QUESTION: What baseline characteristics predict good or poor quality of life among community-dwelling seniors undertaking a three-month progressive resistance exercise program? DESIGN: A prospective cohort observational...QUESTION: What baseline characteristics predict good or poor quality of life among community-dwelling seniors undertaking a three-month progressive resistance exercise program? DESIGN: A prospective cohort observational study. PARTICIPANTS: 63 Japanese men and women over 65 years with mild disability. OUTCOME MEASURES: Health-related quality of life was measured using the Short Form 36. Predictors included age, sex, body mass index, presence of chronic diseases, frequency of exercise, number of falls, and activity limitations measured before undertaking the exercise program. RESULTS: The presence of diabetes negatively predicted a good outcome (OR 0.20, 95% CI 0.05 to 0.88) and positively predicted a poor outcome (OR 4.40, 95% CI 1.21 to 18.86) when adjusted for age, sex and body mass index. The accuracy of the prediction of a good outcome was 1.25 (LR+) and 0.44 (LR-). The accuracy of the prediction of a poor outcome was 7.15 (LR+) and 0.87 (LR-). CONCLUSION: The quality of life improved in a community-dwelling elderly population with mild disability who undertook a three-month group-based progressive resistance exercise program. However, those with diabetes mellitus were more likely to experience decreased quality of life. Therefore, health care providers need to monitor carefully participants with this disease who are undertaking progressive resistance exercise.
QUESTION: Can the risk of developing postoperative pulmonary complications be predicted after upper abdominal surgery? DESIGN: Prospective observational study. PARTICIPANTS: 268 consecutive patients undergoing elective u...QUESTION: Can the risk of developing postoperative pulmonary complications be predicted after upper abdominal surgery? DESIGN: Prospective observational study. PARTICIPANTS: 268 consecutive patients undergoing elective upper abdominal surgery who received standardised pre- and postoperative prophylactic respiratory physiotherapy. OUTCOME MEASURES: Predictors were 17 preoperative and intraoperative risk factors. A postoperative pulmonary complication was diagnosed when four or more of the following criteria were present: radiological evidence of collapse/consolidation, temperature > 38 degrees C, oxyhaemoglobin saturation < 90%, abnormal sputum production, sputum culture indicating infection, raised white cell count, abnormal auscultation findings, or physician's diagnosis of pulmonary complication. RESULTS: 35 participants (13%) developed postoperative pulmonary complications. Five risk factors predicted postoperative pulmonary complications: duration of anaesthesia (OR 4.3, 95% CI 1.7 to 10.8); surgical category (OR 2.3, 95% CI 1.1 to 4.7); current smoking (OR 2.1, 95% CI 1.0 to 4.5); respiratory co-morbidity (OR 2.1, 95% CI 1.0 to 4.4); and predicted maximal oxygen uptake (OR 2.0, 95% CI 1.0 to 4.3). A clinical rule for predicting the development of postoperative pulmonary complications predicted 82% of participants who developed complications. The odds of high risk participants developing pulmonary complications were 8.4 (95% CI 3.3 to 21.3) times that of low risk participants. CONCLUSION: This clinical rule for predicting the risk of developing postoperative pulmonary complications from five risk factors may prove useful in prioritising postoperative respiratory physiotherapy. Further research is needed to validate the rule.
QUESTION: Do people who have had revision arthroplasty report more limitations and less physical activity than those after primary total hip arthroplasty? Can degree of limitation and physical activity be predicted by re...QUESTION: Do people who have had revision arthroplasty report more limitations and less physical activity than those after primary total hip arthroplasty? Can degree of limitation and physical activity be predicted by revision arthroplasty, after adjustment for age, gender, and Charnley classification? DESIGN: Cross-sectional observational study. PARTICIPANTS: 371 people after primary and 134 after revision total hip arthroplasty. OUTCOME MEASURES: Limitations were measured using the Dutch-language version of the WOMAC questionnaire and amount and intensity of physical activity was measured using the SQUASH questionnaire. RESULTS: The revision arthroplasty group reported 12% (95% CI 7 to 17) more limitations than the primary total hip arthroplasty group. They also reported 394 min/wk (95% CI 88 to 701) less physical activity and 1153 min/wk (95% CI 66 to 2241) less intensity of physical activity than the primary total hip arthroplasty group. Having had a revision arthroplasty predicted limitations regardless of whether the prediction was adjusted for age, gender, or Charnley group (B -12.1, 95% CI -17.2 to -7.0). However, having had a revision arthroplasty did not predict either amount (B -121.2, 95% CI -408.0 to 165.7) or intensity (B -912.8, 95% CI -1989.1 to 163.6) of physical activity when the prediction was adjusted for age, gender, and Charnley group. CONCLUSION: People reported more limitations after revision arthroplasty than after primary total hip arthroplasty. However, people after revision arthroplasty appeared to be equally physically active as those after primary total hip arthroplasty after adjusting for age, gender, and Charnley group.
