapist,. FUNDING ACKNOWLEDGEMENTS: None.
ETHICS COMMITTEE: Institutional Review Board approval at
Creighton University, Central Michigan University, Northeastern
University and University of Indianapolis
Research Report Platform Presentation
3245 Wednesday 6 June 12:05
VCEC Ballroom A
STEADINESS ON DESCENDING A STEP IN SUBJECTS WITH
CHRONIC ANKLE INSTABILITY
Kedroff L, Egan E, Morrissey M; Division of Applied Biomedical
Research, King’s College London, London, UK
PURPOSE: The aim of this study was to investigate whether subjects
with chronic ankle instability (CAI) have altered trunk and lower
limb steadiness during a daily activity, stair descent. RELEVANCE:
Ankle sprains are common and disabling with over 30% of patients
progressing to CAI (Konradsen et al, 2002). Rehabilitation programs
focusing on lower limb balance and steadiness have been shown to
reduce recurrence of ankle sprains (Verhagen et al, 2004). Advancing
our knowledge of the impairments in balance implicated in CAI
will help direct future rehabilitation. PARTICIPANTS: Eleven healthy
volunteers (7 females, mean age = 28±6 (standard deviation, SD)
years, height = 1.72±0.1 m) with no history of lower limb pathology
and 17 subjects with CAI (6 females, aged 27±7 years, height
1.76±0.1 m) were studied. The CAI subjects had at least 2 previous
lateral ankle sprains, with at least one sprain in the last 2 years
and a minimum of 3 weeks since the last sprain. Ethics approval
was obtained. METHODS: A system of markers was placed on
anatomical landmarks on the trunk and lower limb and data was
acquired using a 3 dimensional motion analysis system (CODA
MPX30). All subjects were asked to descend a single step (height
= 0.14 m) and the mean performance in the 8 trials was averaged.
CAI subjects stepped down with the unaffected (or least affected)
limb while uninjured subjects stepped down with the non-dominant
limb. Kinematic data during single leg stance was analysed from
the limb not used in the stepping manoeuvre. ANALYSIS: The
kinematic data was sampled at 200Hz and CODA software was
used to calculate steadiness, which was defined as the SD of
displacement of a trunk reference point as well as hip, knee and
ankle joint centres, during the stepping down task. Displacement
was measured in the anteroposterior (AP) and mediolateral (ML)
directions and greater standard deviations were considered indicative
of less steadiness. Statistical significance was assessed using
independent sample t tests at p < 0.05. RESULTS: CAI subjects
were found to be less steady compared to uninjured subjects in
the AP direction in the trunk (p = 0.03), hip (p = 0.01) and knee
(p = 0.01) but this was not significant in the ankle (p = 0.05). The
AP steadiness was less in the CAI group for the trunk (49%),
hip (53%), knee (20%) and ankle (100%). No difference was
found in steadiness in the ML direction between the 2 groups
(p-value range = 0.17-0.98). CONCLUSIONS: CAI subjects show
a consistent reduction in AP steadiness of the trunk and lower
limb on stair descent but no changes in ML steadiness. The
reduction in steadiness in CAI subjects was the greatest at the
ankle but this was not significant. IMPLICATIONS: Traditionally, CAI
rehabilitation programmes have focused on exercises for balance
in the ML direction. This study suggests that it may also be
beneficial to address trunk and lower limb steadiness in the
AP direction. Future studies should evaluate whether altered AP
steadiness has any deleterious effects. KEYWORDS: Steadiness,
balance. FUNDING ACKNOWLEDGEMENTS: None. CONTACT:
louise.kedroff@kcl.ac.uk
ETHICS COMMITTEE: King’s College London Research Ethics
Committee
Platform Presentations, Wednesday 6 June
Research Report Platform Presentation
2571 Wednesday 6 June 12:05
VCEC Meeting Rooms 1-3
MEASUREMENT OF LOCAL LUNG VENTILATION DURING
CHEST PHYSICAL THERAPY IN HEALTHY ADULTS BY MEANS
OF ELECTRICAL IMPEDANCE TOMOGRAPHY (PILOT STUDY)
Wettstein M1 , Riedel T2 ,Radlinger L1 ; 1 Research Physiotherapy,
University Hospital Bern, Switzerland; 2 Paediatric Intensive Care,
University Children’s Hospital Bern, Switzerland
PURPOSE: The aim of the study was to determine the distribution of
lung ventilation in different body positions and under the application
of Flutter® , PEP and CPAP in healthy adults. RELEVANCE: The
knowledge of the distribution of lung ventilation is important for the
respiratory chest physical therapy (CPT), because the efficiency
of mobilization of secretions is dependant on a good ventilation.
Electrical Impedance Tomography (EIT) provides a possibility to
determine the distribution of ventilation in different body positions
during therapy. PARTICIPANTS: 5 healthy physiotherapists (3 m,
2 f, 29.8 +/−5.8 years) familiar with CPT and the use of the
following respiratory aids: Flutter® , PEP and CPAP. METHODS: EIT
measurements were performed during spontaneous breathing and
with the use of three respiratory aids (Flutter® , PEP and CPAP)
in three different body positions (sitting upright, lying on the left
and lying on the right side). The sequence of respiratory aids
and body positions was randomized. CPAP and PEP pressures
were set to 15 mbar (similar to Flutter® -pressure). EIT sampling
rate was 13 Hz. 3 measurements were performed for every body
position and respiratory aid, with a total of 48 measurements of
45 seconds each. ANALYSIS: Descriptive statistics and differences
between respiratory aids (nonparametric: Friedman-Test) as well
as differences between sitting and lying position (nonparametric:
Wilcoxon with Bonferroni correction) were calculated using SPSS.
RESULTS: In sitting position, there was no significant difference
(p = 0.516) of the ventilation of the right and left lung independent of
the used respiratory aid. Following analyzes focus on the right lung:
In lateral position ventilation of the dependent lung increased for 30.1
±16.5% (p = 0.043) and decreased randomly 7.6 ±22.1% (p = 0.500)
for the independent lung during spontaneous respiration. During
CPAP therapy the ventilation of the dependent lung increased by
48.4 ±12.2% (p = 0.043) and decreased for the independent lung by
40.4 ±23.3% (p = 0.043). During Flutter® therapy the ventilation of the
dependent lung decreased by 6.7 ±15.2% (p = 0.225) and increased
for the independent lung by 14.4 ±11.4% (p = 0.080). During PEP
therapy the ventilation of the dependent lung decreased by 2.8
±18.0% (p = 0.500) and increased for the independent lung by 12.4
±14.4% (p = 0.225). CONCLUSIONS: The ventilation distribution
during spontaneous breathing corresponds to the literature. CPAP in-
creases the ventilation in the dependent lung in lateral position, which
has already been shown by other authors. Surprisingly this effect can
not be observed during PEP- and Flutter® -therapy. There is even
a trend to an increased ventilation of the independent lung. These
results must be confirmed in a larger study with calculated adequate
sample sizes. IMPLICATIONS: EIT is a simple non-invasive method
to measure local ventilation. Respiratory chest physical therapy may
be guided by EIT in future. CPAP with appropriate positioning can
be used to improve local ventilation (e.g. atelectasis). Up to now it
was assumed that Flutter® and PEP also increase ventilation of the
dependent lung. This assumption may be wrong, which will influence
in the choice of the positioning during these therapies. KEYWORDS:
Electrical impedance tomography (EIT), ventilation distribution,
Flutter® , PEP, CPAP. FUNDING ACKNOWLEDGEMENTS: none.
CONTACT: physio.medizin@insel.ch
ETHICS COMMITTEE: The study was approved by the Ethics
Committee of Canton Bern, Switzerland
S521
Research Report Platform Presentation
2921 Wednesday 6 June 12:05
VCEC Meeting Rooms 11-12
SHOULDER MUSCLE SIZE, COMPOSITION AND ACTIVITY
FOLLOWING TREATMENT FOR BREAST CANCER
Shamley D1 , Sriniganathan R1 , Watson M2 , Weatherall R3 ,
Sugden E4 ; 1 Oxford Brookes University, Oxford, UK; 2 Department
of Radiology, Nuffield Orthopaedic Centre, Oxford, UK; 3 Centre
for Statistics in Medicine, Oxford, UK; 4 Department of Radiotherapy,
Churchill Hospital, Oxford, UK
PURPOSE: Despite the use of less extensive surgery and where
possible the avoidance of radiotherapy to the axilla, there is still
morbidity affecting the shoulder. Muscle morbidity has been shown
for serratus anterior and lattissimus dorsi. Most soft tissue changes
have been seen from the onset of radiotherapy (dose dependent) to
as late as 3 years after the start of radiotherapy. Current evidence
of shoulder dysfunction is limited to goniometric measurements of
glenohumeral movement and generally excludes scapula movements
and muscle activity. Smooth scapulohumeral rhythm depends on the
timed interaction of the muscles across the shoulder complex. A more
detailed understanding of the effects of treatment for breast cancer
on the muscles of the shoulder is still needed. This study aimed to
provide some of this detail. RELEVANCE: Not every woman treated
for breast cancer has access to an evidenced based rehabilitation
programme. The results of this study will form the basis of a DVD-
based rehabilitation programme to be trialled in the UK and Africa.
PARTICIPANTS: 74 women treated for unilateral carcinoma of the
breast in the last 6 years volunteered for the study. 54 of these
women agreed to have an MRI scan. Exclusion factors were women
with either, a history of shoulder pain or dysfunction, neurological
conditions of the cervical spine or reconstruction surgery. METHODS:
All patients filled in a Shoulder Pain and Disability Index (SPADI).
Bilateral EMG activity of four shoulder muscles was recorded during
3 repeat movements of scaption (n=74). Muscle cross sectional
area and signal intensity of these muscles (n=54) was determined
from axial STIR images of MRI scans. Cross sectional area was
taken at spinal levels T2, T4 and T6. ANALYSIS: The relationship
of both EMG activity and MRI with other factors was explored
using multiple linear regression and stepwise methods. RESULTS:
All muscles were significantly less active on the affected side
(p < 0.001). The longer the time since surgery the greater this effect
for pec major, serratus and rhomboid (p < 0.001). Low activity in
trapezius and rhomboid were associated with a high SPADI score
(p < 0.001). All medical treatment protocols had an association with
the low performance of the muscles (p < 0.001) with no pattern
apparent. Pectoralis major and pectoralis minor on the affected
side are smaller (p < 0.05). A smaller pectoralis major is associated
with a higher SPADI score (p < 0.001) and a smaller pectoralis
minor is associated with a longer time since treatment (p < 0.001).
CONCLUSIONS: Muscle activity at the shoulder is affected by the
treatment for breast cancer and is not confined to a particular
surgical and radiotherapy protocol. These effects can in fact get
worse over time and together with the changes in muscle size of
the pec muscles are likely to lead to altered movement patterns and
pain reported by so many patients. IMPLICATIONS: Rehabilitation
programmes and the training of health care professionals responsible
for delivering these programmes must address these findings. A
DVD-based home programme is being developed and trialled in the
UK and Africa in order to ensure that as many women as possible
have access to evidence based physiotherapy care. KEYWORDS:
cancer; musculoskeletal; EBP. FUNDING ACKNOWLEDGEMENTS:
We would like to thank the Oxford Radcliffe Hospitals Charity fund
for their generous support. CONTACT: drshamley@brookes.ac.uk
ETHICS COMMITTEE: Applied and Qualitative Research Ethics
Committe. AQREC no. A02.064
S522
Research Report Platform Presentation
1236 Wednesday 6 June 12:05
VCEC Meeting Room 16
WORK-RELATED MUSCULOSKELETAL DISORDERS AMONG
PHYSICAL THERAPISTS IN ISRAEL. PREVALENCE,
PREDICTION AND PREVENTION
Rozenfeld V1 , Ribak J2 , Carmeli E3 ; 1 Maccabi health services; 2 Tel
Aviv University Environmental & Occupational Health department.,
Sackler Faculty of Medicne; 3 Tel Aviv University Physical Therapy
Department, Sackler Faculty of Medicne, Steyer School of Health
professions
PURPOSE: Musculoskeletal disorders are a significant problem
among healthcare workers around the world. Physiotherapists (PT’s),
who commonly treat patients with these disorders, are also at risk
of work-related musculoskeletal disorders (WRMSD’s) during their
professional life, despite their knowledge of body mechanism and
injury prevention. The purpose of this study was to investigate the
prevalence of WRMSD’s among Israeli PT’s and their responses to
injury. RELEVANCE: Investigation of the combined effect of all risk
and preventive factors will help to predict the potential incidence
of WRMSD’s in different body areas. PARTICIPANTS: A 5-page
Cromie modified, translated into Hebrew and validated questionnaire
was distributed to 182 PT’s who work in out-patients clinics
and rehabilitation centers, 127 PT’s answered. METHODS: The
Questions included the occupational history of the PT’s life and the
one-year prevalence of WRMSD’s in different body areas, job-related
risk factors, injury prevention strategies and responses to injury, as
well as various demographic data. ANALYSIS: A Chi-square test
was used to find out the relationship between occupational fields and
symptoms in each body area, Spearman correlations were used to
find the relationship between personal and professional risk factors
and symptoms in each body area, multiple regressions were used
for a predictive model for injuries in each body area. RESULTS:
Lifetime prevalence of WRMSD’s was 83%. 45% of PT’s have had
it in the first five years of their career. The highest prevalence of
WRMSD’s was in the following anatomical areas: lower back (80%),
neck (59%), upper back (54%), and wrist/thumb (46%). Working in
rehabilitation centers was related to an increased prevalence of lower
back pain (p < 0.001, OR=8.0). Working in out-patients clinics was
related to an increased prevalence of thumb (p < 0.001, OR=6.0) and
wrist pain (p < 0.01, OR=3.1). The multi-system model was significant
for all 10 body areas and predicts WRMSD’s with explained variance
between 10%-36%. CONCLUSIONS: Factors that turned out to be
the main predictors of WRMSD’s include inadequate training in injury
prevention, continuing to work when injured or hurt, not enough
rest breaks during the day and work scheduling. IMPLICATIONS:
Specific strategies to reduce work-related injury should be developed
and applied to the physiotherapy population in each occupational
specialization as part of preventing WRMSD’s according to predictive
factors in each body area. KEYWORDS: occupational disorders,
prevention, risk factors. FUNDING ACKNOWLEDGEMENTS: This
work was unfunded. CONTACT: rvitaly@smile.net.il
Research Report Platform Presentation
1894 Wednesday 6 June 12:05
VCEC Meeting Room 17
PERSONS WITH DEVELOPMENTAL MOTOR DISABILITIES:
PREDICTING SUCCESS DURING TRANSITION TO ADULTHOOD
Darrah J1 , Magill-Evans J2 , Galambos N3 , Nickerson C1 ;
1 Department of Physical Therapy, University of Alberta, Edmonton,
CANADA; 2 Department of Occupational Therapy, University
of Alberta, Edmonton, CANADA; 3 Department of Psychology,
University of Alberta, Edmonton, CANADA
PURPOSE: The main purpose is to identify factors that predict
employment status and psychosocial maturity in emerging adulthood
and to compare the outcomes for young adults with developmental
WCPT 2007, Research Reports
motor disabilities to those without disabilities. A secondary purpose
is to identify barriers to and facilitators of a successful transition to
young adulthood for persons with developmental motor disabilities.
RELEVANCE: Therapists often provide intensive intervention for
children with cerebral palsy or spina bifida. Historically, little
attention has been paid to the outcome of these children as
they enter adulthood. Knowing the personal and environmental
factors associated with a successful transition to emerging adulthood
(ages 20 to 30) can help direct successful intervention strategies
in childhood, geared to helping therapists know how families
can effectively prepare for the eventual transition to adulthood.
PARTICIPANTS: A volunteer sample of adults 20 to 30 years old
with motor disabilities (MD) (n=76) and without motor disabilities
(NMD) (n=72). Fifty-four adults with cerebral palsy (25 males) and
22 with spina bifida (10 males) participated in the group with MD.
The group with MD had a mean IQ of 86.9 (SD 16.4) and the group
with NMD had a mean IQ of 104.5 (SD 8.9) as measured with the
Kaufman’s Brief Intelligence Test. Mean age of participants was 25.0
years (SD 3.1) for the group with MD and 24.9 years (SD 3.3) for
the group with NMD. Participants were selected if they reported they
could read at the grade 7 level. METHODS: Participants completed
eight reliable and valid questionnaires. They were also interviewed
in their homes using a semi-structured interview. ANALYSIS:
Hierarchical regression analyses were done using SPSS. These
analyses explored predictors of success (defined as employment
status and psychosocial maturity), including personal (age, gender,
cognitive abilities, educational achievement, emotional health, coping
style, gross motor functioning) and environmental (parents’ fostering
of autonomy, family functioning, transportation availability) factors.
RESULTS: For persons with disabilities, being female, being more
physically involved and not having independent transportation were
factors that contributed to a less successful employment history
(36% of the variance explained). Age, depression, problem-focused
coping, and fathers’ fostering of autonomy were factors that explained
65% of the variance of participants’ scores on a measure of
self-reported psychosocial maturity. CONCLUSIONS: Both personal
and environmental factors are associated with employment success
and perceived maturity during emerging adulthood. IMPLICATIONS:
Therapists need to consider the emotional health of young adults and
encourage use of problem-oriented coping skills. Pediatric therapists
can use the results of this study as they discuss employment
challenges with the children and families with whom they work. It
is also important for therapists to be familiar with the employment
opportunities and supports for persons with motor disabilities in their
own communities. KEYWORDS: Transition to Adulthood, Cerebral
Palsy, Spina Bifida, Emerging Adulthood, Psychosocial Maturity,
Employment, Success. FUNDING ACKNOWLEDGEMENTS: The
study was funded by Alberta Heritage Foundation for Medical
Research (AHFMR) and Canadian Institutes of Health Research
(CIHR). Dr. Darrah was funded by a New Investigator Grant from
CIHR. CONTACT: johanna.darrah@ualberta.ca
ETHICS COMMITTEE: Health Research Ethics Board, Edmonton,
AB, Canada and Conjoint Health Research Ethics Board, Calgary,
AB, Canada
Research Report Platform Presentation
2176 Wednesday 6 June 12:30
PP Crystal Pavilion A
INQUIRING ABOUT A HISTORY OF CHILDHOOD ABUSE:
DISCLOSURE CAN ENHANCE CLIENT-CENTERED CARE
Schachter C1 , Teram E2 , Stalker C2 , Lasiuk G4 , Danilkewich A3 ,
Hovey A2 ; 1 School of Physical Therapy, University of Saskatchewan,
Saskatoon, SK Canada; 2 Faculty of Social Work, Wilfrid Laurier
University, Waterloo, ON Canada; 3 College of Medicine, University
of Saskatchewan, Saskatoon, SK Canada; 4 Faculty of Nursing,
University of Alberta, Edmonton, AB Canada
PURPOSE: Within a broader study of the experiences of adult
survivors of childhood sexual abuse with physical therapists and other
Platform Presentations, Wednesday 6 June
health professionals, we sought to examine whether asking about
a history of childhood abuse during history-taking could facilitate
client-centered care and if so, how survivors thought it might do
so. RELEVANCE: The high prevalence rates of childhood sexual
abuse (1 in 3-5 femailes and 1 in 7-10 males) in the general
population suggests that clinicians in all health disciplines work,
often unknowingly, with survivors. This is particularly relevant for
physical therapists because childhood sexual abuse is implicated
in the many chronic pain syndromes in adulthood. PARTICIPANTS:
46 female and 49 male survivors of childhood sexual abuse from
6 Canadian provinces. METHODS: Employing a grounded theory
research approach, we conducted semi-structured interviews about
participants’ experiences with physical therapists and other health
professionals (excluding mental health professionals) and their ideas
about practice that would be sensitive to their needs, including ways
of inquiring about abuse. ANALYSIS: Using the constant comparative
method (Glaser & Strauss, 1967), the data analysis began when the
data collection commenced and informed the ongoing interviewing
process. The audiotaped interviews were transcribed and analyzed
independently by the researchers using NVivo 1.3. The researchers
discussed their analyses to achieve a consensus about themes
seen in the interviews. The data interpretation was also shared
with participants to ensure that it reflected their perspectives.
RESULTS: Most survivors stressed that the experience of childhood
abuse affected their health, their reactions to clinicians, and their
ability to participate in and benefit from healthcare interventions.
They advocated that all clinicians should have basic knowledge
about the dynamics and long-term health effects of interpersonal
violence. Furthermore, a clinician’s knowledge and skill in inquiring
about abuse and sensitively responding to disclosure was crucial
to survivors’ sense of safety, their willingness to share their past
experiences and discuss implications for treatment with the clinician.
Even for survivors who chose not to disclose, inquiry about past
abuse was seen as an indicator of a clinician who understands
that violence can affect the body and the therapeutic relationship.
Participants emphasized that physical therapists must take into
account the implications of a positive history of interpersonal
violence for treatment and identified numerous ways of refining
client-centered care based on this information. CONCLUSIONS: A
history of childhood abuse violence affects client health and health
care. Physical therapists’ inquiry about experiences of childhood
abuse is an important part of understanding the health history
and health care needs of all clients. IMPLICATIONS: These
findings suggest that physical therapy students and clinicians in all
areas of practice should learn about childhood abuse and other
interpersonal violence, and ask adult clients specific questions
about experiences of abuse and other forms of violence. In
order to provide the most appropriate and client-centered care,
clinicians must also explore the implications of a positive history of
interpersonal violence to the client’s needs during examination and
treatment. KEYWORDS: interpersonal violence, client-centered care,
disclosure. FUNDING ACKNOWLEDGEMENTS: This research has
been funded by: Physiotherapy Foundation of Canada, University of
Saskatchewan, Wilfrid Laurier University, Health Canada. CONTACT:
candice.schachter@usask.ca
ETHICS COMMITTEE: Ethics approval for this project was received
from the University of Saskatchewan Behavioral Research Ethics
Board.
S523
Research Report Platform Presentation
591 Wednesday 6 June 12:30
VCEC Meeting Rooms 19-20
PREDIAGNOSTIC BODILY EXPERIENCES IN WOMEN WITH
FIBROMYALGIA, A CHALLENGE FOR PHYSIOTHERAPISTS?
Wanvik A1−4 ; 1 Sør-Trøndelag University College, Faculty of Health
Education and Social Work Trondheim; 2 Norwegian University
of Technology and Science, Institute of Social Work and Health
Science Trondheim; 3 The Norwegian Fibromyalgia Association;
4 The Norwegian Physiotherapist Assosiation
PURPOSE: To investigate prediagnostic bodily experiences of
women with a recent fibromyalgia(FM) diagnosis.To learn as much
as possible about how they understood and coped with theese
experiences in the years before they got FM. RELEVANCE:
Fibromyalgia is a condition that developes over years,with local
and widespread pain which is chronifying.Physiotherapists meet
theese patients while they are developing fibromyalgia, and they
dont seem to be sufficiently aware of this health population as
a risk group for developing fibromyalgia. PARTICIPANTS: Five
women; aged from 27 to 57 years with a recent fibromyalgia
diagnosis, participated.3 came from the Norwegian Fibromyalgia
Assosiation and 2 from a cooperating medical doctor. METHODS:
A qualitative apprach was taken, using a life world intervju, and
a retrospective design. The study is based on the understanding
of the body as a unity of body and self, according to the body
phenomenology theory of Maurice Merleau-Ponty.The interviews
last from 45 to 65 minutes and they are transcribed. ANALYSIS:
The interviews were analysed according to Giorgis phenomenolgical
scientific method, which has 4 steps. Reading through the transcripts
several times,to familiarize, identifying units of meaning and sorting
them into codes, grouping the codes into categories and last,
identifying new patterns and meanings from the text. RESULTS:
The women suffered for many years before they got FM, they
sought many kinds of help for their plains without getting it, in
the prediagnostic years. They all lived through very stressful life
events in the years before the diagnosis,which put a lot of mental
and physcial pressure on them. They ignored tiredness and pain
in their bodies for long periods of time, and put the needs of
other persons before their own needs. They did not seem to
identify with their own body, illustrated by expressions like; “its
ok for me, but not for my body”. In very stressful periods their
bodies felt strange and unreal, like they were performing in a
play, and some felt themselves going outside their own bodies.
They did not understand what was going on with their bodies.
They felt unable to alter the situation and that they had pull
themselves together and to stay in the situation until it was no
longer possible. CONCLUSIONS: What they felt in their bodies
were not information they were in a position to make use of,it
did not make sense to them. They received little help from
health workers to alter their illness behavior. There seemed to
be a dichotomy between their conception of themself and of
their conception of their body. IMPLICATIONS: Physiotherapists
should be able to identify this health population as a risk group
for developing fibromyalgia and to help theese women to gain
a stronger identification with their own bodies, and to healp
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-
S524
ation and by the Norwegian Fibromyalgia Assosiation. CONTACT:
anne.k.wanvik@hist.no
ETHICS COMMITTEE: The medical committe for medical research
ethics, Mid-norway
Research Report Platform Presentation
2213 Wednesday 6 June 12:50
PP Crystal Pavilion A
BEFORE YOU TOUCH: DEVELOPING A RESEARCH-BASED
HANDBOOK FOR CLINICIANS WORKING WITH MEN AND
WOMEN WHO HAVE EXPERIENCED CHILDHOOD ABUSE
Schachter C1 , Stalker C2 , Teram E2 , Lasiuk G3 , Danilkewich A4 ,
Hovey A2 ; 1 School of Physical Therapy, University of Saskatchewan,
Saskatoon, SK Canada; 2 Faculty of Social Work, Wilfrid Laurier
University, Waterloo, ON Canada; 3 Faculty of Nursing, University
of Alberta, Edmonton, AB Canada; 4 College of Medicine, University
of Saskatchewan, Saskatoon, SK Canada
PURPOSE: To create a research-based handbook to assist phys-
ical therapists, other health professionals and students to work
sensitively with men and women survivors of childhood sexual
abuse. RELEVANCE: The high prevalence of childhood sexual abuse
in the general population (1 in 3-5 females, 1 in 7-10 males)
suggests that clinicians often unknowingly encounter survivors in
their everyday practice. We sought to capture the experiential
knowledge of survivors and clinicians to create a Handbook that is
highly relevant to both groups. PARTICIPANTS: 46 female and 49
male survivors of childhood sexual abuse and 200 physical therapists
and other health professionals from across Canada. METHODS:
To ensure the credibility and relevance of the research findings
and to avoid the replication of traditional client-clinician power
dynamics in both the research process and product, we combined
grounded theory and action research methods. Survivors were
interviewed about their experiences with physical therapists and other
health care professionals (excluding mental health professionals)
and asked for their ideas about practice that would be sensitive to
their needs. Using summarized analyses of the interviews, working
groups composed of several men or women survivors and several
professionals (physical therapists, physicians or nurses) met on
several occasions to develop guidelines for practicing in ways that
are sensitive to survivors and realistic for clinicians. Cumulative
information was shaped into the first draft of the Handbook, which
was sent to interview and working group participants for review
and feedback. The second draft of the Handbook was emailed to
clinicians and counselors across Canada; feedback was incorporated
into the next draft. Feedback on the third draft was gathered
via focus groups of physical therapists, nurses, physicians and
dentists in Ontario and Saskatchewan and incorporated into the final
version of the Handbook. ANALYSIS: At each phase of the project,
researchers discussed and agreed upon the interpretation of data
among themselves and then with participants, to ensure that the
analysis was consistent with participants’ perspectives. RESULTS:
The term ‘Sensitive Practice’ was coined to describe practices that
would be sensitive to the needs of survivors. The hallmark of sensitive
practice is the facilitation of the survivor’s feeling of safety during
encounters with clinicians. The guiding principles that contribute to
safety include: respect, taking time, sharing control and information,
establishing rapport, attending to boundaries, and understanding the
dynamics and long term effects of abuse. CONCLUSIONS: The
Handbook on Sensitive Practice offers extensive practical, research-
based suggestions for refining client-centered care of survivors of
childhood abuse. IMPLICATIONS: Since clinicians do not always
know when they are working with survivors, Sensitive Practice
needs to be regarded as universal procedures. The failure to
practice sensitively increases the risk of retraumatizing survivors
and negatively affect their health. Research to identify effective
pedagogical methods for knowledge transfer of Sensitive Practice
to students and clinicians is required to ensure that it becomes
WCPT 2007, Research Reports
used more widely. KEYWORDS: therapeutic relationship, childhood
abuse; client-centered care. FUNDING ACKNOWLEDGEMENTS:
This research has been funded by: Physiotherapy Foundation of
Canada, University of Saskatchewan, Wilfrid Laurier University, and
Health Canada. CONTACT: candice.schachter@usask.ca
ETHICS COMMITTEE: Ethics approval for this research was
received from the University of Saskatchewan Behavioral Research
Ethics Board.
Research Report Platform Presentation
1905 Wednesday 6 June 12:50
VCEC Meeting Room 18
AN ANALYSIS OF PHYSICAL THERAPY PRACTICE RELATED
TO OBESITY MANAGEMENT
Williamson E, Hunt D; Florida Gulf Coast University
PURPOSE: Obesity has become a worldwide epidemic. Until
recently, the emphasis on evaluating overfatness and its clinical
implications has been focused in developed countries. However,
lifestyle and technological changes in developing countries has
made obesity a worldwide concern. Physical therapists traditionally
have had little role in addressing issues related to obesity. In the
United States, the APTA’s Vision Statement 2020 addresses the
issue of providing prevention services. Little evidence has been
presented on how well physical therapists believe they are prepared
for this area of practice nor how frequently they are practicing these
skills. RELEVANCE: This study assists educators and clinicians in
evaluating the preparedness of the profession to address the world
health issue of obesity management. PARTICIPANTS: Members
of the Florida Physical Therapy Association who had active e-
mail accounts were invited to participate. METHODS: A web-based
survey instrument was developed to measure physical therapists’
current use and confidence in patient interview, examination and
intervention skills specific to obesity management. IRB approval was
granted by the sponsoring institution and e-mails were sent to 2109
physical therapists in the State of Florida, of which approximately
1600 appeared to be valid e-mail addresses. Those who elected to
participate returned the survey by electronic anonymous submission.
