Physical Therapy Commons^™

The Incidence Of Falls In Intensive Care Survivors, Shane M. Patman, Diane Dennis, Kylie Hill

Shane Patman

Background: Falling among adults in acute care is an important problem with falls rates in tertiary hospitals ranging from 2% to 5%. Factors that increase the risk of falling, such as advanced age, altered mental status, medications that act on the central nervous system and poor mobility, often characterise individuals who survive a prolonged intensive care unit (ICU) admission.

Purpose: To measure the incidence of falls and describe the characteristics of fallers among intensive care survivors.

Methods: A comprehensive retrospective chart review was undertaken of 190 adults who were intubated and ventilated for ≥168 h and survived their acute care …

Intensive Care Unit Mobility Practices In Australia And New Zealand: A Point Prevalence Study, Susan C. Berney, Megan Harrold, Steven A. Webb, Ian Seppelt, Shane Patman, Peter J. Thomas, Linda Denehy

Shane Patman

Objectives:

To develop a comprehensive set of items describing physiotherapy mobilisation practices for critically ill patients, and to document current practices in intensive care units in Australia and New Zealand, focusing on patients having > 48 hours of mechanical ventilation.

Design:

Prospective, observational, multicentre, single-day, point prevalence study.

Participants and Setting:

All patients in 38 Australian and New Zealand ICUs at 10 am on one of three designated days in 2009 and 2010.

Main Outcome Measures:

Demographic data, admission diagnosis and mobilisation practices that had occurred in the previous 24 hours.

Results:

514 patients were enrolled, with 498 complete datasets. Mean …

Seeing It Helps: Movement-Related Back Pain Is Reduced By Visualization Of The Back During Movement, Benedict M. Wand, Verity M. Tulloch, Pamela J. George, Anne J. Smith, Roger Goucke, Neil E. O'Connell, G Lorimer Moseley

Pamela George

Objectives: The aim of this study was to determine whether visualization of the back influenced parameters of movement-related pain in people with chronic nonspecific low back pain. Methods: We used a randomized cross-over experiment in which 25 participants performed repeated lumbar spine movements under 2 conditions. In the visual feedback condition, patients were able to visualize their back as it moved by the use of mirrors. In the control condition, the mirror was covered so no visualization of the back was possible. Results: The average postmovement pain intensity after participants had moved with visual feedback was less (35.5+/-22.8 mm) than …

Eccentric Fatigue Modulates Stretch-Shortening Cycle Effectiveness - A Possible Role In Lower Limb Overuse Injuries, James R. Debenham, M Travers, William Gibson, A Campbell, G Allison

William Gibson

The role of fatigue in injury development is an important consideration for clinicians. In particular, the role of eccentric fatigue in stretch shortening cycle (SSC) activities may be linked to lower limb overuse conditions. The purpose of this study was to explore the influence of ankle plantarflexor eccentric fatigue on SSC effectiveness during a hopping task in healthy volunteers. 11 healthy volunteers (23.2 ± 6.7 years) performed a sub-maximal hopping task on a custom- built sledge system. 3D motion capture and surface EMG were utilised to measure lower limb stiffness, temporal kinematic measures and muscle timing measures at baseline and …

Chronic Mid Portion Achilles Tendinopathy Is Not Associated With Central Sensitisation, Ian W. Skinner, James R. Debenham, Sarah Krumenachera, Max K. Bulsara, Benedict M. Wand

James Debenham

Achilles tendinopathy (AT) is a common painful and disabling condition and current understanding of its pathophysiology is incomplete. Widespread hyperalgesia as a clinical manifestation of central sensitisation has emerged as a possible contributor to the pain state in chronic musculoskeletal injuries. Eight AT participants and eight healthy, gender, age and activity matched participants were recruited to participate in a case-controlled repeated measures study. Pressure pain threshold (PPT) was measured with a manual electronic algometer at four sites bilaterally; tibialis anterior (TA), patella tendon (PT), common wrist extensor tendon (CWET), and first dorsal interosseous (1DI). We hypothesised a reduction in PPT …

Are There Associations Among Physical Activity, Fatigue, Sleep Quality And Pain In People With Mental Illness? A Pilot Study, Joanne Connaughton, Shane Patman, C Pardoe

Joanne Connaughton

Accessible summary

• Many people with mental health disorders experience fatigue, pain and poor sleep. In other patient groups, physical exercise has been shown to have positive effects on these symptoms.

