Hong Kong Physiotherapy Journal最新文献

Background: The type of foam pad used in the modified Clinical Test of Sensory Interaction and Balance (mCTSIB) influences the accuracy with which elderly fallers are identified. Two types of foam are commonly used in practice: Airex and Neurocom foam.

Objective: The aim of this study was to assess the accuracy with which elderly fallers can be identified when the Airex foam and Neurocom foam are used in the mCTSIB.

Methods: One hundred eighty-four elderly participants with a mean age of 69 years were classified into faller and nonfaller groups based on their 12-month fall history. Balance stability was measured under four conditions of the mCTSIB for 120 s each: standing on a floor or a foam pad with their eyes open or eyes closed. The time needed to maintain stability was measured by a stopwatch, and postural sway characteristics were measured using an acceleration-based system. Comparisons between groups were performed by two-way mixed ANOVA. The accuracy of differentiating elderly fallers from nonfallers with different foam types was evaluated using receiver operating characteristic curve (ROC) analysis. The time to maintain stability under four conditions of the mCTSIB (composite score) and under two conditions on the foam (foam score) were used for the ROC analysis.

Results: The results showed that the nonfallers required more time to maintain stability and had a smaller sway area than the fallers ( $p<0.001$ ). The foam led to a larger difference between groups, suggesting the use of foam in examining the risk of falls. The Airex and the Neurocom foam pads led to a large area under the curve (0.93 to 0.95) in identifying elderly fallers and nonfallers when the composite and foam scores were used. A cutoff score of 447/480 s for the composite score and 223/240 s for the foam score yielded a posttest accuracy of 88% to 89%, with a sensitivity of 0.80-0.92 and specificity of 0.88-0.95.

Conclusion: In conclusion, Airex and Neurocom foam can be used interchangeably with guidance in the mCTSIB, as they led to the accurate identification of elderly fallers among older persons who could walk and live independently in the community.

Background: Stretching and length test of hamstring muscles have been performed commonly to manage lower back pain (LBP) in sports rehabilitation. Previous literatures addressed that stretching techniques and length test of hamstring muscles should be performed with the pelvic maintained in an anterior tilt position. However, there is no study to determine the effectiveness of pressure biofeedback unit (PBU) to maintain in anterior pelvic tilting (APT) on length test and stretching of hamstring muscles.

Objective: To determine the effectiveness of hamstring muscles stretching using a PBU.

Methods: Forty participants with shortness of hamstrings randomized into two groups. Participants performed the active knee extension (AKE) stretching without (control group) or with PBU (intervention group) for four weeks. AKE tests without and with PBU were administered three times before and after hamstrings stretching by each group.

Results: The AKE test without PBU showed a significant main effect of time ( $p<0.01$ ) but not of group ( $p=0.55$ ) on the AKE angle. The AKE test with PBU showed a significant increase in the AKE angle in the post-intervention compared to the pre-intervention assessments in both groups ( $p<0.01$ ). The difference of AKE angle between the pre- and post-intervention results was significantly greater in the intervention group than in the control group ( $p<0.01$ ).

Conclusion: We recommend the use of a PBU to maintain the pelvic anterior tilting position when performing the AKE test or AKE stretching.

Background: Other than pathoanatomical diagnosis, physical therapy managements need the diagnosis of movement-related impairments for guiding treatment interventions. The classification system of the Movement System Impairment (MSI) has been adopted to label the musculoskeletal disorders in physical therapy practice. However, reliability study of this classification system in individuals with shoulder pain has not been reported in the literature.

Objective: This paper investigated the intertester reliability of the diagnosis based on the MSI classification system in individuals with shoulder pain.

Methods: The patients with shoulder pain, between the ages 18-60 years, were recruited if he or she had pain between 30 and 70 on the 100 mm visual analog scale for at least three months. The examiners who were two physical therapists with different clinical experiences received a standardized training program. They independently examined 45 patients in random order. Each patient was examined by both therapists on the same day. The standardized examination scheme based on the MSI approach was used. Patients were identified to subgroup syndromes according to scapular and humeral syndromes and also determining their subcategory syndromes. Six scapular subcategory syndromes included downward rotated, depressed, abducted, wing, internal rotated/anterior tilted, and elevated. Three humeral subcategory syndromes were anterior glide, superior glide, and medial rotated. More than one subgroup and subcategory of syndromes could be identified in each patient. The test results of each session were blinded to another therapist. The percentages of agreement and kappa statistic were determined.

