Hong Kong Physiotherapy Journal最新文献

Background/purpose: To date, there are no published validated Chinese versions of the incremental shuttle walk test (ISWT) instructions despite its wide clinical applications. Translation of the Chinese ISWT instruction is done in an ad-hoc manner within the Chinese-speaking populations, affecting the test's reliability and validity since translation can differ significantly between individuals. This warrants the need for psychometric testing of such translation.

Objectives: To develop a Chinese (Mandarin) version of the ISWT instructions (ISWT-CHN) that is conceptually equivalent to the original English version (ISWT-ENG) and establish its reliability and validity.

Methods: Forward and backward translations from the ISWT-ENG were done to generate the ISWT-CHN. Face and content validity was determined during the translation process. Intra-rater and inter-rater reliability of the ISWT-CHN, construct and criterion validity were established by analysing the ISWT and the gold standard cardiopulmonary exercise test results.

Results: The Item-Content validity index (I-CVI), Scale-level-Content validity index (S-CVI), and content validity ratio (CVR) of the ISWT-CHN were 1.0. Intra-class Correlation Coefficient (ICC) for inter-rater reliability between two raters were excellent ($\text{ICC}=0.99$, 95% CI 0.97-1.0, $p<0.001$; $\text{SEM}=0.85$ m, $\text{MDC}=2.35$ m). The intra-rater reliability of both Raters A ($\text{ICC}=0.92$, 95% CI 0.53-0.98, $p=0.003$; $\text{SEM}=35$ m, $\text{MDC}=97$ m) and B ($\text{ICC}=0.90$, 95% CI 0.76-0.96, $p<0.001$; $\text{SEM}=32$ m, $\text{MDC}=88$ m) were good. In a sample of 32 healthy participants, both ISWT-CHN and ISWT-ENG instruction results showed low-positive correlations with the VO${}_{2\max }$ determined from the cardiopulmonary exercise test (r = 0.439, $p<0.001$; $r=0.448$, $p<0.001$). There is a very high correlation between ISWT-ENG and ISWT-CHN r

Background: Mobile app has been used to improve exercise adherence and outcomes in populations with different health conditions. However, the effectiveness of mobile app in delivering home-based rehabilitation program to elderly patients with hip fracture is unclear.

Objective: The aim of this study was to test the effectiveness of mobile app in delivering home-based rehabilitation program for improving functional outcomes and reducing caregiver stress with enhancing adherence among the elderly patients with hip fracture.

Methods: A randomized controlled trial with an intervention period of two months was performed. Eligible participants were randomized into either experimental group with home-based rehabilitation program using a mobile app or control group with home-based rehabilitation program using an exercise pamphlet. Primary outcomes were Modified Functional Ambulatory Category (MFAC), Elderly Mobility Scale (EMS) and Lower Extremity Functional Scale (LEFS). Secondary outcomes were exercise adherence and Modified Caregiver Strain Index (M-CSI). The outcomes were collected at pre-discharge training session, one month and two months after hospital discharge.

Results: A total of 50 participants were enrolled, with 19 participants in the experimental group and 20 participants in the control group. Eleven participants had withdrawn from the study. The experimental group showed higher exercise adherence than the control group in first month ($p=0.03$). There were no between-group differences in MFAC, EMS, LEFS and M-CSI at the first month and second month.

Conclusion: Use of the mobile app improved exercise adherence, yet it did not improve physical performance, self-efficacy and reduce caregiver stress when compared to a standard home rehabilitation program for elderly patients with hip fracture. Further studies to investigate the benefits of mobile apps are required. (ClinicalTrials.gov ID: NCT04053348.).

Background: Pneumonia is a frequent diagnosis for patients admitted to Australian intensive care units (ICUs) for invasive ventilation. Physiotherapists in ICU provide interventions to enhance respiratory function and physical recovery.

Objective: This retrospective cohort study aimed to describe physiotherapy management of adults with pneumonia who require invasive mechanical ventilation in a single Level 3 ICU in a quaternary teaching hospital.

Methods: All adults admitted with a medical diagnosis of pneumonia requiring invasive mechanical ventilation over a two-year period were included. Demographic and clinical data, including APACHE II score, ventilator-free days (VFDs) to day 28, ICU length of stay (LOS), and type and frequency of physiotherapy episodes of care delivered in ICU, were collected from electronic medical records. Correlations between VFDs to day 28 and the frequency of physiotherapy interventions delivered per subject were examined using Spearman's rho analysis.