• It is unknown whether day-to-day physical activity (not necessarily exercise) affects sleep quality or severity of pain or fatigue in those with mental illness.

• This study observed physical activity, sleep quality, pain and fatigue in four people hospitalized with severe mental illness.

• Significant associations were found between pain and fatigue severity in the morning, but not in the evening. A significant association was found between physical activity and morning and …

Using Mixed Methods To Measure The Perception Of Community Capacity In An Academic–Community Partnership For A Walking Intervention, Charkarra Anderson-Lewis, Diana Castellanos, Arnecca Byrd, Karen Zynda, Alicia Sample, Vickie Reed, Mary Beard, Latessa Minor, Kathleen Yadrick

Diana Cuy Castellanos

H.U.B. City Steps is a 5-year community-based participatory research walking intervention designed to help lower blood pressure in a majority African American population in southern Mississippi via community collaboration and capacity building, increased walking, culturally tailored health education sessions, and motivational interviewing. Building community capacity for physical activity is a key component of this intervention. Qualitative and quantitative methods have been used to assess how project stakeholders perceive the community capacity-building efforts of the project. This article illustrates the baseline results of this mixed methods approach from the perspective of three groups of stakeholders: project researchers and staff, community advisory …

Acute Exercise And Gastric Emptying: A Meta-Analysis And Implications For Appetite Control, Katy Horner, Matthew Schubert, Ben Desbrow, Nuala Byrne, Neil King

Nuala Byrne

Background: Gastric emptying (GE) could influence exercise-induced changes in appetite and energy intake. GE also could contribute tochanges in gastric symptoms and the availability of nutrients during exercise, which will subsequently affect performance. Objective: The objective of this review was to determine the effects of acute exercise on GE using a systematic review and meta-analysis. The most common parameters to determine GE were selected, consisting of half-emptying time and volume emptied. Oral-caecal transit time (OCTT) was also examined. Data Sources: Research databases (PubMed, Scopus, Google Scholar, EBSCOhost, SPORTDiscus) were searched through November 2013 for original studies, abstracts, theses and dissertations …

The Effect Of Low-Volume, High-Intensity Interval Training On Blood Glucose Markers, Anthropometric Measurements, And Cardiorespiratory Fitness In Patients With Type Ii Diabetes., Sujoy Bose

Sujoy Bose

The profound biologic, & societal burden of the syndrome of Diabetes Mellitus (DM) is subject of numerous ongoing research. There is significant interest in non-pharmacologic glycemic control, principally by exercise. While beneficial effects of generic exercise on glucose metabolism have been well established in literature, there is a paucity of research on the volume, intensity, & type of the most optimal forms of exercise that affect glycemic physiology in those with type II DM. The goal of this study was to perform a systematic review of the impact of high intensity interval training (HIIT) on glycemic control in people with …

Virtual Patient Care: An Interprofessional Education Approach For Physician Assistant, Physical Therapy, And Occupational Therapy Students, Michael J. Shoemaker

Michael J Shoemaker, PT, DPT, PhD, GCS

The purpose of this retrospective qualitative case report is to describe how a case-based, virtual patient interprofessional education (IPE) simulation activity was utilized to achieve physician assistant (PA), physical therapy (PT) and occupational therapy (OT) student IPE learning outcomes. Following completion of a virtual patient case, 30 PA, 46 PT and 24 OT students were required to develop a comprehensive, written treatment plan and respond to reflective questions. A qualitative analysis of the submitted written assignment was used to determine whether IPE learning objectives were met. Student responses revealed three themes that supported the learning objectives of the IPE experience: …

Controlling Balance Decline Across The Menopause Using A Balance-Strategy Training Program: A Randomized, Controlled Trial, S. Fu, Nancy Low Choy, Jennifer Nitz

Nancy Low Choy

Objective: To evaluate effectiveness and long-term benefits of a specific balance-strategy training program in sedentary women aged 40-60 years and whether participation leads to adoption of a more active lifestyle. Method: Fifty healthy women were admitted to the randomized, controlled trial on the basis of their activity level. Subjects were randomly assigned to an intervention or control group, with the former attending twice-weekly for 12 weeks. Assessments made pre- and post-intervention and at 9 months follow-up included: personal demographics, hormone replacement therapy medication, activity level, balance measures, somatosensory function, ankle flexibility and leg muscle strength. Results: The intervention group showed …

A Conceptual Model Of Optimal International Service-Learning And Its Application To Global Health Initiatives In Rehabilitation, Celia Pechak, Mary Thompson

Celia M Pechak

Background. There is growing involvement by US clinicians, faculty members, and students in global health initiatives, including international service-learning (ISL). Limited research has been done to examine the profession’s increasing global engagement, or the ISL phenomenon in particular, and no research has been done to determine best practices. This study was intended as an early step in the examination of the physical therapy profession’s role and activities in the global health arena within and beyond academics.

