Evaluation of static and dynamic postural stability in established rheumatoid arthritis: Exploratory study

Background

It has been proposed that people with rheumatoid arthritis experience difficulties in postural control and activities of daily living such as walking. The aim of the study is to evaluate postural stability in rheumatoid arthritis patients.

Method

A convenience sample of 19 rheumatoid arthritis patients (mean duration 13.1 ± 9.2 years) were aged matched with a non-rheumatoid group (n = 21). Postural stability was measured using a force plate for anterior–posterior and mediolateral centre of pressure excursion for 30 s with eyes closed and open. Patients also performed three walks at a self-selected speed and mean temporal–spatial parameters were recorded.

Findings

Significant differences were observed between the groups in anterior–posterior centre of pressure excursion during the eyes open task and the eyes closed task (P < 0.05). No significant differences were found in the mediolateral centre of pressure excursion during either condition (P > 0.05). The rheumatoid group displayed a significantly slower mean walking velocity, double support, cadence and cycle time than the non-rheumatoid group (P < 0.05).

Interpretation

The results from this study showed that rheumatoid arthritis patients displayed a significantly larger centre of pressure excursion in the anterior–posterior direction during quiet standing, when compared to a non-rheumatoid arthritis control group suggesting that postural control mechanisms such as ankle strategies are impeded by the rheumatoid process.     

Voluntary sway and rapid orthogonal transitions of voluntary sway in young adults,and low and high fall-risk older adults

Background

Falls amongst older people have been linked to reduced postural stability and slowed movement responses. The objective of this study was to examine differences in postural stability and the speed of response between young adults, low fall-risk older adults, and high fall-risk older adults during voluntary postural sway movements.

Methods

Twenty-five young adults (25 ± 4 years), and 32 low fall-risk (74 ± 5 years), and 16 high fall-risk (79 ± 7 years) older adults performed voluntary sway and rapid orthogonal transitions of voluntary sway between the anterior–posterior and medial–lateral directions. Measures included reaction and movement time and the amplitudes of the centre of pressure, centre of mass, and the separation distance between the centre of pressure and centre of mass.

Findings

Both fall-risk groups compared to the young had slower reaction and movement time, greater centre of pressure and/or centre of mass amplitude in the orthogonal (non-target) direction during voluntary sway, and reduced anterior–posterior and medial–lateral separation between the centre of pressure and centre of mass during voluntary sway and orthogonal transitions. High compared to low fall-risk individuals had slower reaction and movement time, increased non-target centre of mass amplitude during voluntary sway, and reduced medial–lateral centre of pressure and centre of mass separation during voluntary sway and orthogonal transitions.

Interpretation

Age-related deterioration of postural control resulted in slower reactive responses and reduced control of the direction of body movement during voluntary sway and orthogonal transitions. Slower postural reaction and movement time and reduced medial–lateral control of the centre of mass during voluntary sway movements are associated with increased fall-risk in community-living older people.     

Experimental calf muscle pain attenuates the postural stability during quiet stance and perturbation

Background

The purpose of this study was to evaluate how acute pain changes the postural control and stability during quiet standing and after unexpected perturbations.

Methods

Nine subjects stood as quiet as possible on a movable force platform that recorded the centre of pressure position and provided unexpected floor perturbations, before, during and after experimental calf muscle pain. Bilateral surface electromyography from the tibialis anterior and medial gastrocnemius muscles was recorded. The foot pressure distributions were measured using pressure insoles. Intramuscular injections of hypertonic saline were administrated (right leg) to induce acute pain in the tibialis anterior and/or medial gastrocnemius muscles, and an isotonic injection was used as control.

