Rehabilitation Research and Practice The latest articles from Hindawi Publishing Corporation © 2014 , Hindawi Publishing Corporation . All rights reserved. Perceived Cognitive Decline in Multiple Sclerosis Impacts Quality of Life Independently of Depression Mon, 01 Sep 2014 07:25:13 +0000 Background/Aim. The aim of this study is to examine the effects of perceived cognitive dysfunction and of depression, on self-reported QoL, in a Greek population sample of MS patients. Methods. One hundred outpatients diagnosed with MS completed the Short-Form-36 Health Survey (SF-36), as well as the Perceived Deficits Questionnaire (PDQ) and the Depression subscale of the Mental Health Inventory (MHI), as part of a clinical evaluation which included the Expanded Disability Status Scale (EDSS) estimation. Multiple linear regression was conducted to determine the best linear combination of age, gender, education, EDSS, depression, attention/concentration, retrospective memory, prospective memory, and planning/organization, for predicting QoL scores. Results. In the multivariate regression analysis models, EDSS (), depression (), perceived planning/organization (), and perceived retrospective memory dysfunction () independently predict quality of life scores. Age, sex, education level, and perceived attention/concentration dysfunction, as well as perceived prospective memory dysfunction, do not independently predict quality of life scores. Conclusions. Perceived planning/organization impairment and perceived retrospective memory impairment in MS patients predict QoL independently of the severity of disease and the severity of depression and therefore should be considered in the assessment of patient health status as well as in the design of treatment interventions and rehabilitation. Lampros Samartzis, Efthymia Gavala, Yiannis Zoukos, Achilleas Aspiotis, and Thomas Thomaides Copyright © 2014 Lampros Samartzis et al. All rights reserved. Preoperative Predictors of Ambulation Ability at Different Time Points after Total Hip Arthroplasty in Patients with Osteoarthritis Sun, 10 Aug 2014 13:18:42 +0000 The aims of this study were to identify the preoperative factors influencing ambulation ability at different postoperative time points after total hip arthroplasty (THA) and to examine the cutoff values of predictive preoperative factors by receiver operating characteristic (ROC) curves. Forty-eight women with unilateral THA were measured for hip extensor, hip abductor, and knee extensor muscle strength in both legs; hip pain (visual analog scale, VAS); and the Timed Up and Go (TUG) test pre- and postoperatively. Multiple regression analysis indicated that preoperative knee extensor strength at 3 weeks, hip abductor strength at 4 months, and age at 7 months were strongly associated with postoperative ambulation, measured using the TUG test. Optimal preoperative cutoff values for ambulation ability were 0.56 Nm/kg for knee extensor strength, 0.24 Nm/kg for hip abductor strength, and 73 years of age. Our results suggest that preoperative factors predicting ambulation ability vary by postoperative time point. Preoperative knee extensor strength, hip abductor strength, and age were useful predictors of ambulation ability at the early, middle, and late time points, respectively, after THA. Akiko Kamimura, Harutoshi Sakakima, Fumio Tsutsumi, and Nobuhiko Sunahara Copyright © 2014 Akiko Kamimura et al. All rights reserved. Functional Stretching Exercise Submitted for Spastic Diplegic Children: A Randomized Control Study Sun, 20 Jul 2014 11:36:19 +0000 Objective. Studying the effect of the functional stretching exercise in diplegic children. Design. Children were randomly assigned into two matched groups. Setting. Outpatient Clinic of the Faculty of Physical Therapy, Cairo University. Participants. Thirty ambulant spastic diplegic children, ranging in age from five to eight years, participated in this study. Interventions. The control group received physical therapy program with traditional passive stretching exercises. The study group received physical therapy program with functional stretching exercises. The treatment was performed for two hours per session, three times weekly for three successive months. Main Outcome Measure(s). H∖M ratio, popliteal angle, and gait parameters were evaluated for both groups before and after treatment. Results. There was significant improvement in all the measuring variables for both groups in favor of study group. H∖M ratio was reduced, popliteal angle was increased, and gait was improved. Conclusion(s). Functional stretching exercises were effectively used in rehabilitation of spastic diplegic children; it reduced H∖M ratio, increased popliteal angle, and improved gait. Mohamed Ali Elshafey, Adel Abd-Elaziem, and Rana Elmarzouki Gouda Copyright © 2014 Mohamed Ali Elshafey et al. All rights reserved. Work Status and Return to the Workforce after Coronary Artery Bypass Grafting and/or Heart Valve Surgery: A One-Year-Follow Up Study Sun, 15 Jun 2014 00:00:00 +0000 Background. Several characteristics appear to be important for estimating the likelihood of reentering the workforce after surgery. The aim of the present study was to describe work status in a two-year time period around the time of cardiac surgery and estimate the probability of returning to the workforce. Methods. We included 681 patients undergoing coronary artery bypass grafting and/or heart valve procedures from 2003 to 2007 in the North Denmark Region. We linked hospital data to data in the DREAM database which holds information of everyone receiving social benefits. Results. At the time of surgery 17.3% were allocated disability pension and 2.3% were allocated