QUESTION: Which clinical measures of walking performance best predict free-living physical activity in community-dwelling people with stroke? DESIGN: Cross-sectional observational study. PARTICIPANTS: 42 community-dwelli...QUESTION: Which clinical measures of walking performance best predict free-living physical activity in community-dwelling people with stroke? DESIGN: Cross-sectional observational study. PARTICIPANTS: 42 community-dwelling stroke survivors. OUTCOME MEASURES: Predictors were four clinical measures of walking performance (speed, automaticity, capacity, and stairs ability). The outcome of interest was free-living physical activity, measured as frequency (activity counts) and duration (time on feet), collected using an activity monitor called the Intelligent Device for Energy Expenditure and Physical Activity. RESULTS: Time on feet was predicted by stairs ability alone (B 166, 95% CI 55 to 278) which accounted for 48% of the variance. Activity counts were also predicted by stairs ability alone (B 6486, 95% CI 2922 to 10 050) which accounted for 58% of the variance. CONCLUSION: The best predictor of free-living physical activity in community-dwelling people with stroke was stairs ability.
QUESTION: Does health locus of control predict the smallest worthwhile effect of motor control exercise or spinal manipulative therapy when adjusted for severity of pain? DESIGN: Cross-sectional observational study. PART...QUESTION: Does health locus of control predict the smallest worthwhile effect of motor control exercise or spinal manipulative therapy when adjusted for severity of pain? DESIGN: Cross-sectional observational study. PARTICIPANTS: 86 people with non-specific low back pain who had not yet commenced physiotherapy intervention. OUTCOME MEASURES: Predictors were severity of pain measured over the last 7 days using an 11-point scale from 0 to 10, and external and internal health loci of control measured using Form C of the Multidimensional Health Locus of Control scale. The outcome of interest was smallest worthwhile effect which was measured in terms of the percentage perceived change necessary to make two evidence-based physiotherapy interventions for non-specific low back pain (motor control exercise and spinal manipulative therapy) worthwhile. Data were collected before intervention commenced. RESULTS: Multivariate analysis showed that when adjusted for pain and internal locus of control, external locus of control predicted the smallest worthwhile effect for motor control exercise (B 0.79; CI 0.10 to 1.48), explaining 0.07 of the variance. None of the predictors significantly predicted the smallest worthwhile effect for spinal manipulative therapy. CONCLUSION: Patients with low back pain who have externalised beliefs and agree more strongly with the notion that others are responsible for their condition report higher estimates of smallest worthwhile effect of an active intervention such as motor control exercise than patients who do not have externalised beliefs.
QUESTION: Which measures of activity limitation on admission to rehabilitation after stroke best predict walking speed at discharge? DESIGN: Prospective observational study. PARTICIPANTS: 120 people with stroke undergoin...QUESTION: Which measures of activity limitation on admission to rehabilitation after stroke best predict walking speed at discharge? DESIGN: Prospective observational study. PARTICIPANTS: 120 people with stroke undergoing inpatient rehabilitation. OUTCOME MEASURES: Predictors were admission walking speed, Timed Up and Go, Motor Assessment Scale, Modified Elderly Mobility Scale, and Functional Independence Measure scores measured on admission to rehabilitation. The outcome of interest was walking speed at discharge from inpatient rehabilitation. RESULTS: Admission walking speed (B 0.47, 95% CI 0.27 to 0.67) and Item 2 of the Motor Assessment Scale, ie, moving from supine lying to sitting over the side of a bed (B 0.05, 95% CI 0.01 to 0.09) predicted walking speed on discharge from rehabilitation. These two predictors explained 36% of the variance in discharge walking speed. CONCLUSION: Walking speed at discharge from inpatient rehabilitation was best predicted by admission walking speed and Motor Assessment Scale Item 2.