ANALYSIS: Descriptive statistics were generated for demographic
data as well as participants’ responses to each of the Likert-scale skill
items (1 low, 5 high). A multiple regression analysis was conducted
to determine which of the demographic items were predictive of
the confidence or skill use item groups. RESULTS: Sixty-percent
of the respondents received their education in the southest United
States with the remainder representing all other regions of the
country. Six percent were educated outside the United States. Mean
years of experience was 16.45, with an average of 0.94 post-
professional continuing education sessions on obesity management
issues. Confidence for interview and intervention skills was relatively
high (m = 4.13, and m = 3.93 respectively). Skill usage for each of
the subset areas was consistently lower than confidence level, with
usage of examination skills being the lowest (m = 1.33). Regression
coefficients demonstrated that prior nutrition coursework as well
as being more highly educated were the strongest predictors for
confidence in the included skills (by subset). Negative coefficients
for the degree earned at entry-level were observed to be significant
for items related to use of skills. Years in practice was only
a predictor for confidence in interview skills (b = 0.263, t=2.76,
p = 0.006) CONCLUSIONS: Participating PTs demonstrate poor to
moderate confidence in interview, examination, and intervention skills
related to obesity management. Low levels of usage is observed in
these skills, with examination skills being used at a very minimum
level. IMPLICATIONS: Analysis of practice is necessary to better
understand how well the profession is meeting the needs of the
obese client and what changes are necessary in the entry-level
and post-professional education. Broading the sample will provide
for a more representative group from which to draw conclusions.
Analysis of university curricula, paired with a better understanding of
Platform Presentations, Wednesday 6 June
current practice patterns, will allow for a clear view of the development
needed in the profession. KEYWORDS: Obesity, practice patterns,.
FUNDING ACKNOWLEDGEMENTS: None.
ETHICS COMMITTEE: IRB Committee at Florida Gulf coast
University
Research Report Platform Presentation
869 Wednesday 6 June 12:50
VCEC Meeting Rooms 19-20
THE PERCEPTIONS AND EXPERIENCES OF PATIENTS
RECENTLY DIAGNOSED WITH FIBROMYALGIA SYNDROME
Diver C1,2 , Avis M1 , Freeman K1 ; 1 The University of Nottingham,
Nottingham, UK; 2 Nottingham University Hospitals NHS Trust,
Nottingham, UK
PURPOSE: To describe the perceptions and experiences of patients
on being recently being diagnosed with fibromyalgia syndrome.
RELEVANCE: Fibromyalgia syndrome (FMS) is a musculoskeletal
condition of unknown aetiology characterised by chronic widespread
pain and poor sleep. It predominantly affects middle-aged women.
There is no diagnostic test and diagnosis is criteria based and
often contested. Previous studies have reported patient perceptions
of being diagnosed with fibromyalgia but this is in patients who
have been in receipt of their diagnosis for some time (1-30
years). This study investigates this phenomenon within 2 months
of diagnosis. PARTICIPANTS: 23 patients (22 female, 1 male) with
a first diagnosis of FMS by a Consultant Rheumatologist were
recruited from a Secondary Care Hospital. The patients are part
of a larger longitudinal and on-going 2 year study. METHODS:
Qualitative in-depth semi-structured interviews were used to identify
the perceptions and experiences of patients recently diagnosed with
FMS. An interview guide was formulated from previous research
on FMS and chronic illness. Patients were given of choice of
where the interview was conducted: their home, the hospital, the
university or any other venue they suggested. The Fibromyalgia
Impact Questionnaire (FIQ) was performed at baseline to describe
the sample recruited. Interviews were tape recorded and hand written
notes made. ANALYSIS: The interviews were transcribed verbatim.
They were analysed using qualitative content analysis. The data
was coded using NVivo and then recurrent themes and meanings
were identified. RESULTS: ‘Being diagnosed’ was an important event
in the patient’s life. Four descriptive categories were grounded in
the data, labelled struggle for a diagnosis, meanings attached to
the diagnosis, access to help and the future. For many patients
the receipt of a diagnosis was a significant event in a journey that
had usually begun some years previously with a visit to their GP.
Whilst the diagnostic label legitimised the way they felt, it was also
interpreted as ‘uncertain’ and ‘incurable’ and frequently linked with
previous life events. Provision of a diagnosis provided them access
to help and information that was previously unavailable and for some
to consider the future and begin the process of acceptance and
adaptation. CONCLUSIONS: This study highlights the importance
of receiving a diagnosis to patients with an ‘invisible illness’ like
FMS and the importance of validating both subjective and objective
findings. There are disadvantages of diagnosis associated with
stigma and an uncertain illness trajectory. However, these are out-
weighed by the advantages of being able to construct a new identity,
acknowledgement and acceptance of the illness and the ability to
consider adaptive coping strategies. IMPLICATIONS: Currently there
is a predominance of the “biological” in the biopsychosocial model,
in the assessment and management of patients with FMS.Health
care professionals should be made aware of the importance of
an early diagnosis on the perceptions and experiences of patients
with FMS.In assessing and manageing patients with FMS they
need to consider: the importance of being believed; the role of a
medical diagnosis; the significance of the language used and the
impact of diagnosis on identity and stigma. KEYWORDS: Qualitative
research; Semi-structured interviews; Fibromyalgia syndrome (FMS);
S525
Diagnosis. FUNDING ACKNOWLEDGEMENTS: None. CONTACT:
claire.diver@nottingham.ac.uk
ETHICS COMMITTEE: Nottingham Research Ethics 2, 1 Standard
Court, Park Row, Nottingham NG1 6GN, England, UK
Research Report Platform Presentation
2881 Wednesday 6 June 13:10
PP Crystal Pavilion A
AN INVESTIGATION INTO THE EFFICIENCY OF PATIENT
RECALL ABILITY IMMEDIATELY AFTER PHYSIOTHERAPY
TREATMENT IN AN OUTPATIENT SETTING
Cooney M, Norman L, O’Mahony C; Physiotherapy, School of
Medicine, Trinity College, Dublin
PURPOSE: This study aimed to establish the amount and type
of information currently being delivered to patients in a physio-
therapy outpatient setting. The proportion of the information that
could be recalled immediately afterwards was then investigated.
RELEVANCE: Imparting information to patients forms an essential
part of physiotherapeutic management, as most conditions that
physiotherapists treat require patients to actively participate in
preventing pain and mechanical dysfunction. (Sluijs et al 1993a,
Henry et al 1999, Trede 2000). The effectiveness of this aspect of
intervention is therefore dependent on whether patients remember
the advice they receive. Patients’ ability to recall advice has not
been investigated PARTICIPANTS: Patients who presented to the
out-patients department of a large Dublin hospital with a back
or neck complaint were approached, the study was explained
verbally and in leaflet format. Patients were asked to give informed
consent as to whether they wished to participate. Inclusion criteria
required patients to be over 18 years, English speaking with no
known cognitive/memory defects. Patients attending their first or
second treatment session were recruited, as Sluijs et al (1991)
found that there was a significant increase in the amount of
information physiotherapists gave during these sessions in relation
to the rest of the treatment period. METHODS: The study involved
recording the information given by the physiotherapist treating the
patient. Information was recorded under three headings advice,
exercises and information about the condition. Following treatment
the patient was interviewed. The patient interview firstly obtained the
patient characteristics; age, sex, marital status, occupation, level of
education, previous visits to physiotherapy, chronicity of the condition
and medication intake. A structured interview followed, where the
subjects were asked to recall the information the physiotherapist had
given them, using a standardised set of questions. The questions
were open-ended but referred to a certain topic therefore the
information gained on answering them was calssified as cued recall.
If the information was not recalled, a prompt was given from
a standardised list. The information recalled by this means was
considered cued recall with prompting. ANALYSIS: The number and
type of statements made by the physiotherapist were counted and
categorised. The percentage of statements recalled by patients was
calculated and categorised as either cued recall or prompted recall.
RESULTS: An average of seven statements were made by each
physiotherapist, mostly regarding treatment and exercises. The mean
patient recall was 86%. Advice, treatment and exercises were equally
well recalled, and information on condition the least. Optimal recall
occurred when 6-7 statements were delivered. CONCLUSIONS: At
least 14% of information was lost within the first few minutes post
treatment. While this is a small percentage it raises the question as
to how much is lost over a longer time frame and what effect this has
on the effectiveness of intervention. It is necessary to repeat advice
given. IMPLICATIONS: Physiotherapists need to limit the amount of
information they give to patients, prioritise its content and consider
ways that they can enhance recall. KEYWORDS: patient education,
cued recall, prompted recall. FUNDING ACKNOWLEDGEMENTS:
unfunded. CONTACT: mcooney@tcd.ie
ETHICS COMMITTEE: Dublin Federated Hospitals Joint Ethics
Committee
S526
Research Report Platform Presentation
2755 Wednesday 6 June 13:10
VCEC Meeting Room 18
OBESITY AS A LIFE EXPERIENCE
Rugseth G1 , Engelsrud G2 ; 1 Section for Health Science, University
of Oslo, Norway; 2 Section for Health Science, University of Oslo,
Norway
PURPOSE: The project explores what obese people experience
prior to and during their participation in treatment that is aimed at
changing lifestyle. Through a phenomenological perspective, obesity
is in this project extended from being understood as a risk factor
or a disease to being seen as a personal experience and as a
phenomenon influenced by cultural discourse. RELEVANCE: There
is a growing incidence and prevalence of overweight and obesity
globally. Overweight and obesity are said to be risk factors for the
development of diseases such as type 2 diabetes, hypertension,
cardiovascular disease and cancer. Treatment programmes have
been developed worldwide to support people in their efforts to change
their lifestyle and lose weight. The main issues in these programmes
are reducing food intake and engaging people in a higher level
of physical activity. It is evident that most people who lose weight
during different treatment programmes regain it. This fact challenges
the content of the treatment programmes. Physiotherapists play
a central role in these treatment approaches. PARTICIPANTS:
12 obese persons attending a treatment programme. METHODS:
The informants participated in a treatment programme inspired
by cognitive behavior therapy. The programme had been running
for several years and was organised as group meetings in a
hospital setting. Twelve obese persons were interviewed prior to
their participation in the treatment. Furthermore, eight of these
informants were observed through 17 group meetings in one year.
ANALYSIS: Data has been analysed through a phenomenological
perspective RESULTS: An analysis of the interviews shows that
the experience of losing weight and regaining it is widespread
among the participants. Data from observations in the treatment
group show that this is a common experience and that it is not
communicated during the treatment – neither by the participants
nor the group leader. Further analyses illuminate that weight loss
is an experience associated with ambiguity. To lose weight is for the
subject both strongly desired and connected to a sense of insecurity
and discomfort. They experienced that ambiguity is paid no attention
during the group meetings. Food, meals and exercise are discussed
and described during interviews in multiple and ambiguous ways.
In the treatment group these issues are mostly communicated as
nutrition, which affects weight and demands exercise. The weight
loss experience alters people’s relationships with others. This is
commonly understood as positive: people who lose weight are
described as clever, good-looking and determined. The interviewees
also describe the negative and unwanted implications connected to
this altering of relationships. CONCLUSIONS: Obesity is commonly
treated as an objective phenomenon, as if it existed in itself and
solely as a problem. From the obese person’s perspective, being
obese is a complex experience, understood as both safe, desirable
and unwanted, as a solution as much as a problem, and as a choice
as much as a disease. IMPLICATIONS: Several key issues derived
from the data are given little or no attention from the professionals
running the weight loss treatment. These results has implications
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: gro.rugseth@medisin.uio.no
ETHICS COMMITTEE: National Committees for Research Ethics in
Norway
WCPT 2007, Research Reports
Research Report Platform Presentation
1882 Wednesday 6 June 13:10
VCEC Meeting Rooms 19-20
CLASSIFICATION OF PERSONS WITH FIBROMYALGIA:
RELIABLE AND VALID SUBGROUPS BASED ON THE
MULTIDIMENSIONAL PAIN INVENTORY (MPI-D)
Verra M1,2 , Angst F2 , Brioschi R3 , Lehmann S2 , Aeschlimann A2,4 ;
1 Physiotherapy Department, RehaClinic, Zurzach, Switzerland;
2 Research Department, RehaClinic, Zurzach, Switzerland; 3 Clinical
Psychology, RehaClinic, Zurzach, Switzerland; 4 Rheumatology
Department, RehaClinic, Zurzach, Switzerland
PURPOSE: The aims of this study were to investigate if it was
possible to replicate and describe the three cluster solution and
profiles found in other pain groups and describe cluster profiles
based on self-reported Multidimensional Pain Inventory-scores for
patients with fibromyalgia, describe characteristics of the cluster in
relation to physical function, fear and depression, and coping at the
same point in time and to validate the cluster solution by comparing
clusters in physical function, fear and depression, and coping over
time. RELEVANCE: Physical Therapists realise that the group of
persons with fibromyalgia is extremely heterogeneous with regard
to its etiology and responsiveness to interventions. The process of
subclassification of fibromyalgia is a clinical reality but undertaken on
a individual clinical level. Classification of persons with fibromyalgia
into homogenous subgroups is an important objective in order to
tailor interventions and to control for subgroup differences when
evaluating treatment outcome. PARTICIPANTS: Eighty-five persons
with fibromyalgia took part in the study. All persons were participants
in the in-house Zurzach pain management programmes with a
cognitive-behavioural approach, including physical exercise, and had
no other diagnosis which could interfere with these rehabilitation
activities. METHODS: The measures used were the Multidimensional
Pain Inventory-German version (MPI-D), the Medical Outcomes
Study Short Form 36-German version (SF-36), the Hospital Anxiety
and Depression Scale-German version (HADS-D), and the Coping
Strategies Questionnaire-German version (CSQ-D). ANALYSIS:
Cluster analysis was conducted for the total sample MPI-D subscale
scores. RESULTS: The adaptive copers cluster represented 23% of
the sample, dysfunctional 47% of the sample, and interpersonally
distressed 30% of the sample. The external validation of the cluster
solution showed that there were several significant differences
between clusters in physical function, fear and depression, and
coping measures. There was also a significant interaction effect
(cluster x time) in physical function (SF-36). Persons in the
dysfunctional cluster reported decreased physical function over time.
CONCLUSIONS: These results support the presence of different
subgroups among persons with fibromyalgia. Future research will be
needed to validate these outcomes on persons in different settings.
IMPLICATIONS: This classification on psychosocial factors can be
seen as a complement to a classification based on medical condition.
We hypothesize, that subsequent randomized trials will demonstrate
that effect sizes increase when classification and matching are
taken into account. KEYWORDS: fibromyalgia, subgroups, MPI-D.
FUNDING ACKNOWLEDGEMENTS: This work was funded by the
SPA Rehabilitation Foundation. CONTACT: m.verra@rehaclinic.ch
ETHICS COMMITTEE: The study was approved by the local re-
search ethics committee (Health Department in Aarau, Switzerland).
Platform Presentations, Wednesday 6 June
Research Report Platform Presentation
1070 Wednesday 6 June 13:45
PP Crystal Pavilion A
APROACH TO STUDY AND LEARNING STYLE ACROSS
AN UNDERGRADUATE PHYSIOTHERAPY PROGRAM:
IMPLICATIONS FOR MOVING STUDENT LEARNING FORWARDS
Isles R1,2 , Cantwell R2 ; 1 The University of Queensland, Brisbane,
Australia; 2 The University of Newcastle, Newcastle, Australia
PURPOSE: The aim was to measure physiotherapy students’ learn-
ing styles and approaches to study across an undergraduate program
to provide a profile of these Australian physiotherapy students
and determine whether it remained stable across the program.
Relationships between learning style, approach to study and learning
outcomes as measured by GPA were also sought. RELEVANCE:
Entry-level physiotherapists are required by the profession to possess
certain knowledge, skills and professional attributes but are also
expected to be independent thinkers and problem solvers. Student
learning is influenced by many factors. Personal factors include self-
efficacy, motivation, preferred cognitive learning style and approach
to learning. External factors include the imposed expectations of the
university through curriculum, teaching and assessment practices
and of the profession via professional standards. PARTICIPANTS: A
cohort of undergraduate physiotherapy students from the University
of Queensland were invited into the study in first year and
subsequently in 3rd and 4th years. Forty-seven students completed
all data. METHODS: A longitudinal study included data collection
using Biggs’ Study Process Questionnaire and Kolb’s Learning
Style Inventory. Students provided information on gender, age, first
language and entry score. Course results were also obtained.
ANALYSIS: Learning preferences and demographic information
were investigated for relationships with students GPA at each year
level and overall. Statistical analysis included descriptive statistics,
ANOVA and multiple regression analysis. RESULTS: Students in first
year were predominantly surface learners although this decreased
across the program. Deep and achieving learning increased between
third and fourth years. Dominant learning preference was Abstract
Conceptualisation with a shift from Assimilator to Converger (more
active than reflective) across the program. Success in the clinical
(fourth) year was predicted by Achieving Approach, female gender
and speaking English as the first language. An Achieving Approach,
female gender and younger age predicted cumulative GPA. Deep
learning did not predict higher GPA at any level. CONCLUSIONS:
The nature of the curriculum influenced students learning strategies.
Predominantly science based first year courses were accompanied
by Surface approaches to learning while later, increasing professional
focus on theory and practice and clinical practice immersion saw
a preference for Active Experimentation and the success of an
instrumental Achieving approach to study. This bias towards the
Achieving approach in the clinical year may reflect both the
need to develop clinical and broader management skills and the
underlying competitiveness associated with future employment.
Future qualitative analysis of motivating factors and learning methods
in a broader cohort would provide greater insight to the drivers
of learning. IMPLICATIONS: Physiotherapy teachers and clinical
educators need to develop innovative methods to optimise (deep)
clinical reasoning skills but also to foster the development of
reflective (metacognitive) and professional skills throughout the
program. This must be done in innovative ways academic and
clinical settings. Students should have the opportunity for early
clinical experiences and time for reflection in order to optimise
their knowledge and skill integration. KEYWORDS: Student learning;
styles. FUNDING ACKNOWLEDGEMENTS: Data collection was
supported by research higher degree student allowance through
the University of Queensland. There was no funding from grants.
CONTACT: r.isles@shrs.uq.edu.au
ETHICS COMMITTEE: Ethics Committee of the School of Education
and Faculty of Social and Behavioural Sciences, the University of
Queensland.
S527
Research Report Platform Presentation
1564 Wednesday 6 June 13:45
VCEC Ballroom A
PATELLAR TENDON VERSUS HAMSTRING TENDON
ANTERIOR CRUCIATE LIGAMENT (ACL) RECONSTRUCTION:A
COMPARISON OF SHORT AND LONG TERM OUTCOMES
Keays S1 , Bullock-Saxton J2 , Keays A, Newcombe P, Bullock M;
1 Nambour Selangor Hospital; 2 University of Queensland, Brisbane,
Australia
PURPOSE: This study aimed to compare the short and long term
outcomes of anterior cruciate ligament (ACL) reconstruction using
two different graft sources. RELEVANCE: The choice of graft material
used for ACL reconstruction remains controversial. Despite the need
for well controlled, long-term outcome studies comparing PT with
STG grafting, few studies have followed results for over five years
and no study has included an uninjured control group. This long-
term, prospective study provides evidence based research in relation
to the management of a very common sporting injury frequently
treated by physiotherapists. PARTICIPANTS: Sixty two ACL ruptured
patients awaiting surgery were recruited from an orthopaedic clinic.
Thirty one patients underwent reconstruction using the PT as a
graft (PT Group)and 31 underwent reconstruction using the STG
tendons(STG Group). All patients followed a controlled quadriceps
emphasized physiotherapy program pre-operation and for six months
after surgery. A total of 30 uninjured subjects matched for age, gender
and sporting involvement formed the control group. METHODS:
Patients were assessed pre-surgery, at three weeks post-surgery
(morbidity assessment only), at six months and six years post-
surgery. Uninjured control subjects were assessed over the same
time frame. Assessment at three time frames included: stability
testing (clinical stability and KT 1000 testing); isokinetic quadriceps
and hamstring strength testing at 60 and 120 degrees per second;
functional performance testing comprising three agility (shuttle run,
side step and carioca)and two hop tests, and finally radiology.
ANALYSIS: Mixed model ANOVAs were performed in order to assess
any differences between the groups at each of the time frames as
well as any differences over time periods. RESULTS: At three weeks
post surgery there was a higher morbidity incidence in the PT Group.
At six months post-surgery there was significant loss of quadriceps
strength in the PT Group at both speeds (p < 0.001) and of hamstring
strength at the faster speed in the STG Group (p < 0.05). Fifty-six
patients were assessed at six years post- operation: Two patients
had injured their grafts and five had ruptured the contralateral ACL.
Six subjects had undergone meniscal surgery. Clinical stability was
restored to all, other than the two reinjured, patients. KT1000 side-
to-side differences were the same for the PT (1.9mm) and STG
Groups (2.02mm) but were significantly greater than that of uninjured
control subjects (p < 0.001). In the more demanding functional tests
(hop and triple hop index and carioca), the STG group performed
similarly to the control group, whereas there was a significant
difference (p < 0.05) between the PT and the control groups. The most
important finding was a significantly higher incidence of tibiofemoral
osteoarthritis (OA) in the PT Group(p < 0.001). CONCLUSIONS: Both
types of surgery restored stability to the knee joint but neither graft
restored stability equal to that of uninjured control knees. Hamstring
grafting resulted in less morbidity in the early postoperative stage,
greater quadriceps strength at six months post-surgery and improved
function with a lower incidence of OA six years after surgery.
IMPLICATIONS: Hamstring tendon grafting is possibly the preferred
option for anterior cruciate ligament reconstruction. KEYWORDS:
knee reconstruction outcome. FUNDING ACKNOWLEDGEMENTS:
Nil. CONTACT: skeays@bigpond.com
ETHICS COMMITTEE: University of Queensland, Australia
S528
Research Report Platform Presentation
823 Wednesday 6 June 13:45
VCEC Ballroom B & C
USING AN OUTCOMES-BASED PAY-FOR-PERFORMANCE
PROCESS IN OUTPATIENT THERAPY TO ENCOURAGE
EVIDENCE-BASED TREATMENT: A REAL DATA SIMULATION
Hart D1 , Connolly J2 , Scott K3 , Werneke M4 ; 1 Focus On
Therapeutic Outcomes, Inc.; 2 Connolly Strategies & Initiatives;
3 Presbyterian Health Plan; 4 CentraState Medical Center
PURPOSE: Our purpose was to test through a real data simulation
whether use an outcomes-based risk-adjusted pay-for-performance
(P4P) method used to reimburse therapists treating patients receiving
outpatient therapy would reduce reimbursement or provide a financial
incentive to produce good patient outcomes while using the least
number of treatment visits. RELEVANCE: The P4P concept is
rapidly influencing payers and legislators in the US, and payers in
other countries are exploring P4P methods to reimburse clinicians.
However, most P4P plans are based on process, not outcome, and
most plans were developed for physicians. PARTICIPANTS: Data
from 189,088 patients (50 yr, SD 16, min 18, max 102, 39% male) in
Focus On Therapeutic Outcomes, Inc. data set from 552 outpatient
clinics in 40 US states treated by 3,447 therapists (2000-2003)
were analyzed retrospectively: 94% orthopedic, 4% medical, 2%
neurological conditions. Project had formal IRB approval. METHODS:
Patients entered functional status (FS) data at intake and discharge
(self-report surveys). Therapists entered administrative data at
discharge. Because this was a retrospective data analysis, the project
did not affect customary treatment. ANALYSIS: Using a previously
developed, valid P4P model, patients were partitioned into risk-
adjusted cells by diagnostic group, condition severity, symptom acuity
and age. Within each cell, patients were placed into one of 9
payment groups using above, predicted, and below predicted FS
change (discharge-intake) and visits, which allowed comparisons
of FS change (effectiveness) and visits (efficiency).We developed
P4P payment levels for each risk-adjusted group that collectively
were designed to encourage clinicians to produce good outcomes
efficiently. Payment estimated using the P4P method was compared
to payment using a fee-for-service (FFS) method. RESULTS: There
were 396 homogeneous risk-adjusted cells of patients used in the
P4P method. A 12% reduction in payment was estimated using
the simulation had providers been reimbursed using a P4P method
compared to a FFS method. Using the P4P method, payment
was shifted to patients who reported greater FS gains while using
fewer visits compared to patients who reported lower FS gains
while using more visits. CONCLUSIONS: Results suggest use of a
method of payment for therapy that is based on a risk-adjusted P4P
model using measures of effectiveness and efficiency could reduce
reimbursement, but more importantly, payment based on results
may realign resources to patients who benefit from efficient therapy
and away from patients who are not benefiting but are continuing
to receive treatment. Strengths of the P4P methods include risk-
adjusted outcomes from a large sample. Limitations include the need
for more diverse patients by diagnosis and more risk-adjustment
variables. IMPLICATIONS: Because 1) the P4P process is based on
patient self-reported outcomes and number of treatment visits and 2)
is independent of treatment, practice guideline or provider, the P4P
method of reimbursement may encourage providers to use evidence-
based practice to produce effective and efficient therapy. Findings
suggest a P4P process may allow payers to realign resources to
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: dsailhart@verizon.net
ETHICS COMMITTEE: Institutional Review Board of Focus On
Therapeutic Outcomes, Inc.
WCPT 2007, Research Reports
Research Report Platform Presentation
772 Wednesday 6 June 13:45
VCEC Meeting Room 16
DO THE REDUCTIONS IN ACTIVE KNEE EXTENSION RANGE
OF MOTION DURING SLUMP TESTING SHOW VARIATION
FORM DAY TO DAY?
Reid D, Tucker N, McNair P; Physical Rehabilitation Research
Centre, Auckland University of Technology, Auckland, New Zealand
PURPOSE: The aim of this study was to investigate the variation in
active knee extension range of motion (ROM) during slump testing
within and across days. RELEVANCE: The slump test is commonly
used clinically to assess the interaction of neural tissue in the
spine and lower limbs. There is a paucity of literature that has
investigated the reliability of the test from day to day. PARTICIPANTS:
A convenience sample of 10 male and 10 female asymptomatic
subjects aged between 20-49 years (mean age 30.1 yrs SD: 6.4)
were recruited to participate in the study. METHODS: A test retest
repeated measures methodology was undertaken. During the testing
procedure the subjects were positioned in a KinCom® Isokinetic
dynamometer chair for ease of access. For each test the starting
position was 90º flexion at the knee joint and the ankle in full
dorsiflexion. Knee extension ROM was tested in two slump positions,
first with cervical spine flexion and secondly with cervical spine
extension. In the first position, the subjects were asked to extend
their knee until they reached the point of their perceived maximal
discomfort due to the stretch. At this point the maximum knee
extension angle was recorded. The subjects were then instructed to
extend their cervical spine and extend their knee further if possible.
Knee extension ROM was then recorded in this position. Subjects
repeated this sequence three times on each day. The testing was
repeated with a separation of two days. ANALYSIS: To compare the
data within and across days, a 2-factor repeated measures ANOVA
(trials and days) model was utilised. Typical error was calculated
using the standard deviation of the difference in scores (Day 2-
Day 1 data). The interclass correlation coefficient (ICC) for trial
one and for the average of three trials across days were also
calculated. Data were plotted using Bland and Altman graphs. The
alpha level was set at 0.05. RESULTS: The findings showed that
there was no statistically significant difference across days (p > 0.05).
High ICC values, low typical error, bias values close to zero, and a
random scatter in the Bland and Altman plots indicated the variation
in angles measured across days was relatively low. There was a
significant difference of a small magnitude within days (across trials)
for both cervical spine positions (p < 0.05). The knee flexion angle
was greatest in the first trial compared with latter trials for both
flexed and extended conditions (p < 0.05). There was no interaction
effect (p > 0.05) across day and trial factors. CONCLUSIONS: The
study demonstrated that knee extension ROM could reliably be
measured from day to day, however, some viscoelastic and stretch
tolerance responses may be occurring across trials within testing
on a single day. IMPLICATIONS: These finding indicates that a
clinician should be consistent in using the slump test. If they do
one trial at day one, they should only do one trial at day two of
testing, similarly if they do three trials on day one, then they should
do three trials on subsequent days. KEYWORDS: Slump, Knee
extension, Reliability, Stretch. FUNDING ACKNOWLEDGEMENTS:
None. CONTACT: duncan.reid@aut.ac.nz
ETHICS COMMITTEE: This work was approved by Auckland
University of Technology (AUT) Ethics Committee (05/104)
Platform Presentations, Wednesday 6 June
Research Report Platform Presentation
659 Wednesday 6 June 13:45
VCEC Meeting Room 17
EFFECT OF SIMULATOR TRAINING ON DRIVING AFTER
STROKE: A RANDOMIZED CONTROLLED TRIAL
Akinwuntan A1 , De Weerdt W2 , Feys H2 , Pauwels J2 , Baten G3 ,
Arno P3 , Kiekens C4 ; 1 Medical College of Georgia, Augusta GA,
USA; 2 Katholieke Universiteit Leuven, Belgium; 3 CARA, Belgian
Road Safety Institute, Brussels, Belgium; 4 University Hospital
Pellenberg, Belgium
PURPOSE: The neurological deficits experienced after stroke affect
the ability to perform most activities of daily living including driving, an
activity that many stroke survivors (>50%) wish to continue. Different
methods have been employed to train persons with stroke to resume
driving without convincing evidence of benefits from such training
programs. The authors investigated the effect of the most promising
method (use of driving simulators) on driving training after stroke.
RELEVANCE: An effective and safe training method of driving after
stroke will not only ensure more safe post-stroke drivers but improve
the quality of rehabilitation and further enhance the quality of life
after stroke. PARTICIPANTS: Eighty-three persons with first-ever
stroke and in the subacute phase. METHODS: Subjects performed
a 5-week 15-hour training program in which they were randomly
allocated to either an experimental (simulator-based driving training)
or control (driving-related cognitive tasks) group. Performance in
off-road evaluations and an on-road test were used to assess the
driving ability of subjects pre- and post-training. Outcome of an
official pre-driving assessment administered 6 to 9 months post
stroke was also considered. ANALYSIS: The differences between
the experimental and control groups at pre-training, post-training and
follow-up assessments as well as improvements from pre- to post-
training were tested using unpaired t-tests or Wilcoxon rank sum
tests. Within-group improvements in each group at post-training were
compared using paired t tests or Wilcoxon signed rank tests. The
decisions of driving fitness (in three classes) based on the on-road
test during each assessment period were compared between groups
using chi-square statistics. Improvements in the tasks evaluated in
the simulator immediately after 15 hours of training were investigated
using Wilcoxon signed rank tests. Logistic regression analyses were
performed to identify subgroups of subjects that benefited most
from the training programs. RESULTS: Both groups significantly
improved in a visual and many neuropsychological evaluations
and in the on-road test after training. There were no significant
differences between both groups in improvements from pre- to post-
training except in the “road sign recognition test” in which the
experimental subjects improved more. Significant improvements in
a three-class decision of driving fitness (“fit to drive,” “temporarily
unfit to drive,” and “unfit to drive”) were found in favor of the
experimental group post-training. Significantly more experimental
subjects (73%) than control subjects (42%) passed the follow-
up official pre-driving assessment and were legally allowed to
resume driving. Academic qualification and overall disability together
determined subjects that benefited most from the simulator-based
driving training. CONCLUSIONS: Simulator-based driving training
improved driving ability better than driving-related cognitive tasks,
especially for well educated and less disabled persons with stroke.