a permanent part-time benefit. Being unemployed one year before surgery reduced the likelihood of return to the workforce ( (0.60–0.92)) whereas unemployment at the time of surgery had no impact on return to the workforce ( (0.78–1.18)). Sickness absence before surgery reduced the likelihood of return to the workforce. Conclusion. This study found the work status before surgery to be associated with the likelihood of return to the workforce within one year after surgery. Before surgery one-fifth of the population either was allocated disability pension or received a permanent part-time benefit. Kirsten Fonager, Søren Lundbye-Christensen, Jan Jesper Andreasen, Mikkel Futtrup, Anette Luther Christensen, Khalil Ahmad, and Martin Agge Nørgaard Copyright © 2014 Kirsten Fonager et al. All rights reserved. Effects of Posteroanterior Thoracic Mobilization on Heart Rate Variability and Pain in Women with Fibromyalgia Thu, 29 May 2014 13:15:55 +0000 Fibromyalgia (FM) has been associated with cardiac autonomic abnormalities and pain. Heart rate variability (HRV) is reduced in FM with autonomic tone dominated by sympathetic activity. The purpose of this study was to evaluate the effects of one session of a posteroanterior glide technique on both autonomic modulation and pain in woman with FM. This was a controlled trial with immediate followup; twenty premenopausal women were allocated into 2 groups: (i) women diagnosed with FM and (ii) healthy women . Both groups received one session of Maitland mobilization grade III posteroanterior central pressure glide, at 2 Hz for 60 s at each vertebral segment. Autonomic modulation was assessed by HRV and pain by a numeric pain scale before and after the intervention. For HRV analyses, heart rate and RR intervals were recorded for 10 minutes. FM subjects demonstrated reduced HRV compared to controls. Although the mobilization technique did not significantly reduce pain, it was able to improve HRV quantified by an increase in rMSSD and SD1 indices, reflecting an improved autonomic profile through increased vagal activity. In conclusion, women with FM presented with impaired cardiac autonomic modulation. One session of Maitland spine mobilization was able to acutely improve HRV. Michel Silva Reis, João Luiz Quagliotti Durigan, Ross Arena, Bruno Rafael Orsini Rossi, Renata Gonçalves Mendes, and Audrey Borghi-Silva Copyright © 2014 Michel Silva Reis et al. All rights reserved. A Pilot Project of Early Integrated Traumatic Brain Injury Rehabilitation in Singapore Wed, 21 May 2014 11:13:45 +0000 Objective. Document acute neurosurgical and rehabilitation parameters of patients of all traumatic brain injury (TBI) severities and determine whether early screening along with very early integrated TBI rehabilitation changes functional outcomes. Methods. Prospective study involving all patients with TBI admitted to a neurosurgical department of a tertiary hospital. They were assessed within 72 hours of admission by the rehabilitation team and received twice weekly rehabilitation reviews. Patients with further rehabilitation needs were then transferred to the attached acute inpatient TBI rehabilitation unit (TREATS) and their functional outcomes were compared against a historical group of patients. Demographic variables, acute neurosurgical characteristics, medical complications, and rehabilitation outcomes were recorded. Results. There were 298 patients screened with an average age of years. The most common etiology was falls (77.5%). Most patients were discharged home directly (67.4%) and 22.8% of patients were in TREATS. The TREATS group functionally improved (). Regression analysis showed by the intervention of TREATS, that there was a statistically significant FIM functional gain of 18.445 points (95% CI −30.388 to −0.6502, ). Conclusion. Our study demonstrated important epidemiological data on an unselected cohort of patients with TBI in Singapore and functional improvement in patients who further received inpatient rehabilitation. Siew Kwaon Lui, Yee Sien Ng, Annie Jane Nalanga, Yeow Leng Tan, and Chek Wai Bok Copyright © 2014 Siew Kwaon Lui et al. All rights reserved. Retracted: Therapeutic Management of the Hallux Rigidus Wed, 21 May 2014 08:47:38 +0000 Rehabilitation Research and Practice Copyright © 2014 Rehabilitation Research and Practice. All rights reserved. Does the Motor Level of the Paretic Extremities Affect Balance in Poststroke Subjects? Mon, 19 May 2014 06:46:57 +0000 Background. Poststroke impairment may lead to fall and unsafe functional performance. The underlying mechanism for the balance dysfunction is unclear. Objective. To analyze the relation between the motor level of the affected limbs and balance in poststroke subjects. Method. A prospective, cross-sectional, and nonexperimental design was conducted in a rehabilitation institute. A convenience sample of 44 patients was assessed for motor level using Brunnstrom recovery stage (BRS) and Fugl-Meyer Assessment: upper (FMA-UE) and lower extremities (FMA-LE). The balance was measured by Berg Balance Scale (BBS), Postural Assessment Scale for Stroke Patients (PASS), and Functional Reach Test (FRT). Results. BRS showed moderate correlation with BBS ( to 0.60; ), PASS ( to 0.64; ) and FRT ( to 0.59; ). FMA-UE also exhibited moderate correlation with BBS (; ) and PASS (; ). FMA-LE showed fair correlation with BBS (; ) and PASS (; ). Conclusion. Motor control of the affected limbs plays an important role in balance. There is a moderate relation between the motor level of the upper and lower extremities and balance. The findings of the present study may be applied in poststroke rehabilitation. Kamal Narayan Arya, Shanta Pandian, C. R. Abhilasha, and