Demonstration of the test-retest reliability and sensitivity of the Lower Limb Functional Index as a measure of functional recovery post burn injury: A cross-sectional repeated measures study design

Background: Lower limb burns can significantly delay recovery of function. Measuring lower limb functional outcomes is challenging in the unique burn patient population and necessitates the use of reliable and valid tools. The aims of this study were to examine the test-retest reliability, sensitivity, and internal consistency of Sections 1 and 3 of the Lower Limb Functional Index-10 (LLFI-10) questionnaire for measuring functional ability in patients with lower limb burns over time. Methods: Twenty-nine adult patients who had sustained a lower limb burn injury in the previous 12 months completed the test-retest procedure of the study. In addition, the minimal detectable change (MDC) was calculated for Section 1 and 3 of the LLFI-10. Section 1 is focused on the activity limitations experienced by patients with a lower limb disorder whereas Section 3 involves patients indicating their current percentage of pre-injury duties. Results: Section 1 of the LLFI-10 demonstrated excellent test-retest reliability (intra-class correlation coefficient (ICC) 0.98, 95 % CI 0.96–0.99) whilst Section 3 demonstrated high test-retest reliability (ICC 0.88, 95 % CI 0.79–0.94). MDC scores for Sections 1 and 3 were 1.27 points and 30.22 %, respectively. Internal consistency was demonstrated with a significant negative association (rs=−0.83) between Sections 1 and 3 of the LLFI-10 (p\u3c0.001). Conclusions: This study demonstrates that Section 1 and 3 of the LLFI-10 are reliable for measuring functional ability in patients who have sustained lower limb burns in the previous 12 months, and furthermore, Section 1 is sensitive to changes in patient function over time

Resistance training for rehabilitation after burn injury: A systematic literature review and meta-analysis

Background/aim: Resistance training is beneficial for rehabilitation in many clinical conditions, though this has not been systematically reviewed in burns. The objective was to determine the effectiveness of resistance training on muscle strength, lean mass, function, quality of life and pain, in children and adults after burn injury. Methods: Medline & EMBASE, PubMed, CINAHL and CENTRAL were searched from inception to October 2016. Studies were identified that implemented resistance training in rehabilitation. Data were combined and included in meta-analyses for muscle strength and lean mass. Otherwise, narrative analysis was completed. The quality of evidence for each outcome was summarised and rated using the GRADE framework. Results: Eleven studies matched our inclusion criteria. Primary analysis did not demonstrate significant improvements for increasing muscle strength (SMD 0.74, 95% CI _0.02 to 1.50, p=0.06). Sensitivity analysis to correct an apparent anomaly in published data suggested a positive effect (SMD 0.37, 95% CI 0.08–0.65, p=0.01). Psychological quality of life demonstrated benefit from training (MD=25.3, 95% CI 3.94–49.7). All studies were rated as having high risk of bias. The quality of the evidence was rated as low or very low. Conclusion: Further research with robust methodology is recommended to assess the potential benefit suggested in this review

Multidimensional impact of low-Dye taping on low-load hopping in individuals with and without plantar fasciitis

Objectives: Evaluate the acute effect of low-Dye, placebo and no tape on motor behaviour in individuals with plantar fasciitis (PF). Design: Prospective, experimental. Setting: Motion analysis laboratory. Participants: Ten participants with PF and ten matched controls. Main outcome measures: Hopping behaviour (lower-limb stiffness and ankle angle at peak loading) were evaluated during low-load sleigh hopping, during three taping conditions. Stiffness and ankle angle were determined using three-dimensional motion analysis. Pain during submaximal loading was assessed with a numeric pain rating scale. Results: The lower-limb stiffness response to therapeutic taping was modulated by the presence of PF (interaction, F = 4.48, p = 0.018). Matched controls demonstrated a significant increase in stiffness post application of low-Dye taping (p = 0.001), stiffness was unchanged in the PF group. In the PF group, low-Dye taping decreased hopping pain in comparison to placebo (p = 0.037) and no-tape (p = 0.024). There was no difference in ankle angle at peak loading between the groups or across taping conditions. Conclusions: Low-Dye taping reduces nociceptive inputs more than placebo in the presence of PF pain. Low-Dye tape alters stiffness in the control group but not the PF group. The motor behavioural outputs such as stiffness, during low-load hopping is modulated by both pathology and therapeutic taping

Alternate electrode placement for whole body and segmental bioimpedance spectroscopy

Bioimpedance spectroscopy (BIS) is frequently used to monitor body fluid and body composition in healthy and clinical populations. BIS guidelines state that there should be no skin lesions at the site of electrodes, and if lesions are present, electrode positions should be changed. However, alternate electrode positions are yet to be reported. This study aimed to determine if ventral electrode placements were suitable alternatives for whole body and segmental BIS measurements. Three alternate electrode placements were assessed for whole body BIS using a combination of ventral hand and foot electrode placements. An alternate position was assessed for upper and lower body segmental BIS. The results demonstrated that for whole body BIS, if drive and sense electrodes on the hand are moved to ventral positions, but foot electrodes remain in standard positions, then whole body BIS variables were comparable to standard electrode positioning (percentage difference range=0.01 to 1.65%, p=0.211–0.937). The alternate electrode placement for upper limb segmental BIS, results in BIS variables that are comparable to that of the standard positioning (percentage difference range=0.24–3.51%, p=0.393–0.604). The alternate lower limb electrode position significantly altered all resistance and predicted BIS variables for whole body and lower limb segmental BIS (percentage difference range=1.06–12.09%, p<0.001). If wounds are present on the hands and/or wrist, then the alternate electrode position described in this study is valid, for whole body and upper limb segmental BIS