Findings

Simultaneous pain in tibialis anterior and medial gastrocnemius altered the postural control. During quiet standing: higher medial-lateral centre of pressure speed and increased total sway displacement (P < 0.05), weight moved to the non-painful side, (P < 0.05) and plantar centre of pressure of the left foot was shifted towards the heel’s direction (P < 0.05). During forward perturbation: higher mean displacement in the medial-lateral direction (P < 0.05). After the perturbation: larger sway area (P < 0.05). Pain only in the medial gastrocnemius muscle increased medial-lateral centre of pressure speed (P < 0.05) during the quiet standing. Pain only in the tibialis anterior muscle increased peak pressure on the contralateral foot (P < 0.05).

Interpretation

These findings suggest that large acute painful areas on the calf muscles impair the postural control and potentially increase the risk factors for falls. Further strategies aiming to reduce pain in patients may lead to improvement in balance.     

Between-limb synchronization for control of standing balance in individuals with stroke

Background

During standing, forces and moments exerted at the feet serve to maintain stability in the face of constant centre-of-mass movement. These actions are temporally synchronized in healthy individuals. Stroke is typically a unilateral injury resulting in increased sensori-motor impairment in the contra-lesional compared with the ipsi-lesional lower-limb, which could lead to reduced between-limb synchronization for control of standing balance. The purpose of this study is to investigate between-limb synchronization of standing balance control in individuals with stroke; a potentially important index of control of upright stability.

Methods

Twenty healthy controls and 33 individuals with unilateral stroke were assessed. Stability was assessed during a 30-second quiet standing trial by measuring data from two force plates (one per foot). Limb-specific centre of pressure was calculated. Between-limb synchronization was defined as the coefficient of the correlation between the left and right foot for both the antero-posterior and medio-lateral centre of pressure time series. Synchronization, weight-bearing symmetry, and root mean square of the total centre of pressure excursion were compared between controls and stroke participants.

Findings

Stroke participants swayed more, were more asymmetric, and had less between-limb synchronization than healthy controls. Among individuals with stroke, reduced between-limb synchronization was related to increased postural sway in the medio-lateral direction and increased weight-bearing asymmetry.

Interpretation

Individuals with stroke have reduced temporal synchronization of centre of pressure fluctuations under the feet when controlling quiet standing. The clinical significance of reduced synchronization remains to be determined, although it appears linked to increased medio-lateral sway and weight-bearing asymmetry.     

The relationship between lower-extremity stress fractures and the ground reaction force: A systematic review

Background

Lower-limb stress fracture is one of the most common types of running injuries. There have been several studies focusing on the association between stress fractures and biomechanical factors. In the current study, the ground reaction force and loading rate are examined. There is disagreement in the literature about whether the history of stress fractures is associated with ground reaction forces (either higher or lower than control), or with loading rates.

Methods

A systematic review of the literature was conducted on the relationship between the history of tibial and/or metatarsal stress fracture and the magnitude of the ground reaction force and loading rate. Fixed-effect meta-analysis techniques were applied to determine whether or not the ground reaction force and/or loading rate are different between the stress fracture and control groups.

Findings

Thirteen articles were identified through a systematic search of the literature. About 54% of these articles reported significantly different vertical ground reaction force and/or loading rate between the stress fracture and control groups. Other studies (~ 46%) did not observe any significant difference between the two groups.Meta-analysis results showed no significant differences between the ground reaction force of the lower-limb stress fracture and control groups (P > 0.05). However, significant differences were observed for the average and instantaneous vertical loading rates (P < 0.05).

Interpretation

The currently available data does not support the hypothesis that there is a significant difference between the ground reaction force of subjects experiencing lower-limb stress fracture and control groups. Instead, the vertical loading rate was found to be significantly different between the two groups.     

Frontal plane compensatory strategies associated with self-selected walking speed in individuals post-stroke

Background

Approximately two out of three individuals post-stroke experience walking impairments. Frontal plane compensatory strategies (i.e. pelvic hiking and circumduction) are observed in post-stroke gait in part to achieve foot clearance in response to reduced knee flexion and ankle dorsiflexion. The objective of this study was to investigate the relationship between self-selected walking speed and the kinematic patterns related to paretic foot clearance during post-stroke walking.