Ashutosh Verma Copyright © 2014 Kamal Narayan Arya et al. All rights reserved. Assessing Function and Endurance in Adults with Spinal and Bulbar Muscular Atrophy: Validity of the Adult Myopathy Assessment Tool Mon, 05 May 2014 09:28:35 +0000 Purpose. The adult myopathy assessment tool (AMAT) is a performance-based battery comprised of functional and endurance subscales that can be completed in approximately 30 minutes without the use of specialized equipment. The purpose of this study was to determine the construct validity and internal consistency of the AMAT with a sample of adults with spinal and bulbar muscular atrophy (SBMA). Methods. AMAT validity was assessed in 56-male participants with genetically confirmed SBMA (mean age, 53 ± 10 years). The participants completed the AMAT and assessments for disease status, strength, and functional status. Results. Lower AMAT scores were associated with longer disease duration (; ) and lower serum androgen levels (–0.59; ). The AMAT was significantly correlated with strength and functional status (–0.88; ). The domains of the AMAT exhibited good internal consistency (Cronbach’s α = 0.77–0.89; ). Conclusions. The AMAT is a standardized, performance-based tool that may be used to assess functional limitations and muscle endurance. The AMAT has good internal consistency, and the construct validity of the AMAT is supported by its significant associations with hormonal, strength, and functional characteristics of adults with SBMA. This trial is registered with identifier NCT00303446. Michael O. Harris-Love, Lindsay Fernandez-Rhodes, Galen Joe, Joseph A. Shrader, Angela Kokkinis, Alison La Pean Kirschner, Sungyoung Auh, Cheunju Chen, Li Li, Ellen Levy, Todd E. Davenport, Nicholas A. Di Prospero, and Kenneth H. Fischbeck Copyright © 2014 Michael O. Harris-Love et al. All rights reserved. Effect of Aerobic Exercise Training on Chinese Population with Mild to Moderate Depression in Hong Kong Sun, 30 Mar 2014 12:07:24 +0000 Background. Exercise has been suggested to be a viable treatment for depression. This study investigates the effect of supervised aerobic exercise training on depressive symptoms and physical performance among Chinese patients with mild to moderate depression in early in-patient phase. Methods. A randomized repeated measure and assessor-blinded study design was used. Subjects in aerobic exercise group received 30 minutes of aerobic training, five days a week for 3 weeks. Depressive symptoms (MADRS and C-BDI) and domains in physical performance were assessed at baseline and program end. Results. Subjects in aerobic exercise group showed a more significant reduction in depressive scores (MADRS) as compared to control (between-group mean difference = 10.08 ± 9.41; ) after 3 weeks training. The exercise group also demonstrated a significant improvement in flexibility (between-group mean difference = 4.4 ± 6.13; ). Limitations. There was lack of longitudinal followup to examine the long-term effect of aerobic exercise on patients with depression. Conclusions. Aerobic exercise in addition to pharmacological intervention can have a synergistic effect in reducing depressive symptoms and increasing flexibility among Chinese population with mild to moderate depression. Early introduction of exercise training in in-patient phase can help to bridge the gap of therapeutic latency of antidepressants during its nonresponse period. Cassandra W. H. Ho, S. C. Chan, J. S. Wong, W. T. Cheung, Dicky W. S. Chung, and Titanic F. O. Lau Copyright © 2014 Cassandra W. H. Ho et al. All rights reserved. Reliability of the Function in Sitting Test (FIST) Sun, 16 Mar 2014 11:39:08 +0000 The function in sitting test (FIST) is a newly developed, performance-based measure examining deficits in seated postural control. The FIST has been shown to be internally consistent and valid in persons with neurological dysfunction but intra- and interrater reliability and test-retest reliability have not been previously described. Seven patients with chronic neurologic dysfunction were tested and videotaped performing the FIST on two consecutive days. Seventeen acute care and inpatient rehabilitation physical therapist raters scored six of the videotaped performance of the FIST on two occasions at least 2 weeks apart. Intraclass correlation coefficients were used to calculate the test-retest and intra- and interrater reliability of the FIST. ICC of 0.97 (95% CI 0.847–0.995) indicated excellent test-retest reliability of the FIST. Intra- and interrater reliability was also excellent with ICCs of 0.99 (95% CI 0.994–0.997) and 0.99 (95% CI 0.988–0.994), respectively. Physical therapists and other rehabilitation professionals can confidently use the FIST in a variety of clinical practice and research settings due to its favorable reliability characteristics. More studies are needed to describe the responsiveness and minimal clinically important level of change in FIST scores to further enhance clinical usefulness of this measure. Sharon L. Gorman, Monica Rivera, and Lise McCarthy Copyright © 2014 Sharon L. Gorman et al. All rights reserved. Can Morning Rise in Salivary Cortisol Be a Biological Parameter in an Occupational Rehabilitation Clinic? A Feasibility Study Wed, 05 Mar 2014 12:06:11 +0000 Objective. To test the feasibility of measuring salivary cortisol in an inpatient clinic for occupational rehabilitation, and cortisol as a biological parameter. Methods. In 17 patients in vocational rehabilitation, cortisol in saliva was measured at awakening, 30 min after and before bedtime. The cortisol measures were taken on day 2 and day 22 of the rehabilitation period. Cortisol awakening response was estimated in absolute