However, the findings of the study may have been modified as
a result of the number of dropouts and the possibility of some
neurologic recovery unrelated to training. IMPLICATIONS: The
outcome at follow-up demonstrates the long-term effect of simulator-
based driving training and suggests the usefulness of implementing
such training program in the active rehabilitation phase after stroke.
However, patients with severe post-stroke deficits should be allowed
more time to physically recover before inclusion in such training
programs. KEYWORDS: Cerebrovascular accident; Motor vehicles,
Driving simulators. FUNDING ACKNOWLEDGEMENTS: Supported
by Stichting Van Goethem Brichant and Interfaculty Office for
S529
Development Cooperation of the Katholieke Universiteit Leuven,
Belgium. CONTACT: aakinwuntan@mcg.edu
ETHICS COMMITTEE: Study protocols were approved by the
Medical Ethics Committee of the University Hospitals Leuven,
Belgium.
Research Report Platform Presentation
1302 Wednesday 6 June 13:45
VCEC Meeting Room 18
RESPONSIBILITY FOR PREVENTION, TREATMENT AND
MANAGEMENT OF MUSCULOSKELETAL DISORDERS –
A MATTER FOR THE MEDICAL PROFESSIONALS, EMPLOYERS
OR THE INDIVIDUAL?
Larsson M1−3 , Nordholm L4 ; 1 The Sahlgrenska Academy at
Göteborg University Inst. of Neuroscience and Physiology/Physical
Therapy; 2 The Vårdal Institute; 3 Primary care in södra Bohuslän,
SWEDEN; 4 University college of Borås, SWEDEN
PURPOSE: Musculoskeletal disorders are common and often seen
as a burden both to the individual and to society, but to whom
or what do people place responsibility for prevention, treatment or
management of these disorders? Do people attribute responsibility
to the medical professionals, to employers, to themselves or do they
consider the matter out of their hands? The purpose of this study was
to describe peoples generalized attitudes regarding responsibility
for musculoskeletal disorders and explore associations between
these attitudes and background variables such as gender, age,
education, presence of musculoskeletal disorders, sick leave, phys-
ical activity and visits to care-providers. RELEVANCE: People with
musculoskeletal disorders frequently consult physical therapists. We
believe that knowledge of people’s attitudes regarding responsibility
for musculoskeletal disorders would be helpful to provide the most
efficient prevention, management and treatment of musculoskeletal
disorders. PARTICIPANTS: A random sample of an adult (above
18 years old) general population (in the southwest of Sweden) of
1770 persons, resulting in a response rate of 61% (n=1082) was
included in the study of generalized attitudes regarding responsibility
for musculoskeletal disorders. Approximately 690 persons could be
included in the multiple logistic regression analysis. METHODS: A
cross-sectional postal survey design was used. The letter sent out to
the participants included an information letter, a questionnaire and a
pre-paid reply envelope. The first part of the questionnaire was the
Attitude regarding Responsibility for Musculoskeletal disorders (ARM)
instrument. Part two of the questionnaire included sociodemographic
questions about age, gender and education as well as questions
about physical activity, musculoskeletal disorders, sick leave during
the last 12 months and about visits to care-provider. ANALYSIS:
Descriptive statistics were used to describe participants’ generalized
attitudes regarding responsibility for musculoskeletal disorders.
Multiple logistic regression analyses with stepwise backward removal
of covariates were used to investigate the associations between
attitudes regarding musculoskeletal disorders (as measured with
ARM) and background variables. RESULTS: A majority of the partic-
ipants had internal views regarding responsibility for musculoskeletal
disorders, i.e. they thought that people should take responsibility
themselves. Many people also had attitudes which attributed
responsibility equally to themselves and to the medical professionals.
The main associations found were that lower education, not being
physically active and being on sick leave for musculoskeletal
disorders increased the odds of belonging to the group with the
most external attitude i.e. attributing responsibility to someone else.
CONCLUSIONS: Most people do seem to have the attitude that they
themselves should take responsibility for musculoskeletal disorders
although the associated background variables could be of interest
and should be considered when planning prevention, treatment
and management of musculoskeletal disorders. Future work could
address whether an active approach of agreement of provider
and person concerning responsibility for musculoskeletal disorders
S530
would affect outcome of treatment? IMPLICATIONS: Attitudes have
implications for behaviour. If people think that they themselves
should be active in the prevention, treatment and mangemant
of musculoskeletal disorders, they will be more responsive to
suggestions from health professionals which emphasise self-care,
and this in turn will have implications for societal health care
costs. KEYWORDS: Attitudes;Responsibility;Musculoskeletal disor-
ders. FUNDING ACKNOWLEDGEMENTS: This study was financially
supported by The Vårdal institute, Göteborg university and The
local research council of Göteborg and South Bohuslän. CONTACT:
maria.eh.larsson@vgregion.se
ETHICS COMMITTEE: The study was approved by the Ethics
committee of Göteborg University.
Research Report Platform Presentation
845 Wednesday 6 June 13:45
VCEC Meeting Rooms 19-20
A NEW SELF-MANAGEMENT INTERVENTION FOR STROKE:
A SINGLE CASE STUDY APPROACH EMPLOYING A
RANDOMISED MULTIPLE AB BASIC DESIGN
Jones F1 , Partridge C2 ,Mandy A3 ; 1 St
George’s University
of London and Kingston University, London, United Kingdom;
2 University of Kent, Canterbury, United Kingdom; 3 University of
Brighton, Sussex, United Kingdom
PURPOSE: Recovery after stroke is often stated to be most rapid in
the first few weeks. Factors influencing initial recovery are clearly
described in stroke literature but this often relates to changes in
impairment. But what enables an individual to continue making
progress in terms of activity and participation after discharge from
physiotherapy? Psychological factors such as self-efficacy have been
strongly implemented in enhanced self-management in other chronic
diseases with an associated effect on other health outcomes. This
study aimed to test a stroke self-management intervention specifically
designed to address the main sources of self-efficacy described
by Bandura. RELEVANCE: Despite considerable advances in acute
care, stroke is still one of the most prevalent complex disabilities
in the developed world. Interventions aimed at enhancing self-
efficacy could provide an additional focus towards self-managing
after discharge from conventional therapies. But the most feasible
and effective intervention is not known. This study tests the effect
of a novel stroke self-management intervention on self-efficacy,
mood, activity and participation in a group of community dwelling
stroke survivors. PARTICIPANTS: Seven male and three female
participants, with a mean age 61.5 years (s.d 8.15) maximum age
75 years, minimum age 46 years and an average of 24.2 weeks (s.d
18.29) post stroke. Seven participants had right sided hemiparesis
and three had left sided hemiparesis, three had aphasia. Eight
participants lived with partners, and two lived alone. All lived in
their own homes and none were employed at the time of the
study. METHODS: We utilised a multiple participant, two phase
(baseline followed by treatment) design. The intervention was a self-
management workbook supported by three training sessions. The
workbook provided vignettes of stroke survivors with strong self-
efficacy, also practical solutions to common problems and a diary
to record targets and mastery experiences. The primary outcome
was self-efficacy using a newly validated Stroke Self-efficacy Scale
(SSEQ), and secondary outcomes measured mood, activity and
participation. ANALYSIS: The intervention effect was evaluated with
a randomisation test, as the intervention points were randomly
determined within a preset range for each participant. Individual
participant scores were analysed using a weighted mean trend line.
RESULTS: Statistical analysis of group effects showed a significant
change in self-efficacy (p < 0.01). A change was also demonstrated
in activity, participation and mood for the majority of participants, but
this was not statistically significant. CONCLUSIONS: Self-efficacy
can change through the use of a targeted stroke self-management
intervention, but the causal relationship with other variables such
WCPT 2007, Research Reports
as activity, participation and mood requires further examination.
IMPLICATIONS: A workbook based self-management intervention is
a feasible method for individuals following stroke and can change their
levels of self efficacy. Self-management interventions could be used
to provide additional methods to facilitate the process of recovery and
influence activity, participation and mood KEYWORDS: stroke, self-
management, self-efficacy. FUNDING ACKNOWLEDGEMENTS:
This work was unfunded. CONTACT: f.jones@hscs.sgul.ac.uk
ETHICS COMMITTEE: London-Surrey Borders Research Ethics
Committee
Research Report Platform Presentation
1166 Wednesday 6 June 14:05
PP Crystal Pavilion A
THE PYRAMID MODEL: BRIDGING THE GAP BETWEEN
THEORY AND PRACTICE – A PEDAGOGIC APPROACH
Sjöberg N; Dept. of Physiotherapy, University College Øresund
Copenhagen, Denmark
PURPOSE: In the educational system both lecturers and clinical
teachers experience the students’ frustrations about the discrepancy
between theory and practice. The purpose of the study was to
investigate how the newly qualified physiotherapists experience
their practice in relation to their understanding of the theoretical
background acquired from the academic part of the education.
This knowledge was then discussed in relation to Aristotle’s ideas
about practical wisdom, phronesis and a model was created and
tried out on 3rd semester students. RELEVANCE: This study is
important to both educators and students, because it presents a
model for physiotherapeutic phronesis which helps the students to
identify and explain discrepancies between “what they are taught
to do” and “what they actually do”. PARTICIPANTS: This first part
of the study is based on four qualitative semi-structured interviews
of newly qualified bachelors in physiotherapy and the second part
on 3rd semester students. Inclusion of informants was strategic in
relation to sex, educational institution and work place. METHODS:
The study is a qualitative, hermeneutic study, based on interviews.
The interviews took place between half a year and one-and-half-
year after graduation; were tape-recorded and transcribed in extenso.
The discussion groups in 3rd semester was tape-recorded and
transcribed likewise. The study was carried out according to existing
ethical guidelines. ANALYSIS: The data was analyzed according
to a Giorgi inspired editing-analysis-style. The material was coded
and then categorised and condensed. Communicative validation and
analytical generalization according to Kvale, was used on the first
part of the study and the findings were analysed and discussed
in relation to Aristotle and his theories on ethics. On the basis of
this, the “Pyramid-Model” was created, and the model was tried
out on 3rd semester students in relation to the subject clinical
reasoning, and analyzed using editing-analysis-style. RESULTS: The
newly qualified physiotherapists acts in a “phronetic way”, which is
illustrated by a model of a pyramid. The corners of the pyramid
represent different aspects which influence the physiotherapeutic
“best practice” (phronesis). The corners of the pyramid identified
in this study are: physiotherapeutic technique, culture, ethics and
relation. The “best practice” or the “physiotherapeutic phronesis” is
an imaginary point inside the pyramid, and the location of this point
is defined by the unique situation; i.e. some times phronesis is much
closer to another corner than the technique corner, because of the
attraction from the others. This model was tried out on students and
found useful in discussions on clinical reasoning and “what to do
in real life”. CONCLUSIONS: The Pyramid model seems to be a
useful tool by contributing to the understanding of elements of clinical
reasoning for 3rd semester students before their first clinical practice.
IMPLICATIONS: The Pyramid model might help the students to
reflect on why practice often looks otherwise than theory prompts. It
also helps them to identify elements that influences their practice
and hereby an opportunity to evaluate themselves. KEYWORDS:
Platform Presentations, Wednesday 6 June
Pyramid model, clinical practice, clinical reasoning. FUNDING
ACKNOWLEDGEMENTS: Department of Physiotherapy, University
College Øresund, Copenhagen, Denmark; Skodsborg School of
Physiotherapy, Skodsborg, Denmark. CONTACT: nesj@kbhfys.dk
Research Report Platform Presentation
1799 Wednesday 6 June 14:05
VCEC Ballroom A
HAMSTRING MUSCLE ACTIVATION FOLLOWING AN ANTERIOR
CRUCIATE LIGAMENT RECONSTRUCTION: IMPLICATIONS
FOR REHABILITATION
Clifford A1 , Holder-Powell H2 ; 1 University of Limerick, Ireland;
2 London South Bank University, UK
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
of muscle tissue) and failure of volitional muscle activation are the
main causes of a reduction in hamstring muscle force production
[1,2]. This study examined if a deficit in volitional hamstring activation
exists following an ACL-reconstruction. RELEVANCE: Information
regarding hamstring voluntary muscle activation in clients following
an ACL-reconstruction may be a critical factor in assisting the
design and implementation of effective rehabilitation programmes.
PARTICIPANTS: Following ethical approval, a convenient sample of
subjects who underwent a unilateral ACL-reconstruction and four-
months of rehabilitation were selected to participate in the study.
Eleven individuals (7 males) mean (±SE) age of 33.6 (±2.9) years
volunteered to participate in the study. METHODS: The percutaneous
twitch superimposition method [2] was used to assess voluntarily
activation of the hamstrings from the ACL-reconstructed and
contralateral uninjured legs. A pulse of supramaximal electrical stimuli
was applied to the muscle while the participant performed a maximum
voluntary contraction (MVC) of the hamstrings muscle. Hamstring
muscle force was assessed with subjects seated and stabilised in
a dynamometer (KinCom 125AP, Chatanooga, Tennessee, USA)
while the hamstrings were stimulated using a Digitimer stimulator
model DS7, which controlled the voltage (400volts), pulse width
(200ms) and current amplitude. The pulse frequency (1Hz) and
pulse delay (250ms) were programmed using the Digitimer D4030
programmer. The hamstring muscles were considered to be fully
activated, if no additional force was generated by the supramaximal
twitch of electrical stimulation. ANALYSIS: The amplitudes of the
twitch generated at rest and during three MVCs were measured
and recorded. The hamstrings percentage muscle activation was
calculated for both the ACL-reconstructed and uninjured limbs. The
Wilcoxon signed ranks test (SPSS version 11.5) was used to compare
hamstring muscle activation in the ACL-reconstructed limb with the
uninjured contralateral limb RESULTS: The mean ± standard error
(SE) hamstring muscle activation was calculated to be 89% ±0.8 in
the ACL-reconstructed legs compared to 99% ±4.2 in the uninjured
legs, thus, the ACL-reconstructed hamstrings produced significantly
less (11%) muscle activation (p = 0.04) compared to the uninjured
contralateral side. CONCLUSIONS: A reduced ability to generate all
of the available force in the hamstring muscles was identified, despite
a maximal voluntary effort and four months of rehabilitation following
their ACL-reconstruction. It is recommended that future studies
examine the recovery of volitional activation deficits in the hamstrings
following protocols involving methods like biofeedback, electrically
stimulation and muscle re-education. IMPLICATIONS: The results of
this study have implications for the rehabilitation of clients following
an ACL-reconstruction, as deficits in muscle activation are thought
to contribute towards a slow and suboptimal recovery [1]. Thus, it
is suggested that rehabilitation programmes for clients following an
ACL-reconstruction include exercises to reduce volitional activation
deficits in the hamstring muscles, as traditional exercise programmes
may be inadequate for the recovery of voluntary muscle activation.
References: [1] Mizner RL, Stevens JE, Snyder-Mackler L. Voluntary
S531
activitation and decreased force production of the quadriceps femoris
muscle after total knee arthroplasty. Physical Therapy 83[4], 359-
365. 2003. [2] Rutherford OM, Jones DA, Newham DJ. Clinical and
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
work was part of a PhD project that was done on a studentship
from King’s College London. No funding was received for this project.
CONTACT: amanda.clifford@ul.ie
ETHICS COMMITTEE: Guy’s Research Ethics Committee, King’s
College London Research Ethics Committee and St Mary’s Local
Research Ethics Committee
Research Report Platform Presentation
1351 Wednesday 6 June 14:05
VCEC Ballroom B & C
THE PROBLEM OF PRIORITIZING SCHOLARLY WRITING IN
THE WORKPLACE
Murray R, Newton M; Strathclyde University, Glasgow, UK
PURPOSE: Writing for publication requires a high level of skill,
the development of which appears to be configured, implicitly or
explicitly, within undergraduate and postgraduate curricula. However,
physical therapists report problems in making time and space
for scholarly writing in the workplace. The purpose of this study
was to assess the extent to which practices developed during
a scholarly writing course were sustained in clinical workplaces.
RELEVANCE: Writing for scholarly purposes is the main way
that physical therapists communicate about their work. In order
to move physical therapy forward it is essential that both service
development and research be published. This study explored these
problems by following a group of participants in a Writing for
Publication course, to assess the extent to which lessons learned
about making time and space for writing were implemented on
return to their workplaces. PARTICIPANTS: Clinical professionals,
including physical therapists, who had attended a course designed
to enable them to write for publication were identified. METHODS:
One-to-one semi-structured interviews were conducted with 12 of
the 14 course participants (4 males, 10 females), including six
physical therapists. Interviews lasted approximately 45 minutes
and were audio-recorded. ANALYSIS: Tapes were transcribed
verbatim. Themes were identified and checked by two independent
researchers. RESULTS: Analysis identified five potential barriers to
scholarly writing in the clinical workplace: 1. Participants’ clinical
workplaces ‘did not facilitate writing’. 2. Some felt they had to
‘sneak writing in’ and ‘not advertise’ their writing. 3. In spite of
management support for writing, other priorities were seen to have
more value. Participants were not comfortable prioritizing time for
scholarly writing in the workplace. 4. Participants reported that
they used personal, rather than professional, time for scholarly
writing. 5. Available space, such as clinic and open office, did
not provide an appropriate atmosphere for scholarly writing. A
strength of this study is that it provides detailed, individualized
information about physical therapists’ views on and experiences of
scholarly writing. A weakness is that participants were self-selected.
CONCLUSIONS: These findings show that while participants used
strategies learned on the course for other professional tasks, such
as report writing, they were unable to prioritize scholarly writing in
their workplaces. IMPLICATIONS: The implications of this study are
that making time and space for scholarly writing in the workplace is
problematic for clinicians. Other mechanisms for helping clinicians
to prioritize scholarly writing in the workplace should be devel-
oped. KEYWORDS: Publishing, workplace, prioritizing. FUNDING
S532
ACKNOWLEDGEMENTS: Funded by the Nuffield Foundation (UK).
CONTACT: r.e.g.murray@strath.ac.uk
ETHICS COMMITTEE: National Health Service (NHS) Central
Office for Research Ethics Committees (COREC) and University of
Strathclyde Ethics Committee
Research Report Platform Presentation
1159 Wednesday 6 June 14:05
VCEC Meeting Room 16
THE INTRA- AND INTERTESTER RELIABILITY OF THE
MOVEMENT CONTROL TESTS OF THE LUMBAR SPINE
Luomajoki H1,2 , Kool J3 , Airaksinen O2 , de Bruin E4,5 ;
1 Physiotherapie Reinach, 5734 Reinach, Switzerland; 2 University of
Kuopio, Kuopio, Finland; 3 Rehabilitation Clinic Valens, Switzerland;
4 University hospital of Zürich, Switzerland; 5 ETH Zürich, Switzerland
PURPOSE: To assess the reliability of the observation of move-
ment control in patients with non specific low back pain (LBP).
RELEVANCE: Non-specific LBP is a tremendous problem in our
societies. It is a heterogenic condition. Subgroups need to be
diagnosed much more clearly. Functional stability of the spine
can be examined through movement palpation but the reliability
is poor. Another diagnostic tool is the observation of the control
of active movements of the spine described by Sahrman and
by O’Sullivan. A test battery consisting of 10 movements were
developed, where the observer rates the control to be correct or
not correct. PARTICIPANTS: 40 patients currently in physiotherapy
treatment were included; 27 patients with non specific low back pain
and 13 patients without back pain but in treatment due to another
musculoskeletal problem. The patients did not know the tests before.
A standard instruction was given to all patients. Average age of the
patients was 52 years. METHODS: Patient perfoming 10 tests for
movement control of the lumbar spine adapted after Sahrmann and
O’Sullivan were videoed in a standardized manner. 4 physiotherapists
trained in this specific assessment, blinded to each other and to the
patients rated the performance seen in the videos either correct or not
correct. ANALYSIS: Kappa statistics were calculated to measure the
reliability between the raters and raters to themselves. Kappa values
below 0.4 are considered as poor, between 0.4-0.6 as moderate and
above 0.6 as substancial. Significance of the results and percentual
agreement were calculated as well. RESULTS: The kappa values for
intertester reliability ranged between 0.24-0.71 (P < 0.001). 6 tests
were above 0.6 which means a substancial reliability. The intratester
reliability was between 0.51-0.96 (P < 0.001), all tests but one were
above 0.6. The percentual agreement between the raters was above
80% for all but one test and the intra-rater agreement was by
all tests above 80%. CONCLUSIONS: Our research strenghtens
the findings from earlier studies that the inspectory findings of the
movement control ability of the spine have a good to substancial
reliability. The reliability might be even better if the raters also
knew the anamnesis of the patients videoed. Further studies are
needed to assess the reproducibility of the tests and to assess the
validity of the tests. IMPLICATIONS: Diagnosis of movement control
dysfunction has good intra-rater reliability in 9/10 tests and good
inter-rater reliability in 6/10 tests. KEYWORDS: Movement control
tests, Low back pain, movement impairment syndromes. FUNDING
ACKNOWLEDGEMENTS: None. CONTACT: hannu@physios.ch
ETHICS COMMITTEE: Ethics commitee of the Canton Aargau,
Switzerland
WCPT 2007, Research Reports
Research Report Platform Presentation
1090 Wednesday 6 June 14:05
VCEC Meeting Room 17
TRAINING IN FITNESS CENTERS WITH STROKE: LONG-TERM
IMPACT ON MOTOR, FUNCTIONAL PERFORMANCE AND
QUALITY OF LIFE
Teixeira-Salmela L, Goulart F, Faria C, Britto R, Parreira V;
Universidade Federal de MInas Gerais, Belo Horizonte, Brazil
PURPOSE: To investigate motor, functional performance and quality
of life measures after a training program in fitness centers followed
by one-year of detraining with community-dwelling chronic stroke
survivors. RELEVANCE: Despite clear evidence of physiological
declines during detraining, research is still not clear about the
relationship between declines in functional performance (FP) and
quality of life (QL), since these measures involve more complex
processes. PARTICIPANTS: Thirty participants (17 men and 13
women), mean age of 56.40 ±10.9 years (34 to 83) and mean
time since onset of stroke of 3.8 ±3.4 years (1 to 14) took
part in a combined program of muscle strengthening and physical
conditioning. The training was performed at a fitness center and
consisted of 30 sessions with evaluations at baseline and after
training. Twenty two participants (57.7±12 years) were re-assessed
after a one-year follow-up of detraining, defined as the period of one
year after the interruption of the program. METHODS: Measures
of motor performance included assessment of muscle strength,
spasticity, and symmetry. Muscle strength was evaluated by the
total work produced by the flexors/extensors of the trunk, hip,
knee and ankle; spasticity by the modified Ashworth scale; and
symmetry by the percentage of weight distribution on each lower
limb in a standing position and during the sit-to-stand movement.
Functional performance measures included timed measures of gait
speed and stair climbing, whereas, quality of life was investigated
by the Nottingham Health Profile, whose psychometric properties
of its Brazilian version were previously investigated. The training
program consisted of supervised exercise sessions and followed
a protocol previously employed with chronic stroke survivors and
each training session included: a 5 to 10-minute warm-up consisting
of calisthenics and range of motion exercises and stretching;
30 to 40-minute of aerobic exercises, consisting of walking plus
cycling, each at a target heart rate of at least 70 to 75% of
the maximal heart rate based on age; strength training, using
resistance equipments; a cool-down period, consisting of 5 to 10
minutes of muscular relaxation and stretching exercises. ANALYSIS:
Descriptive statistics and tests for normality and homogeneity of
variance were carried-out for all outcome variables, using SPSS
for Windows (version 13.0). Repeated measures ANOVA, with pre-
planned contrasts, were used to determine whether significant
differences existed between baseline, post-training and follow-up
measures, at a significance level of a<005. RESULTS: The findings
showed significant improvements in all outcome measures after
training, except for the motor performance measures of spasticity
and symmetry. The gains observed in strength measures returned
to baseline after one year of detraining. However, the gains in
all measures of functional performance remained unchanged. In
addition, QL showed the greatest improvement after training and the
gains persisted during follow-up. CONCLUSIONS: The maintenance
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: lfts@ufmg.br
ETHICS COMMITTEE: Ethics Committee Board of the Universidade
Federal de Minas Gerais
Platform Presentations, Wednesday 6 June
Research Report Platform Presentation
973 Wednesday 6 June 14:05
VCEC Meeting Rooms 19-20
DOES AN EXTENDED STROKE UNIT SERVICE WITH EARLY
SUPPORTED DISCHARGE HAVE ANY EFFECT ON BALANCE
OR WALKING SPEED?
Askim T1,2 , Mørkved S2,1 , Indredavik B3,4 ; 1 Department of
Community Medicine and General Practice, Faculty of Medicine,
Norwegian University of Science and Technology, Trondheim,
Norway; 2 Clinical Services, University Hospital of Trondheim,
Norway; 3 Stroke Unit, University Hospital of Trondheim, Norway;
4 Department of Neuroscience, Faculty of Medicine, Norwegian
University of Science and Technology, Trondheim, Norway
PURPOSE: Effective stroke unit care with early mobilisation improves
functional outcome after stroke, however increased risk of falling is
a major problem among persons with stroke and impaired balance
is one of the main reasons for falling. A new kind of service has
been developed during the last decade that offers Early Supported
Discharge (ESD). In the present study the aims were to evaluate
the effect of an extended stroke unit service with ESD on balance
and walking speed, and to explore the association between initial leg
paresis, initial movement ability and balance one year after a stroke.
RELEVANCE: Functional disability after stroke is costly to the health
care system. This study seeks more knowledge about improvement
of function after stroke. PARTICIPANTS: Sixty-two patients admitted
to the Stroke Unit at Trondheim University Hospital, fulfilling the
inclusion criteria, were included in the trial. METHODS: A randomized
controlled design was used, comparing the ESD with ordinary stroke
unit service. The outcome measures were Berg Balance Scale (BBS)
and walking speed at one, six, twenty-six and fifty-two weeks after the
stroke. On the multiple regression analysis BBS was dichotomised
into good balance (BBS  45) versus poor balance (BBS < 45).
The ESD service consisted of stroke unit treatment combined with
a home-based program including follow up care co-ordinated by a
mobile stroke team that offers early supported discharge and works in
close co-operation with the primary health care system during the first
four weeks after discharge. The intervention placed emphasize on
task spesific exercise therapy in the patients’ home. ANALYSIS: In all
analysis between groups Mann–Whitney U-test was used for ordinal
data, t-test for ratio data, and c2 tests for nominal data. Multiple
logistic regression was used to analyse the association between initial
leg paresis, initial movement ability and balance fifty-two weeks after
stroke allowing adjustments for potential confounders as age, sex,
treatment group and number of days from onset of symptoms to
hospital admission. RESULTS: 23 patients in each group completed
all assessments on BBS. The differences in change between the
two groups showed a trend toward greater improvement in the ESD
group compared to the ordinary service group from one week follow
up to six weeks follow up (p = 0.065) and from one week follow up to
twenty-six weeks follow up (p = 0.142) on the BBS, but no differences
in change between the two groups on fast walking speed. All patients
with initial severe leg paresis suffered from poor balance one year
after the stroke. The odds ratio for poor balance was 42.1 (95%
confidence interval; 3.5–513.9) among patients with no initial walking
ability. CONCLUSIONS: Our results do not conclusively indicate
that ESD has an effect on balance. We found a strong association
between initial severe leg paresis, initial inability to walk and poor
balance after one year. IMPLICATIONS: Further research should
emphasize task specific exercise therapy with a higher intensity
in addition to ESD to enhance further improvement on balance
and walking speed in order to facilitate an active life for persons
with stroke. KEYWORDS: stroke, balance, rehabilitation. FUNDING
ACKNOWLEDGEMENTS: This study has received financial support
from The Norwegian Fund for Post-graduate Training in Physio-
therapy and from Clinical Services, St. Olavs Hospital, Trondheim
University Hospital, Norway. CONTACT: torunn.askim@ntnu.no
ETHICS COMMITTEE: Regional Committee for Medical Research
Ethics in Norway, REK
S533
Research Report Platform Presentation
1297 Wednesday 6 June 14:25
PP Crystal Pavilion A
DIAGNOSING UNILATERAL NEGLECT: HYPOTHESIS
GENERATION AND PATTERN RECOGNITION IN
PHYSIOTHERAPISTS’ CLINICAL REASONING
Plummer-Damato P1 , Morris M2 , Denisenko S3 ; 1 University of
California Los Angeles, Los Angeles, USA; 2 University of Melbourne,
Melbourne, Australia; 3 La Trobe University, Melbourne, Australia
PURPOSE: To identify the clinical reasoning processes used by
physiotherapists in the assessment of unilateral neglect (ULN)
and to ascertain whether therapists generate hypotheses about
the different types of neglect. RELEVANCE: Understanding clinical
decision making processes is important in identifying how particular
behavioural symptoms are recognised, interpreted, and classified
in clinical practice. PARTICIPANTS: The participants were 14
physiotherapists recruited from the Victorian branch of the Neurology
Special Interest Group of the Australian Physiotherapy Association.
METHODS: Participants observed a 27-minute videotaped assess-
ment of an experienced physiotherapist assessing a patient with
left ULN following stroke. The participants were not told that the
patient had ULN. At predetermined intervals, the videotape was
paused and the participants documented their thoughts pertaining
to the case at that point in time. There were 5 segments of the
assessment: initial interview, sensory, motor function, balance and
gait, and standardised tests for neglect. ANALYSIS: A transcript of
responses was prepared for each participant. Each transcript was
read by two researchers independently several times and patterns
in the participants’ thinking were noted. Data were then displayed
in a matrix to facilitate comparison across participants for each
segment of the assessment. The data for each section of the
video were then examined for evidence of hypothesis generation.
