Rehabilitation Research and Practice http://www.hindawi.com The latest articles from Hindawi Publishing Corporation © 2014 , Hindawi Publishing Corporation . All rights reserved. Acute Effect of Topical Menthol on Chronic Pain in Slaughterhouse Workers with Carpal Tunnel Syndrome: Triple-Blind, Randomized Placebo-Controlled Trial Mon, 15 Sep 2014 00:00:00 +0000 http://www.hindawi.com/journals/rerp/2014/310913/ Topical menthol gels are classified “topical analgesics” and are claimed to relieve minor aches and pains of the musculoskeletal system. In this study we investigate the acute effect of topical menthol on carpal tunnel syndrome (CTS). We screened 645 slaughterhouse workers and recruited 10 participants with CTS and chronic pain of the arm/hand who were randomly distributed into two groups to receive topical menthol (Biofreeze) or placebo (gel with a menthol scent) during the working day and 48 hours later the other treatment (crossover design). Participants rated arm/hand pain intensity during the last hour of work (scale 0–10) immediately before 1, 2, and 3 hours after application. Furthermore, global rating of change (GROC) in arm/hand pain was assessed 3 hours after application. Compared with placebo, pain intensity and GROC improved more following application of topical menthol ( and , resp.). Pain intensity of the arm/hand decreased by −1.2 (CI 95%: −1.7 to −0.6) following topical menthol compared with placebo, corresponding to a moderate effect size of 0.63. In conclusion, topical menthol acutely reduces pain intensity during the working day in slaughterhouse workers with CTS and should be considered as an effective nonsystemic alternative to regular analgesics in the workplace management of chronic and neuropathic pain. Emil Sundstrup, Markus D. Jakobsen, Mikkel Brandt, Kenneth Jay, Juan Carlos Colado, Yuling Wang, and Lars L. Andersen Copyright © 2014 Emil Sundstrup et al. All rights reserved. How Important Are Social Support, Expectations and Coping Patterns during Cardiac Rehabilitation Mon, 15 Sep 2014 00:00:00 +0000 http://www.hindawi.com/journals/rerp/2014/973549/ Purpose. To investigate the predictive role of relevant social and psychosocial determinants on emotional distress among patients after cardiac rehabilitation. Methods. A longitudinal prospective study examined short-term (6 months) and long-term (2 years) impact of predictors on anxiety and depression complaints in 183 patients with 6-months follow-up data attending a four-week rehabilitation stay at the Krokeide Centre in Bergen, Norway. The patients mainly suffered from coronary heart disease. Emotional distress, coping, social support, socioeconomic status, and negative expectations were measured by means of internationally validated questionnaires. A composite score of anxiety and depression complaints was used as the outcome measure in the study. Results. This study revealed that task-oriented coping improved emotional status in long-term followup, and negative expectations were associated with emotional distress in short-term followup. A higher socioeconomic status and more social support predicted improved emotional status in short- as well as long-term followup. Conclusions. Fewer negative expectations and functional coping along with social support are important factors for the prevention of emotional distress after cardiac disease. Such elements should be addressed and encouraged in patients during cardiac rehabilitation. Maria J. C. Blikman, Hege R. Jacobsen, Geir Egil Eide, and Eivind Meland Copyright © 2014 Maria J. C. Blikman et al. All rights reserved. Understanding the Burden on Caregivers of People with Parkinson’s: A Scoping Review of the Literature Sun, 14 Sep 2014 07:18:07 +0000 http://www.hindawi.com/journals/rerp/2014/718527/ Caregivers are healthcare assets because they care for patients at home; however, when clinicians focus solely on patients, caregivers’ needs may not be recognized. The purpose of this scoping literature review is to identify the burdens on caregivers of people with Parkinson’s disease. CINAHL and PubMed databases were searched to locate thirteen original articles, one systematic review, and one meta-analysis within the last five years that highlighted caregivers’ burdens. Results indicate the need to identify practical interventions that decrease caregivers’ physical, psychological, and socioeconomic burdens. Correlates of Parkinson’s caregiver burdens are not clearly available. Caregivers’ contextual demographic information is missing, as is an understanding of how caregivers negotiate day-to-day caregiving activities. Gaps exist about how caregivers reconcile multiple medications and manage rehabilitation needs of the patient at home. A recommendation for practice is a systematic evaluation of the caregivers’ capacity at the time of clinic visit. Rozina Bhimani Copyright © 2014 Rozina Bhimani. All rights reserved. The Effects of Two Different Ankle-Foot Orthoses on Gait of Patients with Acute Hemiparetic Cerebrovascular Accident Tue, 09 Sep 2014 09:23:17 +0000 http://www.hindawi.com/journals/rerp/2014/301469/ Objective. To compare the effects of two types of ankle-foot orthoses on gait of patients with cerebrovascular accident (CVA) and to evaluate their preference in using each AFO type. Design. Thirty individuals with acute hemiparetic CVA were tested without an AFO, with an off-the-shelf carbon AFO (C-AFO), and with a custom plastic AFO (P-AFO) in random order at the time of initial orthotic fitting. Gait velocity, cadence, stride length, and step length were collected using an electronic walkway and the subjects were surveyed about their perceptions of each device. Results. Subjects walked significantly faster, with a higher cadence, longer stride, and step lengths, when using either the P-AFO or the C-AFO as compared to no AFO (). No significant difference was observed between gait parameters of the two AFOs. However, the subjects demonstrated a statistically significant preference of using P-AFO in relation to their balance, confidence, and sense of safety during ambulation (). Moreover, if they had a choice, % of the participants preferred the P-AFO and % preferred the C-AFO. Conclusions. AFO use significantly improved gait in patients with acute CVA. The majority of users preferred the P-AFO over