value and as percent rise of the value at awakening. Results. The cortisol awakening response in absolute value was 6.7 (SD = 4.9) nmol/L on day 2 and 2.7 (SD = 5.6) nmol/L on day 22. The change was not statistically significant. The mean value for cortisol morning rise calculated in percent was 186% on day 2 and 51% on day 22. Conclusion. It is possible to conduct a clinical study including salivary cortisol in a rehabilitation clinic. This study indicates that cortisol morning rise may be a useful biological parameter for effect of intervention in a rehabilitation clinic; this remains to be tested in a larger population. Kari Storetvedt and Anne Helene Garde Copyright © 2014 Kari Storetvedt and Anne Helene Garde. All rights reserved. Preoperative Strength Training for Elderly Patients Awaiting Total Knee Arthroplasty Thu, 13 Feb 2014 14:04:02 +0000 Objective. To investigate the feasibility and effects of additional preoperative high intensity strength training for patients awaiting total knee arthroplasty (TKA). Design. Clinical controlled trial. Patients. Twenty-two patients awaiting TKA. Methods. Patients were allocated to a standard training group or a group receiving standard training with additional progressive strength training for 6 weeks. Isometric knee extensor strength, voluntary activation, chair stand, 6-minute walk test (6MWT), and stair climbing were assessed before and after 6 weeks of training and 6 and 12 weeks after TKA. Results. For 3 of the 11 patients in the intensive strength group, training load had to be adjusted because of pain. For both groups combined, improvements in chair stand and 6MWT were observed before surgery, but intensive strength training was not more effective than standard training. Voluntary activation did not change before and after surgery, and postoperative recovery was not different between groups (). Knee extensor strength of the affected leg before surgery was significantly associated with 6-minute walk () and the stair climb (, ). Conclusion. Intensive strength training was feasible for the majority of patients, but there were no indications that it is more effective than standard training to increase preoperative physical performance. This trial was registered with NTR2278. D. M. van Leeuwen, C. J. de Ruiter, P. A. Nolte, and A. de Haan Copyright © 2014 D. M. van Leeuwen et al. All rights reserved. Erratum to “Effect of Long-Term Climbing Training on Cerebellar Ataxia: A Case Series” Mon, 03 Feb 2014 07:14:30 +0000 Marianne Anke Stephan, Sylvie Krattinger, Jérôme Pasquier, Shahid Bashir, Thomas Fournier, Dieter Georg Ruegg, and Karin Diserens Copyright © 2014 Marianne Anke Stephan et al. All rights reserved. Virtual Reality Rehabilitation from Social Cognitive and Motor Learning Theoretical Perspectives in Stroke Population Thu, 09 Jan 2014 13:39:02 +0000 Objectives. To identify the virtual reality (VR) interventions used for the lower extremity rehabilitation in stroke population and to explain their underlying training mechanisms using Social Cognitive (SCT) and Motor Learning (MLT) theoretical frameworks. Methods. Medline, Embase, Cinahl, and Cochrane databases were searched up to July 11, 2013. Randomized controlled trials that included a VR intervention for lower extremity rehabilitation in stroke population were included. The Physiotherapy Evidence Database (PEDro) scale was used to assess the quality of the included studies. The underlying training mechanisms involved in each VR intervention were explained according to the principles of SCT (vicarious learning, performance accomplishment, and verbal persuasion) and MLT (focus of attention, order and predictability of practice, augmented feedback, and feedback fading). Results. Eleven studies were included. PEDro scores varied from 3 to 7/10. All studies but one showed significant improvement in outcomes in favour of the VR group (). Ten VR interventions followed the principle of performance accomplishment. All the eleven VR interventions directed subject’s attention externally, whereas nine provided training in an unpredictable and variable fashion. Conclusions. The results of this review suggest that VR applications used for lower extremity rehabilitation in stroke population predominantly mediate learning through providing a task-oriented and graduated learning under a variable and unpredictable practice. Bita Imam and Tal Jarus Copyright © 2014 Bita Imam and Tal Jarus. All rights reserved. Allocation of Attentional Resources toward a Secondary Cognitive Task Leads to Compromised Ankle Proprioceptive Performance in Healthy Young Adults Thu, 02 Jan 2014 11:08:12 +0000 The objective of the present study was to determine whether increased attentional demands influence the assessment of ankle joint proprioceptive ability in young adults. We used a dual-task condition, in which participants performed an ankle ipsilateral position-matching task with and without a secondary serial auditory subtraction task during target angle encoding. Two experiments were performed with two different cohorts: one in which the auditory subtraction task was easy (experiment 1a) and one in which it was difficult (experiment 1b). The results showed that, compared with the single-task condition, participants had higher absolute error under dual-task conditions in experiment 1b. The reduction in position-matching accuracy with an attentionally demanding cognitive task suggests that allocation of attentional resources toward a difficult second task can lead to compromised ankle proprioceptive performance. Therefore, these findings indicate that the difficulty level of the cognitive task might be the possible critical factor that decreased accuracy of