Only hypotheses pertaining to ULN were analysed. RESULTS:
Physiotherapists used both hypothetico-deductive reasoning and
pattern recognition in their thinking related to ULN. A hypothetico-
deductive clinical reasoning approach, which is characterised by
specific testing to confirm a hypothesis, was evident amongst
therapists who, after forming a hypothesis about neglect, thought
about strategies to test their hypothesis. Pattern recognition, which
does not involve explicit testing of a hypothesis, was evident in
a small group of clinicians who evaluated their early hypotheses
of ULN through observation of the patient’s non-verbal behaviour
during the interview; they did not wait for the hypothesis to be
formally tested. This clinical reasoning behaviour is consistent with
models of pattern recognition in which clinicians use knowledge
from prior experience (i.e. recognise a pattern of symptoms)
to make a diagnosis. Hypotheses concerning specific types of
neglect were infrequently generated. Physiotherapists concentrated
on verifying the presence of neglect and quantifying the severity
of the syndrome, rather than differentially diagnosing the specific
types. CONCLUSIONS: Physiotherapists collect a large amount of
data through observation and they use this information to formulate
and evaluate clinical hypotheses about neglect. Existing knowledge
and previous experience may influence whether a therapist uses a
pattern recognition or hypothesis testing model of clinical reasoning.
The lack of hypothesis generation for different types of ULN suggests
that clinicians do not typically distinguish between the different types
of neglect in routine clinical assessment. IMPLICATIONS: Failure
to explicitly identify the nature of ULN implies that the primary
factors contributing to a person’s functional limitations may not always
be addressed specifically in treatment. Education in the different
types of ULN may help clinicians to refine their neglect-related
hypotheses. KEYWORDS: clinical reasoning, diagnosis, unilateral
neglect. FUNDING ACKNOWLEDGEMENTS: This research was not
funded.
ETHICS COMMITTEE: La Trobe University Faculty Human Research
Ethics Committee.
S534
Research Report Platform Presentation
1890 Wednesday 6 June 14:25
PP Crystal Pavilion B & C
DOCUMENTING THE PROCESS AND INITIAL OUTCOMES FROM
INTERPROFESSIONAL CLINICAL PLACEMENT EXPERIENCES
Asseraf-Pasin L1 , Birlean C1 , Redden K1 , Takahashi S2 , Shore B1 ;
1 McGill University; 2 Shriners Hospital for Children
PURPOSE: Little is known about students’ interprofessional attitudes
in the context of interprofessional clinical education (Hind, Norman,
Cooper, Gill, Hilton, Judd & Jones, 2003). The purpose of this
study was to understand (primarily from the students’ perspective)
the planning, process, and outcomes from an interprofessional (IP)
clinical placement. An IP education program was developed by an
IP team in a Spina-Bifida pediatric clinic because administration
pushed for the team to meaningfully integrate students doing clinical
placements. RELEVANCE: This presentation will explain how an IP
clinical placement was organized, developed, evaluated, and used
to inform subsequent IP clinical placements. PARTICIPANTS: Five
students (2 physiotherapy, 2 nursing, 1 occupational therapy), three
preceptors (1 physiotherapist, 1 nurse, 1 occupational therapist),
and one clinical nurse specialist (IPE program director) participated
in this study. All students who were involved in the placement
participated. The three preceptors most directly involved with the
students were invited to participate, and the IPE program director
was a key informant and crucial to understanding program planning.
METHODS: The program was observed qualitatively by (a) regular
communication with the program director, (b) notes from the
preceptor meetings throughout the program, (c) a student-journaling
activity, and (d) open-ended follow-up forms asking students
about their understanding of own and other professional roles,
and interprofessional education and practice. Three standardized
questionnaires (Entry Level Interprofessional Questionnaire (Pollard
et al., 2004), Interdisciplinary Education Perception Scale (Hawk
et al., 2002), Attitudes towards Health Professionals Questionnaire
(Lindqvist et al., 2005)) were administered to students before and
after the clinical placement. ANALYSIS: Descriptive statistics create
pre-post profiles of the five students and summarize student-ratings
of usefulness and level of interest on key components of the
clinical placement. Transcripts of open-ended questionnaire items,
observations, preceptor notes, and student-journaling activities were
inductively analyzed through open coding (Strauss, & Corbin, 1998).
RESULTS: Students held positive attitudes toward interprofessional
education and practice. Students reported learning about own and
other professional roles from the IP clinical placement. The key
challenge reported by students and preceptors was creating a
balanced schedule between time spent on clinical competencies
and interprofessionalism. CONCLUSIONS: Success of this program
indicates that interprofessional education helps clarify professional
roles for students, and that learning together enhances clinical place-
ment experiences. In the words of one student: “I think each student
should experience an IP clinical placement at least once during their
program. Ideally, this would be in the second year when they have a
good understanding of their own profession but can still benefit from
learning about others. Learning in school about the roles of HCPs
is not the same as working and interacting with them. You learn
more and gain a greater respect when you work interprofessionally
within a team. This is a good way to promote IPP in the future; it
is the best way to attain interprofessional care!” IMPLICATIONS:
This presentation will generate discussion around the need to
increase IP in clinical placements in order to prepare physiotherapists
for practice in health care systems that are increasingly support-
ing IP patient and family-centered practice. KEYWORDS: Pro-
cess/Outcomes/Interprofessionalism/Clinical Placement. FUNDING
ACKNOWLEDGEMENTS: The McGill Educational Initiative on
Interprofessional Collaboration: Partnership for Patient and Family-
Centred Practice. CONTACT: liliane.asseraf.pasin@mcgill.ca
ETHICS COMMITTEE: McGill University, Faculty of Medicine
WCPT 2007, Research Reports
Research Report Platform Presentation
1951 Wednesday 6 June 14:25
VCEC Ballroom A
DETERMINANTS OF SELF-EFFICACY IN THE REHABILITATION
OF PATIENTS WITH AN ANTERIOR CRUCIATE LIGAMENT
INJURY
Thomeé P1 , Währborg P, Börjesson M, Thomeé R, Eriksson B,
Karlsson J; 1 Dept of Orthopaedics, Lundberg Laboratory, Gröna
Stråket 12, Sahlgrenska University Hospital, 41345 Göteborg,
Sweden
PURPOSE: The purpose of this study was to explore several
independent measures (both physical and psychological) believed
to affect perceived self-efficacy in the rehabilitation of patients
with an anterior cruciate ligament (ACL) injury. RELEVANCE: We
hypothesise that self-efficacy may be determined by important factors
to consider in rehabilitation such as coping with pain and locus of
control, as well as previous experience of injuries/illness, quality of
life, symptoms and physical function. PARTICIPANTS: A total of 116
patients with a mean age of 31 years (18-55) were consecutively
included in the study. Forty-five patients had an ACL-deficient knee
and 71 patients had undergone an ACL reconstruction. They were
rehabilitated for at least three to six months and able to read and
understand the Swedish language. The Human Research Ethics
Committee at the Faculty of Medicine, Göteborg University, Sweden,
approved the study. Written informed consent was obtained and the
rights of subjects were protected. METHODS: For this explorative
descriptive study the Knee Self-Efficacy Scale (K-SES) was used
as the dependent measure. K-SES is a new valid and reliable
instrument, with good responsiveness to perceived self-efficacy. The
dependent and 39 independent measures were documented at one
visit; 12 months post injury/reconstruction. ANALYSIS: The K-SES
score was transformed to normal scores by the transformation by
Blom. All correlations between the K-SES and the independent
measures with a p-value of  0.1 were used in a regression
model to identify the determinants of the K-SES. RESULTS: Forty
per cent of the variance in the complete K-SES was explained
by the Lysholm score, KOOS-Sport/Recreation, Internal Locus of
Control and Locus of Control by Chance. Forty-one per cent
of the variance in patients’ present perceived self-efficacy was
explained by the same independent measures. When it came to the
perceived self-efficacy of future capability 38% of the variance was
explained by the Lysholm score, KOOS-Sport/Recreation, Tegner-
Present level and Internal Locus of Control. CONCLUSIONS: Self-
reported symptoms/functions and Internal Locus of Control were thus
the most important determinants of self-efficacy for patients with an
ACL injury. In order to strengthen self-efficacy, these determinants
should be considered by the clinicians involved in the rehabilitation.
IMPLICATIONS: The results from the present study are new and
important to consider for the physical therapist when planning and
executing the rehabilitation program for patients with an ACL injury.
The present study demonstrates that self-efficacy was closely related
to self-reported symptoms and functions, as well as to Internal Locus
of Control. In addition, perceived self-efficacy of future capability
appears to be influenced by the present physical activity level. The
rehabilitation of a patient who is physically fit and determined to
resume his/her prior activity may be more successful because of
that patient’s strong self-efficacy. As a result, the strategies may have
to be different when dealing with a patient who is less physically fit
and has poorer self-efficacy. KEYWORDS: anterior cruciate ligament
injury, rehabilitation, K-SES, self-efficacy, determinants. FUNDING
ACKNOWLEDGEMENTS: This study was supported by a grant
from the Swedish National Centre for Research in Sports and the
Local Research and Development Council of Göteborg and southern
Bohuslän. CONTACT: pia.thomee@telia.com
ETHICS COMMITTEE: The Human Research Ethics Committee at
the Faculty of Medicine, Göteborg University, Sweden, approved the
study.
Platform Presentations, Wednesday 6 June
Research Report Platform Presentation
1424 Wednesday 6 June 14:25
VCEC Meeting Room 17
REDUCED BONE DENSITY AND BONE STRENGTH INDEX IN
THE HEMIPARETIC RADIUS IN INDIVIDUALS WITH CHRONIC
STROKE
Pang M1−3 , Ashe M2,3 , Eng J2,3 ; 1 Hong Kong Polytechnic University,
Hong Kong, China; 2 University of British Columbia, Vancouver,
Canada; 3 GF Strong Rehabilitation Centre, Vancouver, Canada
PURPOSE: This primary purposes of this study were to (1) compare
bone status in the radius between the paretic and non-paretic
side following chronic stroke, and (2) to determine the relationship
between volumetric bone mineral density of the radius and stroke
impairments. RELEVANCE: Individuals with stroke often sustain
residual physical impairments in the upper extremity, such as muscle
weakness, spasticity and reduced motor control. These factors may
contribute to secondary bone loss and increase the risk of upper
extremity fractures. Indeed, wrist fracture is the second most common
type of wrist fracture among people with stroke. Understanding how
stroke influences bone health will provide important information in
devising effective strategies for preventing or treating bone loss in
this population. PARTICIPANTS: A convenience sample of 63 older
adults (50 years of age or older) with chronic stroke (stroke onset
1 year or more) were recruited from the community. METHODS:
Peripheral quantitative computed tomography (pQCT) was used
to obtain a cross-sectional image of the radius at the 30% site
(measured from the distal endplate) on both sides. The outcomes
variables were total bone mineral content (mg/mm), total bone
mineral density (mg/mm3 ), cortical thickness (mm), and polar stress-
strain index (mm3 )(a bone strength index). In addition, Fugl-Meyer
Motor Assessment was performed to assess motor impairment.
The amount of use scale of the Motor Activity Log was used
to measure how frequent the participant used the paretic arm in
daily functional activities. Hand-held dynamometry was used to
evaluate isometric muscle strength of shoulder flexion, shoulder
abduction, elbow flexion, elbow extension and hand grip. A composite
muscle strength score was calculated by summing the force value
obtained from each muscle group (in Newtons). Spasticity at the
wrist was measured by Modified Ashworth Scale. ANALYSIS:
Descriptive analysis was performed to yield the mean and standard
deviation of each outcome variable. Paired t-tests were performed
to compare the pQCT variables between the paretic and non-
paretic side. Multiple regression analysis was performed to predict
total bone mineral density from basic demographics and stroke
impairments. A significance level of 0.05 was set for all statistical
tests. RESULTS: Total bone mineral content, total bone mineral
density and cortical thickness, and polar stress-strain index on
the paretic side were significantly lower than those on the non-
paretic side (p < 0.05). Multiple regression analysis revealed that
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
hemiparetic side was compromised. Decreased muscle strength is
a major determinant of bone density in the radius. IMPLICATIONS:
Strengthening exercises may be an important strategy to preserve
or improve bone density of the upper extremity in individuals with
stroke. KEYWORDS: stroke, bone density, osteoporosis, muscle
strength. FUNDING ACKNOWLEDGEMENTS: Natural Sciences and
Engineering Research Council of Canada (Marco Pang). Heart and
Stroke Foundation of Canada (Janice Eng); Canadian Institutes for
Health Research (Maureen Ashe, Janice Eng); The Michael Smith
Foundation for Health Research (Maureen Ashe, Janice Eng); British
Columbia Medical Services Foundation (Maureen Ashe).
ETHICS COMMITTEE: University of British Columbia research
ethics committee. GF Strong Rehabilitation Centre research ethics
committee
S535
Research Report Platform Presentation
2061 Wednesday 6 June 14:25
VCEC Meeting Room 18
WORK ABILITY AND WORK STRESS AMONG SOCIAL
SERVICES AND HEALTH CARE PROFESSIONAL TEACHERS IN
FINLAND
Jaakkola-Hesso S1 , Nygard C2 , Savinainen M2 ; 1 Satakunta
University of Applied Sciences; 2 Tampere School of Public Health,
University of Tampere Finland
PURPOSE: The aim of this study was to describe work ability and
work stress in a group of teachers in a cross-sectional study in
autumn 2005 in social services and health care professional teachers
in Finland. RELEVANCE: Applied Sciences has been developed to
many different sectors in Finland during last ten years. Employees
have been required knowledge to many different fields to be able to
work in this area. With increasing age and demands of work, such
as teaching in the different environments and the individual physical
demands, work stress increasing among the professional teachers.
Based on different studies the teachers stress and the work load have
been the main reasons to burn out. PARTICIPANTS: A total of 1200
teachers were the target group for this study. The questionnaire was
sent to the teachers using Internet. The participants answered to the
guestions anonymously. The participants were either senior lectures
or full-time teachers. In all 419 of teachers answered to WAI. Mean
age was 50.2 years of all, female (50.4 years) and male (48.1 years).
In all 478 of teachers answered to QPSNordic. In this study The
subjects were divided for two age groups <45 and>45 and gender
groups. METHODS: The WAI and QPSNordic34+ were used as a
method. ANALYSIS: The statistical analyses were carried out using
SPSS package. The statistical significance was tested with the t-test.
RESULTS: The WAI was classified as good work ability in all groups.
In general men and younger subjects had higher WAI compared
to the others. In average every fourth of teachers perceived high
stress. There were differences between women and men in mastery
of work and in job demands. Women perceived higher mastery
of work and job demands than men. There were no differences
between full time lectures and senior lectures in psychological
variables. CONCLUSIONS: The results of study are parallel with
earlier studies concerning WAI among different age groups. Although
the teachers perceived high mastery of work they perceived rather
high stress level. It is important to notice that the superior support
was rather low among the teachers and the combination of high
demand with low control has negative effect on well-being. An
interesting finding is that there are not much differences between
senior lecturer and full time lecturer. IMPLICATIONS: This study
will develop occupational physiotherapist‘s skills in assessing loading
factors in work. KEYWORDS: Work ability, WAI, QPS-index, stress,
teacher. FUNDING ACKNOWLEDGEMENTS: This study is not
funded. CONTACT: first name.last name@samk.fi
ETHICS COMMITTEE: University of Tampere and all the participant
schools in the study
Research Report Platform Presentation
1595 Wednesday 6 June 14:25
VCEC Meeting Rooms 19-20
FACTORS THAT INFLUENCE FUNCTIONAL INDEPENDENCE
POST STROKE
Mamabolo V, Mudzi W, Stewart A; University of the Witwatersrand,
Johannesburg, South Africa
PURPOSE: The influence of demographic, physical and environ-
mental factors on patients who have had a stroke has not been
well established. The objectives of this study were to establish the
degree of functional independence of patients who have had a
stroke and to establish factors that influence functional independence
post stroke. RELEVANCE: Information about factors that influence
patient’s functional independence post stroke could be used to plan
S536
the patient’s length of hospital stay, the frequency of outpatient visits
to the physiotherapy department for rehabilitation; and to also provide
patients and their caregivers with information on the possible pattern
of recovery based on the identified factors. PARTICIPANTS: Patients
were sought from four stroke outpatient public health facilities in
the Gauteng province of South Africa. A sample of convenience
(68 patients) was derived from patients who were attending a
stroke class at these facilities. Patients who had aphasia were
only included if they had a caregiver who could respond to the
questionnaire on their behalf. The following were excluded from the
study: patients who were dependent in activities of daily living before
the stroke, those who had more than one stroke, institutionalised
or hospitalised patients, patients who were not willing to participate
in the study were also excluded for ethical reasons. METHODS:
This was a quantitative research using a descriptive cross sectional
study design. The Barthel Index was used to establish the degree
of functional independence on discharge from the hospital and at
the time of data collection (more than six weeks post stroke); and
a self designed questionnaire was used to establish demographic,
physical and environmental factors. Intra and inter rater reliability
tests were done to validate the questionnaire. The questionnaire
was interviewer administered. ANALYSIS: Data were summarised
using frequency distributions, percentages and cross tabulations.
Furthermore, after dichotomising the Barthel Index, the influence
of the observed factors was studied using a logistic regression
within a 95% confidence interval. Odds ratios were also calculated.
RESULTS: Ninety three percent of the patients were functionally
independent post discharge. Younger patients had the highest
likelihood of improved functional independence (p = 0.003); married
patients recovered functional independence faster than those who
were single (p = 0.05). The following factors also improved chances
of being functionally independent: bowel continence (p = 0.003); par-
ticipating in community (p = 0.02) and household (p = 0.01) activities.
Having a caregiver decreased the chances of regaining functional
independence (p = 0.04). CONCLUSIONS: Factors that influence
functional independence post stroke are: age, marital status, bowel
continence, caregiver availability, participating in household and
community ativities. IMPLICATIONS: The patient’s marital status as
well as availability and the role of the caregiver should be established.
It is also necessary to encourage patients and to teach the caregivers
to encourage them to participate in household and community ac-
tivities post stroke. KEYWORDS: Stroke, Functional independence.
FUNDING ACKNOWLEDGEMENTS: Medical Research Council of
South Africa and Physiotherapy department of the University of the
Witwatersrand. CONTACT: mamabolomv@therapy.wits.ac.za
ETHICS COMMITTEE: Human Research Ethics Committee (Medi-
cal). Approval number: M050449
Research Report Platform Presentation
1310 Wednesday 6 June 14:45
PP Crystal Pavilion A
THE NATURE OF CLINICAL DECISION MAKING IN
CARDIOPULMONARY PHYSIOTHERAPY
Smith M1,2 , Higgs J2 , Ellis E2 ; 1 Charles Sturt University; 2 The
University of Sydney
PURPOSE: In the field of cardiopulmonary physiotherapy (CP),
decision making has received limited research attention. The aim
of this research was to develop an understanding of the nature of
decision making in acute care CP. RELEVANCE: This study was
undertaken to inform the education of CP practitioners in the process
of clinical decision making. PARTICIPANTS: Fourteen participants
who were engaged in the practice of CP in three experience
categories (novice, intermediate and more experienced) took part
in the study. Participants were recruited from three Australian
metropolitan hospitals. Participants practised across a range of acute
care clinical areas (e.g. intensive care, post-abdominal surgery and
respiratory medicine). METHODS: A qualitative research study was
WCPT 2007, Research Reports
conducted using a hermeneutic approach. Data was collected from
each participant on two occasions by observing them undertaking
their usual daily patient care activities, and interviewing them about
their decision making. A process of participant checking was used
to confirm that the collected data was reflective of the decision
making of the participants. ANALYSIS: Data analysis involved an in-
depth, iterative process of reading and interpretation of the research
texts to identify the nature and processes of decision making.
Texts for analysis were constructed from the collected data in the
form of field-notes from the observation, and interview transcripts.
The texts were interpreted, guided by hermeneutic devices: the
hermeneutic circle and fusion of horizons. Credibility of the research
was enhanced by the adoption of a critical, reflexive approach
by the researcher during data collection, text construction and
interpretation. RESULTS: Decision making in CP is essentially a
sequential process focussing on making decisions about problems,
then making concurrent and inter-related decisions about interaction
and intervention, and finally making decisions about evaluation.
Decision making was dependent upon the attributes of the decision
and decision making situation. Where decision making was perceived
to be simple the decision making process was conducted rapidly with
limited awareness or conscious recognition of progressing through a
series of decision making stages. Where decisions were more difficult
more conscious attention and deliberation was involved at key points.
In decision making about problems, practitioners aim to develop a
picture of patient’s problems in sufficient depth to allow them to
progress to making decisions about intervention. Decision making
about intervention uses concurrent lines of reasoning to consider
intervention options, evaluate risk versus benefit, and incorporate
perceptions of practitioner self-efficacy. Decision making about
evaluation occurs during and about the decision making process
and informs future decisions. CONCLUSIONS: This research has
revealed that clinical decision making in CP is a complex process
that is adaptable and flexible according to decision attributes and
foci. IMPLICATIONS: The nature of decision making in CP revealed
in this research provides a basis for educating beginning practitioners
to increase their preparedness for the reality of clinical practice.
This research also provides a basis for pursuing research that
aims to promote quality decision making. KEYWORDS: Decision
making, clinical reasoning. FUNDING ACKNOWLEDGEMENTS:
Australian Physiotherapy Research Foundation (PRF) and Charles
Sturt University. CONTACT: mesmith@csu.edu.au
ETHICS COMMITTEE: The University of Sydney ethics committee
and the ethics committees of the hospitals involved.
Research Report Platform Presentation
2203 Wednesday 6 June 14:45
PP Crystal Pavilion B & C
BEYOND PROFFESIONAL BARRIERS: INTERDISCIPLINARY
EDUCATION IN MEDICAL AND HEALTH CARE SCIENCES
Younis A1,2 ; 1 St. George’s University of London, London:
UK; 2 Faculty of Health and Social Care Sciences, Kingston
University,London: UK
PURPOSE: Collaborative learning in healthcare education has, in
recent years, achieved much attention. Indeed in 1988, the World
Health Organisation (WHO) published the document: ‘Learning
together to work together’ the pupose of which was to facilitate
Inter-Professional Education (IPE). The need for closer working
between health and social care professions has, since then, been
continually reinforced at both national and international policy level
(Department of Health 1989, 1996, 1997, 1998). At St George’s,
University of London and Kingston University UK, we have a well-
established inter-professional educational programme aimed at level
1. The purpose of this paper is to evaluate the effectiveness of our
Inter-Professional Education (IPE) programme according to students’
perceptions. RELEVANCE: Primarily, it is hoped that IPE helps foster
improved teamwork among multi-disciplinary professionals, breaks
Platform Presentations, Wednesday 6 June
down unhelpful stereotypical attitudes and facilitates future joint
working. Additionally, education in health and social care sciences
is costly. This study, therefore, identifies students’ perceptions
regarding the effectiveness of IPE and informs us directly of their
views of the IPE programme in order to help ensure that the
objectives of the course are being met and that better ways of
delivering IPE may be identified. PARTICIPANTS: 208 students from
six different disciplines at St Georges University London and the
Faculty of Health and Social Care Sciences at Kingston University
participated in a Common Foundation Programme (CFP) which
was designed within our Faculty to address the needs of health
care in the UK. METHODS: Students’ perceptions were assessed
through the completion of a questionnaire. Full ethical approval was
given by the Faculty of Health and Social Care Sciences ethics
committee. ANALYSIS: Non-parametric ANOVA, Kruskal-Wallis test
and cross tabulation were used to determine the differences between
disciplines, as well as frequency distribution, minimum and maximum,
range, mean and standard deviation (SD). The data was analysed
using the Statistical Package for Social Sciences (SPSS) version
13. Significance was accepted at P < 0.05. RESULTS: In general the
majority (n=169, 81.4%) of the participants enjoyed the experience
of IPE. There was no statistical significance difference between
disciplines (p > 0.05) regarding; students’ opinions of the suitability
of each topic for IPE delivery, level of interaction between disciplines
in each topic, and suitability of teaching methods. However, there was
a statistically significant difference for lecturer availability: p = 0.001
and for suitability of examples given during delivery: p = 0.009
CONCLUSIONS: Overall, the students have been very positive about
the experience. However, there are some areas of concern which
should be addressed in the future design of any Inter-Professional
Education modules. These include: more interactive teaching
methods and joint projects, and making sure case studies are
relevant across disciplines in order to facilitate the passage BEYOND
PROFFESIONAL BARRIERS IMPLICATIONS: The implication of
this study concerns the improvement in methods of interdisciplinary
education in medical and health care sciences, with the intention
of promoting holistic approaches to patient care. KEYWORDS: Inter-
professional, Education, Collaboration, Learning, Stereotypes, Team-
work, Roles. FUNDING ACKNOWLEDGEMENTS: N/A. CONTACT:
ayounis@hscs.sgul.ac.uk
ETHICS COMMITTEE: Full ethical approval was given by the Faculty
of Health and Social Care Sciences ethics committee of Kingston
University, UK.
Research Report Platform Presentation
2455 Wednesday 6 June 14:45
VCEC Ballroom A
CHANGES IN MUSCLE STRENGTH AND FUNCTION AFTER
ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION
Drechsler W, Cramp M, Scott O; University of East London,
London, UK
PURPOSE: Despite post operative rehabilitation, studies report
quadriceps weakness early (Morrissey et al. 2000) and later
(Mikkelsen et al. 2000) after anterior cruciate ligament reconstruction
(ACLR). The underlying reasons for this persistent muscle weakness
are unresolved and strategies that control motor unit recruitment
remain unknown. Surface electromyographic (EMG) signal has
been used to estimate motor unit recruitment patterns and median
frequency of muscle (Stulen & De Luca 1981). This study monitored
neuromuscular changes in quadriceps femoris muscle at one and
three months after ACLR. RELEVANCE: Rehabilitation programmes
may be optimised by identifying and considering recruitment control
strategies employed during submaximal and maximal contractions
following surgery. PARTICIPANTS: Thirty one patients (28M, 6F)
recovering from ACLR (mean (SD), age 30(8) years were tested
one and three months after surgery. Physically inactive (RC) and
sports participants (SC) acted as controls. METHODS: Changes
S537
in isometric muscle strength (MVC), voluntary activation, function
(Hughston Clinic Questionnaire) and surface electromyogram (EMG)
parameters were examined. Median frequency (Hz) and amplitude
(mV) of rectus femoris using Fast Fourier Transform were calculated
during 5-s isometric contractions at 100%, 75%, 50% and 25% of
MVC. ANALYSIS: Statistical analysis was performed using Statistical
Package for the Social Sciences (SPSS 10.0). Comparisons between
variables were analyzed by one way analysis of variance (ANOVA),
and Bonferroni post hoc tests assessed any test, limb or group
differences. Association between variables was measured by linear
regression. RESULTS: One month after surgery, a significant
correlation (p < 0.01) was found between activation level (%) and
MVC of injured knee extensors. By three months, most patients
had achieved full activation but still had muscle weakness. At
one and three months post surgery and for all levels of MVC
contraction, the median frequencies of the injured limbs were
significantly lower (p < 0.05) compared to the SC group as were those
of the RC group. There was a significant lowering of the median
frequencies of the uninjured limbs compared to the SC group at
75 and 100% of MVC. The EMG amplitude of the uninjured and
injured limbs mirrored those of the SC and RC groups, respectively.
Regression analysis showed the functional questionnaire and level
of activation of the knee extensors can predict knee function one
year after surgery. CONCLUSIONS: Muscle activation patterns
altered following ACL injury and repair and contribute to subsequent
changes in muscle fibre properties during detraining and subsequent
retraining. IMPLICATIONS: These neuromuscular adaptations after
knee surgery provide a basis to develop specific muscle strength
training that includes recruitment of large, fast contracting muscle
fibres. In addition, combination of functional scores and level of
activation predicts functional performance beyond the rehabilitation
phase and can inform rehabilitation regimes specific to the individual.
These data further our understanding of the persistent knee extensor
weakness evident after ACLR. KEYWORDS: ACLR, muscle strength,
function, motor unit recruitment, EMG, median frequency. FUNDING
ACKNOWLEDGEMENTS: This work was supported by the School
of Health & Biosicience, University of East London. CONTACT:
w.drechsler@uel.ac.uk
ETHICS COMMITTEE: University of East London Ethics committee
and East London & City Health Authority Ethical Committee.
Research Report Platform Presentation
2592 Wednesday 6 June 14:45
VCEC Ballroom B & C
STROKE AND HEALTH-RELATED KNOLWEGE, BELIEFS,
AND BEHAVIORS OF CHINESE CANADIANS: STATUS AND
IMPLICATIONS FOR PHYSICAL THERAPISTS
Wang S1 , Li Z2 , Jongbloed L1 , Dean E1 ; 1 School of Rehabilitation
Sciences, University of British Columbia, Vancouver, Canada;
2 School of Communication and Culture, Royal Roads University,
Victoria, Canada
PURPOSE: Stroke is a leading cause of death in Chinese Canadians
(CCs); the fastest growing group of immigrants. The needs of CCs
in relation to health and stroke education are not well documented.