Methods

Gait analysis was performed at self-selected walking speed for 21 individuals post-stroke. Four kinematic variables were calculated during the swing phase of the paretic limb: peak pelvic tilt (pelvic hiking), peak hip abduction (circumduction), peak knee flexion, and peak ankle dorsiflexion. Paretic joint angles were analyzed across self-selected walking speed as well as between functionally relevant ambulation categories (Household < 0.4 m/s, Limited Community 0.4–0.8 m/s, Community > 0.8 m/s).

Findings

While all subjects exhibited similar foot clearance, slower walkers exhibited greater peak pelvic hiking and less knee flexion, ankle dorsiflexion, and circumduction compared to faster walkers (P < .05). Additionally, four of the fastest walkers compensated for poor knee flexion and ankle dorsiflexion through large amounts of circumduction.

Interpretation

These findings suggest that improved gait performance after stroke, as measured by self-selected walking speed, is not necessarily always accomplished through gait patterns that more closely resemble healthy gait for all variables. It appears the ability to walk fast is achieved by either sufficient ankle dorsiflexion and knee flexion to achieve foot clearance or the employment of circumduction to overcome a deficit in either ankle dorsiflexion or knee flexion.     

Effects of kinesiotaping on foot posture in participants with pronated foot: A quasi-randomised,double-blind study

Objective

To investigate whether kinesiotaping improves excessive foot pronation compared with sham kinesiotaping.

Design

Quasi-randomised, double-blind study.

Setting

One primary care centre.

Participants

One hundred and thirty participants were screened for inclusion. Sixty-eight participants with pronated feet [Foot Posture Index (FPI) ≥ 6] were enrolled, and the follow-up rate was 100%.

Interventions

Participants were allocated into one of two groups: an experimental kinesiotaping group (KT1) and a sham taping group (KT2). Measures were collected by a blinded assessor at baseline, and 1 minute, 10 minutes, 60 minutes and 24 hours after taping.

Main outcome measures

The primary outcome was total FPI score, and the secondary outcome was rear-foot FPI score.

Results

There were no significant differences in total FPI score between kinesiotaping and sham taping at any time point. Similarly, there were no significant differences in rear-foot FPI score, apart from at 60-minute follow-up when the difference between groups was significant (P = 0.04) but the effect size was very small (0.85 points on the rear-foot FPI score between −6 and +6).

Conclusions

Kinesiotaping does not correct foot pronation compared with sham kinesiotaping in people with pronated feet.     

The effect of interlocking parallel screws in subcapital femoral-neck fracture fixation: a cadaver study

Background

A new locking-plate for femoral-neck fractures that provides angular stability to three screws in an inverted triangle configuration was evaluated. The plate is not fixed to the lateral cortex and therefore represents a new treatment principle.

Methods

Twelve pairs of cadaver femurs (mean T-score − 1,95 (range − 4,5–0)) with subcapital femoral-neck fractures angulating 60° were randomly allocated to fracture-fixation using either three individual screws or three interlocked screws. Subject-specific axial force and torque were applied by a hip simulator and three-dimensional migrations were recorded. The femurs underwent 10,000 cycles of simulated partial weight-bearing, followed by 10,000 cycles of simulated full weight-bearing and stair climbing.

Findings

On average interlocking reduced femoral-head centre migrations 1.6 mm (95% CI 0.1–3.1, P = 0.04). The intra-pair correlation of migration was 0.953 (Pearson's r). Interlocking did not change rotational stability (P = 0.87). Adding a locking plate did not affect the risk of failure, however all failed femurs were fixed using the smallest-sized aiming guide.

Interpretations

Adding a lateral interlocking plate to three screws might improve the fracture stability. However, none of the implants were able to resist the unwanted deformation of the proximal femur. Regardless of the fixation, female sex, reduced bone quality and small sized femurs appear to increase risk of failure.     