position-matching task. We conclude that increased attentional demand with difficult cognitive task does influence the assessment of ankle joint proprioceptive ability in young adults when measured using an ankle ipsilateral position-matching task. Kazuhiro Yasuda, Yuki Sato, Naoyuki Iimura, and Hiroyasu Iwata Copyright © 2014 Kazuhiro Yasuda et al. All rights reserved. Content Analysis of Work Limitation, Stanford Presenteeism, and Work Instability Questionnaires Using International Classification of Functioning, Disability, and Health and Item Perspective Framework Sat, 28 Dec 2013 10:24:16 +0000 Background. Presenteeism refers to reduced performance or productivity while at work due to health reasons. WLQ-26, SPS-6, and RA-WIS are the commonly used self-report presenteeism questionnaires. These questionnaires have acceptable psychometric properties but have not been subject to structured content analysis that would define their conceptual basis. Objective. To describe the conceptual basis of the three questionnaires using ICF and IPF and then compare the distribution and content of codes to those on the vocational rehabilitation core set. Methods. Two researchers independently linked the items of the WLQ-26, SPS-6, and RA-WIS to the ICF and IPF following the established linking rules. The percentage agreement on coding was calculated between the researchers. Results. WLQ-26 was linked to 62 ICF codes, SPS-6 was linked to 17 ICF codes, and RA-WIS was linked to 74 ICF codes. Most of these codes belonged to the activity and participation domains. All the concepts were classified by the IPF, and the most were rational appraisals within the social domain. Only 12% of codes of the core set for vocational rehabilitation were used in this study to code these questionnaires. Conclusion. The specific nature of work disability that was included in these three questionnaires was difficult to explain using ICF since many aspects of content were not confined. The core set for vocational rehabilitation covered very limited content of the WLQ-26, SPS-6, and RA-WIS. Vanitha Arumugam, Joy C. MacDermid, and Ruby Grewal Copyright © 2013 Vanitha Arumugam et al. All rights reserved. Immediate Beneficial Effects of Mental Rotation Using Foot Stimuli on Upright Postural Stability in Healthy Participants Thu, 26 Dec 2013 10:38:11 +0000 The present study was designed to investigate whether an intervention during which participants were involved in mental rotation (MR) of a foot stimulus would have immediate beneficial effects on postural stability (Experiment 1) and to confirm whether it was the involvement of MR of the foot, rather than simply viewing foot stimuli, that could improve postural stability (Experiment 2). Two different groups of participants ( in each group) performed MR intervention of foot stimuli in each of the two experiments. Pre- and postmeasurements of postural stability during unipedal and bipedal standing were made using a force plate for the intervention. Consistently, postural sway values for unipedal standing, but not for bipedal standing, were decreased immediately after the MR intervention using the foot stimuli. Such beneficial effects were not observed after the MR intervention using car stimuli (Experiment 1) or when participants observed the same foot stimuli during a simple reaction task (Experiment 2). These findings suggest that the MR intervention using the foot stimuli could contribute to improving postural stability, at least when it was measured immediately after the intervention, under a challenging standing condition (i.e., unipedal standing). Tsubasa Kawasaki and Takahiro Higuchi Copyright © 2013 Tsubasa Kawasaki and Takahiro Higuchi. All rights reserved. Shoulder Pain, Functional Status, and Health-Related Quality of Life after Head and Neck Cancer Surgery Wed, 25 Dec 2013 14:18:38 +0000 Head and neck cancer (HNC) patients experience treatment-related complications that may interfere with health-related quality of life (HRQOL). The purpose of this study was to describe the symptom experience (shoulder pain) and functional status factors that are related to global and domain-specific HRQOL at one month after HNC surgery. In this exploratory study, we examined 29 patients. The outcome variables included global HRQOL as well as physical, functional, emotional, and social well-being. Symptom experience and functional status factors were the independent variables. In the symptom experience variables, shoulder pain distress was negatively associated with physical well-being (). Among the functional status variables, eating impairment was negatively related to global HRQOL () and physical well-being (). Speaking impairment and impaired body image explained a large amount of the variance in functional well-being (). This study provided initial results regarding symptom experience and functional status factors related to poor HRQOL in the early postoperative period for HNC patients. Hsiao-Lan Wang, Juanita F. Keck, Michael T. Weaver, Alan Mikesky, Karen Bunnell, Janice M. Buelow, and Susan M. Rawl Copyright © 2013 Hsiao-Lan Wang et al. All rights reserved. Home-Based Multidisciplinary Rehabilitation following Hip Fracture Surgery: What Is the Evidence? Tue, 17 Dec 2013 14:31:09 +0000 Objective. To determine the effects of multidisciplinary home rehabilitation (MHR) on functional and quality of life (QOL) outcomes following hip fracture surgery. Methods. Systematic review methodology suggested by Cochrane Collboration was adopted. Reviewers independently searched the literature, selected the studies, extracted data, and performed critical appraisal of studies. Summary of the results of included studies was provided. Results. Five