Objectives. The purposes of this study were: (1) to identify and analyze the common structures and processes among established ISL programs within physical therapist …

A Call For A Critical Examination Of Ethics In Global Health Initiatives In Physical Therapy Education, Celia Pechak, Shaun Cleaver

Celia M Pechak

No abstract provided.

International Service-Learning And Other International Volunteer Service In Physical Therapist Education Programs In The United States And Canada: An Exploratory Study, Celia Pechak, Mary Thompson

Celia M Pechak

Background and Purpose. Reflecting increasing globalization, some physical therapist educators are incorporating international service and learning opportunities in curricula. This study had 3 purposes: (1) to determine the frequency/location of international service-learning (ISL) and other international volunteer service (OIVS) in United States and Canadian physical therapist education programs; (2) to explore the program differences between those with and without ISL or OIVS; and (3) to examine faculty’s perceptions of barriers to and benefits of ISL.

Subjects. The program directors from 213 physical therapist education programs in the United States and Canada were surveyed.

Methods. A questionnaire was developed, frequencies were …

Rationale And Design Of The Prsm Study: Pulmonary Rehabilitation Of Self Management For Chronic Obstructive Pulmonary Disease (Copd), What Is The Best Approach?, Angela Chang, Terry Haines, Claire Jackson, Ian Yang, Jennifer Nitz, Nancy Low Choy, Bill Vicenzino

Nancy Low Choy

Background:
Pulmonary rehabilitation is only accessible by a small proportion of individuals with COPD. For the vast majority who are not able to access these programs, self management approaches may be an alternative to improve health care outcomes.

Methods:
The PRSM study is a three group randomised controlled trial with individual randomisation, blinded outcome assessment, 3 monthly follow-up assessments across a 12-month period and concurrent economic evaluation. The inclusion criteria are adults with COPD. The primary outcome measure is the St George Respiratory Disease Questionnaire. Secondary outcome measures include a series of questionnaires (Frenchay Activities Index, International Physical Activity Questionnaire, …

Falling Is Not Just For Older Women: Support For Pre-Emptive Prevention Intervention Before 60, Jennifer Nitz, Nancy Low Choy

Nancy Low Choy

Objective
This study aimed to report falls and identify factors that might predict a fall in women aged between 40 and 80 years and thus provide evidence of earlier falls and need for morbidity preventive intervention.

Design and participants
A prospective cohort study design over 5 years. Personal demographic data of age, co-morbidities, number of prescribed medications, falls, activity level and living situation were obtained at face-to-face interview. Height, weight, body mass index and postural stability were measured in participating women living independently in the community.

Results
Women were categorized into age decade cohorts, with 463 remaining at the year …

Linking Stability To Demographics, Strength And Sensory System Function In Women Over 40 To Support Pre-Emptive Preventive Intervention, Nancy Low Choy, Sandra Brauer, Jennifer Nitz

Nancy Low Choy

Objective
To investigate differences in demographics, strength and sensory system function of 254 women aged 40-80 years categorized as stable, unsteady or unstable using simple balance tests.

Method
Demographics (age, height, weight, medications, co-morbidities, falls history, activity level), measures of quadriceps, hip abductor and adductor strength, somatosensory, visual and vestibular function were recorded. Subjects were categorized as stable (completed all trials), unsteady (failed one/two trials) or unstable (failed all trials) after three 10-s trials of bilateral stance (foam surface, eyes closed (EC)) and one-leg stance (firm surface, eyes open (EO)), and the results were compared.