QUESTIONS: Do symptomatic female office workers perform computing tasks with higher cervical postural muscle loads (in terms of higher amplitudes and less muscular rest) and more discomfort compared with asymptomatic ind...QUESTIONS: Do symptomatic female office workers perform computing tasks with higher cervical postural muscle loads (in terms of higher amplitudes and less muscular rest) and more discomfort compared with asymptomatic individuals? Are these differences in postural muscle loads consistent across bilateral (typing) and unilateral (mousing) conditions? DESIGN: an experimental case-control study. PARTICIPANTS: 18 symptomatic female office workers and 21 asymptomatic female office workers. INTERVENTION: Three conditions (typing, mousing, and type-and-mouse) were performed in random order. OUTCOME MEASURES: Muscle load was measured as median amplitude and gap frequency using surface EMG of bilateral cervical erector spinae and upper trapezius. Discomfort was measured using a numerical rating scale. RESULTS: The case group demonstrated 4.3% (95% CI 0.1 to 8.4) higher amplitude during typing and 3.5% (95% CI 0.1 to 6.9) higher amplitude during type-and-mouse in the right cervical erector spinae compared with the control group. There was a similar difference between groups in the left cervical erector spinae which also demonstrated a 1.2 gaps/min (95% CI -2.3 to 0.0) lower frequency during typing. The case group had significantly higher discomfort during all conditions compared with the control group. The case group demonstrated higher median amplitudes and lower gap frequencies than the control group during bilateral conditions (typing and type-and-mouse) compared with unilateral conditions (mousing) for both muscle groups. CONCLUSION: There was increased amplitude and decreased muscular rest in the cervical erector spinae of office workers performing typing and mousing tasks. These findings may represent a mechanism underlying computer-related musculoskeletal disorders.
QUESTION: Is ventilator-induced hyperinflation in sidelying more effective than sidelying alone in removing secretions and improving respiratory mechanics in ventilated patients with pulmonary infection? DESIGN: Randomis...QUESTION: Is ventilator-induced hyperinflation in sidelying more effective than sidelying alone in removing secretions and improving respiratory mechanics in ventilated patients with pulmonary infection? DESIGN: Randomised crossover trial with concealed allocation and intention-to-treat analysis. PARTICIPANTS: 30 mechanically ventilated patients with pulmonary infection in an adult intensive care unit. INTERVENTION: The experimental intervention was 30 minutes of ventilator-induced hyperinflation using pressure support ventilation in sidelying; the control intervention was 30 minutes of sidelying. Participants received both interventions on the same day, with a five-hour washout period between them. OUTCOME MEASURES: Secretion clearance was measured as sputum volume retrieved during the intervention. Respiratory mechanics were measured as static compliance and total resistance of the respiratory system before and after the intervention. RESULTS: The experimental intervention cleared 1.3 ml (95% CI 0.5 to 2.2) more secretions than the control. After ventilator-induced hyperinflation in sidelying, respiratory compliance had increased 4.7 ml/cmH(2)O (95% CI 2.6 to 6.8) more than in sidelying alone. There was no difference in total resistance of the respiratory system between the interventions (mean difference 0.3 cmH(2)O/l/s, 95% CI -0.8 to 1.3). CONCLUSION: The application of hyperinflation using pressure support ventilation in mechanically ventilated patients with pulmonary infection improves secretion clearance and increases static compliance of the respiratory system.
QUESTION: Is progressive resistance exercise a safe and effective form of exercise to improve glycaemic control in people with type 2 diabetes? DESIGN: Systematic review with meta-analysis of randomised controlled trials...QUESTION: Is progressive resistance exercise a safe and effective form of exercise to improve glycaemic control in people with type 2 diabetes? DESIGN: Systematic review with meta-analysis of randomised controlled trials. PARTICIPANTS: People with type 2 diabetes mellitus. INTERVENTION: Progressive resistance exercise. OUTCOME MEASURES: The primary outcome was glycaemic control measured as percentage glycosylated haemoglobin (HbA1c). Secondary outcomes were body composition (lean body and fat free mass in kg), and muscle strength (% change in 1RM, dynamometry, change in maximum weight lifted). RESULTS: The search yielded nine relevant trials that evaluated 372 people with type 2 diabetes. Compared to not exercising, progressive resistance exercise led to small and statistically significant absolute reductions in HbA1c of 0.3% (SMD -0.25, 95% CI -0.47 to -0.03). When compared to aerobic exercise there were no significant differences in HbA1c. Progressive resistance exercise resulted in large improvements in strength when compared to aerobic (SMD 1.44, 95% CI 0.83 to 2.05) or no exercise (SMD 0.95, 95% CI 0.58 to 1.31). There were no significant changes in body composition. CONCLUSIONS: Progressive resistance exercise increases strength and leads to small reductions in glycosylated haemoglobin that are likely to be clinically significant for people with type 2 diabetes. Progressive resistance exercise is a feasible option in the management of glycaemia for this population.