Results: From 208 records screened, 66 subjects with an ICU admission diagnosis of pneumonia, who required invasive mechanical ventilation, were included. Median (IQR) ICU LOS was 10 (5-17) days, and mortality rate was 15.2% ( $n=10$ ). The cohort had a median of 20.5 (IQR 2-25) VFDs to day 28. Community-acquired pneumonia (66.7%, $n=44$ ) was the most frequent type of pneumonia diagnosis. There were 1110 episodes of physiotherapy care, with patients receiving a median of 13.5 (IQR 6.8-21.3) episodes during their ICU stay, with a median rate of 1.2 (IQR 1.0-1.6) episodes per day. Over 96.7% of patients with pneumonia received physiotherapy treatment during their ICU stay. Overall, physiotherapy treatments consisting only of respiratory techniques were most commonly provided (55.1%, $n=612$ ). Airway suctioning (92.4%, $n=61$ ), patient positioning (72.7%, $n=48$ ) or positioning advice to nurses (77.3%, $n=51$ ), and hyperinflation techniques (63.6%, $n=42$ ) were among the respiratory techniques most delivered.

Conclusion: This study described the current intensive care physiotherapy management in a single center for adults with pneumonia who required invasive mechanical ventilation, demonstrating that respiratory physiotherapy interventions are often provided for this ICU patient cohort. Further research is warranted to determine the efficacy of respiratory physiotherapy interventions to justify their use for ICU patients with pneumonia receiving invasive mechanical ventilation.

Background: Anterior cruciate ligament (ACL) injury is a common sport injury and investigation of landing biomechanics is helpful in injury prevention and rehabilitation. Recent study found a lateral single-leg drop landing test resulted in the highest peak knee valgus angle (PKVA), but its reliability on patients who received ACL reconstruction (ACLR) is unknown.

Objective: This study aimed to investigate the reliability in both within and between days on the normalized vertical ground reaction force (NVGRF) and kinematics of lower limbs after receiving ACLR. The findings can form the cornerstone for further study related to lateral jumping-and-landing biomechanics in patients with ACLR.

Methods: This was a test-retest reliability study. Twelve patients (four females and eight males) who received ACLR with mean age of 29.4 (SD $\pm$ 1.66) were recruited. The subjects were instructed to jump laterally from 30 cm height and landed with single-leg for five times. The procedure was conducted on both legs for comparison. The NVGRF and local maxima of the hip, knee and ankle angles during the first 100 ms in all three planes were analyzed. The measurement was conducted by the same assessor to evaluate the within-session reliability, and the whole procedure was repeated one week later for the evaluation of the between-session reliability. Intra-class correlation coefficient (ICC) test was used to assess the within- and between-session reliability by ICC (3, 1) and ICC (3, K) respectively.

Results: The within-session reliability of NVGRF [ICC (3, 1)] was 0.899-0.936, and its between-session reliability [ICC (3, K)] was 0.947-0.923. Overall reliability for kinematics within-session [ICC (3, 1)] was 0.948-0.988, and the between-session reliability [ICC (3, K)] was 0.618-0.982, respectively. Good to excellent reliability for the lateral single-leg drop landing test was observed in most of the outcome measures for within- and between-session. The ICC value of NVGRF of ACLR leg was lower than that of the good leg in the within-session which may associate with lower neuromuscular control in ACLR leg than that of the good leg.

Conclusion: The results of this study support the use of a lateral single-leg drop landing test to evaluate lower limb biomechanics for ACLR.

Background: In developing countries, lower respiratory tract infection is a major cause of death in children, with severely ill patients being admitted to the critical-care unit. While physical therapists commonly use the manual hyperinflation (MHI) technique for secretion mass clearance in critical-care patients, its efficacy has not been determined in pediatric patients.

Objective: This study investigated the effects of MHI on secretion mass clearance and cardiorespiratory responses in pediatric patients undergoing mechanical ventilation.

Methods: A total of 12 intubated and mechanically ventilated pediatric patients were included in this study. At the same time of the day, the patients received two randomly ordered physical therapy treatments (MHI with suction and suction alone) from a trained physical therapist, with a washout period of 4 h provided between interventions.

Results: The MHI treatment increased the tidal volume [ $V_t$ ; 1.2 mL/kg (95% CI, 0.8-1.5)] and static lung compliance [ $C_{\text{stat}}$ ; 3.7 mL/cmH₂O (95% CI, 2.6-4.8)] immediately post-intervention compared with the baseline ( $p<0.05$ ). Moreover, the MHI with suction induced higher $V_t$ [1.4 mL/kg (95% CI, 0.8-2.1)] and $C_{\text{stat}}$ [3.4 mL/cmH₂O (95% CI, 2.1-4.7)] compared with the suction-alone intervention. In addition, the secretion mass [0.7 g (95% CI, 0.6-0.8)] was greater in MHI with suction compared with suction alone ( $p<0.05$ ). However, there was no difference in peak inspiratory pressure, mean airway pressure, respiratory rate, heart rate, blood pressure, mean arterial blood pressure or oxygen saturation ( $p>0.05$ ) between interventions.

Conclusions: MHI can improve $V_t$ , $C_{\text{stat}}$ and secretion mass without inducing adverse hemodynamic effects upon the pediatric patients requiring mechanical ventilation.