QUESTIONS: Are volunteered and endorsed descriptors of recalled breathlessness consistent with descriptors of exercise-induced breathlessness? Are volunteered and endorsed descriptors of exercise-induced breathlessness c...QUESTIONS: Are volunteered and endorsed descriptors of recalled breathlessness consistent with descriptors of exercise-induced breathlessness? Are volunteered and endorsed descriptors of exercise-induced breathlessness consistent? DESIGN: Within-participant, repeated measures, experimental study. PARTICIPANTS: 57 people with symptomatic chronic respiratory disease aged 71 years. INTERVENTION: There were three conditions. The first was recalled breathlessness. Two conditions of exercise-induced breathlessness were created by getting the participants to undertake the 6-min Walk Test twice (breathlessness 1 and 2). OUTCOME MEASURES: Descriptors of breathlessness were volunteered (where participants' used their own words) or endorsed (from a pre-existing list of 15 breathlessness statements). RESULTS: Emotive descriptors made up 65% of recalled descriptors compared with 11% of exercise-induced descriptors, whereas physical descriptors made up 35% of recalled descriptors compared with 89% of exercise-induced descriptors. Of the 237 potential language pairs volunteered to describe recalled and exercise-induced breathlessness 1, only 27 (11%) were identical whereas of the 171 potential language pairs endorsed as describing recalled and exercise-induced breathlessness 1, 66 (39%) were identical. Of the 175 potential language pairs of descriptors volunteered to describe exercise-induced breathlessness 1 and 2, 72 (41%) were identical whereas of the 153 potential language pairs endorsed as describing exercise-induced breathlessness 1 and 2, 71 (46%) were identical. CONCLUSION: The language used to describe exercise-induced breathlessness immediately after two walking challenges was similar. However, descriptions of recalled breathlessness did not consistently match descriptions of exercise-induced breathlessness, which may reflect the different contexts under which breathlessness was recalled and induced.
QUESTION: In children with intellectual disability, is lung function lower than in healthy peers and does it improve with exercise? DESIGN: Randomised trial with intention-to-treat analysis and assessor blinding. PARTICI...QUESTION: In children with intellectual disability, is lung function lower than in healthy peers and does it improve with exercise? DESIGN: Randomised trial with intention-to-treat analysis and assessor blinding. PARTICIPANTS: Forty-four 12-year old children with Down syndrome or other intellectual disability with an average IQ of 42 (SD 8). INTERVENTION: The experimental group performed aerobic exercise for 30 minutes, five days per week, for eight weeks. The exercise was supervised walking, running, and cycling, with a target of moderate intensity. The control group continued usual activities and performed no specific exercise. OUTCOME MEASURES: Lung function as FEV1 and FVC in litres was measured with spirometry at baseline and after the intervention at eight weeks. Prior to the baseline measures, all participants underwent familiarisation of spirometry for one week. RESULTS: At baseline, FEV1 of the children with intellectual disability was a mean of 87% (95% CI 83 to 91) and FVC was 94% (95% CI 91 to 97) of predicted normal values. After intervention, FEV(1) had increased by 160 ml (95% CI 30 to 290) and FVC by 330 ml (95% CI 200 to 460) more in the experimental group than the control group. CONCLUSION: An 8-week program of aerobic exercise improves lung function in children with intellectual disability significantly. TRIAL REGISTRATION: ACTRN12609000365268.