Results
Both balance tasks identified …

Age-Related Changes In Strength And Somato-Sensation During Mid-Life Support Rationale For Targeted Preventive Intervention Programs, Nancy Low Choy, Sandra Brauer, Jennifer Nitz

Nancy Low Choy

Age-related changes in strength and somatosensation have a negative impact on balance with advanced age. Knowledge of the decades of life when strength and somatosensation show initial and subsequent reductions could inform balance assessment and targeted preventive intervention. We report a cross-sectional study investigating strength and somatosensation of 316 healthy women aged 20–80 years. Demographics, health profile, and activity level were recorded. Strength of quadriceps, hip abductors and adductors, and lower limb somatosensation (tactile acuity, vibration threshold, and joint position error) were measured. Significant age-related changes in strength and somatosensory function were identified, even when demographic variables of activity level, …

Timed Stance Performances Reflect Differences In Age, Prevalence Of Co-Morbidities, Medication Use, Fall’S History And Activity Level: Early Screening For Balance Loss Is Indicated, Nancy Low Choy, Sandra Brauer, Jennifer Nitz

Nancy Low Choy

Objectives:
To determine if 10-second trials of bilateral and one-legged stance measures detected balance loss and influence of known risk factors for falls in women aged 20–80 years.

Methods:
456 healthy adult women attempted 10-second trials of bilateral stance (firm and foam surfaces) and one-legged stance, with eyes open (EO) and eyes closed (EC). Data for age, co-morbidities, medication use, fall history and activity level were compared for three categories of stability: (i) stable: all trials completed; (ii) unsteady: completed/failed one to two trials; and (iii) failed all trials.

Results:
Bilateral stance on foam (EC) and one-legged stance (EO) yielded …

Changes In Activity Level In Women Age 40 To 80 Years, Jennifer Nitz, Nancy Low Choy

Nancy Low Choy

Objectives
The purpose of this study was to report habitual physical activity levels in women and document the change in level of activity and factors affecting this change over a 5-year period.

Methods
A 5-year prospective cohort design was used. Women aged 40-80 years, living independently in the community, were recruited via the electoral role. The effects were investigated, first, of age, activity level, history of falls, number of co-morbidities and medications, body mass index and stability at baseline on change in activity level and, second, change in these demographics on activity level over the study period.

Results
Data from …

Acsm's Metabolic Calculations Handbook, Stephen Glass, Greg Dwyer

Stephen C Glass

This handbook provides a step-by-step approach to using metabolic equations, from basic math principles to applying the equations to an exercise plan. Chapters focus separately on each equation, provide an easy-to-follow process of solving, and demonstrate the varied uses of the equation in clinical as well as fitness settings.

Each chapter includes a set of problems that focus on real-world applications of the equation. Step-by-step problem solution explanations are provided at the end of each chapter. A comprehensive exam at the end of the book tests the reader's skill in using the equations.

The Relationship Of Cervical Joint Position Error To Balance And Eye Movement Disturbances In Persistent Whiplash, Julia Treleaven, Gwendolen Jull, Nancy Low Choy

Nancy Low Choy

Cervical joint position error (JPE) has been used as a measure of cervical afferent input to detect disturbances in sensori-motor control as a possible contributor to a neck pain syndrome. This study aimed to investigate the relationship between cervical JPE, balance and eye movement control. It was of particular interest whether assessment of cervical JPE alone was sufficient to signal the presence of disturbances in the two other tests. One hundred subjects with persistent whiplash-associated disorders (WADs) and 40 healthy controls subjects were assessed on measures of cervical JPE, standing balance and the smooth pursuit neck torsion test (SPNT). The …

The Effect Of Depression On Balance Decline In Mature Women, Jennifer Nitz, Nancy Low Choy, Meredith Ogilvie

Nancy Low Choy

Depression has been identified as a risk factor for falls, and a change in balance ability over time has yet to be investigated. This study aimed to identify if, over a 3-year period, balance ability changed in 26 women who were on medication for depression, compared to 26 non-depressed women. The two groups were matched for age, number of co-morbidities, activity level, medications, and height. All participants were simultaneously enrolled in a larger, longitudinal study of ageing. Balance measures included the Functional Reach (FR) test, Lateral Reach (LR) test, Step Test (ST), Timed Up and Go, and the Modified Clinical …

Is Signal Analysis Important For Measuring Standing Balance In Chronic Whiplash?, Julia Treleaven, Robert Murison, Gwendolen Jull, Nancy Low Choy, Sandy Brauer

Nancy Low Choy

Dizziness and or unsteadiness, associated with episodes of loss of balance, are frequent complaints in those suffering from persistent problems following a whiplash injury. Research has been inconclusive with respect to possible aetiology, discriminative tests and analyses used.