Results: The results showed that agreement levels in identifying subgroup syndromes was fair (71.11% agreement, kappa coefficient $=$ 0.34) and classifying subcategories syndromes were poor to substantial (73.33-91.11% agreement, kappa coefficient $=$ 0.20 $-$ 0.66). The overall agreement and kappa value of the MSI classification of subcategory syndromes was poor (kappa coefficient $=$ 0.11; 95% CI 0.05-0.18). The agreement level of subcategories for scapular depression and humeral superior glide syndromes was substantial. The scapular winging, depression, and downward rotation were the three syndromes that were most frequently identified by both the examiners.

Conclusion: The intertester reliability between therapists with different experience according to the MSI approach for shoulder pain classification was generally acceptable to poor due to the nature of the classification system. The standardized procedure and intensive training can be used for inculcating novice therapists with adequate level of intertester reliability of examination.

Background: With dramatic increase in the number of older individuals, special efforts have been made to promote the levels of independence and reduce fall rates among these individuals.

Objective: To investigate the effects of Thai dance exercises over 6 weeks on functional mobility and fall rates in community-dwelling older individuals.

Methods: Sixty-one community-dwelling older adults were interviewed and assessed for their demographics and fall data during 6 months prior to participation in the study. Then they completed the quasi-experimental Thai dance exercise program for 50 minutes/day, 3 days/week over 6 weeks. Their functional mobility relating to levels of independence and safety were assessed prior to training, at 3-week and 6-week training. After completing the program at 6 weeks, participants were prospectively monitored for fall data over 6 months.

Results: Participants improved their functional mobility significantly after 3- and 6-week training $(p<0.01)$ . The number of faller individuals obviously decreased from 35% $(n=21)$ prior to training to only 8% $(n=5)$ after training $(p<0.01)$ .

Conclusion: The current findings further extend benefits of Thai dance as an alternative musical exercise program to promote levels of independence and safety among community-dwelling older adults.

Background: Evidence suggests patients with non-specific low back pain (NSLBP) have altered lumbar and pelvic movement patterns. These changes could be associated with altered patterns of muscle activation.

Objective: The study aimed to determine: (1) differences in the relative contributions and velocity of lumbar and pelvic movements between people with and without NSLBP, (2) the differences in lumbopelvic muscle activation patterns between people with and without NSLBP, and (3) the association between lumbar and pelvic movements and lumbopelvic muscle activation patterns.

Methods: Subjects (8 healthy individuals and 8 patients with NSLBP) performed 2 sets of 3 repetitions of active forward bending, while motion and muscle activity data were collected simultaneously. Data derived were lumbar and pelvic ranges of motion and velocity, and ipsilateral and contralateral lumbopelvic muscle activities (internal oblique/transverse abdominis (IO/TA), lumbar multifidus (LM), erector spinae (ES) and gluteus maximus (GM) muscles).

Results: Lumbar and pelvic motions showed trends, but exceeded 95% confidence minimal detectable difference $($ MDD ${}_{95})$ , for greater pelvic motion $(p=0.06)$ , less lumbar motion $(p=0.23)$ among patients with NSLBP. Significantly less activity was observed in the GM muscles bilaterally $(p<0.05)$ in the NSLBP group. A significant association $(r=-0.8$ , $p=0.02)$ was found between ipsilateral ES muscle activity and lumbar motion, while moderate, but statistically non-significant associations, were found between GM muscle activity bilaterally and lumbar velocity $($ ipsilateral: $r=-0.6$ , $p=0.14$ ; contralateral: $r=-0.6$ , $p=0.16)$ in the NSLBP group.

Conclusion: Findings indicated patients had greater pelvic contribution, but less lumbar contribution which was associated with less activation of the GM bilaterally.