QUESTIONS: Is rehabilitative ultrasound imaging a valid measure of trunk muscle size and activation? Are rehabilitative ultrasound imaging measures sensitive to change? DESIGN: Systematic review of studies of criterion-r...QUESTIONS: Is rehabilitative ultrasound imaging a valid measure of trunk muscle size and activation? Are rehabilitative ultrasound imaging measures sensitive to change? DESIGN: Systematic review of studies of criterion-related validity, construct validity, and sensitivity to change. PARTICIPANTS: People with low back pain and asymptomatic controls. OUTCOME MEASURE: Trunk muscle size and activation measured by rehabilitative ultrasound imaging, MRI and/or EMG. RESULTS: 37 studies were included. 10 studies investigated criterion-related validity and provided evidence that while ultrasound may be a valid measure of trunk muscle size, the validity of ultrasound to quantify muscle activation is context-dependent, depending on the muscle involved, the contraction strategy utilised, and the intensity of muscle contraction. 23 studies provided evidence of construct validity by demonstrating the ability of ultrasound measurement to differentiate individuals in terms of back pain, anthropometry, and postures. Six studies contained a limited amount of information about sensitivity to change. CONCLUSIONS. It is valid to use rehabilitative ultrasound imaging to measure trunk muscle size and activation during most isometric sub-maximal contractions. Ultrasound measures appear sensitive to both positive and negative change.
QUESTION: Does assessment by a multidisciplinary team, or assessment by a community nurse with the ability to refer to other professionals, reduce further falls in recurrent fallers? DESIGN: Cluster-randomised, controlle...QUESTION: Does assessment by a multidisciplinary team, or assessment by a community nurse with the ability to refer to other professionals, reduce further falls in recurrent fallers? DESIGN: Cluster-randomised, controlled trial. SETTING: 18 general practices in the UK. PARTICIPANTS: Adults aged at least 65 years, living in the community, who had experienced 2 or more falls in the past year, and who did not present to an emergency department for their most recent fall. Inability to participate for one year, abbreviated mental test score less than 7, and nursing home placement were exclusion criteria. Randomisation of 516 participants allotted 213 to care by the multidisciplinary team (secondary care), 141 to care by the community nurse (primary care), and 162 to usual care. INTERVENTIONS: Participants allocated to secondary care attended a multidisciplinary clinic (comprising a doctor, nurse, physiotherapist, and occupational therapist) with referral for investigations, interventions, (including Homecheck), and follow-up if necessary. Participants allocated to primary care were assessed by a community nurse who identified risk factors for falls and could refer to other professionals. Participants in the usual care group were assessed by their usual primary care physicians, who provided management at their own discretion. OUTCOME MEASURES: the primary outcome was the proportion of participants in each group who had at least one fall during the follow-up period of 12 months. Other outcomes were death, move to institutional care, change in Barthel score, change in the timed Get Up and Go score, fall-related fractures, and hospitalisations. Participants lost to follow-up were assumed to have had an adverse outcome. RESULTS: 466 participants contributed data to the primary outcome, with an adverse outcome assumed for a further 39 participants on falls and other dichotomous outcomes. At 12 months, 75% of the secondary care group, 87% of the primary care group, and 84% of the usual care group had fallen. Secondary care prevented significantly more falls than usual care (adjusted odds ratio 0.52, 95% Ci 0.35 to 0.79). the secondary care group also had a significantly more positive Barthel index than the usual care group. the groups did not significantly differ on the other outcomes. The data were also analysed without imputing adverse outcomes for participants who were lost to follow-up. Compared to the usual care group, the secondary care group had significantly fewer falls, fractures, hospitalisations, and deaths. CONCLUSION: Multidisciplinary assessment of elderly, recurrent fallers reduces the risk of further falls compared to usual care. Assessment of risk factors for falls by a community nurse with the potential to refer to other professionals did not have the same benefit.