Impact on the biomechanics of overground gait of using an ‘Echelon’ hydraulic ankle–foot device in unilateral trans-tibial and trans-femoral amputees

Background

If a prosthetic foot creates resistance to forwards shank rotation as it deforms during loading, it will exert a braking effect on centre of mass progression. The present study determines whether the centre of mass braking effect exerted by an amputee's habitual rigid ‘ankle’ foot was reduced when they switched to using an ‘Echelon’ hydraulic ankle–foot device.

Methods

Nineteen lower limb amputees (eight trans-femoral, eleven trans-tibial) walked overground using their habitual dynamic-response foot with rigid ‘ankle’ or ‘Echelon’ hydraulic ankle–foot device. Analysis determined changes in how the centre of mass was transferred onto and above the prosthetic-foot, freely chosen walking speed, and spatio-temporal parameters of gait.

Findings

When using the hydraulic device both groups had a smoother/more rapid progression of the centre of pressure beneath the prosthetic hindfoot (p ≤ 0.001), and a smaller reduction in centre of mass velocity during prosthetic-stance (p < 0.001). As a result freely chosen walking speed was higher in both groups when using the device (p ≤ 0.005). In both groups stance and swing times and cadence were unaffected by foot condition whereas step length tended (p < 0.07) to increase bilaterally when using the hydraulic device. Effect size differences between foot types were comparable across groups.

Interpretation

Use of a hydraulic ankle–foot device reduced the foot's braking effect for both amputee groups. Findings suggest that attenuation of the braking effect from the foot in early stance may be more important to prosthetic-foot function than its ability to return energy in late stance.     

Oxford Grading Scale vs manometer for assessment of pelvic floor strength in nulliparous sports students

Objectives

To compare pelvic floor muscle strength in nulliparous sports students measured using the modified Oxford Grading Scale and a Peritron manometer; and to compare the manometric measurements between continent and incontinent subjects.

Design

Cross-sectional study. All subjects were evaluated twice on the same day; first by vaginal digital examination and subsequently by vaginal pressure using a Peritron manometer.

Participants

Forty-three nulliparous female sports students [mean age 21 (standard deviation 4) years] from the Sports Faculty of the University of Porto.

Results

This study found a significant moderate correlation between the Oxford Grading Scale score and peak pressure on manometry (r = 0.646, P = 0.002). Mean maximal strength for the entire group was 70.4 cmH₂O (range 21 to 115 cmH₂O). Out of 43 subjects, 37% (n = 16) demonstrated signs of incontinence. On manometry, no significant differences were found in vaginal resting pressure or peak pressure between the continent and incontinent groups.

Conclusions

There was moderate correlation between peak pressure on manometry and the Oxford Grading Scale score. Peritron manometer measurements of pelvic floor muscle contractions showed no significant differences in vaginal resting pressure and peak pressure in continent and incontinent subjects.     

Effect of textured insoles on balance and gait in people with multiple sclerosis: an exploratory trial

Objectives

To investigate the immediate effects of textured insoles on balance and gait in people with multiple sclerosis (MS), and to explore any effects after 2 weeks of wear.

Study design

Within-session repeated-measures design with an exploratory follow-up period.

Setting

Hospital gait laboratory.

Participants

Forty-six individuals with MS (34 females, 12 males), with a mean (SD) age of 49 (7) years, who could walk 100 m unassisted or using one stick/crutch.

Intervention

Participants were tested wearing three types of insoles in a random order: control (smooth), Texture 1 (Algeos) or Texture 2 (Crocs™). Participants were allocated at random to wear one type of textured insoles for 2 weeks, after which they were retested.

Main outcome measures

Standing balance (centre of pressure excursions and velocity) was measured with eyes open and eyes closed on a Kistler force platform. Spatio-temporal parameters of gait were measured using a GAITRite system.