studies were included. Over the short-term, functional status and lower extremity strength were better in the MHR group compared to the no treatment group (NT). Over the long-term, the MHR group showed greater improvements in balance confidence, functional status, and lower extremity muscle strength compared to NT group, whereas the effect on QOL and mobility was inconsistent across the studies. Several methodological issues related to study design were noted across the studies. Conclusion. The MHR was found to be more effective compared to the NT in improving functional status and lower extremity strength in patients with hip fracture surgery. Results of this review do not make a strong case for MHR due to high risk of bias in the included studies. Further research is required to accurately characterize the types of disciplines involved in MHR and frequency and dosage of intervention. Kathleen Donohue, Richelle Hoevenaars, Jocelyn McEachern, Erica Zeman, and Saurabh Mehta Copyright © 2013 Kathleen Donohue et al. All rights reserved. Intrarater and Interrater Reliability of the Flexicurve Index, Flexicurve Angle, and Manual Inclinometer for the Measurement of Thoracic Kyphosis Thu, 12 Dec 2013 12:15:45 +0000 Objective. This study aimed to describe the interrater and intrarater reliability of the flexicurve index, flexicurve angle, and manual inclinometer in swimmers. A secondary objective was to determine the level of agreement between the inclinometer angle and the flexicurve angle and to provide an equation to approximate one angle from the other. Methods. Thirty swimmers participated. Thoracic kyphosis was measured using the flexicurve and the manual inclinometer. Intraclass correlation coefficient, 95% confidence interval, and standard error of measurement were computed. Results. The flexicurve angle and index showed excellent intrarater (ICC = 0.94) and good interrater (ICC = 0.86) reliability. The inclinometer demonstrated excellent intrarater (ICC = 0.92) and interrater (ICC = 0.90) reliability. The flexicurve angle was systematically smaller and correlated poorly with the inclinometer angle (). The following equations can be used for approximate conversions: flexicurve angle = (0.275 × inclinometer angle) + 8.478; inclinometer angle = (1.396 × flexicurve angle) + 8.694. Conclusion. The inclinometer and flexicurve are both reliable instruments for thoracic kyphosis measurement in swimmers. Although the flexicurve and inclinometer angles are not directly comparable, the approximate conversion factors provided will permit translation of flexicurve angle to inclinometer angle and vice versa. Eva Barrett, Karen McCreesh, and Jeremy Lewis Copyright © 2013 Eva Barrett et al. All rights reserved. Assessing and Comparing Global Health Competencies in Rehabilitation Students Sat, 07 Dec 2013 11:07:23 +0000 Purpose. Globalization is contributing to changes in health outcomes and healthcare use in many ways, including health professionals’ practices. The objective of this study was to assess and compare global health competencies in rehabilitation students. Method. Online cross-sectional survey of physiotherapy and occupational therapy students from five universities within Ontario. We used descriptive statistics to analyze students’ perceived knowledge, skills, and learning needs in global health. We used Chi-square tests, with significance set at , to compare results across professions. Results. One hundred and sixty-six students completed the survey. In general, both physiotherapy and occupational therapy students scored higher on the “relationship between work and health,” “relationship between income and health,” and “socioeconomic position (SEP) and impact on health” and lower on “Access to healthcare for low income nations,” “mechanisms for why racial and ethnic disparities exist,” and “racial stereotyping and medical decision making.” Occupational therapy students placed greater importance on learning concerning social determinants of health (). Conclusion. This paper highlights several opportunities for improvement in global health education for rehabilitation students. Educators and professionals should consider developing strategies to address these needs and provide more global health opportunities in rehabilitation training programs. Mirella Veras, Kevin Pottie, Debra Cameron, Govinda P. Dahal, Vivian Welch, Tim Ramsay, and Peter Tugwell Copyright © 2013 Mirella Veras et al. All rights reserved. Early Physical Activity and Discharge Destination after Stroke: A Comparison of Acute and Comprehensive Stroke Unit Care Wed, 04 Dec 2013 12:02:24 +0000 Background. Common models of acute stroke care include the acute stroke unit, focusing on acute management, and the comprehensive stroke unit, incorporating acute care and rehabilitation. We hypothesise that the rehabilitation focus in the comprehensive stroke unit promotes early physical activity and discharge directly home. Methods. We conducted a two-centre prospective observational study of patients admitted to a comprehensive or acute stroke unit within 14 days poststroke. We recruited 73 patients from each site, matched on age, stroke severity, premorbid function, and walking ability. Patient activity was measured using behavioural mapping. Therapy activity was recorded by therapist report. Time to first mobilisation, discharge destination, and length of stay were extracted from the medical record. Results. The comprehensive stroke unit group included more males, fewer partial anterior circulation infarcts, more lacunar infarcts, and more patients ambulant without aids prior to their stroke. Patients in the comprehensive stroke unit spent 14.4% more (95% CI: 