Dynamic Balance in Spinal and Bulbar Muscular Atrophy: Relationship between Strength and Performance of Forward Lunge, Step Up and Over, and Step Quick TurnRead the full article
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Blood Lactate AUC Is a Sensitive Test for Evaluating the Effect of Exercise Training on Functional Work Capacity in Patients with Chronic Heart Failure
Purpose. Exercise training is an essential treatment option for patients with chronic heart failure (CHF). However, it remains controversial, which surrogate measures of functional work capacity are most reliable. The purpose of this paper was to compare functional capacity work measured as capillary lactate concentrations area under the curve (AUC) with standard cardiopulmonary exercise testing (CPET) with VO2peak and the 6-minute walk test (6 MWT). Methods. Twenty-three patients in New York Heart Association (NYHA) class II/III with left ventricular ejection fraction (LVEF) <35% were randomised to home-based recommendation of regular exercise (RRE) (controls), moderate continuous training (MCT) or aerobic interval training (AIT). The MCT and AIT groups underwent 12 weeks of supervised exercise training. Exercise testing was performed as standard CPET treadmill test with analysis of VO2peak, the 6 MWT and a novel 30-minute submaximal treadmill test with capillary lactate AUC. Results. All patients had statistically significant improvements in VO2peak, 6 MWT and lactate AUC after 12 weeks of exercise training: 6 MWT (p =0.035), VO2peak (p =0.049) and lactate AUC (p =0.002). Lactate AUC (p =0.046) and 6MWT (p =0.035), but not VO2peak revealed difference between the exercise modalities regarding functional work capacity. Conclusion. 6-MWT and lactate AUC, but not VO2peak, were able to reveal a statistically significant improvement in functional capacity between different exercise modalities.
A Scoping Review of the Evidence regarding Assessment and Management of Psychological Features of Shoulder Pain
Background and Aim. Shoulder pain is second only to low back pain among costs associated with the care of musculoskeletal disorders. Psychological factors, social factors, and mental health can contribute to shoulder pain and resulting functional disability. The purpose of this scoping review was to identify the nature of the research that has integrated psychological assessment and treatment in the management of shoulder pain. Methods. A scoping review of research studies identified through PubMed, EMBASE, and CINAHL and graduate theses identified using Google Scholar was conducted to determine studies and systematic reviews that addressed the management of psychological aspects of shoulder pain with or without neck pain. The search terms included psychological factors, anxiety, depression, catastrophic thinking, fear of movement, and psychological treatments. Two investigators screened study titles and abstracts. Data extraction, content analysis, and thematic coding focused on the dimensions of pain addressed (emotional, behavioural, and cognitive) and treatment approaches used (dimensions targeted, specific treatment parameters) and the linkage between treatment targets/rationale with interventions/outcomes measured. Results. Ten studies (seven randomized trials and three cohorts) were identified that addressed the psychological aspects of shoulder pain. Out of seven RCTs, four compared psychological interventions with usual care. Eight studies used cognitive approaches, including emotional freedom techniques (EFT), pain coping strategies (PCS), physical-cognitive-mindfulness training (PCMT), psychological flexibility, face-to-face cognitive-behavioural treatment (CBT), and cognitive therapy using virtual reality (V.R.). Three studies used the behavioural approaches as their intervention, including behavioural therapy and Graded Exercise Therapy (GET). Pain intensity was addressed as the primary outcome in two studies and as a secondary outcome in five studies. Cognitive factors were evaluated in 50% of the articles using nine different measures. Emotional factors were evaluated in 80% of articles using ten different measures. Reduction of pain intensity and catastrophic thinking concerning pain was achieved in most studies using a biopsychosocial approach (70%). Applying a behavioural approach was associated with reductions in kinesiophobia and pain catastrophizing. Cognitive approaches had a positive association with reductions in the emotional aspect of pain. Only one study specifically linked rationale or specific physical and psychosocial treatment targets with the treatments provided and outcomes measured. Conclusions. Small pools of studies indicate that the rationale and treatment targeting are poorly defined in biopsychosocial interventions for shoulder pain. However, these benefits have been demonstrated when cognitive or behavioural components are added to the standard physical treatment of shoulder pain. A better definition of treatment targets, description of intervention components, and linkage of outcomes to targets are needed to advance our understanding of optimizing bio-psychosocial approaches.
Preliminary Evaluation of a New Orthotic for Patellofemoral and Multicompartment Knee Osteoarthritis
Purpose. Traditional knee osteoarthritis (OA) braces are usually indicated for a minority of patients with knee OA, as they are only suitable for those with unicompartmental disease affecting the tibiofemoral joint. A new assistive brace design is intended for use in a wider range of knee OA patients with heterogeneous symptoms characteristic of patellofemoral, tibiofemoral, or multicompartmental knee OA. The purpose of this case series was to explore whether the use of this novel “tricompartment offloader” (TCO) brace was associated with clinically relevant improvements in pain and function. Materials and Methods. A retrospective analysis of individuals with knee OA () was conducted to assess pain, function, physical activity, and use of medication and other treatments before and after brace use. Validated outcome measures including the Visual Analog Scale (VAS) and Lower Extremity Functional Scale (LEFS) were used to assess pain and physical function (primary outcome measures). Exploratory measures were used to quantify physical activity levels and use of medication and other treatments (secondary outcome measures). Results. Average total pain (VAS) scores decreased by 36.6 mm and physical function (LEFS) scores increased by 16.0 points following the use of the TCO brace. Overall, 70% of the participants indicated increased weekly physical activity and 60% reported a decrease in their use of at least one other treatment. Conclusions. Results from this case series suggest that the TCO brace shows strong potential to fill a conservative treatment gap for patients with heterogeneous symptoms of knee OA that are characteristic of patellofemoral or multicompartment disease. Further investigation is warranted.