Results

The textured insoles had no significant immediate effects on balance or gait, apart from an increase in anteroposterior sway range with eyes open for Texture 2 insoles [mean difference 4.5 (95% confidence interval 0.6 to 8.4) mm]. After 2 weeks, balance was not significantly different, but both types of textured insoles showed significant effects on spatio-temporal parameters of gait, with mean stride length increases of 3.5 cm (Texture 1) and 5.3 cm (Texture 2) when wearing the insoles.

Conclusions

After 2 weeks of wear, there were improvements in spatio-temporal parameters of gait. However, it is unclear whether this was a placebo effect or a learning effect.     

Effect of RAS inhibition on TGF-β, renal function and structure in experimentally induced diabetic hypertensive nephropathy rats

Objective

Transforming growth factor-β (TGF-β) implicated in the pathogenesis of diabetic nephropathy. Hence, developing agents that antagonize fibrogenic signals is a critical issue facing researchers.

Material and methods

Fifty rats were allocated to five groups: 1 = control rats, 2 = diabetic hypertensive rats 3 = diabetic hypertensive rats treated with spironolactone, 4 = diabetic hypertensive rats treated with moexpril, 5 = diabetic hypertensive rats treated with both spironolactone and moexpril. Measurement of TGF-β, aldosterone, creatinine and ACE. Degree of fibrosis was calculated.

Results

Serum creatinine, mean arterial blood pressure (MAP), aldosterone, ACE, TGF-β and renal fibrosis increased significantly in untreated diabetic hypertensive rats compared with control rats. Administration of spironolactone, moexpril, or both decreased these changes.

Conclusions

Addition of the spironolactone to moexpril was more effective in reducing fibrosis and improvement of renal function than monotherapy with either drug, possibly due to a dual inhibitory effect on the RAS, and thus suppression of TGF-β.     

The effects of sandals on postural stability in patients with rheumatoid arthritis: An exploratory study

Background

Rheumatoid arthritis results in postural instability, pain and functional limitations. As rheumatoid arthritis progresses, localised forefoot deformities such as hallux valgus and clawing of the lesser toes occur, leading to a high proportion of people with rheumatoid arthritis wearing sandals. Sandals may affect postural stability due to poor motion control. The aim was to assess two different open-toe sandals on postural stability in people with rheumatoid arthritis.

Methods

Twenty women with rheumatoid arthritis were assessed in quiet standing under four conditions: (1) open-back sandal; (2) closed-back sandal; (3) own footwear and (4) bare feet. Postural stability was assessed as postural sway in the anterior-posterior and medial-lateral directions, with eyes open and eyes closed, using a pressure mat. Repeated measures analysis of variance tested the interaction effect of the footwear and eye conditions on anterior-posterior and medial-lateral sway.

Findings

In eyes-open, there was no significant difference in anterior–posterior sway (P = .169) and medial-lateral sway (P = .325) for footwear conditions. In eyes-closed testing, compared with barefoot conditions, increased anterior–posterior sway was observed with participants' footwear (P < .0001), the open-back sandal (P = .005), and the closed-back sandal (P = .017). With eyes closed, increased anterior–posterior sway was also observed with the participants' footwear compared with the closed-back sandal (P = .041). Increased medial-lateral sway was observed with the closed-back sandal compared with bare feet (P = .014).

Interpretation

Sandals may be detrimental to older women with well-established rheumatoid arthritis when eyes are closed. Further investigation is needed to evaluate the effect of sandals on dynamic tasks.     

Effect of telmisartan on QT interval variability and autonomic control in hypertensive patients with left ventricular hypertrophy

Objectives

The aim of the study was to examine the effect of the antihypertensive AT1 receptors antagonist telmisartan on cardiovascular autonomic function and QT dispersion in hypertensive patients with LVH.