8.9%–19.8%; ) of the day in moderate or high activity, 18.5% less time physically inactive (95% CI: 5.0%–32.0%; ), and were more likely to be discharged directly home (OR 3.7; 95% CI 1.4–9.5; ). Conclusions. Comprehensive stroke unit care may foster early physical activity, with likely discharge directly home. Tanya West, Leonid Churilov, and Julie Bernhardt Copyright © 2013 Tanya West et al. All rights reserved. Social Support Contributes to Outcomes following Distal Radius Fractures Mon, 04 Nov 2013 09:47:53 +0000 Background. Distal radius fractures are the most common fracture of the upper extremity and cause variable disability. This study examined the role of social support in patient-reported pain and disability at one year following distal radius fracture. Methods. The Medical Outcomes Study Social Support Survey was administered to a prospective cohort of 291 subjects with distal radius fractures at their baseline visit. Pearson correlations and stepwise linear regression models (-to-remove 0.10) were used to identify whether social support contributes to wrist fracture outcomes. The primary outcome of pain and disability at one year was measured using the Patient Rated Wrist Evaluation. Results. Most injuries were low energy (67.5%) and were treated nonoperatively (71.9%). Pearson correlation analysis revealed that higher reported social support correlated with improved Patient Rated Wrist Evaluation scores at 1 year, , . Of the subscales within the Social Support Survey, emotional/informational support explained a significant proportion of the variance in 1-year Patient Rated Wrist Evaluation scores, , (1, 181) = 9.98, . Conclusion. Lower emotional/informational social support at the time of distal radius fracture contributes a small but significant percentage to patient-reported pain and disability outcomes. Caitlin J. Symonette, Joy MacDermid, and Ruby Grewal Copyright © 2013 Caitlin J. Symonette et al. All rights reserved. Interrater Reproducibility of Knee Movement Analyses during the Stance Phase: Use of Anatomical Landmark Calibration with a Rigid Marker Set Thu, 03 Oct 2013 11:05:46 +0000 Objective. Measurements of knee joint movement in gait analysis may result in large errors caused by misplacement of reflective markers by the testers. To properly understand the measurement results, it is important to guarantee the reliability of the measurement method used for the purpose. The aim of this study was to confirm the interrater reproducibility of a measurement method with a rigid marker set (RMS). Methods. The study subjects were four healthy adults, and the testers were three physical therapists. The interrater reproducibility of the measurements was verified by using the coefficient of multiple correlations (CMCs) and the standard error of measurement (SEM). Results. The average CMCs values of 4 subjects in knee joint movement at the stance phase were greater than 0.8, and the average SEM values of 4 subjects in knee joint movement at the stance phase were also relatively good (maximum error: 2.42°). Conclusion. Based on these results, the measurement method with estimation of anatomical landmarks using the RMS can prevent misplacement during attachment of the reflective markers, as long as the testers have sufficient experience in attaching reflective markers. Takashi Fukaya, Hirotaka Mutsuzaki, and Yasuyoshi Wadano Copyright © 2013 Takashi Fukaya et al. All rights reserved. Does the Inclusion of Virtual Reality Games within Conventional Rehabilitation Enhance Balance Retraining after a Recent Episode of Stroke? Sun, 18 Aug 2013 14:00:13 +0000 This randomised controlled and double-blinded pilot study evaluated if interactive virtual reality balance related games integrated within conventional rehabilitation sessions resulted in more superior retraining of dynamic balance compared to CR after stroke. 19 subjects diagnosed with a recent episode of stroke were recruited from a local rehabilitation hospital and randomly assigned to either a control or an experimental group. Subjects in the control groups underwent 60 minutes of conventional rehabilitation while those in the experimental groups underwent 40 minutes of convention rehabilitation and 20 minutes of self-directed virtual reality balanced rehabilitation. Functional Reach Test, Timed Up and Go, Modified Barthel Index, Berg Balance Scale, and Centre of Pressure of subjects in both groups were evaluated before and on completion of the rehabilitation sessions. Results indicate that the inclusion of interactive virtual reality balance related games within conventional rehabilitation can lead to improved functional mobility and balance after a recent episode of stroke without increasing treatment time that requires more health professional manpower. B. S. Rajaratnam, J. Gui KaiEn, K. Lee JiaLin, Kwek SweeSin, S. Sim FenRu, Lee Enting, E. Ang YiHsia, Ng KeatHwee, Su Yunfeng, W. Woo YingHowe, and S. Teo SiaoTing Copyright © 2013 B. S. Rajaratnam et al. All rights reserved. Physiotherapy Treatment in Patients with Hemophilia and Chronic Ankle Arthropathy: A Systematic Review Mon, 12 Aug 2013 11:07:41 +0000 Haemophilic arthropathy of the ankle causes pain and deterioration in gait, causing disability. Although some physiotherapy modalities are effective in the management of acute bleeding, the results are unknown in chronic arthropathy. Our objective was to determine the most effective physiotherapy procedures for treating the haemophilic arthropathy of the ankle and to assess the methodological quality of the studies. A systematic review was carried out in the Cochrane Database, PubMed, MEDLINE, ISI Web of Knowledge, PEDro, TESEO, and specialized journals (Haemophilia and