the Cf-AFO especially when asked about balance and sense of safety. Noel Rao, Jason Wening, Daniel Hasso, Gnanapradeep Gnanapragasam, Priyan Perera, Padma Srigiriraju, and Alexander S. Aruin Copyright © 2014 Noel Rao et al. All rights reserved. Clinical Understanding of Spasticity: Implications for Practice Thu, 04 Sep 2014 00:00:00 +0000 http://www.hindawi.com/journals/rerp/2014/279175/ Spasticity is a poorly understood phenomenon. The aim of this paper is to understand the effect of spasticity on daily life and identify bedside strategies that enhance patient’s function and improve comfort. Spasticity and clonus result from an upper motor neuron lesion that disinhibits the tendon stretch reflex; however, they are differentiated in the fact that spasticity results in a velocity dependent tightness of muscle whereas clonus results in uncontrollable jerks of the muscle. Clinical strategies that address function and comfort are paramount. This is a secondary content analysis using a qualitative research design. Adults experiencing spasticity associated with neuromuscular disorder were asked to participate during inpatient acute rehabilitation. They were asked to complete a semistructured interview to explain and describe the nature of their experienced spasticity on daily basis. Spasticity affects activities of daily living, function, and mobility. Undertreated spasticity can lead to pain, immobility, and risk of falls. There were missed opportunities to adequately care for patients with spasticity. Bedside care strategies identified by patients with spasticity are outlined. Uses of alternative therapies in conjunction with medications are needed to better manage spasticity. Patient reports on spasticity are important and should be part of clinical evaluation and practice. Rozina Bhimani and Lisa Anderson Copyright © 2014 Rozina Bhimani and Lisa Anderson. All rights reserved. Whole Body Vibration Exercises and the Improvement of the Flexibility in Patient with Metabolic Syndrome Wed, 03 Sep 2014 07:43:56 +0000 http://www.hindawi.com/journals/rerp/2014/628518/ Vibrations produced in oscillating/vibratory platform generate whole body vibration (WBV) exercises, which are important in sports, as well as in treating diseases, promoting rehabilitation, and improving the quality of life. WBV exercises relevantly increase the muscle strength, muscle power, and the bone mineral density, as well as improving the postural control, the balance, and the gait. An important number of publications are found in the PubMed database with the keyword “flexibility” and eight of the analyzed papers involving WBV and flexibility reached a level of evidence II. The biggest distance between the third finger of the hand to the floor (DBTFF) of a patient with metabolic syndrome (MS) was found before the first session and was considered to be 100%. The percentages to the other measurements in the different sessions were determined to be related to the 100%. It is possible to see an immediate improvement after each session with a decrease of the %DBTFF. As the presence of MS is associated with poorer physical performance, a simple and safe protocol using WBV exercises promoted an improvement of the flexibility in a patient with MS. Danúbia da Cunha Sá-Caputo, Pedro Ronikeili-Costa, Rafaelle Pacheco Carvalho-Lima, Luciana Camargo Bernardo, Milena Oliveira Bravo-Monteiro, Rebeca Costa, Janaina de Moraes-Silva, Dulciane Nunes Paiva, Christiano Bittencourt Machado, Paula Mantilla-Giehl, Adriano Arnobio, Pedro Jesus Marin, and Mario Bernardo-Filho Copyright © 2014 Danúbia da Cunha Sá-Caputo et al. All rights reserved. Perceived Cognitive Decline in Multiple Sclerosis Impacts Quality of Life Independently of Depression Mon, 01 Sep 2014 07:25:13 +0000 http://www.hindawi.com/journals/rerp/2014/128751/ 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 http://www.hindawi.com/journals/rerp/2014/861268/ 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 http://www.hindawi.com/journals/rerp/2014/814279/ 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 http://www.hindawi.com/journals/rerp/2014/631842/ 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 http://www.hindawi.com/journals/rerp/2014/898763/ 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 http://www.hindawi.com/journals/rerp/2014/950183/ 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 http://www.hindawi.com/journals/rerp/2014/130543/ 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 http://www.hindawi.com/journals/rerp/2014/767859/ 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 http://www.hindawi.com/journals/rerp/2014/873872/ 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 Clinicaltrials.gov 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 http://www.hindawi.com/journals/rerp/2014/627376/ 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 http://www.hindawi.com/journals/rerp/2014/593280/ 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 http://www.hindawi.com/journals/rerp/2014/793641/ 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 http://www.hindawi.com/journals/rerp/2014/462750/ 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 http://www.hindawi.com/journals/rerp/2014/207137/ 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 http://www.hindawi.com/journals/rerp/2014/594540/ 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 http://www.hindawi.com/journals/rerp/2014/170304/ 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 http://www.hindawi.com/journals/rerp/2013/614825/ 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 http://www.hindawi.com/journals/rerp/2013/890962/ 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 http://www.hindawi.com/journals/rerp/2013/601768/ 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 http://www.hindawi.com/journals/rerp/2013/875968/ 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 http://www.hindawi.com/journals/rerp/2013/475870/ 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 http://www.hindawi.com/journals/rerp/2013/208187/ 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 http://www.hindawi.com/journals/rerp/2013/498014/ 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 http://www.hindawi.com/journals/rerp/2013/867250/ 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.