Methods

Twenty-five patients (18 males and seven women, mean age 49.8 ± 5.2 years) with mild essential arterial hypertension and LVH were compared with 25 age-matched healthy controls. All the participants underwent a complete clinical examination, including electrocardiogram for QT interval measurements and 24 h ambulatory ECG monitoring for measurement of heart rate variability. The ECG, 24 h ambulatory ECG, and echocardiogram were repeated after eight weeks of treatment.

Results

At baseline, hypertensive patients showed QT dispersion (p < 0.001) and QTc dispersion (p < 0.001) significantly higher than control subjects. An eight-week telmisartan treatment significantly reduced blood pressure (p < 0.0001), without significant change in left ventricular mass. Telmisartan-based treatment induced an increased vagal activity without significant change of sympathetic activity and a reduction of QT dispersion (p < 0.001) and QTc dispersion (p < 0.001).

Conclusions

These data suggest that therapy with telmisartan significantly improves the sympathovagal balance increasing parasympathetic activity, and cardiac electrical stability reducing the heterogeneity of ventricular repolarization in hypertensive subjects. These effects could contribute to reduce arrhythmias as well as sudden cardiac death in at-risk hypertensive patients.     

Biomechanical assessment of a novel bone lengthening plate system — A cadaveric study

Background

Although many types of external fixators have been developed for distraction osteogenesis, all have some drawbacks. We recently developed a novel bone lengthening plate to overcome these problems. The purpose of this study is to conduct biomechanical analyses using cadavers to assess the stability of the bone lengthening plate in relation to distraction length and femoral bone mineral density.

Methods

We used human cadaveric femurs (n = 18) to assess the effects of distraction length and bone mineral density on the biomechanical stability of the bone lengthening plate. After establishing control (n = 6, 0 mm lengthening) and experimental groups (n = 12, 30 mm lengthening), we measured biomechanical stability (structural stiffness, ultimate load, and displacement) under a compressive load. The experimental group was subdivided into a group with normal bone mineral density (n = 6) and a group with osteoporosis (n = 6), and the biomechanical stability of these groups was compared.

Finding

Structural stiffness differed significantly between the control (417.6 N/mm) and combined experimental groups (185.6 N/mm, p = 0.002). Ultimate load also differed significantly between the control (1327.8 N) and combined experimental (331.4 N, p = 0.002) groups. Bone mineral density was unrelated to structural stiffness (p = 0.204), ultimate load (0.876), or displacement (0.344). In all cases, failure of the bone lengthening plate occurred at the longitudinal connectors, such as the connecting columns between the upper and lower plates, and the lengthening shaft of the bone lengthening plate.

Interpretation

The biomechanical stability of the bone lengthening plate was affected by the lengthening length but not by bone mineral density. In addition, biomechanical stability during lengthening was most strongly influenced by the longitudinal connectors.     

Contributors to fatigue resistance of the hamstrings and quadriceps in cerebral palsy

Background

The purpose of this study was to elucidate relationships between quadriceps and hamstrings voluntary muscle fatigue and upper motor lesion impairments in cerebral palsy in order to gain a better understanding of their contribution to the observed fatigue resistance.

Methods

Seventeen ambulatory subjects with cerebral palsy (mean age: 17.0, SD = 4.8 years) were recruited. Quantitative measures of strength, spasticity, cocontraction, and stiffness for both muscle groups were collected on an isokinetic dynamometer and entered in a factor analysis. The resulting factors were used as independent variables in a multiple regression analysis with quadriceps and hamstrings fatigue as dependent variables.

Findings

Five independent factors explained 90% of the variance. In order of loadings, higher hamstring cocontraction and spasticity and lower hamstring strength were associated with lower levels of hamstring fatigue. Higher quadriceps cocontraction and lower quadriceps strength were the most predictive of lower levels of quadriceps fatigue.