Haematologica). It included articles with at least one group undergoing any kind of physiotherapy treatment and with pretest and posttest evaluation, published before April 2013. An analysis of variables was performed and assessed the methodological quality of studies. Five studies met the criteria for inclusion. Hydrotherapy treatments, strength training and balance strength, balance training, and sports therapy, have improved range of movement, pain, balance, and subjective physical performance. The proposed methodological analysis was not possible due to the low quality of the studies. Although the results are positive, they lack rigorous evidence on the effects of treatments. Studies are needed to establish the efficacy of the various forms of physiotherapy in the haemophilic arthropathy of the ankle. Rubén Cuesta-Barriuso, Antonia Gómez-Conesa, and José Antonio López-Pina Copyright © 2013 Rubén Cuesta-Barriuso et al. All rights reserved. Prognostic Value of the Six-Minute Walk Test in Heart Failure Patients Undergoing Cardiac Surgery: A Literature Review Wed, 24 Jul 2013 10:02:05 +0000 Background. The prognostic value of cardiopulmonary exercise testing (CPET) is known, but the predictive value of 6MWT in patients with heart failure (HF) and patients undergoing coronary artery bypass grafting (CABG) is not established yet. Objective. We conducted a systematic review exploring the prognostic value of 6MWT in HF patients undergoing cardiac surgery. The aim was to find out whether the change in the distance walked during follow-up visits was associated with prognosis. Data Source. We searched “PubMed” from January 1990 to December 2012 for any review articles or experimental studies investigating the prognostic value of 6MWT in HF patients and patients undergoing cardiac surgery. Results. 53 studies were included in the review, and they explored the role of 6MWT in cardiology, cardiac surgery, and rehabilitation. The results did not show the relation between the six-minute walk distance and adverse events after CABG. The predictive power of the distance walked for death in HF patients undergoing cardiac surgery was not found. It is not yet proved if the change in the six-minute walk distance is associated with prognosis. The predictive power of the six-minute walk distance for death in HF patients undergoing cardiac surgery remains unclear. Dominika Zielińska, Jerzy Bellwon, Andrzej Rynkiewicz, and Mohamed Amr Elkady Copyright © 2013 Dominika Zielińska et al. All rights reserved. Anterior-Posterior Instability of the Knee Following ACL Reconstruction with Bone-Patellar Tendon-Bone Ligament in Comparison with Four-Strand Hamstrings Autograft Wed, 10 Jul 2013 08:57:50 +0000 Purpose. To evaluate anterior-posterior knee laxity using two different autografts. Material-Methods. 40 patients, (34 males and 6 women), 17–54 years old (mean: 31), were included in the present study. Group A (4SHS = 20) underwent reconstruction using four-strand hamstrings, and group B (BPBT = 20) underwent reconstruction using bone-patellar tendon-bone autograft. Using the KT-1000 arthrometer, knee instability was calculated in both knees of all patients preoperatively and 3, 6, and 12 months after surgery at the ACL-operated knee. The contralateral healthy knee was used as an internal control group. Results. Anterior-posterior instability using the KT1000 Arthrometer was found to be increased after ACL insufficiency. The recorded laxity improved after arthroscopic ACL reconstruction in both groups. However, statistically significant greater values were detected in the bone-patellar tendon-bone group, which revealed reduction of anteroposterior stability values to an extent, where no statistical significance with the normal values even after 3 months after surgery was observed. Conclusions. Anterior-Posterior instability of the knee improved significantly after arthroscopic ACL reconstruction. The bone-patellar tendon-bone graft provided an obvious greater stability. A. G. Angoules, K. Balakatounis, E. C. Boutsikari, D. Mastrokalos, and P. J. Papagelopoulos Copyright © 2013 A. G. Angoules et al. All rights reserved. Parkinson’s Disease and Forced Exercise: A Preliminary Study Wed, 19 Jun 2013 18:43:18 +0000 Objective. The concept of forced exercise has drawn attention for the treatment of Parkinson’s disease symptoms with anecdotal reports of success. This study sought to ascertain any significant effect of forced exercise using a motorized stationary bicycle when compared to controls on Parkinson’s disease symptoms in a blinded, randomized, and controlled setting. Setting. Parkinson’s disease outpatient clinic, Veterans Administration Medical Center. Method. We assessed 23 patients (13 experimental and 10 controls) on a number of standard Parkinson’s measures at baseline, after participation in eight weeks of twice weekly forced exercise or eight weeks of conventional clinic care, and then after a three-month period had elapsed. Dependent measures were UPDRS-III, Berg Balance Scale, finger taping test, and the PDQ-39. Results. Results did not demonstrate any main effect differences between the exercise and control groups on any measure at any point in time. A within subjects effect was demonstrated for the forced exercise group on overall UPDRS-III scores at the three-month end point. No other within group effects were noted. Results suggest that early enthusiasm for forced exercise may need tempering. Limitations of the study are discussed as well as numerous logistical challenges to this type of study. Abu Qutubuddin, Timothy Reis, Raed Alramadhani, David X. Cifu, Alan Towne, and William Carne Copyright © 2013 Abu Qutubuddin et al. All rights reserved.