Relationship between Trunk Position Sense and Trunk Control in Children with Spastic Cerebral Palsy: A Cross-Sectional Study
Background and Aim. Children with spastic cerebral palsy (CP) have impaired trunk control. Joint position sense, a component of proprioception, plays a crucial role in maintaining spinal mobility and stability. The current study is aimed at analysing the relationship between trunk control and trunk position sense in children with spastic CP. Methods. In this study, 24 children with spastic CP aged between 8 and 15 years were recruited. They were classified based on their functional performance using Gross Motor Function Classification System (GMFCS). Trunk control and trunk position sense were assessed using the trunk control measurement scale (TCMS) and digital goniometer, respectively. The correlation between these variables was tested using Spearman’s correlation coefficient. Results. Significant negative correlation was found between trunk position sense and TCMS score. Similarly, a significant moderate correlation was found between trunk position sense and GMFCS. A strong negative correlation was also found between GMFCS and TCMS. Conclusion. Children with spastic CP with better trunk position sense had better trunk control. Similarly, children with higher functional performance had better trunk control and lesser error in trunk position sense. The current findings imply the relevance of proprioceptive training of the trunk for enhancing trunk motor control in children with spastic CP.
Immediate Effect of Restricted Knee Extension on Ground Reaction Force and Trunk Acceleration during Walking
Gait parameters calculated from trunk acceleration reflect the features of gait; however, they cannot evaluate the gait pattern corresponding to the gait cycle. This study is aimed at investigating the differences in gait parameters calculated from trunk acceleration during gait corresponding to the gait cycle in healthy subjects with restricted knee extension. Participants included eight healthy volunteers who walked normally (NW) and with knee orthosis that restricted knee extension (ER). The ground reaction force (GRF), joint angles, and trunk acceleration during walking were measured using four force plates, a three-dimensional motion analysis system, and an inertial measurement unit. The peak GRF of the vertical components, joint ranges of motion, and moments of force were analyzed. The root mean square (RMS) and amplitude peak ratio (AR) of autocorrelation function were calculated from the trunk acceleration waveform. The first peak GRF and peak ankle dorsiflexion angles significantly increased during ER. The peak hip extension, knee flexion, knee extension angles, and the peak moment of knee extension significantly decreased during ER compared to that during NW. The acceleration AR significantly decreased during ER compared to that during NW. There was no significant difference in the RMS between the two conditions. The acceleration AR may show the temporal postural structure with restricted knee extension from the terminal stance phase for the ipsilateral limb to the initial stance phase for the contralateral limb. These results suggest that novel metrics for accelerometry gait analysis can reveal gait abnormalities, with restricted knee extension corresponding to the gait cycle.
Translation, Cross-Cultural Adaptation, and Psychometric Validation of the Chinese/Mandarin Cardiac Rehabilitation Barriers Scale (CRBS-C/M)
Objective. Cardiovascular diseases are among the leading causes of morbidity in China and around the world. Cardiac rehabilitation (CR) effectively mitigates this burden; however, utilization is low. CR barriers in China have not been well characterized; this study sought to translate, cross-culturally adapt, and psychometrically validate the CR Barriers Scale in Chinese/Mandarin (CRBS-C/M). Methods. Independent translations of the 21-item CRBS were conducted by two bilingual health professionals, followed by back-translation. A Delphi process was undertaken with five experts to consider the semantics and cross-cultural relevance of the items. Following finalization, 380 cardiac patients from 11 hospitals in Shanghai were administered a validation survey including the translated CRBS. Following exploratory and confirmatory factor analysis, internal consistency was assessed. Validity was tested through assessing the association of the CRBS-C/M with the CR Information Awareness Questionnaire. Results. Items were refined and finalized. Factor analysis of CRBS-C/M (, Bartlett’s test ) revealed five factors: perceived CR need, external logistical factors, time conflicts, program and health system-level factors, and comorbidities/lack of vitality; Cronbach’s alpha () of the subscales ranged from 0.67 to 0.82. The mean total CRBS score was significantly lower in patients who participated in CR compared with those who did not, demonstrating criterion validity ( vs. ; ). Construct validity was supported by the significant associations between total CRBS scores and CR awareness, sex, living situation, city size, income, diagnosis/procedure, disease severity, and several risk factors (all ). Conclusions. CRBS-C/M is reliable and valid, so barriers can be identified and mitigated in Mandarin-speaking patients.