Interpretation

Greater motor impairments of the agonist muscle, particularly cocontraction, spasticity, and weakness, were associated with lower rates of muscle fatigue of the same muscle during performance of a voluntary fatigue protocol for the hamstrings and quadriceps. Muscles are highly adaptable; therefore, the results of this study suggest that the observed fatigue resistance may be due to the effect of the primary neural insult on motor unit recruitment and rate modulation or the result of secondary adaptations to spasticity, weakness, or excessive cocontraction.     

Factors contributing to evidence-based pressure ulcer prevention. A cross-sectional study

Background

Implementation of evidence-based care for pressure ulcer prevention is lacking. As the hospital organization is complex, more knowledge is needed to understand how nursing care in this area can be improved.

Objectives

The present study investigated the associations between variables on different levels in the healthcare setting (patient, unit, hospital) and the documentation of (1) risk assessment and (2) skin assessment within 24 h of admission, the use of (3) pressure-reducing mattresses and (4) planned repositioning in bed.

Design

A cross-sectional study.

Settings

One university hospital and one general hospital.

Participants

Geriatric (n = 8), medical (n = 24) and surgical (n = 19) units. All adult patients (>17 years), in total 825, were included.

Methods

A one-day prevalence study was conducted using the methodology specified by the European Pressure Ulcer Advisory Panel, together with the established methods used by the Collaborative Alliance for Nursing Outcomes. Independent variables were patient characteristics, hospital type, unit type, nurse staffing and workload. Dependent variables were documented risk and skin assessment within 24 h of admission, pressure-reducing mattresses and planned repositioning in bed. The data were analysed with Logistic regression using the Generalized Estimating Equation (GEE) approach.

Results

Patients at risk of developing pressure ulcers (Braden < 17) had higher odds of having risk assessment documented, and of receiving pressure-reducing mattresses and planned repositioning. Patients at the general hospital were less likely to have risk and skin assessment documented and to receive pressure-reducing mattresses. On the other hand, planned repositioning was more likely to be used at the general hospital. When total hours of nursing care was lower, patients had higher odds of having pressure-reducing mattresses but were less likely to have planned repositioning.

Conclusion

Patient characteristics (high age and risk score) and hospital type were associated with pressure ulcer prevention. Surprisingly, nurse staffing played only a minor role. Leaders in healthcare organizations should establish routines on different levels that support evidence-based pressure ulcer prevention, and registered nurses need to assume responsibility for bedside care.     

Changes in Spasticity,Widespread Pressure Pain Sensitivity,and Baropodometry After the Application of Dry Needling in Patients Who Have Had a Stroke: A Randomized Controlled Trial

Objective

The purpose of this study was to determine the effects of deep dry needling (DDN) on spasticity, pressure sensitivity, and plantar pressure in patients who have had stroke.

Methods

A randomized controlled trial was conducted. Thirty-four patients who previously had a stroke were randomly assigned either an experimental group that received a single session of DDN over the gastrocnemius and tibialis anterior muscles on the spastic leg or a control group that received no intervention. Spasticity (evaluated with the Ashworth Scale); pressure pain thresholds over the deltoid muscle, second metacarpal, and tibialis anterior muscle; and plantar pressure (baropodometry) were collected by a blinded assessor before and 10 minutes after intervention.

Results

A greater number of individuals receiving DDN exhibited decreased spasticity after the intervention (P < .001). The analysis of covariance showed that pressure pain thresholds increased bilaterally in patients receiving DDN compared with those who did not receive the intervention (P < .001). The analysis of covariance also found that patients receiving DDN experienced bilateral increases of support surface in the forefoot, unilateral increase of the support surface in the rear foot of the treated (affected) side, and bilateral decreases in mean pressure (all, P < .02) as compared with those who did not receive DDN.

Conclusions

Our results suggest that a single session of DDN decreases spasticity and widespread pressure sensitivity in individuals with poststroke spasticity. Deep dry needling also induced changes in plantar pressure by increasing the support surface and decreasing the mean pressure.     