We examined stoke-related health knowledge, behaviors and beliefs
of CCs in reference to European Canadians (ECs), and the effect
of acculturation of the CCs on these variables. RELEVANCE:
Canada is a cultural mosaic. Health white papers in recent years
have identified the need for culturally sensitive and responsive
health care (Romanow Report 2002; Kirby Report 2002). Immigrants
from Confucian-heritage countries are a growing proportion of
immigrants to countries worldwide. An understanding of the needs
of this unique group will help promote the ideals of culturally
sensitive and responsive health care. PARTICIPANTS: Convenience
samples of CCs (n=103) and ECs (n=103) from the Lower Mainland
of British Columbia, Canada. METHODS: An ethically-approved,
cross-sectional, descriptive study was conducted. The questionnaire
S538
was primarily based on closed-ended questions from established
tools and consisted of four parts: stroke-related knowledge, health
behaviors, health beliefs, and demographic information. Stroke-
related knowledge was assessed with open-ended questions.The
back-translation method was used to translate the questionnaire
into Chinese. Traditional and simplified Chinese versions were
used. ANALYSIS: Descriptive statistics were used to describe
subject characteristics, frequencies to compare behaviors and
beliefs, and chi-square tests and correlations to compare differences
between groups, and sub-groups of the CCs based on median
split of years in Canada. The p value was 0.05. RESULTS:
Demographically, the groups were comparable with the exception of
income (p < 0.05). Compared with ECs, CCs were less awareness
of stroke risks, warning signs, and emergency response. Preferred
health information sources were media, family and friends for the
CCs, and health professionals for the ECs (p < 0.05). With respect to
dietary habits, both groups consumed fewer than the recommended
number of servings of the major food groups (Health Canada
2006). CCs are less likely to smoke and drink alcohol than ECs
(p < 0.05) and are more sedentary (p < 0.05). The level of exercise
for most respondents was less than that recommended (American
College of Sports Medicine 2005). Compared with ECs, the health
beliefs of CCs with respect to diet were more consistent with
established guidelines, yet fewer appreciated the importance of
regular exercise and normal weight (p < 0.05). CCs reported more
stress from all causes than ECs (p < 0.05). Years in Canada had little
relationship to stroke-related knowledge and behaviors reported by
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
findings related to diet and exercise of Asian immigrants concur
with other studies. Hofestede’s theoretical dimensions of culture
helped explain differences in stroke-related knowledge, behaviors,
and beliefs between groups, and identified distinct strategies for
delivering health education to CCs. IMPLICATIONS: By enhancing
their understanding of differences and similarities between these
groups, physical therapists may enhance the cultural sensitivity of
their interventions and overall management. KEYWORDS: Chinese
Canadians, culturally sensitive health care, health behaviors, health
beliefs, health knowledge, health knowledge translation, responsitive
health care. FUNDING ACKNOWLEDGEMENTS: None. CONTACT:
elizabeth.dean@ubc.ca
ETHICS COMMITTEE: University of British Columbia, Canada,
Ethics Review Board
Research Report Platform Presentation
1198 Wednesday 6 June 14:45
VCEC Meeting Room 16
ACTIVE MOVEMENT CONTROL TESTS OF THE LOW BACK
AMONG PATIENTS WITH LBP AND NO LBP
Luomajoki H1,2 , Kool J3 , Airaksinen O2 , de Bruin E4,5 ;
1 Physiotherapie Reinach, 5734 Reinach, Switzerland; 2 University
of Kuopio. Finland; 3 Rehabilitation Clinic, Valens, Switzerland;
4 University hospital of Zürich. Switzerland; 5 ETH Zürich Switzerland
PURPOSE: Validation of active movement control tests by comparing
the test performance score between patients with and without low
back pain (LBP). RELEVANCE: Movement impairment syndroms
are a promising possible subgroup among patients with low back
pain. Active movement control tests are based on those originally
described by Sahrmann and by O’Sullivan. The tests are a reliable
tool for the diagnosis in this syndrom. PARTICIPANTS: We examined
242 persons (mean age 46 years in both groups) with a battery of
10 tests on the ability to control the active movements of the low
back. 121 persons were currently suffering of LBP and further 121
persons did not have currently or in the last 3 months any LBP.
METHODS: A cross sectional study with a standardized protocol
WCPT 2007, Research Reports
to examine the performance of 10 active movement control tests.
Each test is rated whether correct ot incorrect. The reliability of
the tests has been shown in earlier studies. ANALYSIS: The effect
size (d) between the groups were calculated where d < 0.20 is
considered small, 0.2-0.5 medium and over 0.8 large effect size.
T-tests for the significance of the difference between the groups
were calculated, where P values <0.01 are considered showing high
significant results. RESULTS: The effect size d was 0.79 between
the groups by a p < 0.001 which means a large effect size by a very
clear significance for the result. LBP patients scored in average 3.0/10
tests incorrectly whereas persons not suffering from LBP scored 1.4
/ 10 tests incorrectly (8.6/10 correct). CONCLUSIONS: There is a
clear difference between the sampled populations with and without
low back pain in the active movement control tests. This might be an
important outcome measure in the effectivity studies of LBP and an
important detail to try to improve by treating LBP patients. Further
studies are needed to examine the construct validity of the active
movement control tests as a specific assessement tool for a specific
subgroup of LBP. IMPLICATIONS: Active movement control tests
are a promising tool to be used in examination and treatment of
LBP patients. KEYWORDS: Active movement control tests, LBP,
Cross sectional study. FUNDING ACKNOWLEDGEMENTS: None.
CONTACT: hannu@physios.ch
ETHICS COMMITTEE: Ethics committee of canton Aaragau in
Switzerland
Research Report Platform Presentation
2173 Wednesday 6 June 14:45
VCEC Meeting Room 17
ADAPTING THE CO-OP TREATMENT APPROACH FOR ADULTS
WITH STROKE: PHASE ONE, EXPERT OPINION
McEwen S1 , Polatajko H1 , Ryan J2 , Birkenmeier R3 , Huijbregts M2 ;
1 University of Toronto; 2 Baycrest Centre for Geriatric Care;
3 Washington University School of Medicine
PURPOSE: The purpose of this multi-phased project is to determine
the adaptability of the CO-OP approach for use with adults with
stroke. The Phase 1 research questions were: 1. What is the
perspective of expert stroke rehabilitation clinicians regarding the
utility of the CO-OP approach for use with adults with stroke?
2. What adaptations do they recommend? RELEVANCE: There is
little evidence on how best to improve participation outcomes for
people with stroke. The Cognitive Orientation to daily Occupational
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
participation. CO-OP is an integrated approach to skill acquisition that
includes elements critical for the generalization and transfer of skills
from rehabilitation programs to real life. Skill acquisition is viewed
from a learning perspective and emphasis is on integrating activities
in the larger context of life participation. It is hypothesized that once
adapted, CO-OP will be more effective in improving participation
post stroke compared to current approaches. PARTICIPANTS:
(Phase one) Five expert occupational therapists (OTs) and three
expert physical therapists (PTs) with an average of 16 years
work experience were recruited. Theoretical sampling was used to
ensure a mix of expertise, discipline, work setting, and experience.
METHODS: A multi-phased study to adapt CO-OP for use in stroke
is currently underway, using a combination of expert opinion, single
case experimental design, and process evaluation. This Phase 1
used expert opinion. In a workshop format, stroke rehabilitation
clinicians were introduced to the CO-OP approach. Subsequently,
they participated in a focus group to discuss the potential applicability
of the approach for adults with stroke, and to elicit recommendations
for adaptations. Demographic information was collected, and the
focus group was audiotaped and transcribed verbatim. ANALYSIS:
The transcription was analyzed line by line by three of the authors,
looking for evidence of the participant’s perspective on the utility of the
Platform Presentations, Wednesday 6 June
approach for adults with stroke, as well as specific recommendations
for its adaptation. They initially worked independently, and then
discussed their findings to reach consensus. RESULTS: CO-OP
was perceived as a novel, promising, and exciting approach for
stroke rehabilitation. Challenges to implementing the approach in
adults with stroke may include using the approach in people
with executive functioning impairments, and potential differences in
the way adults and children learn motor skills. Recommendations
include training implications, timing, and methods to introduce
the approach to clients. Therapists articulated a range of stroke
rehabilitation beliefs and attitudes, particularly around client-centred
goal-setting, that may facilitate or hinder the future adoption of this
approach. CONCLUSIONS: A group of expert stroke rehabilitation
therapists consider the CO-OP approach as novel and promising
for use with adults with stroke and specific recommendations
for adaptations have been made. IMPLICATIONS: The CO-OP
approach has potential to provide therapists with a successful,
structured, and integrated approach to stroke rehabilitation. Further
work is underway to examine the adaptations required from the
client’s perspective, and a controlled trial is planned. KEYWORDS:
stroke rehabilitation, learning, physiotherapy practice. FUNDING
ACKNOWLEDGEMENTS: This project has received funding from the
Physiotherapy Foundation of Canada and the James S. McDonnell
Foundation. CONTACT: sara.mcewen@utoronto.ca
ETHICS COMMITTEE: Baycrest Centre for Geriatric Care and
University of Toronto Health Sciences II
Research Report Platform Presentation
2654 Wednesday 6 June 14:45
VCEC Meeting Room 18
PAIN AND DISABILITY OUTCOMES FROM A PREVENTION
AND EARLY ACTIVE RETURN-TO-WORK SAFELY (PEARS)
PROGRAM
Kozlowski A1,3 , Yassi A2,3 ; 1 School of Rehabilitation Sciences,
University of British Columbia, Vancouver, Canada; 2 Department
of Health Care and Epidemiology, University of British Columbia,
Vancouver, Canada; 3 Occupational Health and Safety Agency
for Healthcare, Vancouver, Canada
PURPOSE: Healthcare workers (HCWs) are at high risk of
musculoskeletal injuries (MSIs). Pain and disability are associated
with MSIs. The Prevention and Early Active Return-to-work Safely
(PEARS) program was developed to address rising incidence of
MSIs in HCWs, and consequences of MSI such as time loss,
claim costs, and pain and disability. The PEARS program combined
primary and secondary prevention strategies under a culture of
participatory health and safety managed jointly by healthcare unions
and management. Successful reduction of MSI incidence was
reported previously. The purpose of this study was to (1) report on
secondary prevention outcomes of pain and disability, and (2) develop
prediction models for pain and disability outcome at discharge.
RELEVANCE: Physical therapy (PT) is integral to both primary
and secondary prevention components of PEARS. Integration of PT
intervention with workplace components can facilitate optimal and
safe recovery and return to function. Measurement of clinical and
other outcomes can support clinical decision making and program
planning. PARTICIPANTS: PEARS is a prevention and voluntary
early-intervention program for HCWs with, or at risk of MSI. All
HCWs with an MSI incident are referred to PEARS, and offered
PT, ergonomic workplace assessment, work practice modification,
and if necessary, integrated return-to-work planning with modified
hours and/or duties to facilitate early and safe recovery. HCWs
can also be referred by self, physician, union, or management
representatives. The program typically lasts a maximum of seven
weeks. METHODS: Pain and disability scores were captured for the
Visual Analogue Discomfort Scale (VADS), the Oswestry Disability
Index (ODI), and the Disabilities of the Arm, Shoulder and Hand
(DASH) questionnaire at initial and discharge visits for PEARS
S539
participants, along with 14 predictor variables. Mean change was
reported along with group and individual change indices of effect size
(ES) and reliable change proportion (RCP). Standard model building
methods identified predictive variables associated with pain and
disability outcomes at discharge for simple and multiple regression
models. The study included 2624 participant records from three
health regions. Initial pain and disability scores were moderately low,
but substantial improvement was observed on all three measures
with ESs ranging from 0.9–1.1 and RCPs from 43.2% to 61.5%.
Regression analysis found several individual predictors, but only
age remained significant in multiple models. ANALYSIS: PEARS
participants reported substantial reduction of pain and disability
at discharge supported by large ES and moderate RCP values.
However, models did not identify as many variables predictive of
disability as was expected. This may be due to data loss from low
outcome completion and model specification error. These findings
demonstrate success of the secondary prevention component of
PEARS, and provide guidance for improvement of program evaluation
methods. RESULTS: CONCLUSIONS: IMPLICATIONS: Strategies
to increase outcome completion are necessary for PEARS and other
PT programs that use standardized pain and disability outcome
measures. Doing so can enhance interpretation of clinical effec-
tiveness and development of robust prediction models which could
further guide development and implementation of primary prevention
strategies. KEYWORDS: muscloskeletal injury, occupational health,
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
Institute of Musculoskeletal Health and Arthritis.
Research Report Platform Presentation
1801 Wednesday 6 June 14:45
VCEC Meeting Rooms 19-20
FAMILY MEDIATED EXERCISES (FAME) FOLLOWING STROKE –
A SURVEY OF THE VIEWS OF ‘FAMILY MEMBERS/FRIENDS’
Galvin R1 , Stokes E1 , Cusack T2 ; 1 School of Medicine, Trinity
Centre for Health Sciences, James’s St, Dublin 8; 2 School of
Physiotherapy and Performance Science, College of Life Sciences,
Unviersity College Dublin
PURPOSE: The primary aim of this project is to determine
whether ‘family mediated exercise intervention’ (FAME) in addition
to routine physiotherapy improves muscle strength and function in
the lower limb in persons with stroke. In effect, the nominated ‘family
member/friend’ of the person with stroke receives training from the
physiotherapist and then helps the person with stroke to complete a
series of exercises each day. RELEVANCE: One major component of
stroke rehabilitation is exercise intervention. It has been suggested
that the dose of physiotherapy intervention that occurs post stroke
is, at best, ‘homeopathic’ (Pomeroy & Tallis 2002). De Weert and
Feys (2002) report that: ‘Physiotherapists need to develop strategies
whereby patients and caregivers take full responsibility for the bulk of
therapy – for instance, training of balance, strength and endurance,
repetition of simple tasks, group therapy, fitness-related training and
family involvement.’ However, the penetration from science in to
clinical practice is relatively non-existent. PARTICIPANTS: In order
to explore the views of family/friends of people with stroke on their
perceived role in the delivery of exercises (FAME) by them under
the supervision of a physiotherapist, a self-report questionnaire
was administered.‘Family members/friends’ (n=100) of people with
stroke who were actively receiving inpatient physiotherapy in a
selection of Dublin hospitals were invited to participate in the
study. METHODS: The self-report questionnaire was designed by
the authors and reviewed by five senior physiotherapists (PT’s)
in neurology/age related healthcare. The Survey Review Board in
St. James’s Hospital, Dublin, also reviewed the questionniare. The
questionnaire contained four sections that documented demographic
S540
details of the participant, frequency of participants involvement in
their ‘family member/friends’ physiotherapy, the views of participants
on the delivery of exercises by them with and without the supervision
of a PT and reasons that limit or could potentially enhance
participants participation in physiotherapy. ANALYSIS: Descriptive
statistics (mean, mode, mean) were primarily used to consider
the responses of the participants. In addition, chi-squared tests
were carried out to determine if male and female respondents
differed significantly in their responses to particular questions.
RESULTS: Ninety-one respondents reported that they would be
available to help their ‘family member/friend’ with a stroke with
his/her exercises. However only 36% reported that they had been
invited to attend physiotherapy sessions by the PT since their
‘family member/friend’ commenced physiotherapy. The majority of
respondents were willing to help deliver exercises in the hospital
and in the home setting (range 86%-99%) unsupervised following
suitable training by the PT. Commitment to work was documented as
the primary that limited respondents’ participation in physiotherapy
(24%). CONCLUSIONS: Family members of people with stroke
are willing to participate in physiotherapy. Suitable training by
the physiotherapist is necessary in order to optimise participation.
Strategies that may enhance participation in physiotherapy should
be implemented. IMPLICATIONS: The application of these findings
in the rehabilitation setting will enable the optimal involvement and
active participation of willing ‘family members/friends’ of people with
a stroke in their individually prescribed rehabilitation programmes.
KEYWORDS: Stroke, physiotherapy, family involvement. FUNDING
ACKNOWLEDGEMENTS: This project was in receipt of a gift cheque
from the ‘Friends of the Royal Hospital Donnybrook’. CONTACT:
rgalvin@tcd.ie
ETHICS COMMITTEE: Research Ethics Committee, Trinity College
Dublin.
Research Report Platform Presentation
1312 Wednesday 6 June 15:05
PP Crystal Pavilion A
A MODEL OF FACTORS INFLUENCING CARDIOPULMONARY
PHYSIOTHERAPY DECISION MAKING
Smith M1,2 ,Higgs J2 ,
Ellis E2 ; 1 Charles Sturt University; 2 The
University of Sydney
PURPOSE: Quality decision making is an essential element of good
clinical practice. A description of factors influencing cardiopulmonary
decision making is not evident in the research literature. The aim
of this study was to identify factors that influence decision making
in acute care hospital settings by cardiopulmonary physiotherapists
with varying levels of clinical experience. RELEVANCE: This study
was undertaken to inform clinical decision making by physiother-
apists as it relates to their everyday practice and to inform the
education of beginning physiotherapy practitioners. PARTICIPANTS:
Fourteen participants engaged in the practice of cardiopulmonary
physiotherapy in three experience categories (novice, intermediate
and more experienced) took part in the study. Participants were
recruited from three Australian metropolitan hospitals and practised
across a range of acute care clinical areas (e.g. intensive care,
post-abdominal surgery and respiratory medicine). METHODS: A
qualitative research study was conducted using a hermeneutic
approach. Data was collected from each participant on two occasions
by observing them undertaking their usual daily patient care activities,
and interviewing them about their decision making. A process of
participant checking was used to check that the collected data was
reflective of the decision making of the participants. ANALYSIS:
Data analysis involved an in-depth, iterative process of reading
and interpretation of the research texts. Texts for analysis were
constructed from the collected data in the form of field-notes from
the observation and interview transcripts. The texts were interpreted,
guided by hermeneutic devices: the hermeneutic circle and fusion
of horizons. Credibility of the research was enhanced by the
WCPT 2007, Research Reports
adoption of a critical, reflexive approach by the researcher during
data collection, text construction and interpretation. RESULTS: The
findings of this research resulted in the development of a model
of factors influencing clinical decision making in cardiopulmonary
physiotherapy. At the core of this model is the dependence of
decision making upon the nature of the decision task, particularly
as related to the uncertainty and difficulty of the task. This
core process of decision making was influenced by the physical,
organisational and socio-professional factors that constituted the
complex, variable and uncertain contexts of cardiopulmonary deci-
sion making. Cardiopulmonary decision making is also influenced by
practitioner factors including clinical experience, frames of reference
and particular decision making capabilities. Cardiopulmonary phys-
iotherapy practitioners develop cognitive, metacognitive, emotional
and social capabilities that enable them to make decisions in
the complex contexts of acute care settings. With increasing
experience cardiopulmonary physiotherapists demonstrate more
advanced capabilities for making optimal decisions in the contexts
of acute care cardiopulmonary physiotherapy decision making.
CONCLUSIONS: This research has revealed that clinical decision
making in cardiopulmonary physiotherapy is influenced by multiple,
complex interacting factors. Understanding, critiquing and improving
clinical decision making requires consideration of each of these
factors. IMPLICATIONS: The model developed in this research offers
a conceptual framework for cardiopulmonary physiotherapy teaching,
practice and research and has the potential to enhance the quality
of decision making in acute care settings. KEYWORDS: Clinical
reasoning, decision making. FUNDING ACKNOWLEDGEMENTS:
This work was supported financially by the Australian Physiotherapy
Research Foundation (PRF) and Charles Sturt University. CONTACT:
mesmith@csu.edu.au
ETHICS COMMITTEE: The University of Sydney and ethics
committees of the hospitals involved
Research Report Platform Presentation
2763 Wednesday 6 June 15:05
VCEC Ballroom A
IN VIVO KINEMATICS OF ANTERIOR CRUCIATE LIGAMENT
DEFICIENT KNEES DURING BILATERAL SQUATTING USING A
SINGLE-PLANE SHAPE-MATCHING TECHNIQUE
Gamada K1 , Yamaguchi S2 , Banks S3 , Moriya H2 ; 1 Department
of Physical Therapy, Hiroshima International University,
Higashi-Hiroshima Japan; 2 Department of Orthopaedic Surgery,
Graduate School of Medicine, Chiba University, Chiba, Japan;
3 Department of Mechanical and Aerospace Engineering, University
of Florida, Gainesville, USA
PURPOSE: Rupture of the anterior cruciate ligament (ACL) often
leads to early osteoarthritis (OA). The nature of pathomechanics in
knees with ACL-deficiency (ACLD) during in vivo, dynamic activities
has not been clearly understood. The goals of this in vivo study
were to demonstrate the pathological kinematics of ACLD and
determine the roles of the 2 bundles of the ACL during squatting.
RELEVANCE: Knowledge of the pathological kinematics of ACLD
during squatting will provide important implications for the use of
closed kinetic chain exercises for knees with ACLD and ACL-
reconstruction. PARTICIPANTS: Five patients with unilateral ACLD
participated in this IRB-approved, prospective study. Combined
ligament injuries, radiographic OA, underage patients were excluded.
A mean interval from injury to the testing was 144 months (range:
3-300 months). METHODS: A shape-matching technique (Banks,
1996) using single-plane lateral fluoroscopy and CT-based patient-
specific knee models were used for kinematic analysis of bilateral
squatting. Patients performed 2 sets (ACLD and contralateral knees)
of 3 cycles of bilateral squatting under fluoroscopic surveillance at
15 Hz in a wide and open stance technique to avoid overlapping
of the contralateral knees. They also underwent CT scan at 0.5mm
slice pitch, from which geometric bone models of the femur and tibia
Platform Presentations, Wednesday 6 June
were created. ANALYSIS: A custom program (KneeTrack) produced
by a co-author (SB) were used for the shape-matching procedure
to obtain 6 degrees-of-freedom knee kinematics, whose estimated
errors were 1.5mm in sagittal translations and 1.5 degrees in 3
rotations (Fregly, 2005). Cardan/Euler angle convention (Tupling and
Pierrynowski, 1987) was used for quantitative analyses. Two-way
repeated measure ANOVA was used for kinematics comparisons
and p < 0.05 were used for the level of significance. RESULTS:
Both ACLD and contralateral knees demonstrated increasing tibial
internal rotation with knee flexion between 0º and 100º in which the
rotation angles between the 2 groups were not statistically significant.
The ACLD knees showed continuing tibial internal rotation at 120º
and 130º, while the contralateral knees’ rotation remained constant
after 100º. The contralateral normal knees showed significantly more
external rotation at 120º and 130º. There was significant tibial anterior
translation at all flexion angles between 0º and 130º. The medial
anteroposterior contact points were relatively constant throughout
the flexion range, and those of the ACLD knees were located more
posteriorly at 0º, 10º, and 100º. The lateral anteroposterior contact
points moved more dynamically from anterior to posterior, and those
of the ACLD knees were located more posteriorly at 0º, 10º, 20º,
120º and 130º. CONCLUSIONS: In ACLD knees, the tibia translated
anteriorly throughout the flexion range, perhaps due to the deficient
posterolateral bundle of the ACL. The tibial internal rotation of the
ACLD knees was larger in deep flexion, which may be due to the
deficiency of the anteromedial bundle of the ACL based on the
knowledge of in vitro biomechanics. IMPLICATIONS: A closed kinetic
chain exercise, e.g. squatting, may not be a safe activity for ACLD
knees. This information should be implemented in future exercise
prescription for rehabilitation of ACL injury. KEYWORDS: ACL
deficient knee, pathokinematics, in vivo knee kinematics. FUNDING
ACKNOWLEDGEMENTS: No funding for this study was received by
any of the authors. CONTACT: kazgamada@ortho-pt.com
ETHICS COMMITTEE: Approved by the Ethics Committee at Faculty
of Medicine, Chiba University
Research Report Platform Presentation
2661 Wednesday 6 June 15:05
VCEC Ballroom B & C
HEALTH KNOWLEDGE, BELIEFS, AND BEHAVIORS OF
INDOCANADIANS WITH SPECIAL REFERENCE TO HEART
DISEASE: IMPLICATIONS FOR PHYSICAL THERAPISTS
Rodrigues G1 , Jongbloed L2 , Li Z3 , Dean E2 ; 1 Back in Motion
Rehabiltation Inc., Surrey, British Columbia, Canada; 2 School of
Rehabilitation Sciences, University of British Columbia, Vancouver,
Canada; 3 School of Communication and Culture, Royal Roads
University, Victoria, Canada
PURPOSE: Mortality from ischemic heart disease (IHD) of East
Indians who emigrate to the West, is due to lifestyle as well
as hereditary. Prevention strategies targeted towards this group
requires an understanding of factors that influence health behaviors
that predispose IHD. This study examined IHD-related knowledge,
beliefs and behaviors of IndoCanadians (ICs) and European
Canadians (ECs) to elucidate the role of culture on health behaviors.
RELEVANCE: South Asians comprise one of the largest non-
European immigrant groups in Canada as well as other cultures.
Health white papers have identified the need for culturally sensitive
and responsive healthcare. Although IHD is the leading cause of
death in Canada, the cross-cultural effectiveness of health education
strategies warrants elucidation. We argue that health education
content and delivery warrant being adapted to the individual, based
on cultural considerations. An understanding of the needs of this
unique group will promote the ideals of culturally sensitive and
responsive healthcare for minority groups. With the association
between lifestyle conditions and affluence, preventing and managing
these conditions through effective health education is a physical
therapy priority across cultural groups including the dominant culture.
S541
PARTICIPANTS: 102 first-generation ICs and 102 ECs, recruited via
convenience sampling from community centers across the Lower
Mainland of British Columbia, Canada, participated. METHODS:
A descriptive, comparative study, based on a structured self-
administered questionnaire, was conducted. Based on established
tools, the questions focused on health knowledge, beliefs, behaviors
and sociodemographic information. The back-translation method was
used to translate the questionnaire into Punjabi. ANALYSIS: De-
scriptive statistics described subject characteristics, and IHD-related
knowledge, behaviors, and beliefs. Chi-square tests and independent
t-tests examined group differences. Within-group differences were
examned for gender and age for both groups; and for ICs based
on median split of the number of years lived in Canada. The p
value was 0.05. RESULTS: ICs had less knowledge of IHD risks
(p < 0.05), and were less likely to exercise or eat healthfully compared
with ECs (p < 0.05). Barriers and motivating factors identified by
the two groups reflected their cultural orientations, e.g., focus on
relation to others than self. Duration of residence in Canada for
IC immigrants had no effect on knowledge, physical activity, and
health beliefs, although leisure-time activity and dietary practices
improved with increased time of residency in Canada (p < 0.05).
CONCLUSIONS: Differences between the East Indian and Canadian
cultures with respect to health beliefs and behaviors can be explained
based on cultural theory. Although the findings support that ICs
have less healthy lifestyles compared with ECs, there was no
evidence to support these worsened over time in Canada. The
urban environment may have a role in lifestyle practices given
high rates of IHD mortality among urban dwelling East Indian
compared with migrant ICs. The present study supports that IC
cultural values augment the effect of the Canadian environment in
influencing health behaviors. IMPLICATIONS: Insights are provided
into ways health education targeted toward these two groups can
be conceptualized, designed, and disseminated. Physical therapists
practicing in culturally diverse settings need to consider the role
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
Memorial Foundation and the Physiotherapy Foundation of Canada.
CONTACT: elizabeth.dean@ubc.ca
ETHICS COMMITTEE: The Ethics Review Board of the University of
British Columbia, Canada.
Research Report Platform Presentation
2404 Wednesday 6 June 15:05
VCEC Meeting Room 16
THE RELIABLE IDENTIFICATION OF A SUBGROUP OF
“HYPERVIGILANT” PATIENTS WITH NON-SPECIFIC LOW BACK
PAIN USING A CLINICAL EXAMINATION
McCarthy C1 , Gittins M2 , Roberts C2 , Oldham J2 ; 1 Warwick
Medical School, University of Warwick; 2 University of Manchester
PURPOSE: Non-Specific Low Back Pain (NSLBP) accounts for over
85% of all Low Back Pain diagnoses. Homogenous subgroups of pa-
tient presentation may exist within this heterogeneous condition. This
study evaluated a typical physiotherapy clinical examination’s item
reliability and ability to identify homogenous subgroups of patients
with NSLBP. RELEVANCE: There is a body of evidence suggesting
that targeting treatment to subgroups of patients with NSLBP is more
effective than not adopting this strategy of management. Importantly,
valid subgroups of NSLBP are yet to be fully established. This work
evaluated the contribution that a typical physiotherapy examination
made to identifying subgroups of NSLBP. PARTICIPANTS: Three
hundred and one patients with NSLBP, referred from primary and
secondary care, were examined by 54 physiotherapists. The study
was undertaken in 27 physiotherapy departments across the UK. The
sample of patients demonstrated moderate disability and pain. The
physiotherapists were experienced (average years since qualification,
S542
13yrs) and the majority had post-graduate qualifications. METHODS:
Patients were examined by physiotherapists using a standardised
clinical examination, developed using a Delphi consensus technique.
Each patient was examined by two physiotherapists, to allow an inter-
tester reliability study to be conducted. Only the items with acceptable
reliability were then entered into the next stage of analysis. Data
were then analysed for the presence of distinct subgroups using
k-means cluster analysis. Clusters identified by the first rater were
then compared with the clusters identified by the second rater in
a cross validation technique. ANALYSIS: Clinical examination items
were analysed for agreement using kappa coefficients and weighted
kappa coefficients for ordinal data. 95% C.I.s were calculated. K-
means cluster analysis was conducted to examine for between 2
and 5 potential clusters. Agreement in the numbers of clusters
identified in rater one and rater two’s data was assessed using kappa
coefficients. RESULTS: The inter-tester reliability of the majority of
items was moderate to substantial (52% of items with kappa > 0.40).
A k-means cluster analysis of the two data sets revealed substantial
agreement on the presence of two subgroups (k = 0.63). One group
(n=47, 16%) had higher fear avoidance beliefs related to physical
activity, sensory pain, anxiety and disability. They were more likely
to be provoked by, and avoidant of, pain provocative tests. They
were also more likely to be judged as having central sensitisation
and a dominant psychosocial component to their pain presentation.
Tests that highly predicted membership of the hypervigilant group
included the presence of allodynia whilst a negative straight leg raise
reduced the probability of membership of this group significantly.
CONCLUSIONS: The identification of a group of hypervigilant
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
questions did not contribute to the discrimination of any subgroups of
NSLBP. IMPLICATIONS: There is a strong need for the development
of a discriminatory, examination instrument that will allow us to
further identify valid subgroups of NSLBP. KEYWORDS: Low Back
Pain, Diagnosis, Reliability. FUNDING ACKNOWLEDGEMENTS:
This work was funded by a Post Doctoral Fellowship from the UK
NHS Research Capacity Generation Agency. Many thanks go to the
many patients and clinicians involved in the study.