The aim of this pilot research was to identify the test conditions and the most appropriate method for the analysis of sway that may differentiate subjects with persistent whiplash associated disorders (WAD) from healthy controls. The six conditions of the Clinical Test for Sensory Interaction in Balance was performed in both comfortable and tandem stance in 20 subjects with persistent WAD compared …

Retraining Balance Using Task-Focussed Work-Stations, Nancy Low Choy

Nancy Low Choy

Extract:

This chapter aims to:
Present a task-oriented approach to retraining balance and mobility using workstations as an effective mode of delivering tailored interventions to individual or small groups of residents or community-based elders who are: frail aged; elders who ambulate with supervision within residential care facilities; or elders who are independently ambulant in the community.

Provide an outline of workstations that illustrate varying levels of challenge but address the multiple aspects of balance and mobility that need to be considered while retraining balance and mobility in elders.

© Copyright Elsevier Limited, 2004

A Theoretical Framework For The Assessment And Treatment Of Balance And Mobility Deficits, Nancy Low Choy

Nancy Low Choy

Extract:

This chapter aims to:
Review the theoretical elements that contribute to balance and mobility as a basis for assessing balance and mobility in the elderly, and presenting a tailored but multidimensional approach to assessing and retraining balance and mobility deficits in the elderly.

Describe a process of assessing balance and mobility in the elderly that uses observational and problem-solving skills while analysing balance and mobility tasks, identifies and measures impairments, and monitors progress and outcomes for elders of varying functional motor ability.

© Copyright Elsevier Limited, 2004

Normal Values Of Balance Tests In Women Aged 20 - 80, Rosemary Isles, Nancy Low Choy, Marie Steers, Jennifer Nitz

Nancy Low Choy

Objectives:
To determine normal values for four commonly used clinical functional balance tests from community-dwelling women aged 20 to 80 and to identify any significant decline due to aging.

Design:
A cross-sectional study was undertaken to provide normative values for four clinical balance tests across 6 decade cohorts.

Setting:
The Betty Byrne-Henderson Center for Women and Aging, Royal Womens' Hospital, Brisbane, Australia.

Participants:
Four hundred fifty-six community-dwelling, independently ambulant women with no obvious neurological or musculoskeletal-related disability, aged 20 to 80, were randomly recruited from a large metropolitan region.

Measurements:
The clinical balance measures/tests were the Timed Up and Go …

The Efficacy Of A Balance Strategy Training Circuit For Community Based Elders Who Have Had A Fall, Jennifer Nitz, Nancy Low Choy

Nancy Low Choy

Background:
Older people participate in exercise programmes to reduce the risk of falls but no study has investigated a specific balance strategy training intervention presented in a workstation format for small groups.

Objective:
To determine whether a specific balance strategy training programmeme delivered in a workstation format was superior to a community based exercise class programme for reducing falls.

Design:
A randomised controlled trial model.

Setting:
Neurological Disorders, Ageing and Balance Clinic, Department of Physiotherapy, The University of Queensland.

Subjects:
73 males and females over 60 years, living independently in the community and who had fallen in the previous year …

The Efficacy Of A Work-Station Intervention Program To Improve Functional Ability And Flexibility In Ageing Clients With Cerebral Palsy: A Pilot Study, Nancy Low Choy, Rosemary Isles, Ruth Barker, Jennifer Nitz

Nancy Low Choy

Purpose:
Health care workers associated with the long-term care of ageing clients with Cerebral Palsy have reported on the adverse effects of less active daily activity programmes with resultant decreased functional mobility. While the negative effects of ageing have been reported in these clients, programmes have not been implemented to determine whether these adverse changes can be reversed or prevented. The efficacy of a work-station intervention programme to improve functional ability and flexibility in ageing clients with cerebral palsy was investigated.

Method:
A clinical intervention study using repeated measures (pre/post-intervention and at follow-up) to evaluate efficacy was undertaken. Twenty-two clients …

Medial-Lateral Postural Stability And Balance In Community Dwelling Women Over 40 Years Of Age, Jennifer Nitz, Nancy Low Choy, Rosemary Isles

Nancy Low Choy

Objective:
To document the change in medial–lateral balance in women aged between 40 and 80 years.

Design:
A cross-sectional study of six measures of medial–lateral balance was undertaken.

Setting:
The Betty Byrne Henderson Centre for Women and Ageing, Royal Women's Hospital, Australia.

Subjects:
Five hundred and three community-dwelling women between 40 and 80 years of age were randomly recruited from a large metropolitan region with 366 subjects admitted after applying exclusion criteria.

Measurements:
The clinical measurements included the lateral reach and step tests while laboratory measurements were gathered from the Balance Master software programs for unilateral stance and limits of …