QUESTION: Does a graded exercise program emphasising lumbar stabilising exercises reduce pain and disability at 12 months, compared with a walking program, for patients with recurrent low back pain? DESIGN: Randomised co...QUESTION: Does a graded exercise program emphasising lumbar stabilising exercises reduce pain and disability at 12 months, compared with a walking program, for patients with recurrent low back pain? DESIGN: Randomised controlled trial. SETTING: A single private physiotherapy clinic in Sweden. PARTICIPANTS: 71 patients with recurrent mechanical low back pain (>8 weeks duration, with at least 1 pain-free period during the past year) and without leg pain were allocated to one of two groups, using a concealed allocation process. The groups were comparable at baseline with respect to age, sex, proportion of participants who had sought care for back pain, and pain duration (approximately 10 years). INTERVENTIONS: The graded exercise program and the walking program were both 8 weeks' duration. The exercise program was individually supervised by a physiotherapist weekly for 45 minutes. In the walking program, patients met with a physiotherapist for 45 minutes in week 1 and again in week 8. The exercise program consisted primarily of stabilising exercises for the lumbar spine, commencing with re-learning activation of the transversus abdominis and multifidus muscles, with assistance of a pressure biofeedback cuff. Exercises were progressed according to clinical judgement, pain levels, and movement control and quality. Progression entailed incorporation of muscle activation in upright positions and during functional activities. Continued implementation of the exercises in daily life was encouraged. The reference group were instructed to walk for 30 minutes daily at the fastest pace that did not aggravate pain. Walking compliance was monitored with a self-completed daily diary. OUTCOMES: The primary outcomes were perceived pain and disability at 12 months, measured by self-completed questionnaires returned by post. Disability was measured with the Oswestry Disability Questionnaire (scale 0-100, where 100 = maximum disability). Pain was measured with 100-mm visual analogue scale (where 100 = worst pain imaginable). RESULTS: At 12 months 86% of patients were followed up. At this time there was no clinically-important difference between the groups with respect to median (IQR) change in pain: exercise group -12 (-34 to -3); walking group -12 (-22 to 0). For disability at 12 months, the between-group difference in median scores was 8 on the Oswestry score: exercise group -10 (-20 to -2); walking group -2 (-12 to 2). CONCLUSION: Lumbar stabilising exercises appear to have a similar effect on pain and disability for patients with recurrent low back pain as a daily walking program.
QUESTION: What is the effect of the addition of arthroscopy to physiotherapy and medication in patients with osteoarthritis (OA) of the knee? DESIGN: Randomised, controlled trial with blinded outcome assessment and inten...QUESTION: What is the effect of the addition of arthroscopy to physiotherapy and medication in patients with osteoarthritis (OA) of the knee? DESIGN: Randomised, controlled trial with blinded outcome assessment and intention-to-treat analysis. SETTING: A university sports medicine clinic in Ontario, Canada. PARTICIPANTS: Adults with idiopathic or secondary moderate-to-severe oa of the knee (Grade 2, 3, or 4 radiographic severity on the modified Kellgren-Lawrence classification). Key exclusion criteria were large meniscal tears, inflammatory arthritis, previous arthroscopic treatment for knee OA and more than 5 degrees of lateral deformity. Randomisation of 188 participants allotted 94 to an intervention group and 94 to a control group. INTERVENTIONS: The intervention group underwent arthroscopy within 6 weeks after randomisation and a standard physiotherapy and medication regimen was initiated within 7 days after surgery. the control group initiated the same physiotherapy and medication regimen at an equivalent time. Physiotherapy was provided for 1 hour once a week for 12 weeks. It included range-of-motion and strengthening exercises to be performed at home twice daily, information about activities of daily living, instruction in the use of heat and cold, and an educational video. Exercises were individualised according to the severity of oa and age. After the 12-week period, participants were advised to continue the exercise program. medications (potentially including paracetamol, non-steroidal anti-inflammatory drugs, hyaluronic acid, and glucosamine) were prescribed according to standard guidelines. OUTCOME MEASURES: The primary outcome was the WOMAC score at 2 years follow up. The WOMAC is scored from 0 (worst) to 2400, with subscales for pain, stiffness, and physical function. Secondary outcomes included the Physical Component Summary Score of the Short Form-36 (0 to 100); the McMaster Toronto Arthritis patient preference (MACTAR) questionnaire (0 to 500); and the Arthritis Self-Efficacy Scale (ASES) (10 to 100). RESULTS: 168 participants completed the study. After 2 years, the mean (SD) WOMAC scores were 874 (624) in the intervention group and 897 (583) in the control group, mean difference 23 (95% CI -208 to 161). The groups differed on the SF-36 by only 0.2 (95% CI -3.2 to 3.6), on the MACTAR questionnaire by only 6 (95% CI -37 to 49), and on each of the ASES subscales by less than 6 (all non-significant). CONCLUSION: The addition of arthroscopy to a regimen of physiotherapy and medication does not improve physical function, pain, or health-related quality of life in patients with moderate-to-severe OA of the knee.