Background: Autonomic nervous system balance is altered in cystic fibrosis (CF), although its influence on physical fitness has been poorly explored.

Objective: This study aimed to evaluate the association of heart rate variability (HRV) with exercise capacity and levels of daily physical activity in children and adolescents with mild-to-moderate CF.

Methods: A cross-sectional study including individuals with CF aged 6-18 years, not under CFTR modulator therapy, was performed. Sociodemographic (age, sex) and clinical information (airway colonization, pancreatic insufficiency, and genotyping) were collected. In addition, exercise capacity (modified shuttle test - MST), lung function (spirometry), body composition (bioimpedance), levels of daily physical activity (5-day accelerometer), and HRV (both at rest and during the MST) were evaluated.

Results: 30 individuals (20 females) aged $11.2\pm 3.7$ years, mean FEV ${}_{1}62.8\pm 27.6$ %, were included. A sympathovagal balance (LF/HF) increase ( $p<0.001$ ) during the MST was shown, indicating a predominance of sympathetic modulation. The standard deviation of all RR intervals (SDNN) and the high frequency (HF) index during exercise correlated significantly with FEV₁ ( $r=0.45$ , $p=0.01$ and $r=0.46$ , $p=0.01$ ; respectively). MST distance also correlated positively and significantly with SDNN ( $r=0.43$ , $p=0.01$ ), square root of the mean of the sums of squares of frequencies between RR intervals greater than 50 ms - RMSSD ( $r=0.53$ , $p<0.01$ ), low frequency - LF ( $r=0.48$ , $p<0.01$ ), HF ( $r=0.64$ , $p<0.01$ ), dispersion of points perpendicular to the short-term identity line - SD1 ( $r=0.40$ , $p=0.02$ ) and negatively with LF/HF ( $r=-0.57$ ,

Background: Although different types of neural mobilization (NM) exercises induce different amounts of longitudinal nerve excursion and strain, the question whether the increased longitudinal stress and nerve excursion from sliding or tensioning intervention may subtly affect the neural functions has not been answered yet.

Objective: To compare the effects of tensioning NM versus sliding NM of the median nerve on peripheral and autonomic nervous system function.

Methods: In this randomized controlled trial, 90 participants were randomly assigned to tensioning NM, sliding NM, or sham NM. The neurophysiological outcome measures included peak-to-peak amplitude of the dermatomal somatosensory evoked potential (DSSEP) for dermatomes C6, C7, C8, and T1. Secondary outcome measures included amplitude and latency of skin sympathetic response. All outcome measures were assessed pretreatment, immediately after the two weeks of treatment and one week after the last session of the treatment.

Results: A 2-way repeated measures ANOVA revealed significant differences between the three groups. The post hoc analysis indicated that tensioning NM significantly decreased the dermatomal amplitude for C6, C7, C8, and T1 ( $p<0.005$ ). Sympathetic skin responses in the gliding NM group showed lower amplitudes and prolonged latencies post-treatment when compared to tensioning NM group ( $p<0.05$ ). In contrast, no significant changes were observed in the DSSEPs and skin sympathetic responses for participants in the sham treatment group ( $p>0.05$ ).

Conclusions: A tensioning NM on the median nerve had a possible adverse effect on the neurophysiology variables of the nerves involved in the neural mobilization. Thus, tensioning NM with the current parameters that place increased stress and strain on the peripheral nervous system should be avoided.

Background: Trunk stability is key in controlling body balance and movements. Trunk Stabilization Exercises (TSE) and Conventional Trunk Exercises (CTE) are performed to improve dynamic balance. The authors have previously reported that dynamic balance was improved by a 12-week and 6-week TSE program. However, there is a dearth of research on its immediate effect on dynamic balance in trained soccer players.

Objective: To compare the immediate effect of TSE with that of CTE on dynamic balance in trained soccer players.

Methods: Forty-eight male soccer players (24.60 ± 1.38 years) participated in this crossover study, wherein each participant took part in three exercise sessions: TSE, CTE, and No Exercise control (NE), each consisting of three steps: pre-test, intervention and post-test, with an interval of one week between each exercise condition. To assess dynamic balance, the Y Balance Test-Lower Quarter (YBT-LQ) score in the anterior, posteromedial, and posterolateral directions was measured before and 5 minutes after each intervention.

Results: The YBT-LQ composite score was significantly improved after TSE (0.51) as compared to CTE (0.22) and NE (0.04) (p<0.05). Furthermore, in TSE and CTE conditions, YBT-LQ scores of the posterolateral and posteromedial directions significantly improved at the post-test (p<0.05).

Conclusion: Both TSE and CTE are effective in immediately improving dynamic balance; however, TSE showed greater improvement as compared to the latter. Immediate improvements in the posteromedial and posterolateral directions of the YBT-LQ were demonstrated after performing the TSE and CTE.