ETHICS COMMITTEE: South East MREC
Research Report Platform Presentation
2149 Wednesday 6 June 15:05
VCEC Meeting Room 17
A STRUCTURAL EQUATION MODEL OF PHYSICAL FUNCTION
POST STROKE
Barclay-Goddard R1,2 , Lix L2 , Wood-Dauphinee S3 , Mayo N3 ;
1 Department of Physical Therapy, School of Medical Rehabilitation,
University of Manitoba, Winnipeg, Canada; 2 Department of
Community Health Sciences, University of Manitoba, Winnipeg,
Canada; 3 Division of Clinical Epidemiology and School of Physical
and Occupational Therapy, McGill University, Montreal, Canada
PURPOSE: To describe the dimensions of physical function at one
month post stroke and their associations. RELEVANCE: Physical
function is widely recognized as an important component of health
related quality of life (HRQL). Improvements in client HRQL may
be achieved by understanding the way in which physical function
is conceptualized by individuals post stroke. PARTICIPANTS: 678
persons with stroke participated as part of a one-year study entitled
“Understanding Quality of Life Post-Stroke: A Study of Individuals
and their Caregivers”, funded by the Canadian Stroke Network. The
mean age was 67.3 (14.8) years, 45.1% of the participants were
female and 49.5% had a right sided lesion. METHODS: Self report
data were from generic and stroke-specific instruments of HRQL
including the SF-36, EuroQuol, Health Utilities Index, Stroke Impact
Scale and the Preference Based Stroke Index. Ethics approval was
WCPT 2007, Research Reports
received from the University of Manitoba Health Research Ethics
Board. ANALYSIS: Structural equation modeling was used to test
two models of physical function. The first model used confirmatory
factor analysis to test a model with three latent variables of pain,
mobility, and self care. The second model used structural regression
to test the associations among these latent variables. All analyses
were performed using LISREL software. RESULTS: The mobility
latent variable included walking, stairs, and other aspects of physical
activity. Self care included items of activities of daily living, strength,
and dexterity – measures of strength and hand dexterity were
significantly associated with self care rather than mobility. The three-
factor model provided a good fit to the data. A structural regression
model in which pain has a direct effect on mobility and an indirect
effect on self care provided a good fit to the data. CONCLUSIONS:
Mobility, pain, and self care describe dimensions of physical function
one month after stroke. The effect of pain on self care appears to
be indirect, through mobility. Future work will evaluate change in
these dimensions of physical function over time. Validation of the
model in other chronic disease populations is an important next
step. IMPLICATIONS: Modeling physical function post stroke may
assist physiotherapists in understanding the components of physical
function and assist in determining goals with the client, improving
physical function and health related quality of life. KEYWORDS:
physical function, stroke, structural equation modeling. FUNDING
ACKNOWLEDGEMENTS: Original study funded by the Canadian
Stroke Network. CONTACT: barclayg@cc.umanitoba.ca
ETHICS COMMITTEE: University of Manitoba Health Research
Ethics Board
Research Report Platform Presentation
3099 Wednesday 6 June 15:05
VCEC Meeting Room 18
THE INFLUENCE OF INJURED WORKERS’ PERCEPTIONS OF
FUNCTION ON THEIR WORK STATUS AFTER SUSTAINING
A WORK-RELATED UPPER EXTREMITY MUSCULOSKELETAL
INJURY
Switzer-McIntyre S1 , Jaglal S1,2 , Hogg-Johnson S3,4 , Irvine-
Doran D5 , Holness D6,7 ; 1 University of Toronto, Faculty of Medicine,
Department of Physical Therapy; 2 Toronto Rehabilitation Institute;
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
PURPOSE: The purpose of this research was to describe the
characteristics of Ontario Workplace Safety and Insurance Board
(WSIB) claimants, who sustain an upper extremity injury, in order
to identify patterns and determine if a worker’s perceived level of
function affects their work status. RELEVANCE: The study builds
on the concept that returning to work is a multifactorial process
involving a number of physical and psychosocial factors that are
influenced by the injured worker, the health care professionals, the
employer, and the WSIB. What has not evolved in the literature to
date is how an individual’s perception of their function influences
work status. PARTICIPANTS: Subjects sustained a work-related
musculoskeletal upper extremity injury. The mean age of the study
sample is 40.2 years, 68 of the 106 participants were male. Of
the participants 42.5% were on full work duties, 22.6% on modified
work and 34.9% not at work. METHODS: A consecutive sampling
design. Workers were interviewed by telephone at approximately six-
weeks post-accident. The primary measures included; self perception
of function, the Disability Arm Shoulder and Hand Questionnaire,
select questions from the Job Content Questionnaire and open-
ended questions regarding perceptions of ability to work. ANALYSIS:
Univariate analysis followed by bivariate analysis was used to identify
trends, quantify impact and discern associations between work status
and all variables. Content analysis was used to systematically and
objectively determine the presence of patterns within the qualitiative
Platform Presentations, Wednesday 6 June
data. RESULTS: As hypothesized, an individual’s perception of their
function is related to their work status (p < 0.0001), as is their
perception of disability (p < 0.0001). Both an individual’s perception
of function and disability are strongly associated with work status at
baseline, however for this sample of workers, perceived function (OR
2.1, 95% CI 1.4 3.2) appears to have a slightly stronger relationship
than the DASH (OR 0.56, 95% CI 0.3 1.04). Those individuals who
perceived their level of function to be close to pre-accident level were
much more likely to be at work. The qualitative data supports the
overall findings, those individuals who felt valued, had modified work
programs in place, access to health care and perceived their level of
function to be close to or at their pre-accident level were much more
likely to be at work. CONCLUSIONS: While the factors that influence
work status are multidimensional; perception of function appears to
be one of the factors to consider in the overall equation. Future work
in this area is required to provide more insight into the predictive
value of self-perception of function over time on work status.
IMPLICATIONS: When an individual’s perception of their recovery
is probed duirng a physical therapy assessment it appears that
questions related to how long they feel it will take to return to activity
and whether or not they are ready to return to their pre-accident job
are good indiciators of their liklihood to return to work. The value
of a simple clinical question, which is used in everyday practice;
“What is your level of function today as compared to before your
injury” has been validated. KEYWORDS: return to work, workplace
health, optimizing function. FUNDING ACKNOWLEDGEMENTS:
Workplace Safety and Insurance Board of Ontarion, Work & Health
Scholarship; William T. McEachern Fellowship; University of Toronto,
Institute of Medical Science Merit Award; University of Toronto Open
Scholarship; University of Toronto, Department of Physical Therapy.
CONTACT: s.switzer.mcintyre@utoronto.ca
ETHICS COMMITTEE: University of Toronto, Research Ethics Board
as well as the Workplace Safety and Insurance Board of Ontario
Research Ethics Board
Research Report Platform Presentation
2114 Wednesday 6 June 15:05
VCEC Meeting Rooms 19-20
TELEHEALTH DELIVERY OF MOST, A STROKE SELF-
MANAGEMENT PROGRAM TO REMOTE AREAS IN NORTHERN
ONTARIO: RESULTS OF THE PILOT EVALUATION
Huijbregts M1,2 , Taylor D3 , Cameron J2 , Kagan A4 , McEwen S2 ,
Streiner D1 ; 1 Baycrest, Toronto, Canada; 2 University of Toronto,
Toronto, Canada; 3 St. Joseph’s Care Group, Thunder Bay, Canada;
4 Aphasia Institute, Toronto, Canada
PURPOSE: Moving on after Stroke (MOST) is a multi-modal psycho-
educational and exercise program based on self-management
principles for persons with stroke and their care partners. It
is associated with improved community reintegration and health
behaviours changes. Previous telehealth delivery of MOST used
videoconferencing with one facilitator-in-training and all study
participants in one location and the second facilitator at a distant site,
and identified a need to disseminate the program to more isolated
communities. The purpose of this current study was to explore
the feasibility of videoconference delivery to remote communities in
preparation for a randomized controlled trial. RELEVANCE: Many
individuals have difficulty resuming a satisfying life after stroke. For
those living in remote areas the problem is exacerbated by lack
of programming, scarce healthcare resource and isolation. Small
numbers of people limit opportunities for peer-support, and cost-
efficient delivery of programs. The use of telehealth to improve
access and to reduce the discrepancy in services was an important
recommendation of the recent Canadian government Romanow
report. PARTICIPANTS: People with stroke in Northwestern Ontario
three to eighteen months post stroke were invited by mail and
screened for eligibility. On average, the 11 participants were 72
years old and 11.5 months post stroke. METHODS: This was a
S543
pre-post pilot study conducted in preparation for a randomized trial
with a wait list control. Seven participants and two facilitators formed
the main Thunder Bay group and four participants connected by
videoconference from two remote locations. The primary outcomes
were: participant perceptions, attendance rate, Goal Attainment
Scaling, Reintegration to Normal Living Index (RNL), Activity-specific
Balance Confidence Scale (ABC), Geriatric Depression Scale (GDS),
Berg Balance Scale and the Six-minute Walk Test (6MWT). Data
were collected pre- and post-program, and at three-month follow-
up. Focus groups and in-depth interviews were conducted following
the program. ANALYSIS: Data analysis was conducted using
SPSS Version 14, and included descriptive statistics, comparison
of Thunder Bay to the remote group and comparisons of pre-
post outcomes for the group as a whole. Thematic analysis of
the focus group and interview data was conducted. RESULTS:
Two participants dropped out, one from each group. Attendance
rates were 83.3% overall, 89.8% for the Thunder Bay group and
70.4% for the remote group. Goal Attainment Scaling increased
for all participants by an average of 2.2 on the five point scale.
Improvements were seen on the GDS, ABC and the 6MWT. Findings
from the focus group and interviews revealed the program provided
both people with stroke and care partners with greater awareness
and acceptance of stroke, increased social support and improved
ability to cope. In addition, they reported a decrease in their perceived
loneliness when they were able to share with others in a similar
situation, even if they were in a different community. All participants
reported that videoconferencing decreased their sense of isolation.
CONCLUSIONS: Telehealth is a feasible method to disseminate
programs to rural and remote areas. IMPLICATIONS: Results from
this pilot study have been used to inform a larger randomized
controlled trial to evaluate the effectiveness of this program delivery.
KEYWORDS: stroke, community integration, telehealth. FUNDING
ACKNOWLEDGEMENTS: Heart and Stroke Foundation of Ontario.
CONTACT: taylord@tbh.net
ETHICS COMMITTEE: Baycrest Centre Research Ethic Board;
St. Joseph’s Care Group Board Ethics commmittee; Thunder Bay
Regional Health Sciences Centre RET
Research Report Platform Presentation
2164 Wednesday 6 June 15:25
PP Crystal Pavilion A
FACTORS THAT INFLUENCE THE DECISION MAKING OF
CLINICIANS IN CHOOSING A BALANCE ASSESSMENT METHOD
McGinnis P1,2 , Hack L2 , Nixon-Cave K2 , Michlovitz S2 ; 1 Richard
Stockton College of NJ, Pomona, NJ, USA; 2 Temple University,
Philadelphia, PA, USA
PURPOSE: The aims of this descriptive study were to 1) understand
the selection and utilization of balance assessment methods from
the perspective of the clinician, 2) ascertain what therapists studied
knew about available options and explore why they selected the
methods used, and 3) determine whether practice choices matched
recommendations from the literature. RELEVANCE: Evidence-
based practice is a key component of APTA’s Vision Statement.
The literature provides a variety of balance assessment methods
therapists could utilize during examination of patients with balance
deficits. However, little is known about how or why therapists
select assessment approaches for specific patients. PARTICIPANTS:
Eleven therapists were selected via purposeful sampling in order
to explore a range of factors proposed to influence assessment
decisions (6 from outpatient, 5 from inpatient rehab settings).
Participants included 8 females and 3 males; clinical experience
ranged from 4-18 years. METHODS: Qualitative methods permitted
in depth exploration of decision making. Data sources included
repeated interviews, analysis of balance assessment methods used,
and expert opinion. Credibility of the findings was established
by use of low inference data, member check, and triangulation
among participants and data sources. ANALYSIS: Qualitative data
S544
analysis software was utilized during a process of open and
axial coding, followed by thematic analysis. Inter rater reliability
of the coding scheme with an outside reader yielded 0.79 kappa
coefficient, or substantial agreement. RESULTS: The following
themes emerged from the data. Therapists used practical knowledge
drawn from experience to guide assessment decisions. Observation
of patients’ movement was the primary assessment and diagnostic
tool. The perceived value of information gathered from various
assessment approaches mattered more than testing time when
selecting approaches for specific patients. The primary advantage
of using quantitative balance tests was providing numeric data for
documentation purposes. Among participants studied, the influence
of the literature in guiding assessment decisions was limited. A
Three Stage Model of Balance Assessment Decision Making was
derived from the data, depicting both the decision making process,
and reasons influencing therapists’ choices. Participants studied were
aware of a broad range of balance assessment methods, and most
frequently used gait observation, Berg Balance Test, and ratings of
Normal, Good, Fair, or Poor. At times, therapists used quantitative
balance tests in a manner consistent with recommendations from
the literature, but they also used them for a variety of other
purposes. Participants also used a wide range of assessment
approaches based on observation and description of movement
that were not supported by research literature or expert panel
recommendations. CONCLUSIONS: Previous models of assessment
decision making have described the process therapists use during
patient examination. Current findings also provide insight into the
reasons influencing assessment decisions. In the complex and
busy nature of clinical practice, therapists gathered data that they
considered meaningful during patient examination. IMPLICATIONS:
If the goal of the profession is to foster integrating research
evidence into clinical practice, then the practical knowledge and
perceived values of therapists must be combined with findings
from the literature. Deeper understanding of factors influencing
assessment decisions will increase insight into the practice of
physical therapy. KEYWORDS: Decision-making; Balance; Examina-
tion; Evidence-based practice. FUNDING ACKNOWLEDGEMENTS:
None. CONTACT: Patricia.McGinnis@stockton.edu
ETHICS COMMITTEE: Temple University- Office for Human Subjects
Protections Institutional Review Board
Research Report Platform Presentation
3225 Wednesday 6 June 15:25
VCEC Ballroom B & C
THE ROLE OF THE CANADIAN PHYSICAL THERAPIST IN
GLOBAL HEALTH: A SWOT ANALYSIS
Alappat C1 , Siu G1 , Penfold A1 , McGovern B1 , McFarland J1 ,
Raman S2 ; 1 University of Toronto, Toronto, Canada; 2 University
of North Carolina at Chapel Hill, Chapel Hill, NC, USA
PURPOSE: The purpose of this study was to assess the current
and future roles of Canadian physical therapists (PTs) in global
health initiatives (GHIs). The results of the study were used to
generate a series of recommendations that may be used to guide
the global health activities of Canadian PTs. RELEVANCE: The role
of rehabilitation is poorly defined in developing nations. Canadian
PTs may be well-positioned to use their professional skills and
knowledge to contribute to the development of rehabilitation in
GHIs. This study provides recommendations in practice, policy
and education to enhance the work of Canadian PTs in GHIs.
PARTICIPANTS: Twenty-five internal and external sources were
interviewed. Internal informants were PTs purposively selected
from a group of members of the International Health Division
(IHD) of the Canadian Physiotherapy Association (CPA). External
informants were also purposively selected through a list generated
within the executive committee of the IHD in order to maximize
diversity of experiences and perspectives. The list of external
informants included non-Canadian PTs as well as other health care
WCPT 2007, Research Reports
professionals involved in GHIs across the globe. METHODS: The
research design consisted of three phases: Phase 1: Identification
and recruitment of key informants; Phase 2: Telephone interviews;
and Phase 3: Data analysis using a qualitative software program
(NVivo). ANALYSIS: A SWOT (Strengths, Weaknesses, Opportu-
nities, and Threats) Analysis was used to categorize transcribed
data into sub-themes according to the framework. RESULTS:
Strengths of Canadian PTs included their educational background
and training, professional adaptability, communication and teaching
skills. Weaknesses included a lack of field experience and unrealistic
expectations. Informants identified Opportunities in direct education
and curriculum development, rehabilitation service development, and
advocacy for the profession and clients. However, Threats that limited
these opportunities included limited resources, cultural and language
barriers, and local health care systems. CONCLUSIONS: The
Strengths and Opportunities appear to outweigh the Weaknesses
and Threats highlighting the potential for Canadian PTs to expand
their involvement in GHIs. In addition to direct clinical service
provision, Canadian PTs can undertake larger roles in education,
advocacy, and program implementation. These results however
highlight that there is a need for ongoing research regarding these
potential opportunities. IMPLICATIONS: The results suggest that
Canadian PTs are well positioned to partners with expanding physical
therapy education programs in developing nations, and to promote
the enlargement of rehabilitation programs that maximize use of local
resources and ensure sustainability. At the macro level, opportunities
for advocacy in policy-making exist both in developing nations,
in particular for rehabilitation programs inclusive of persons with
disabilities; and in Canada, where PTs can focus on increasing
governmental support for GHIs with a rehabilitation focus. In order to
enhance the role of the PT, we highlight the benefits of incorporating
global health themes into entry-level physical therapy curricula
and clinical internships. KEYWORDS: Global Health Initiatives,
SWOT analysis. FUNDING ACKNOWLEDGEMENTS: Physiotherapy
Foundation of Canada.
ETHICS COMMITTEE: Health Sciences I Research Ethics Board at
the University of Toronto
Research Report Platform Presentation
2947 Wednesday 6 June 15:25
VCEC Meeting Room 16
THE EFFECTS OF GRADED ACTIVITY FOR LOW BACK PAIN ON
PAIN-RELATED FEARS AND THEIR INFLUENCE ON RETURN
TO WORK
Staal B1,2 , Hlobil H2,3 , Koke A4 , Twisk J5 , Tjabe S2,3 , van
Mechelen W2,6 ; 1 Department of Epidemiology, Maastricht
University; 2 Department of Social Medicine, Institute for Research
in Extramural Medicine, VUmc Amsterdam; 3 KLM Health, Safety
and Environment, Schiphol; 4 Pain management and Research
Center, University Hospital Maastricht; 5 Department of Clinical
Epidemiology and Biostatistics, Institute for Research in Extramural
Medicine, VUmc Amsterdam; 6 Body@work, Research Center
Physical Activity, Work and Health, TNO-VU Amsterdam
PURPOSE: The purposes of this analysis were: (1) to study the
effects of a graded activity intervention for low back pain on
pain-related fears (given the earlier found positive results of this
intervention with regard to return to work), and (2) to investigate
whether reductions in pain-related fears due to the graded activity
intervention may cause a more rapid return to work. RELEVANCE:
The graded activity intervention, which can be described as a
behaviourally-oriented physical exercise programme, has been found
effective for low back pain in occupational health care, in terms of
return to work. Positive effects on (cognitive)-behavioural outcomes,
such as pain-related fears are also expected in view of the
operant conditioning behavioural background of the intervention.
In order to improve and refine knowledge about the working
mechanisms of the graded activity intervention, it is important to
Platform Presentations, Wednesday 6 June
know what characteristics of the intervention influence return to
work. PARTICIPANTS: Eligible sick-listed workers with low back
pain, who were employed by an airline company. They were
randomly assigned to a graded activity group (n=67) or a usual
care group (n=67). METHODS: The effects of graded activity were
studied in a randomised controlled trial in a Dutch occupational
care setting, and compared with usual care. Measurements were
taken at baseline, and after 3, 6, and 12 months follow-up. Primary
outcomes of this study were return to work, functional status and
pain. Secondary outcomes consisted amongst others of measures for
pain-related fears (i.e. fear-avoidance beliefs about physical activity
and work, and fear of movement/(re-)injury). ANALYSIS: In order
to meet our first purpose, analysis of covariance was applied to
analyse the differences in improvement between the two groups
regarding pain-related fears. To meet our second purpose variables
indicating a reduction in pain-related fears were added to a basic
Cox regression model which described the relationship between
treatment allocation and return to work over a 12-month follow-
up period. If our hypothesis is correct, adding reductions in pain-
related fears to the model should lead to a reduction in the hazard
ratio for return to work. RESULTS: The differences in improvement
between the two groups were statistically significant, and in favour of
the graded activity group for fear-avoidance beliefs about physical
activity and work and fear of movement/(re-)injury at 3 months
follow-up. After adding the reductions in pain-related fears over 3
months as separate variables to the basic Cox regression model,
the hazard ratio for return to work did not decrease contrary to
our hypothesis. CONCLUSIONS: The graded activity group showed
positive effects for reductions in pain-related fears, compared to
usual care. Reduction in pain-related fear was not found to play
an intermediate role between graded activity and return to work.
IMPLICATIONS: Physiotherapists who treat low back pain patients
and wish to improve return to work and pain-related fears may
consider a graded activity intervention. No recommendations can
be provided regarding the working mechanisms of this intervention
and, subsequently, which elements of the intervention need special
attention. KEYWORDS: low back pain, pain-related fears, return to
work. FUNDING ACKNOWLEDGEMENTS: The study was funded
by the Dutch Health Insurance Executive Council (CVZ). CONTACT:
bart.staal@epid.unimaas.nl
ETHICS COMMITTEE: The study was approved by the medical
ethical commitee of the VU university medical center in Amsterdam,
the Netherlands
Research Report Platform Presentation
1852 Wednesday 6 June 15:25
VCEC Meeting Room 17
MOTOR IMAGERY ABILITY AFTER STROKE
Malouin F1,2 , Doyon J3 , Durand A4 , Richards C1,2 ; 1 Department of
Rehabilitation, Laval University, Quebec City, Qc., Canada; 2 Center
for Interdisciplinary Research in Rehabilitation and Social Integration
(CIRRIS); 3 Department of Psychology and Unité de neuroimagerie
fonctionnelle, Institut universitaire de gériatrie, University of Montreal;
4 Institut de réadaptation en déficience physique de Québec
PURPOSE: Motor imagery ability is a prerequisite to benefit
from mental practice and this ability can be lost after a stroke.
The Kinesthetic and Visual Imagery Questionnaire (KVIQ-20), a
questionnaire adapted for testing motor imagery in persons with
stroke, provides a reliable tool to determine whether this ability is
intact or reduced after stroke. Study objectives were to investigate
1) the effects of a stroke on motor imagery ability as measured
by the KVIQ-20; 2) the influence of the side of the hemispheric
lesion and 3) whether the ability to imagine movements on the
affected and unaffected sides is comparable. RELEVANCE: Except
for a few case reports of patients with focalized brain lesions, very
little is known about the effects of cerebral lesions on the ability
to engage in motor imagery. PARTICIPANTS: Thirty four persons,
S545
mean age (60.5±8.2 y) who had sustained a stroke (CVA group)
in the right (RHL: n=21) or left (LHL: n=13) cerebral hemisphere
and 34 age-matched (59.3±10.5y) healthy persons (CTL group)
were administered the KVIQ-20. Patients with severe communication
or perceptual impairments were excluded. METHODS: The KVIQ-
20 assesses on a 5-point ordinal scale the clarity of the image
(visual: V subscale) and the intensity of the sensations (kinesthetic:
K subscale) that the subjects are able to imagine from the first-
person perspective. The questionnaire includes movements from the
limbs, trunk, head and shoulders. ANALYSIS: Total scores from
the V and K subscales were averaged for each group and sub-
groups; total V and K subscores were also averaged for each side
for items involving movements of the upper (UL) and lower limbs
(LL). Statistical analyses were made using 2x2 and 3x2 ANOVAs with
repeated measures followed by the post-hoc Bonferroni procedure.
The statistical level of significance was set at 0.05. RESULTS: In both
groups, the V subscores (CVA: 37.6±7.7; CTL: 37.3±8.2) were larger
(p = 0.000) than the K subscores (CVA: 33.5±9.6; CTL: 32.7±8.5)
and there was no group difference. Likewise, V subscores remained
larger than K subscores when comparing sub-groups of patients
(RHL and LHL). For the UL, in the CVA group, the V subscores
were smaller (p = 0.001) when imagining movements on the affected
side (10.9 ±2.3)than for those on the unaffected side (11.9±2.4).
For the LL, however, the K subscores were smaller (p = 0.05) when
imagining movements on the affected side (13.29±4.4) compared to
those on the unaffected side (14.4±4.1). In the CTL group, there was
no side difference for UL and LL. CONCLUSIONS: Irrespective of the
side of the cerebral lesion, patients demonstrated a level of motor
imagery ability similar to age-matched healthy subjects and both
groups demonstrated better visual than kinesthetic imagery. However,
in contrast to healthy individuals, patients had more difficulty
when imagining movements on their affected side. IMPLICATIONS:
Patients without severe communication and perceptual impairments
are able to imagine movements and thus they could benefit from
mental practice training. However, the level of ability between sides
can be different. KEYWORDS: Stroke, motor imagery questionnaire,
mental practice. FUNDING ACKNOWLEDGEMENTS: This work was
supported by the Quebec Provincial Rehabilitation Research Network
(FRSQ) and the CIHR. CONTACT: Francine.Malouin@rea.ulaval.ca
ETHICS COMMITTEE: The etics committee of the «Institut de
réadqaptation en déficience physique de Québec»
Research Report Platform Presentation
3193 Wednesday 6 June 15:25
VCEC Meeting Room 18
THE PROGNOSTIC VALUE OF WORKERS’ EXPECTATIONS
FOR RECOVERY IN PREDICTING TIMELY RETURN TO WORK
Battié M1 , Gross D1,2 ; 1 Department of Physical Therapy, University
of Alberta, Canada; 2 Workers’ Compensation Board Alberta/Millard
Health, Canada
PURPOSE: There has long been an interest in identifying indi-
viduals reporting work-related injuries who are at high risk for
prolonged disability. However, previous research has demonstrated
that predicting successful return to work is a complicated and
challenging task involving multiple factors. We expanded on recent
work that has attempted to broaden the scope of contextual
factors influencing work disability by examining injured worker’s
expectations of recovery. In particular, we sought to determine
whether perceptions of physical capacity to resume and sustain
regualr work activities, have prognostic value for timely, successful
return to work. RELEVANCE: While the majority of claimants with
‘soft tissue injuries’ return to work quickly, a small portion remains off
work for prolonged periods and goes on to long-term disability. Return
to function, including return to work, is often an important goal of
physical therapy for such individuals. The identification of prognostic
factors for prolonged work disability, including potentially modifiable
psychosocial factors, could be important in the development of more
S546
effective care strategies. PARTICIPANTS: Study participants were
work injury claimants entering the primary rehabilitation centre of the
Workers’ Compensation Board of Alberta, Canada for rehabilitation or
assessment between April 2001 and March 2002. All had open claims
for back injury or clearly objective trauma-related injuries (such as
fractures, dislocations or amputations) and were on total temporary
disability. METHODS: We conducted a prospective cohort study. A
measure of patient expectations for recovery and resumption of work
was added to data routinely collected at initial (baseline) assessment
at the rehabilitation centre. Data on a variety of possible confounding
factors were also gathered, including age, gender, occupational
loading category, Pain Disability Index, numeric pain rating, and
time from date of injury to date of baseline measures, among
others. Time in days from baseline measurements to suspension
of total temporary disability status in the following year served as
a proxy outcome measure of timely return to work and functional
recovery. ANALYSIS: Cox proportional hazards regression analysis
was used for univariate and multivariable analyses. Initially, analyses
were performed on the entire dataset, then seperately for back
versus objective injury subgroups. RESULTS: The entire sample
consisted of 536 claimants, including 317 back injury claimants
and 219 objective injury claimants. Better recovery expectations
were crudely associated with faster suspension of disability benefits
(HRR=0.91 (95% CI, 0.83-0.99), which diminished somewhat in the
multivariable analysis controlling for Pain Disability Index score, and
other identified confounding factors (HRR=0.93 (95% CI, 0.85-1.02)).
The prognostic value of worker’s expectations of recovery and return
to work tended to be higher among back injury claimants than
among those with clearly defined trauma and resultant pathology.
CONCLUSIONS: Reocvery expectations have a modest effect on
timely return to work, which appears somewhat greater in claimants
with back problems than clear trauma. IMPLICATIONS: Physical
therapists should be aware that recovery expectations, particularly
related to perceptions of physical capacity to resume and sustain
work activities, may influence timely return to work. Thus, it
could be helpful to specifically identify and address such percep-
tions during the rehabilitation process, particularly in back injury
claimants. KEYWORDS: Recovery expectations; Workers’ Compen-
sation; return-to-work; occupational rehabilitation, prospective cohort
study. FUNDING ACKNOWLEDGEMENTS: Funding was recieved
from the Workers’ Compensation Board of Alberta. CONTACT:
http://www.uofaweb.ualberta.ca/rehabmed/MicheleCritesBattie.cfm
ETHICS COMMITTEE: Ethics approval was obtained from the
University of Alberta’s Health Research Ethics Board.
Research Report Platform Presentation
2857 Wednesday 6 June 15:25
VCEC Meeting Rooms 19-20
AN INVESTIGATION INTO A HOME-BASED MOBILITY
REHABILITATION PROGRAMME FOR LATE-STAGE STROKE. A
PILOT RANDOMISED CONTROLLED TRIAL
Baer G1 , Durward B2 , Weller D3 ; 1 Dept of Physiotherapy, Queen
Margaret University College, Edinburgh, Scotland, UK; 2 Faculty
of Health and Social Sciences, Galsgow Caledonian University,
Glasgow, UK; 3 Dept of General Practice, University of Edinburgh,
Edinburgh UK
PURPOSE: This study investigated the efficacy of different task
specific exercise practice regimes (whole practice – WP or part
practice – PP) of functional tasks in a population of chronic
stroke subjects. This abstract reports results related to mobility.
RELEVANCE: The underlying theoretical rationale was based on
Motor Learning theory, suggesting that whole practice of tasks is
superior to part practice of components of tasks in neurologically
normal subjects. A number of authors have advocated the superiority
of WP over PP in a clinical setting. PARTICIPANTS: 64 chronic stroke
were recruited for the study, (31 male, 33 female). Mean age was 72.9
years (+ 9.0), mean time since stroke was 30.3 months (+ 28.8).