The effectiveness of a self-efficacy-enhancing intervention for Chinese patients with colorectal cancer: A randomized controlled trial with 6-month follow up

Background

Colorectal cancer is a major public health problem. There is growing support for colorectal cancer survivors who are experiencing problems after cancer treatment to engage in self-management programs to reduce symptom distress. However, there is inconclusive evidence as to the effectiveness of such program especially in Asian region.

Objectives

This study tested the effects of a six-month nurse-led self-efficacy-enhancing intervention for patients with colorectal cancer, compared with routine care over a six-month follow up.

Design

A randomized controlled trial with repeated measures, two-group design.

Setting

Three teaching hospitals in Guangzhou, China.

Participants:

One hundred and fifty-two Chinese adult patients with a diagnosis of colorectal cancer were recruited. The intervention group (n = 76) received self-efficacy-enhancing intervention and the control group (n = 76) received standard care.

Method

The participants were randomized into either intervention or control group after baseline measures. The outcomes of the study (self-efficacy, symptom distress, anxiety, depression and quality of life) were compared at baseline, three and six months after the intervention.

Results

Sixty-eight participants in the intervention group and 53 in the control group completed the study. Their mean age was 53 (SD = 11.3). Repeated measure MANOVA found that the patients in the intervention group had significant improvement in their self-efficacy (F = 7.26, p = 0.003) and a reduction of symptom severity (F = 5.30, p = 0.01), symptom interference (F = 4.06, p = 0.025), anxiety (F = 6.04, p = 0.006) and depression (F = 6.96, p = 0.003) at three and six months, compared with the control group. However, no statistically significant main effect was observed in quality of life perception between the two groups.

Conclusions

The nurse-led self-efficacy enhancing intervention was effective in promoting self-efficacy and psychological well-being in patients with colorectal cancer, compared with standard care. The intervention can be incorporated into routine care. Future empirical work is required to determine the longer term effects of the intervention.     

Predictors of shuttle walking test performance in patients with cardiovascular disease

Objective

The incremental shuttle walking test (ISWT) is used to estimate cardiorespiratory fitness, but data from healthy individuals suggest that demographic and anthropometric measures account for much of the variance in test performance. The aim of this study was to determine whether anthropometric, demographic and selected gait measures also predict ISWT performance (i.e. distance walked) in patients with cardiovascular disease.

Design

Observational study.

Setting

A community-based cardiac rehabilitation centre (Cohort 1) and a hospital outpatient cardiac rehabilitation programme (Cohort 2).

Participants

Sixteen patients with clinically stable cardiovascular disease (Cohort 1) and 113 patients undergoing cardiac rehabilitation (Cohort 2).

Interventions

Patients in Cohort 1 performed the ISWT on two occasions. Anthropometric data and walking and turning variables were collected. Linear regression analyses were used to identify the predictors of test performance. The authors subsequently attempted to validate the equation created by comparing predicted and actual ISWT values in a larger (n = 113) validation sample (Cohort 2).

Main outcome measures

Distance walked during ISWT, step length and height.

Results

No gait or turning measures were significantly associated with ISWT performance. Distance walked correlated most strongly with step length (r = 0.83, P < 0.05) and height (r = 0.74, P < 0.05). Given the similarity of these correlations and the rarity of step length assessment in clinical practice, ISWT performance was predicted using patient's height; this explained 55% of the variance in ISWT performance. Height was also the best predictor in Cohort 2, explaining 17% of test variance (P < 0.01). Body mass index explained an additional 3% of variance (P < 0.05) in ISWT performance.

Conclusions

Routine clinical measures, particularly patient's height, are predictive of ISWT performance. The findings of the present study are in partial agreement with similar studies performed in healthy individuals, and it remains unclear whether the ISWT performance of patients with cardiovascular disease is influenced by the same factors as the ISWT performance of healthy individuals.