Background: Occupational health physiotherapy has been practiced in the UK over several decades. In the past decade, the role of occupational health physiotherapy has gained recognition as a profession that can be embedded within occupational health departments; however, limited information is known about the role of physiotherapists from professional groups outside the allied health domain in this context.

Objective: The aim of this study is to explore the experiences of occupational health doctors and nurses about the role of physiotherapy in occupational health rehabilitation.

Methods: This study is a qualitative investigation underpinned by an interpretative construct. Thirteen semi-structured interviews were conducted. Two occupational health doctors and 12 nurses were purposively recruited from two National Health Service (NHS) hospitals. Data were analyzed using thematic content analysis, coded manually and verified by member checking.

Results: The benefits of occupational health physiotherapists were rapid access intervention, advanced knowledge and clinical reasoning, evidence-based practice, and providing an additional perspective. The emerging themes of the challenges that occupational health physiotherapists may face include dealing with occupational health challenges, managing role conflicts, personal qualities and attributes, and role substitution.

Conclusion: Participants described numerous roles of occupational health physiotherapists ranging from clinical to organizational components. On-going research is needed to support the role development of physiotherapists providing occupational health rehabilitation and to further advocate for its relevance in this setting.

Background: Clinical outcomes are very important in clinical assessment, and responsiveness is a component inside the outcome measures that needs to be investigated, particularly in chronic nonspecific low back pain (CNSLBP).

Objective: This study aimed to investigate the responsiveness of pain, functional capacity tests, and disability in individuals with CNSLBP.

Methods: Twenty subjects were assessed in pain using the following methods: visual analog scale (VAS) and numeric pain rating scale (NPRS), functional capacity tests: functional reach test (FRT), five-time sit-to-stand test (5 TSST), and two-minute step test (2 MST), and disability level: modified Oswestry Disability Questionnaire (MODQ), Thai version before and after 2-week intervention session. For interventions, the subjects received education, spinal manipulative therapy, and individual therapeutic exercise twice a week, for a total of two weeks. The statistics analyzed were change scores, effect size (ES), and standardized response mean (SRM).

Results: The most responsive parameter for individuals with CNSLBP was pain as measured by numeric pain rating scale (NPRS) (ES -0.986, SRM -0.928) and five-time sit-to-stand test (5 TSST) (SRM -0.846).

Conclusion: This study found that NPRS pain and 5 TSST were responsive in individuals with CNSLBP at two weeks after the beginning of interventions.

Background: The impact of residential setting on the performance of older adults on commonly used instruments of mobility has not been closely investigated.

Objective: This study aimed to (1) explore whether mobility test performance differed between those who lived in urban and rural communities, and (2) report preliminary reference values for these tests according to residential setting.

Methods: The study used a descriptive design. Individuals who were aged 60 years and above, had no significant disability, and resided in urban and rural areas in the Philippines $(n=180)$ , participated in the study. Researchers measured mobility performance using the 10-Meter Walk Test (10MWT) (both comfortable gait velocity (CGV) and fast gait velocity (FGV)), Five Times Sit to Stand Test (FTSST), and Six-Minute Walk Test (6MWT). Preliminary reference values for the mobility tests were presented as means, standard deviations, and 95% confidence intervals. Scores were compared based on residential setting (urban versus rural).

Results: Urban-dwellers scored consistently better compared to their rural counterparts on the CGV, FGV, FTSST, and 6MWT using independent samples $t$ -test $(p<0.001)$ . Data were further divided according to age and sex, and comparison of the mobility test scores between urban- and rural-dwellers within each subgroup showed similar differences $(p<0.01)$ .

Conclusion: Results provide preliminary evidence for the influence of residential setting on the mobility test performance of Filipino older adults. The study provides a good starting point for confirmatory research with a representative sample to (1) illustrate differences in mobility performance according to residential setting, (2) investigate how specific factors associated with residential settings contribute to differences in mobility performance, and (3) determine the extent to which clinicians should consider an older person's residential setting when interpreting mobility test results.