WCPT 2007, Research Reports
38 subjects had suffered a right Cerebrovascular accident (CVA),
26 suffered a left CVA. Ethical approval was received from Lothian
Research Ethics Committee. METHODS: Subjects were randomly
allocated to one of three groups: a control (CON), a PP or WP
group in a single blind randomised controlled trial of a four week
programme of functional tasks. A research physiotherapist visited
participants in their own home three times during the four weeks
to teach subjects either PP or WP exercises targeted at mobility
and lower limb function. CON subjects were given information about
stroke. Baseline outcome measures were taken on two occasions
prior to the intervention phase and meaned (base). The baseline was
compared to outcomes taken at the end of intervention (OM3) and a
48 hour retention test (OM4). Outcome measures included the Motor
Assessment Scale (MAS), Timed Up and Go over 2 m (TUG2m),
gait speed and a step test. ANALYSIS: Data were plotted to examine
distribution of data and descriptive data determined. Box and whisker
plots were derived and formal statistical testing using ANCOVA was
conducted. RESULTS: ANCOVA showed no statistically significant
differences for any of the measures at OM3 compared to baseline
or between OM3 and OM4. MAS: Base-OM3 p = 0.799; OM3-OM4
p =0.281; TUG2m: Base- OM3 p = 0.652; OM3-OM4 p =0.545;
Gait speed: Base- OM3 p = 0.719; OM3-OM4 p =0.859; Step Test:
Base- OM3 p = 0.677; OM3-OM4 p =0.788. Despite no statistically
significant findings, clinically relevant improvements were found. This
was most notable in the Step test with an increase in median
score from 0 (baseline) to 3 (OM3) reducing to 2 (OM4) for WP
and increased median score from 2 (baseline) to 4 maintained at
(OM3 and OM4) for PP. MAS scores also improved by 3 points
from baseline to OM3, which was maintained at OM4 in the WP
group. CONCLUSIONS: While no statistically significant changes
were found there were some clinically relevant improvements. Post-
study power calculations based on velocity data showed the study
to be underpowered and a sample of 175 per group required to give
80% power to detect mean differences between the groups of 0.2
standard deviations at the 5% significance level. IMPLICATIONS:
Valuable data to inform future trials has been provided. Future studies
with a larger sample are required to determine the efficacy of PP
or WP strategies in chronic stroke. KEYWORDS: whole practice;
part practice; chronic stroke. FUNDING ACKNOWLEDGEMENTS:
This work was funded by the Primary Care Research Fund,
Chief Scientist Office, Scotland (grant 00B/3/19/F26). CONTACT:
gbaer@qmuc.ac.uk
ETHICS COMMITTEE: Lothian Research Ethics COmmittee
Poster Displays, Wednesday 6 June
Research Report Poster Display
02-06 Wednesday 6 June 09:00
VCEC Exhibit Hall B & C
CHANGE IN THE LEVEL OF SKILL FOR MANUAL BREATHING
ASSIST TECHNIQUE IN THE PRACTICAL WORKSHOP
Masuda M1 , Yoshino T2 , Ihashi K3 , Momose K4 , Harada T5 , Ito N1 ;
1 Department of Physical Therapy, Nippon Engineering College,
Tokyo, Japan; 2 Department of Physical Therapy, Ibaraki Prefectural
University, Inashiki, Japan; 3 Department of Physical Therapy,
Yamagata Prefectural college of health and medical sciences,
Yamagata, Japan; 4 Department of Physical Therapy, Shinsyu
University, Matsumoto, Japan; 5 Department of Rehabilitation
Medicine, Iida City Hospital, Iida, Japan
PURPOSE: The purpose of this study was to evaluate change in
the skillful level of the manual breathing assist technique (MBAT) in
practical workshop and to obtain the benefits of the 5-day workshop
which is currently being implemented and the indications about
how to impart the future skills. RELEVANCE: The research by
Takahashi et al. points out MBAT as the most commonly used
method during implementation of respiratory physical therapy in
Japan, however pain and discomfort during implementation of the
Poster Displays, Wednesday 6 June
skills have been reported. In order to produce the effects of
MBAT, it is indicated that accumulation of training experiences
above a certain level and acquisition of clinically applicable skills
are necessary. PARTICIPANTS: The subjects were 24 physical
therapists participating in the 612th Workshop hosted by the
Japanese Physical Therapy Association. Skill measurement was
incorporated in the contents of the workshop, and we obtained
the subjects’ consent for participation in the measurement before
they began to take the workshop. METHODS: Qualitative evaluation
of skills and measurement of tidal volume were performed in a
female physical therapist as a subject. After each participant carried
out the MBAT 8 times, tidal volume change during implementation
of the respiratory assistance method and qualitative evaluation
of the respiratory assistance method were done with VAS. The
respiromonitor AE-300 (Minato Medical Science Co.) was used in
tidal volume measurement. The number of the qualitative evaluation
items of skills was 9 items, “overall impression”, “comfort”, “contact
sites”, “palm contact condition”, “tenderness of touch”, “direction of
assistance”, “strength of assistance”, and “range of assistance”. The
right edge of VAS as “a level possible to continue the MBAT (good)”
and the left edge as “a level not possible to continue the MBAT
(bad)”.Early measurement was performed in the afternoon of the first
day. Final evaluation was done in the afternoon of the fourth day of
the workshop. ANALYSIS: For the increased tidal volume and the
qualitative evaluation of skills, a paired t-test was used in order to find
a significant difference between the early measurement and the final
measurement. In addition, Pearson’s correlation coefficient was used
in order to find items correlated with “comfort” of VAS. RESULTS: For
the increased tidal, the average early-stage volume was 296±150
ml, and the average final-stage volume was 406±122 ml, showing a
significant increase compared to the early stage volume (P < 0.01).
For the qualitative evaluation of skills, the final stage evaluation
showed a significant increase in all items compared to the early
stage evaluation (p < 0.01). Evaluation items correlated most highly
with “comfort” among the qualitative evaluation items were “palm
contact condition” (p = 0.769) and “timing of assistance” (p = 0.737).
CONCLUSIONS: In the 5-day practical workshop, the original aim of
skills – increased tidal volume could be achieved, and simultaneously
more “comfortable” skills could be acquired. IMPLICATIONS: We
need to study whether we can aim at shortening of hours to impart
skills centering on “palm contact condition” and “timing of assistance”
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.
Research Report Poster Display
02-10 Wednesday 6 June 09:00
VCEC Exhibit Hall B & C
THE EFFECTS OF HOME-BASED EXERCISE ON EXERCISE
PERFORMANCE AND QUALITY OF LIFE IN PATIENTS WITH
CHRONIC HEART FAILURE: A META-ANALYSIS
Chien C1 , Wu Y; 1 School and Graduate of Physical Therapy,
Medical College, National Taiwan University, Taipei, Taiwan
PURPOSE: A lot of evidence demonstrated that supervised exercise
training improves exercise capacity and quality of life (QOL) in
patients with chronic heart failure (HF), however, relatively little
research related to the effects of home-based training. This study
was to perform a meta-analysis to assess the effects of home-
based exercise training on exercise capacity and QOL in patients
with HF. RELEVANCE: The home-based training model can benefit
more patients if the evidence supports the effectiveness and safety.
PARTICIPANTS: Randomized controlled trials related to home-
based cardiac rehabilitation or exercise training in patients with
HF were considered in this meta-analysis. The evaluated outcome
measures included exercise performance and QOL. METHODS:
Electronic databases were searched for English language articles
S547
with relevant keywords and Medical Sub Headings (MeSH). The
methodological quality of study we considered is randomization or
randomized cross-over study design. ANALYSIS: For continuous
variables, post-intervention net difference between groups were
compared and a weighted or standardised mean difference (WMD
or SMD) and 95% confidence intervals (CI) were calculated. For
each outcome, a test of heterogeneity was carried out to determine
whether a random or fixed effect was applied. Dichotomous outcomes
were expressed as odds ratios (OR) and 95% CI. RESULTS:
Fourteen studies published from 2000 to 2006 with 727 participants
were included. The majority of studies included patients with both
primary and secondary HF, NYHA II or III, age over 50-year-old
and predominant male patients. The home-based intervention was
performed from 6-week to 9-month, low-to-moderate intensity of
aerobic training with reported adherence around 70%. Home-based
exercise significantly increased 6MWT (WMD random effect model)
by 37.9 meters (95% CI 4.9 to 70.8), peak VO2 (WMD random effect
model) by 2.62 ml/kg/min (95% CI 1.25 to 3.99). QOL measured by
Minnesota Heart Failure Questionnire was not statistically significant
with −1.35 points by training (WMD random effect model, 95% CI
−6.66 to 3.96). Hospitalizations for cardiac events with OR 0.62
(95% CI 0.24 to 1.60), non-cardiac events with OR 1.57 (95% CI
0.52 to 4.75), and mortality with OR 0.95 (95% CI 0.32 to 2.82)
were found during the study period. CONCLUSIONS: Home-based
exercise training is effective to improve exercise capacity in HF
patients, QOL is maintained or improved after training. The meta-
analysis was done on the trials in stable, mild to moderate HF
patients aged over 50-year-old and may not represent the total
population of patients with HF. Further research is needed to
investigate the most effective dose of training and appropriate
monitoring strategy to improve the adherence of home-based model.
IMPLICATIONS: In the multidiscipline case management teamwork,
PT can assist HF patients to improve their exercise capacity,
QOL, and symptoms through the home-based training. Home-based
cardiac rehabilitation is more cost-saving than hospital-based, PT
should devote more to home-based cardiac rehabilitation in the era
of health care cost shortage. KEYWORDS: Heart failure, Exercise
training, Home-based. FUNDING ACKNOWLEDGEMENTS: This
study was unfund. We acknowledged the master student Tzu-An
Chen in our labaratory for the articles search and identification.
CONTACT: d94428001@ntu.edu.tw
Research Report Poster Display
03-14 Wednesday 6 June 09:00
VCEC Exhibit Hall B & C
INCREASING THE NUMBER OF MINORITY PHYSICAL
THERAPY STUDENTS TO REDUCE HEALTH DISPARITIES IN
NORTH CAROLINA
Radwan H, Rainey Y, Cowie R; Winston Salem State University
PURPOSE: The purpose of this study was to demonstrate a
series of initiatives to increase the number of enrolled minority
students in PT education programs in the state of NC and US.
RELEVANCE: The actual and perceived quality of care for an
individual is largely dependent on the availability of health care
professionals whose backgrounds are as diverse as the populations
they serve. Statistics show that in all health professions, minority
populations including African American, Native American, Asian
and Hispanic/ Latino persons remain under-represented relative to
the ethnic demographics of the United States (US) and the state
of North Carolina (NC). In 2005, the number of minority physical
therapists in the US was about 11.2% (APTA PT Fact Sheet, ‘05) as
compared to 33.8% of combined minority populations in 2005 (US
Census Bureau, ‘05). On the other hand, the number of minority
physical therapists in NC is approximately 6% as compared to
the 32.0% minority population statewide (US Census Bureau, ’05).
There is a shortage of minority graduate students in all physical
therapy programs. The percentage of all minority students enrolled
S548
in PT education programs nationally is 15.6% (APTA, ’05). The
relatively few Historically Black Colleges and Universities (HBCUs)
with accredited PT programs can play a major role in increasing
the number of minority physical therapists. WSSU is an HBCU
with such a program. PARTICIPANTS: This abstract presents data
from five years of student admission and progression data leading
towards PT professional practice at WSSU. METHODS: A series
of department and university initiatives were designed to prepare
students from all ethnic backgrounds to deliver PT services to diverse
populations within a variety of practice settings. These initiatives
include: preadmission counseling and assistance to increase the
overall number and quality of applicants; carefully executed, objective
admission policies and a variety of financial incentives to increase
the number of highly qualified enrollees; curricular innovations to
enhance academic and clinical success, build self-confidence, and
maximize retention of all students; assistance toward early success
on the PT Licensing Examination including continuous evaluation of
academic and clinical skills; hiring and retaining a mission-driven and
diverse faculty, staff and administration to support these initiatives.
ANALYSIS: Five years of admission data were collected, tabulated
and analyzed using descriptive techniques and compared to the state
and national statistical data. RESULTS: The initiatives listed above
allowed the WSSU program to exceed the current national average
of 15.6% by steeply increasing the number of minority enrollees from
33.2% in 2000 (N=6) to 55.6% in 2004 (N=18). While this number
dropped to 28.5% in 2005 (N=20), it rebounded to 37.5% in 2006
(N=24). CONCLUSIONS: Initiatives such as those developed by the
faculty, staff and administration of WSSU should be implemented
and consistently applied in order to increase the number of minority
students in PT education programs. IMPLICATIONS: This continued
effort to enroll more minority PT students will help decrease the health
disparities and provide for an increased quality of physical therapy
care for underserved populations throughout NC and the nation.
KEYWORDS: Health Disparities, Minority PT Students, Admission
and Progression Initiatives. FUNDING ACKNOWLEDGEMENTS:
N/A. CONTACT: radwanh@wssu.edu
ETHICS COMMITTEE: Department Accreditation Committee.
Research Report Poster Display
03-22 Wednesday 6 June 09:00
VCEC Exhibit Hall B & C
THE DEVELOPMENT AND QUALITY ASSESSMENT OF
EXAMINATIONS WITHIN THE CLINICAL PART OF THE
PHYSIOTHERAPY EDUCATION
Højvang A; CVSU-Fyn. Odense. Denmark
PURPOSE: To develop and control the quality of clinical teaching,
so that it reflects, documents and evaluates the professional and
social competencies which the students must develop and learn
in the course of their clinical training RELEVANCE: Examination
structure has an important regulatory function with regard to student
motivation and learning. The primary objective is to ensure a clear
connection between teaching and clinical trials and that the clinical
examinations test the students in the required competencies as set
out by the directive and curriculum. The second objective is to ensure
that quality control is developed across disciplines and considers
both theory and practice, and to develop new evaluation models
that meet the above demands. PARTICIPANTS: 6 clinical teachers
from 6 selected enrolled locations and 6 randomly selected students.
The enrolled clinical locations have been selected to ensure as
great a variety as possible regarding the type of client, scope and
review methods in the 4.th, 5.th and 6.th semesters. METHODS:
Practical discourse analysis-an anthropological research method with
an initial focus group interview comprised of clinical teachers; field
studies observing the clinical examinations followed by individual
interviews with the observed participants, with the goal of testing
hypotheses and explaining why the participants performed as they
did. Six clinical examination observations have been conducted.
WCPT 2007, Research Reports
Two for each semester where the clinical examinations are
conducted. ANALYSIS: Focus group interviews are transscribed and
subsequently schematised. All observations are written down and
subsequently analysed and schematised by developing hypotheses
and questions regarding the participants‘performance.These empiri
are compared with the competencies theory and the directive
requirements stating which competencies must be tested during
clinical training. Data analysis is undertaken in an interdisciplinary
group consisting of 1 theory-based teacher, 1 clinical trainer and
1 physiotherapy and occupational therapy student. Workshops are
held together with students, theoreticians and clinical trainers with
the goal providing ongoing information and inspiration in support of
the analysis process. RESULTS: The examination with its starting
point in a realistic practice situation with a patient lives up to
directive requirements. Practice competencies are documented as a
snapshot on the examination day, whilst interdisciplinary and social
competencies in practice and the student‘s practical development
can not be evaluated over time. The demands on students in clinical
examinations are different in practice, and examination difficulty and
marking criteria are unclear to the students. There is a demand
for more written work as well as for two sensors per clinical
examination. CONCLUSIONS: Methods of teaching and learning
must be developed. Clinical examinations must be developed to
ensure the correct assessment of the required competencies. The
report findings point to a combination of different types of exam
forms containing both formative and substantive evaluations together
with self-evaluation directly targeted at the competencies requiring
evaluation. IMPLICATIONS: Methods of teaching and learning and
the clinical exams must be developed to ensure that they are
testing the required competencies. KEYWORDS: clinical educa-
tion,evaluation,competencies. FUNDING ACKNOWLEDGEMENTS:
This research report was funded by The Danish Ministry of Education
and CVSU-Fýn. CONTACT: amh@cvsu.dk
Research Report Poster Display
05-02 Wednesday 6 June 09:00
VCEC Exhibit Hall B & C
LEARNING STYLE, LEARNING STRATEGY, AND LOCUS OF
CONTROL: A DESCRIPTION OF STUDENTS IN A DISTANCE
PHD PROGRAM
Hill C, Nof L, Hellman M; Nova Southeastern University
PURPOSE: Exceedingly high attrition rates (40–50%) have been
reported in the United States with the growth of distance education.
The purpose of this study was to describe, in a cross-sectional
study that identifies learning style and motivation, the students who
are in a one-of-a-kind distance PhD program at Nova Southeastern
University; a program with an impressive 3.5% attrition rate.
RELEVANCE: The factors that help reduce attrition from online
programs have not yet been clearly identified. This study attempted
to discover those factors by considering learning styles and their
contribution to student retention. PARTICIPANTS: All students who
were matriculating in the PhD, PT program as of January, 2005,
were included in the study. METHODS: A three-part online survey
was sent to all seventy-four students in the program. The first part
of the survey contained demographic information; the second part
was the Kolb Learning Style (LSI) Inventory, and the third part
was the Nowicki-Strickland Locus of Control (LOC). ANALYSIS: For
the qualitative questions, answers were grouped into themes by
each author and then compared for agreement. Descriptive statistics
were used to categorize respondents based on the Kolb LSI and
the Nowicki-Strickland LOC. Chi Square was used to determine
if there were any between-group differences. RESULTS: Thirty-
one surveys were returned, for a 40% response rate. Wanting to
perform research, furthering the career, and convenience of online
education were identified as the predominant motivating factors
keeping students in the program. Family issues, financial implications,
and volume of course work were identified as the predominant
Poster Displays, Wednesday 6 June
de-motivating factors that made it difficult for students to stay in
the program. For the Kolb LSI, there was no significant difference
between the NSU students and the norms for the general population
in terms of learning style. For the Nowicki-Strickland LOC, the vast
majority of students (74%)fell in the high internal motivation category.
Only 23% fell into the average internal/external motivation category,
and 3.2% fell in the high external motivation category, similar to
those in a study by Terrell (2002). The norms across the general
population were 33%, 52%, and 15% respectively. There was a
significant difference (p = 0.000) between the general population and
the NSU students. CONCLUSIONS: Though significance was found
in comparing the general population with the NSU students, the
populations are too different to draw conclusions from this statistic.
It is the authors’ opinion that the answer lies in the nature of
the students who attend the program and the profession’s move
to a doctoral entry level degree. Longitudinal studies that include
successful completion of the dissertation process may provide
additional insight into what makes students succeed in a distance
education environment at the doctoral level. IMPLICATIONS: Those
who score as highly internally motivated should do well in a
physical therapy online learning environment, while those who score
as highly externally motivated may be better suited to traditional
learning. This should be discussed with potential students before
they commit time and resources to physical therapy distance learning
programs. Faculty may need to maintain a high degree of contact
with those students. KEYWORDS: distance education. FUNDING
ACKNOWLEDGEMENTS: The project was funded by the Health
Professions Division of Nova Southeastern University.
ETHICS COMMITTEE: Internal Review Board, Nova Southeastern
University.
Research Report Poster Display
06-18 Wednesday 6 June 09:00
VCEC Exhibit Hall B & C
EDUCATIONAL ISSUES IN PHYSICAL THERAPY-A WORLD
PERSPECTIVE WITH EMPHASIS ON CARDIOPULMONARY
EDUCATION
Matsuo Y1 , Cahalin L2 , Collins S3 , Matsuya A1 , Caro F4 ;
1 Kobe Gakuin University, Kobe, Japan; 2 Northeastern University,
Boston, MA, USA; 3 University of Massachusetts, Lowell, MA, USA;
4 University of Massachusetts, Boston, MA, USA
PURPOSE: To provide a worldwide perspective of physical therapy
educational issues(PTEI) with emphasis on cardiopulmonary physical
therapy(CPPT) education in 40 separate countries. RELEVANCE:
Very little information exists regarding physical therapy educational is-
sues (PTEI) in various regions of the world. A better understanding of
worldwide PTEI may facilitate physical therapy(PT) education around
the globe. PARTICIPANTS: Two separate surveys in six different
languages (English, Spanish, French, Portuguese, Japanese, and
Korean) were sent electronically to the program directors(PD) and
cardiopulmonary instructors(CI) of every PT school in 29 out of 40
countries (the PT programs in the remaining 11 countries could
not be accessed despite numerous attempts). METHODS: The PD
survey examined four major areas including instruction hours(IH) in
four domains of PT (musculoskeletal, neurologic, cardiopulmonary,
and integumentary), clinical affiliation IH, teaching/learning models,
and the terminal PT degree awarded to graduates. The CI survey
examined two major aspects of the CPPT education including the
instructors background (profession, teaching experience, and clinical
experience) and IH in many areas of the CPPT curriculum. An
introduction letter describing the study was included with the surveys
and stated that returning the completed survey provided informed
consent. Reminder e-mails and additional surveys were resent
to non-respondents. ANALYSIS: Descriptive and non-parametric
analyses were performed with the level of significance set at p < 0.05.
RESULTS: The overall PD response rate was 20% and the CI
response rate was 81%. The greatest PD and CI response rates
S549
were from Japan (45% and 41%) and the USA (26% and 64%).
Therefore, detailed analyses of Japanese and the USA data were
performed and revealed that compared to the USA, Japanese PT
schools have (1)a greater coefficient of variation in CPPT IH (73%
versus 40%), (2)significant less CPPT CI experience in most of
cardiopulmonary diseases(p < 0.05), but significant greater CPPT
instruction by PT CI(p < 0.05), and (3)significant fewer IH in many
areas of CPPT(p < 0.05). Other important findings include a signifi-
cant (1)inverse relationship between the overall PT IH and the ratio of
CPPT IH in both Japan and the USA (p < 0.05),(2)greater number of
clinical affiliation hours in the USA compared to Japan (p < 0.001),and
(3)greater percentage of time spent in CPPT disease management
and clinical case studies in the USA(p < 0.001). CONCLUSIONS: The
survey results from Japan, the USA, and other countries indicate
that there is substantial diversity in PTEI among countries. The less
than optimal response rate is surprising considering the methods
used to administer the survey. The results of this study are the
first to compare and contrast PTEI around the globe which may be
helpful to improve PT education and the development of worldwide
PT practice. The specific analyses between Japan and the USA have
revealed significant differences in the approach to CPPT education.
IMPLICATIONS: Further investigation of these differences and a
more comprehensive and complete examination of international
PTEI is needed. KEYWORDS: Education, Cardiopulmonary Physical
Therapy, World Perspective. FUNDING ACKNOWLEDGEMENTS:
We gratefully acknowledge the funding support of Japanese Pfizer
Research Foundation. CONTACT: yos-matsuo@umin.ac.jp
Research Report Poster Display
08-02 Wednesday 6 June 09:00
VCEC Exhibit Hall B & C
A HONG KONG SURVEY OF THE USE AND PERCEIVED
EFFECTIVENESS OF TENS AND OTHER MODALITIES FOR THE
TREATMENT OF PAIN
Scudds R, Scudds R; Hong Kong Polytechnic University, Hung
Hom, Kowloon, Hong Kong
PURPOSE: The purpose of this study was to determine the use and
perceived effectiveness of transcutaneous electrical nerve stimulation
(TENS) and other electrotherapeutic modalities by registered phys-
iotherapists in the clinical setting in Hong Kong. RELEVANCE: Data
from this study will provide more accurate information about practice
patterns in Hong Kong. PARTICIPANTS: Completed questionnaires
were received from 205 registered physiotherapists. Approximately
one half of the respondents worked in an outpatient settings and
the majority (73.1%) had at least five years experience. METHODS:
A random sample of 30 percent of physiotherapists registered in
Hong Kong was sent a mail survey. The potential respondents were
sent an original questionnaire and then, four weeks later, the non-
respondents were sent a reminder letter and a second questionnaire.
The questionnaire asked the respondents about their demographic
information and about the use of TENS and other electrotherapeutic
modalities in their clinical practice. Specific questions about the
effectiveness of these modalities for acute and chronic pain as well
as specific types of pain that are commonly seen in clinical practice
were also included. Perceived effectiveness of each modality was
rated on a 9-point scale, with 1 being least effective and 8 being most
effective. ANALYSIS: Descriptive statistics were used to analyse the
data. Frequency distributions were used to determine the pattern
of modalities use. Means, standard deviations, and medians were
used to describe the perceived effectiveness of each modality for
the treatment of pain. RESULTS: After two mailings, 34.1 percent
of the questionnaires were completed and returned. The modalities
used more frequently by Hong Kong physiotherapists to treat pain
were TENS (97%), ice and superficial heating modalities (both
89.3%), ultrasound (85.5%) and interferential therapy (IFT)(79%).
Less used, but still common modalities included shortwave diathermy
(SWD) (49.8%), acupuncture (48.8%), laser (44.9%) and pulsed
S550
electromagnetic fields (34.1%). For the treatment of acute pain,
the modalities with the highest perceived effectiveness were ice
(mean = 6.61), IFT (mean = 6.27), and acupuncture (mean = 5.12).
IFT (mean = 6.40), acupuncture (mean = 6.16)), and SWD (mean
= 5.27) were rated the highest for the treatment of chronic pain.
CONCLUSIONS: For the treatment of both acute and chronic pain,
acupuncture was rated highly in terms of effectiveness, but used
in practice less frequently than other modalities rated as been less
effective. This may be a result of the current requirements needed
to use acupuncture in local hospital settings. IMPLICATIONS:
Physiotherapists use multiple modalities for the treatment of pain.
However, they should be allowed to use those that they perceive
to be most effective. KEYWORDS: Electrotherapeutic modalities,
effectiveness, pain. FUNDING ACKNOWLEDGEMENTS: Unfunded
project.
ETHICS COMMITTEE: Department of Rehabilitation Sciences Ethics
Review Committee, Hong Kong Polytechnic University
Research Report Poster Display
08-06 Wednesday 6 June 09:00
VCEC Exhibit Hall B & C
THE USE OF NEUROMUSCULAR ELECTRICAL STIMULATION
TO IMPROVE GAIT IN CHILDREN WITH SPASTIC DIPLEGIC
CEREBRAL PALSY
Al-Khatrawi W1 , Al- AbdulWahab S2 ; 1 Department of Physiotherapy,
King Fahad Hospital, Madina, Saudi Arabia; 2 Department of Health
Rehabilitation Sciences, King Saud University, Riyadh, Saudi Arabia
PURPOSE: Walking Patterns of spastic diplegic children due to
cerebral palsy (CP) are often inefficient. In spastic diplegia (SD),
more proximal involvement is typical. Biomechanically, gluteus
medius muscle plays an essential role in stabilizing the pelvis;
dysfunction of this muscle due to lack of normal muscular co-
activation with the hip adductors leads to inadequate abduction
during walking, and a relatively unstable pelvis. This study was
designed to investigate the short and relatively long term effects of
continuous neuromuscular electrical stimulation (NMES) of both hip
abductors on the temporal-spatial gait parameters, some of lower
extremity kinematics, and hip adductors muscle tone in children
with (SD)due to CP. RELEVANCE: Different types of (NMES) have
been used to enhance the ability of walking among this population.
However, NMES of the gluteus medius muscle using a surface
electrode during functional walking training has never been reported
as a management option to improve the gait pattern in (SD) children.
PARTICIPANTS: Experimental group of twenty one ambulant spastic
diplegic children (mean age = 7.4±2.1 years) were compared to a
patient control group of ten spastic diplegic children and a healthy
control group of twenty normal children with matched anthropometric
characteristics. METHODS: The experimental (SD) group received
three different NMES management programs; the 1st NMES program
was designed to evaluate the immediate and short-term effects
of bilateral continuous NMES of both gluteus medius muscles,
during walking. The 2nd NMES program was aimed to evaluate
the effect of 15 minutes of simultaneous and continuous NMES
of both gluteus medius during walking; 3 sessions a day for a
week. The 3rd NMES program was similar to the 1st NMES and
was designed to detect any additional changes in gait after full
adaptation to NMES and completion of the 2nd NMES program.
Dual channel stimulator with self adhesive electrodes at the tolerable
motor threshold level was used with frequency of 20Hz and pulse
width of 50ms. The effect of NMES programs was assessed using
three-dimensional gait analysis system (Motion Analysis Corp., Santa
Rosa, CA, USA) and Modified Ashworth Scale. ANALYSIS: One –
Way ANOVA with special contrast and repeated measures was
employed. RESULTS: Significant improvement of gait parameters
including the temporal spatial characteristics, most of the kinematics,
and hip adductor muscle tone of the experimental group (p < 0.001-
0.05) was observed. CONCLUSIONS: It is obvious that the designed
WCPT 2007, Research Reports
NMES management programs used in this study have significant
positive effects on the gait parameters of spastic diplegic children.
Many proposed mechanisms including reciprocal inhibition, carryover
effects, muscle activation, and increase of blood supply were
discussed and highlighted. IMPLICATIONS: In the light of this study,
gait training programs in CP should be attained either during the
application of NMES, or during the expected carryover period to get a
facilitated walking performance. KEYWORDS: Electrical Stimulation,
CP, Gluteus Medius, gait. FUNDING ACKNOWLEDGEMENTS: This
study was completely funded by the 1st author who thank Prince
Sultan Humanitarian City for facilitating the use of the motion analysis
and motor performance laboratory. CONTACT: wafmalik@yahoo.com
ETHICS COMMITTEE: Research and The Ethical Committee at
College of Applied Medical Sciences, King Saud University, Saudi
Arabia.
Research Report Poster Display
08-10 Wednesday 6 June 09:00
VCEC Exhibit Hall B & C
DOSE-RESPONSE OF FUNCTIONAL ELECTRICAL
STIMULATION ON UPPER EXTREMITY FUNCTION IN PATIENTS
WITH STROKE
Hsu S1 , Hu M1,4 , Wang Y2 , Yip P3,4 ; 1 School and Graduate Institute
of Physical Therapy, College of Medicine, National Taiwan University,
Taipei, Taiwan; 2 Department of Physical Medicine and Rehabilitation,
National Taiwan University Hospital, Taipei, Taiwan; 3 Department
of Neurology, National Taiwan University Hospital, Taipei, Taiwan;
4 Stroke Center, National Taiwan University Hospital, Taipei, Taiwan
PURPOSE: It has been proposed that electrical stimulation (ES)
enhances motor recovery of upper extremity after acute stroke. But
the long treatment time proposed by the literature is not practical
in common clinics. The aim of our study is to investigate the
treatment effects of clinical dosage of functional electrical stimulation
(30- minutes/session electrical stimulation for 4 weeks) on upper
limb motor recovery in stroke patients and to investigate whether
any dose-response of functional electrical stimulation. RELEVANCE:
this study may provide evidence and reference for clinical practice
PARTICIPANTS: Patients met the following inclusion criteria and
were recruited for this study: 1)stroke onset less than 2 months,
2)Brunnstrom stage of upper extremity 4, 3) no contraindication of
electrical stimulation, 4)signed informed consent form. METHODS:
Forty-five patients with stroke who received inpatient rehabilitation
program were enrolled. Patients were randomized to ES-high
intensity, ES-low intensity or control group. The ES-low intensity
group received 30 minutes/day, 5 days per week, and a total of 4
weeks of electrical stimulation. The ES-high intensity group received
60 minutes/day, 5 days per week, and a total of 4 weeks of electrical
stimulation. All patients also received regular rehabilitation. Fugl-
Meyer Arm subscale (FMA) and Action Research Arm Test (ARAT)
were assessed at baseline, 4 and 12 weeks. ANALYSIS: The
univariate analysis and two-way ANOVA with repeated measure were
used for statistical analysis. The results were accepted as statistically
significant at p < 0.05. RESULTS: There was no significant difference
in demographic data, FMA score and ARAT score at baseline among
three groups. Two-way ANOVA with repeated measure revealed that
the FMA score was higher in both ES groups than the control
group at 4-week (low-intensity group, p = 0.017; high-intensity group,
p = 0.033) and 12-week (low-intensity group, p = 0.005; high-intensity
group, p = 0.05) follow ups. The ARAT score was higher in both
ES groups than the control group at 12-week (low-intensity group,
p = 0.018; high-intensity group, p = 0.03) follow up. The difference of
effects on the FMA and ARAT failed to reach significance between
the low-dose and high-dose ES groups (p > 0.05). CONCLUSIONS:
Our study demonstrated significant treatment effect of additional
10 hours and 20 hours of ES on arm functions for patients with
stroke up to 12 weeks post treatment.Our study failed to demonstrate
significant dose-reponse of ES for arm function of stroke patients,
Poster Displays, Wednesday 6 June
thus future study may consider further decreasing the ES dosage until
the minimal effective clinical dose is identified to provide evidence
for clinical practice. IMPLICATIONS: it is advised that a minimal
of 10 hours of ES in addition to regular rehabilitation for stroke
patients may improve the recovery of arm functions for patients
with stroke at acute stage. It may be a practical program in clinical
setting. KEYWORDS: stroke, electrical stimulation, upper extremity
function, dose-response. FUNDING ACKNOWLEDGEMENTS: This
study was funded by Bureau of Health Promotion, Department of
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
VCEC Exhibit Hall B & C
RETEST RELIABILITY OF GRIP STRENGTH MEASURES
USING SINGLE OR MULTIPLE MEASUREMENTS FOR
COMMUNITY-DWELLING OLDER ADULTS
Wang C; Department of Physical Therapy, Tzu-Chi College
of Technology
PURPOSE: To examine the effect of using a single measurement
or the mean of multiple measurements on the retest reliability and
measurement error of grip strength measurement in community-
dwelling older adults. RELEVANCE: To improve the reliability
of grip strength measurement. PARTICIPANTS: A convenience
sample of 50 community-dwelling older adults (ages=72.1±6.8) was
recruited from a local community center through a newsletter, flyers,
and personal contact. All participants were able to follow simple
commands and were ambulatory. METHODS: This was a one week
retest reliability study. Prior to participation, all participants read and
signed an approved consent form. All subjects’ dominant hand grip
strengths were measured with a Jamar hand dynamometer in the
standard position (sitting, with arms adducted by their sides, elbow
at 90 degrees of flexion, and dynamometer handle at position 2)
as described by the American Society of Hand Therapists. Subjects
were asked to squeeze the handle as forcefully as they could
for 5 seconds. After one minute of rest, a second measurement
was taken. All subjects returned for grip strength measurements
one week later at about the same time of day. ANALYSIS:
Test retest reliability of grip strength using the first measurement,
the second measurement, and the mean of both measurements
of both sessions was calculated using the intra-class correlation
coefficient with 2-way random and absolute agreement definition
(ICC). The standard error of measurement (SEM) and the smallest
real difference (SRD = 1.96ו 2 × SEM) are also reported. RESULTS:
The descriptive statistics of grip strength, one week retest reliability,
SEM, and SRD of the grip strength measure are reported for using
the first measurement, the second measurement, and the mean
of both sessions (Table). The one week retest reliabilities of the
grip strength measurements were 0.90, 0.93, and 0.94, respectively,
using the first measurement, the second measurement, and the
mean of both measurements from each session. The SEM and
SRD were about 2kg and 6kg, respectively, when using either the
second measurement or the mean of both measurements of both
sessions. The SEM and SRD were 3kg and 7.5kg, respectively,
when using the first measurement of both sessions. CONCLUSIONS:
The one week retest reliability of grip strength measure was reliable
(ICC0.9) across three conditions. However, the SEM and the SRD
were less when using the second measure or the mean of both
measures of each session. Since the reliability of a measure is
sample dependent, the retest reliability of grip strength measure
needs to be determined for the population of interest. Using the
average score of two measurements could reduce the SRD value
by 1.65 kg compared to using the first measure and reduce by 0.1kg
compared to using the second measure. IMPLICATIONS: Based on
our results, we suggest that a practice trial be given to participants
S551
to familiarize the testing and that the second measurement in each
session be used to achieve better reliability and less measurement
error during grip strength assessment in community-dwelling older
adults. KEYWORDS: reliability, grip strength, older adults. FUNDING
ACKNOWLEDGEMENTS: This study was partially supported by a
research grand from the National Science Council, Taiwan (NSC93-
2314-B-277-003). CONTACT: cywang@tccn.edu.tw
ETHICS COMMITTEE: The Protection of Human Subjects Institu-
tional Review Board Tzu-Chi University and Hospital
Research Report Poster Display
09-18 Wednesday 6 June 09:00
VCEC Exhibit Hall B & C
MUSCLE ACTIVITY IN POLIO AFFECTED MUSCLES
(TIBIAL ANTERIOR) DURING WALK WITH AND WITHOUT
ANKLE-FOOT-ORTHOSIS
Krossén C1 , Klefbeck B2,3 , Weinberg J4 , Nilsson B4 ; 1 Department
of Rehabilitation Medicine Stockholm, Danderyd University Hospital,
Sweden; 2 Division of Physiotherapy, Department of Neurobiology,
Health Care Sciences and Society, Karolinska Instituet, Stockholm,
Sweden; 3 Department of Physical Therapy, Karolinska University
Hospital, Huddinge, Sweden; 4 Department of Clinical Neuroscience,
Karolinska Institutet, Stockholm, Sweden
PURPOSE: To evaluate the impact of ankle-foot-ortosis (AFO) in
patients with prior polio with weak dorsal foot extensors on muscle
activity in tibial anterior (TA) and biceps femoris (BF) muscles
during walk. RELEVANCE: The TA is often affected in patients with
poliomyelitis with weak dorsal foot extensors. Prior studies have
shown an EMG overuse of TA during normal walk in patients with
prior polio. AFO is used by some of these patients. The AFO lifts
the foot and prevents the patient from stumbling and makes the
gait more secure. To prevent the patients with prior polio from
muscle fatigue and increasing weakness, the recommendation is
not to overuse their polio affected muscles. No study has been
found of the effect of AFO on the muscle activity in patients with
prior polio. PARTICIPANTS: Sixteen subjects, eleven women and
five men, median 67.5 years of age (range 45-73) with prior polio
with reduced muscle strength in lower extremity, TA 2-3 and BF <4
measured with manual muscle test (0-5 scale), were included in the
study. METHODS: The subjects wore their ordinary walking shoes.
Six subjects were familiarized with the use of AFO and used their
own AFO and the others used an AFO just for the test. Surface
electrodes were placed on TA and BF in the weaker leg. Under the
same shoe, contact electrodes were placed to register heel strike
and toe off. All electrodes were connected to the Viking II EMG
machine with a 20-meter long cable. The subjects walked in a corridor
40 m back and forth and were randomised to start walking with
or without the AFO. From each subject the best recordings during
heel strike to heel strike were chosen. For each subject 21 steps
from walking with AFO and 21 steps from walking without AFO were
taken out for analysis and the integrated EMG activity was measured.
ANALYSIS: Nonparametric analysis, Wilcoxon Rank Test was used.
RESULTS: There was a significant decrease in muscle activity from
heel strike to heel strike in TA while walking with AFO (p= 0.001,
median 253 mVms without AFO, 183 mVms with AFO), both in swing
face (p = 0.002 median 96 mVms without, 67 mVms with) and in
stance face (p = 0.011 median 144 mVms without, 106 mVms with).
There was a tendency towards a decrease in muscle activity BF while
walking with AFO. CONCLUSIONS: AFO reduces muscle activity in
polio affected TA while walking. In future work it would be of interest
to study if long-term use of AFO could prevent overuse in TA and
thus slow down the progression of muscle weakness in the polio
affected TA. IMPLICATIONS: The findings of reduced muscle activity
while using an AFO can be of importance for the physiotherapist
to motivate patients with prior polio to use AFO. KEYWORDS:
EMG, poliomyelitis, walking. FUNDING ACKNOWLEDGEMENTS:
S552
The Swedish Association of Survivors of Traffic Accidents and Polio
provided funding for the study. CONTACT: charlott.krossen@ds.se
ETHICS COMMITTEE: Ethics approval by Forskningsetisk kommitté
Syd, Karolinska Institutet, Stockholm, Sweden 42/00, 2000-02-07.
Research Report Poster Display
09-22 Wednesday 6 June 09:00
VCEC Exhibit Hall B & C
LOWER EXTREMITY FLEXORS AND EXTENSORS ISOKINETIC
TESTING DURING CLOSED KINETIC CHAIN
Elhafez S, Nassif N, Elhafez G, Abdelwahid S, Ali M; Department of
Biomechanics, Faculty of Physical Therapy, Cairo University, Egypt
PURPOSE: This study was conducted to determine the lower
extremity flexors/extensors ratio of the dominant side in normal
individuals during closed kinetic chain (CKC) isokinetic testing and to
investigate the effect of velocity on this ratio. RELEVANCE: Although
the CKC activities have been introduced and well documented
as an alternative tool to evaluate patient’s ability to return to a
higher functional level, limited data exists about muscle strength
balance during this type of activities. This study provides the
information regarding muscle strength balance in multiple joint
performance, i.e. CKC activity which may help in assessment of
functional performance and for injury prevention. PARTICIPANTS:
Thirty healthy male subjects with a mean age of 19.8±2.9 years
volunteered to participate in the study. They were free from any
musculoskeletal impairment. METHODS: Each subject was asked to
perform a CKC testing (leg press task) which consisted of concentric
isokinetic lower extremity flexion and extension at linear velocities
of 24.44 cm/sec (slow velocity), 48.89 cm/sec (medium velocity),
and 73.33 cm/sec (fast velocity). The test was performed using
a Biodex system 3-isokinetic dynamometer. ANALYSIS: One way
ANOVA with repeated measures was performed using StatGraphics
software to test the effect of the three velocities on the peak force
ratio. RESULTS: The main outcome of this study was that the peak
force ratios of the lower extremity flexors and extensors were 0.36,
0.48, and 0.60, at slow, medium and fast velocities respectively. There
was a significant increase (p < 0.05) in flexors/extensors ratios of
peak force with increased speed. The total work and average power
ratios remained constant around 0.30 with no significant difference
(p > 0.05) between the three tested velocities. CONCLUSIONS: Ratio
of peak force is velocity dependent. When using this ratio as an
evaluative tool of the leg strength, the velocity dependent changes
in the flexors/extensors ratio must be taken into consideration. Total
work produced and average power generated, are highly relevant
measures but are not affected by increasing speed. IMPLICATIONS:
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:
Isokinetic, Closed Chain. FUNDING ACKNOWLEDGEMENTS: This
study was not funded. CONTACT: drsobhymahmoud@yahoo.com,
Nagui3@gega.net
ETHICS COMMITTEE: Egyptian Physical Therapy Syndicate
Research Report Poster Display
11-06 Wednesday 6 June 09:00
VCEC Exhibit Hall B & C
CONNECTION BETWEEN POSTURAL CONTROL AND
SENSORY NEUROPATHY IN PATIENTS WITH TYPE 1 DIABETES
Feher Kiss A1 , Nagy E1 , Barnai M1 , Varkonyi T2 , Horvath G3 ;
1 University of Szeged Faculty of Health Sciences Department
of Physiotherapy; 2 University of Szeged Faculty of Medicine
Department of Internal Medicine; 3 University of Szeged Faculty
of Medicine Department of Physiology
PURPOSE: The somatosensory information may be deteriorated in
type I diabetes influencing the displacement of the centre of pressure
WCPT 2007, Research Reports
(COP). The aim of the study is to compare postural mechanisms
measured by single force platform in healthy subjects under different
visual conditions and patients with diabetic sensory neuropathy.
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
impairment sites. PARTICIPANTS: 9 patients with type 1 diabetes (D)
and 9 healthy control subjects (C) took part in the study. The subjects
were randomly selected. METHODS: The COP displacement was
quantified in Romberg position by using a single force platform
under two visual conditions (eyes open and eyes closed). First the
sway path was calculated in anteroposterior (AP) and mediolateral
(ML) directions. Secondly the data were analysed by fast Fourier
transformation in various frequency bands (low: 0-0.1 Hz; middle
low: 0.1-0.5 Hz; middle high: 0.5-1 Hz; high: 1-3 Hz). Sensory nerve
function (CPT-Current Perception Threshold) was studied with a
Neurometer using transcutaneous electrical stimulation. ANALYSIS:
All data were subjected to analysis of variance The post hoc test
was the LSD multiple comparison test. The Pearson correlation was
applied to determine the relationship between the data. RESULTS:
The D showed a significantly longer sway path in AP direction
than the C without visual control. In the low frequency band the
D showed a significantly higher power with eyes open in the ML
direction compared with the AP direction, whereas without visual
control the AP power was significantly higher. In the middle low
and middle high frequency bands both in AP and ML directions
the lack of visual input significantly increased the frequency power.
The D showed significantly higher values with eyes closed in each
frequency band I the AP direction than the C. Significant correlation
was found between the CPT of median nerve at 2000 Hz and the
sway path in all conditions. Interestingly the CPT of peroneal nerve
at 2000 Hz correlated with the sway path only in ML direction in
EC condition. CONCLUSIONS: The significantly higher sway values
seen in case of the D without visual input suggests the involvement of
somatosensory system. The frequency analysis revealed a significant
increase of frequency power in AP direction at each frequency band.
The high correlation between the CPT values at 2000 Hz and the high
frequency band values are consistent with the findings that the high
frequency band is linked with propriocepive control. Interestingly the
best correlations was seen with the median nerve, and not with the
peroneal nerve which may be explained by the fact that every third
diabetic patient has Carpal tunel entrapment. IMPLICATIONS: Since
the correlation between the CPT and frequency band values was
better in case of median nerve it needs further electrophysiological
investigation in order to clarify its reason. KEYWORDS: Diabetic
neuropathy, neurometer, force platform, postural sway. FUNDING
ACKNOWLEDGEMENTS: The work was unfunded.
Research Report Poster Display
11-10 Wednesday 6 June 09:00
VCEC Exhibit Hall B & C
PULMONARY FUNCTION IN HIV CHILDREN
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
University of São Paulo - São Paulo – Brazil
PURPOSE: In Brazil between 1983 and 2004, more than 9231 new
cases of HIV – Mother to Child Transmission had been registered,
part of this children usual develops respiratory diseases and course
with changes in pulomonary function, whichever is responsible for
50% of cause of deaths.Outcome: Evaluated pulmonary function
(forced vital capacity (FVC) and forced expiratory volume in first
second (FEV1)) in a positive HIV children population (Mother to
Child Transmission). RELEVANCE: To verify if any alterations in
pulmonary function is preview detected in children with positive
HIV Mother to Child Transmission. PARTICIPANTS: Children with
age between 6 and 17 years old, who were in treatment with
Anti-retro viral therapy in a medical centre (CEADIPe) of Federal
Poster Displays, Wednesday 6 June
University of São Paulo. METHODS: Patients were evaluated and
subdivided in three clinical classification, A (soft symptom or sign),
B (moderate symptom or sign), C (severe symptom or sign). They
were evaluated by a physiotherapist and performed a spirometric test.
ANALYSIS: Data were analyzed using SPSS for Windows (Version
6.0, Microsoft Windows) and statistical significance was attained
when p < 0.05. Means and standard errors of the mean (SEM) were
used to summarize the data. The statistical significance of different
values for FVC, FEV1 and FEV1/FVC ratio was determined with the
t test. RESULTS: The medium values for FVC was 1.7±0.4 L and for
FEV1 1.43±0.37 L with the FEV1/FVC ratio of 84.49±13.71%. When
analysed in subgroups of clinical classification, group A showed a
FVC 1.76±0.4 L, group B 1.70±0.41 L and group C 1.61±0.35 L
(p = 0.917). FEV1 in group A was 1.59±0.32 L, group B 1.41±0.35 L
and group C 1.32±0.45 L (p = 0.597). In relation to FEV1/FVC ratio,
group A showed a medium value of 90.8±9.2%, group B 83.41±14%
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
this kind of population. KEYWORDS: Pulmonary function, HIV, chil-
dren evaluation, Vital capacity. FUNDING ACKNOWLEDGEMENTS:
N.A.
ETHICS COMMITTEE: The Ethics Committee for Human Research
of the Federal University of São Paulo approved this study.
Research Report Poster Display
12-14 Wednesday 6 June 09:00
VCEC Exhibit Hall B & C
CONCURRENT VALIDITY OF THE STAR EXCURSION BALANCE
TEST IN A GERIATRIC POPULATION
Stockert B, Dawna B, Priscilla L, Kevin L, Judd M; Department
of Physical Therapy, California State University, Sacramento,
California, United States
PURPOSE: The purpose of this study was to determine the
concurrent validity of the Star Excursion Balance (Star) Test in a
geriatric population. RELEVANCE: The ability to maintain balance
during activities of daily living is essentail for maintaining an
independent lifestyle. The Star Test examines balance in single leg
stance. Reports by Hertel and Stockert have shown that the Star
Test has good test-retest reliablity in subjects 20-40 and greater
than 59 years old. The validity of the Star Test has not been
demonstrated in the literature. PARTICIPANTS: All 28 subjects
were community dwellers able to stand and walk independently.
Subjects were 61-83 years old (x=73), weighed 108-223 pounds
(x=155)and were 58-73 inches tall (x=66). There were 9 males
and 19 females. METHODS: Informed consent was obtained from
all subjects. Subjects performed the Star Test, Berg Balance Test,
Dynamic Gait Index and the 30 second sit-to-stand in a single
test session. The test administrators followed standard protocols
described in the literature. The subjects completed the Yale Physical
Activity Survey. ANALYSIS: Data were analyzed using SPSS v14.0.
We determined the strength and significance of the relationship
between the test results and survey responses using a Spearman
Correlation Coefficient (rho) for nonparametric data. Significance was
set at p < 0.05. RESULTS: The Star Test was not correlated to the
other tests or the survey responses. The strength of the relationship
between the Dynamic Gait Index and 30 second sit-to-stand was fair
and the correlation was significant (r = 0.40; p = 0.034). The strength
of the relationship between the Berg Balance Test and the Dynamic
Gait Index was fair but the correlation only approached significance
(r = 0.32; p = 0.097). CONCLUSIONS: We found the strength of the
correlation between the tests results and survey responses was fair
to nonexistent. We believe this may be due in part to the high level
of function found in the subjects, i.e., half of the subjects scored the
maximum on the Berg Balance Test and/or the Dynamic Gait Index
(ceiling effect). We believe that the lack of correlation between the
S553
Star Test and the other measures may be a function of what each
test measures, i.e., the Star Test may be measuring a different or
unique combination of attributes. IMPLICATIONS: We did not find
any correlation between the Star Excursion Balance Test and other
balance tests commonly used in clinical settings. While the test-
retest reliability of the Star Test has been shown the validity of the
Star Test was not demonstrated in this study. Further studies will
need to be conducted in order to establish the value of the Star
Test in terms of concurrent and predictive validity. KEYWORDS:
Star Excursion Balance Test; balance test; geriatric; assessment.
FUNDING ACKNOWLEDGEMENTS: The study was funded in part
through a “Research & Creative Activities” grant from California
State University, Sacramento, California, United States. CONTACT:
bstockert@csus.edu
ETHICS COMMITTEE: Committee for the Protection of Human
Subject, California State University, Sacramento, United States
Research Report Poster Display
12-18 Wednesday 6 June 09:00
VCEC Exhibit Hall B & C
A STUDY OF DYNAMIC POSTURAL CONTROL BY
PERTURBATION ROTATIONAL STIMULATION WITH A
MOVABLE PLATFORM
Tanaka T1 , Maeda Y2 , Shirogane S3 , Oyama Y4 , Sugihara S5 ,
Ishikawa A6 , Izumi T7 , Ino S8 , Ifukube T8 , Nakajima Y9 ,
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
Medical University; 7 School of Engineering, Hokkaido Tokai
University; 8 Research Center for Advanced Science and
Technology, The University of Tokyo; 9 Section Of Human
Engineering,Department Of Product Technology,Hokkaido Industrial
Research Institute; 10 Department of Clinical and Rehabilitation
Engineering, Hokkaido Instutuse of Technology
PURPOSE: We examined a dynamic postural control for external
rotational stimuli on yaw and pitch movable platform by carrying
out a three-dimensional kinematic and EMG analysis. RELEVANCE:
There are few studies of dynamic standing balance induced by
rotational stimuli on a movable platform. Dynamic postural control
is necessary to maintain balance. PARTICIPANTS: Ten healthy
adults voluntarily (23.4±2.2 years) participated in the experiments.
METHODS: We obtained finding from the surface electromyographic
(sEMG). The sEMG signals were used to study the firing bilateral
behavior on gastrocnemius, tibialis anterior, rectus femoris, biceps
femoris, gluteus medius, rectus abdominis, and paraspinal muscles.
The VICON (motion analysis system) was used for measuring
the angle of the head, trunk, pelvis, hip, knee, and ankle joints.
The VICON and the sEMG were synchronized. The perturbation
stimulation was done by the moving platform with four directions
of platform tilting up and down in yaw axis, tilting left and right
in pitch axis. The angular stimulation strengths (degrees) of 3.8 º,
7.5 º, and 15 º were used. Each period of perturbation stimulation
was 200ms. All subjects tried to maintain an erect standing position
while each external perturbation stimulation was active. ANALYSIS:
We defined from T0 (the onset of perturbation) to T1 (the end
of perturbation) as “first period”, T1 to T2 (200 msec after T1)
as “second period”. The integrated sEMG (%MVC·msec) of each
period was calculated. Moreover, a time which activity of sEMG
was started after perturbation stimulation was measured as a latent
EMG response. For three-dimensional motion analysis, the maximal
values of angle of the head, trunk, pelvis, hip, knee, and ankle
joints were calculated during each stimulation period. RESULTS:
For tilting upward, TA was more active than other muscles at first
period, and activity of gastrocnemius became twice as much at the
second period. For tilting downward, the activity of gastrocnemius
was larger 2.2 times greater than other muscles at the first period.
S554
For the maximal angle values, the ankle mainly dorsiflexed when the
platform tilted upward and the ankle mainly plantarflexed when the
platform tilted downward. When the platform tilted to the left, the left
hip adducted and the right hip abducted and the right hip and knee
flexed. When the platform tilted to the right, the result was opposite
to the tilting to the left. Accooding to the latency time, the activity of
gastrocnemius and tibialis anterior muscles were shorter than other
muscles in both yaw and pitch axes conditions. CONCLUSIONS: The
results of EMG and kinematic analyses showed that the ankle and
knee strategies were used to maintain standing balance under the
condition of perturbation stimulation by the moving platform in yaw
axis. Moreover, the hip and knee strategies were used in pitch axis.
Standing balance exercise for adjusting versatile ADLs may benefit
by the assessment of dynamic postural control in the condition of
an unstable floor in which a linear stimulation or rotational stimuli
occurred IMPLICATIONS: Effective clinical balance assessment and
exercise for improving dynamic postural poor balance strategy are
needed for assessment. KEYWORDS: dynamic posural control, mov-
able platform,balance strategy. FUNDING ACKNOWLEDGEMENTS:
This work was supported by the Northern Advancement Center for
Science & Technology,2005. CONTACT: t.tanaka@scu.ac.jp
ETHICS COMMITTEE: SAPPORO CITY UNIVERSITY
Research Report Poster Display
12-22 Wednesday 6 June 09:00
VCEC Exhibit Hall B & C
INFLUENCE OF CUTANEOUS ANAESTHESIA ON WALKING
DYNAMIC BEHAVIOR AND STABILOMETRIC SCORES IN
HEALTHY SUBJECTS
Roland-Gosselin A1 ,
Chavet P2 ,
Pognant-Gros E2 ,
Rabischong P1 ;
1 Laboratory of Motion Analysis, Centre Propara, Montpellier,
France; 2 Aerodynamics and Biomechanics of Motion Laboratory
(LABM), Marseille, France
PURPOSE: Anaesthesia of the skin of the sole of the foot has
been shown to disturb motor control. The activity of the skin
mechanoreceptors around the knee is important and is correlated
with the speed and the amplitude of the active movement as shown
by Edin. We want to quantify whether the skin around the ankle,
like the skin around the arm, plays an important role during motor
control. RELEVANCE: In reeducation of the ankle, the instability of
standing patients is frequently seen by physiotherapists. However,
are only the ligaments and muscle receptors implicated in the loss
of this motor control around this joint? The skin mecanoreceptors
of the lower limbs are very active during movement and seem to
participate in proprioception. We can evaluate their importance for
motor control during static and dynamic tasks, eg., walking on a
treadmill and standing on a force-plate, by suppressing their activity
with anaesthesia of the skin around the two ankles. PARTICIPANTS:
20 young (21-26 years) healthy voluntary subjects, students of the
university, were recruited. Inclusion criteria: desease-free, pain-free,
without orthopedic abnormalities, not currently under medication, and
without prior surgical intervention. METHODS: − The cutaneous zone
around the two ankles was anaesthetised with EMLA cream (5%)
and the level of anaesthetic effect was quantified with monofilaments,
− Anesthetic effect was quantified during different tasks: (1) Subjects
walking on a treadmill (servo-controlled by torque) and 3D kinematic
movement was evaluated at 4 different speeds (Elite BTS). A force
plate was embedded under the treadmill belt, (2) Subjects in a
standing position on a force plate during 10 stable and unstable
conditions (SATEL force-plate), (3) Seated subjects, with eyes closed
(EC), measuring the ability to reproduce different angular positions
of the ankle. One observer recorded all the data. ANALYSIS:
ANOVAs were used to compare the temporal parameters during
walking and the stabilometric scores (24 parameters) before and
after anaesthesia. Bonferroni correction was applied. RESULTS: The
anaesthesia significantly influenced all the parameters (p < 0.001).
These decreased significantly (p < 0.05) for the stance and swing
WCPT 2007, Research Reports
phases, and very significantly for the step and double support
phases. The interaction (speed/anaesthesia effect) is significantly
different only for the swing phase. During the stabilometric tests
the instability is increased (p < 0.05), especially during the unstable
conditions with EC. CONCLUSIONS: These results show that the
skin mecanoreceptors play an important proprioceptive role for
motor control during static and dynamic conditions and seems to
confirm the observations of Moberg and Edin. But the mechanism
of the concious and unconcious proprioception is not yet clearly
understood. Other studies with skin anaesthesia (e.g., associating
EMG and propioceptive scores) are necessary to better understand
the importance of this inter-activity. The different levels of motor
control perturbation induced by skin anaesthesia between subjects
are considerable and must be evaluated. IMPLICATIONS: This
aspect of the proprioceptive role of the skin can enhance the
work of the physiotherapist and suggests that skin sensitivity could
be an important component of physiotherapy treatment, as has
already been suggested by Dellon. KEYWORDS: Skin anaesthesia,
proprioception. FUNDING ACKNOWLEDGEMENTS: Our thanks in
particular to the Laboratoire d’Aerodynamique et de Biomécanique
de Marseille (LABM). We also thank Dr. MT JIMENO who carried
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: augustinrogo@yahoo.fr
ETHICS COMMITTEE: The Committee of Medical Research of the
University of Marseille, France.
Research Report Poster Display
14-02 Wednesday 6 June 09:00
VCEC Exhibit Hall B & C
ALTERATION IN LOWER LIMB KINEMATICS AND KINETICS
IN INDIVIDUALS WITH HIP OSTEOARTHRITIS DURING STAIR
CLIMBING
Protopapadaki A1 , Drechsler W1 , Cramp M1 , Coutts F2 , Scott O1 ;
1 University of East London, London, UK; 2 Queen Margaret
University College, Edinburgh, UK
PURPOSE: This study was designed to investigate lower limb
kinematics and kinetics during stair ascent and descent in hip
osteoarthritic patients. It was anticipated that individuals with hip
osteoarthritis (OA) would have altered joint kinematics and kinetics
during stair ascent and descent. RELEVANCE: Understanding stair
climbing characteristics of individuals with hip OA furthers the
understanding of joint pathology and intervention. However, there
is no data in the literature regarding stair climbing patterns in
patients with hip OA. The aim of this ethically approved study was
to monitor changes in hip, knee and ankle angles and moments of
the affected lower limb during stair ascent and descent in patients
with hip OA. PARTICIPANTS: Nine patients with hip OA; 6M,
3F, mean (SD), age 63.78 (6.78) years and nine elderly healthy
subjects; 4M, 5F, age 64.78 (4.92) years with no history of lower
limb injuries, back or pelvis pathology, systemic or neuromuscular
disease participated in the study. All were able to go upstairs and
down stairs without using a handrail. METHODS: The stair case
consisted of four steps (rise height 18 cm, tread length 28.5 cm).
Kinematic and kinetic data of the lower limb was collected using
a ten camera Vicon motion analysis system (Oxford Metrics LTD,
UK) and one Bertec Force Platform (Model MIE Ltd, Leeds, UK)
positioned on the second stair step. ANALYSIS: Key variables
included for analysis were: temporal characteristics, hip/knee/ankle
angles, and external hip/knee/ankle moments, during stair ascent
and stair descent. One way ANOVA was performed to determine
possible significant differences between hip OA patients and controls.
Statistical significance was defined as p < 0.05. RESULTS: During
stair ascent, subjects with hip OA showed: significantly reduced
hip flexion angles (p < 0.05), external ankle dorsiflexion moments
(p < 0.05) and stride velocity (p < 0.001) and significantly increased
Poster Displays, Wednesday 6 June