Movement quality within a physiotherapy perspective years after scoliosis surgery

Master i FysioterapivitenskapFYST395MAMD-FYS

The within-day and between-day reliability of using sacral accelerations to quantify balance performance.

OBJECTIVES: To investigate the between-day and within-day reliability of a sacral mounted accelerometer to quantify balance performance and different balance metrics. DESIGN: Experimental, cross-sectional. SETTING: Laboratorial experiment. PARTICIPANTS: Thirty healthy volunteers. MAIN OUTCOME MEASURES: Balance tasks were double leg stance, tandem stance and single leg stance with eyes open and closed. Performance was measured by converting accelerations into path length (PL, length of the sway trace), jerk (jerkiness of sway trace) and root mean square (RMS) of the accelerations. RESULTS: Within-day ICC for PL were excellent (mean 0.78 95%CI 0.68-0.89), with Jerk and RMS demonstrating means of 0.60 and 0.47, respectively. The mean percentage minimal detectable change (MDC) within-day were small for PL (mean 6.7%, 95%CI 5.3-8.1). Between-day ICC were good for PL (mean 0.61, 95%CI 0.50-0.71), but more varied for Jerk and RMS. The mean percentage MDC was small for PL (mean 6.1%, 95%CI 5.0-7.2). No significant differences were determined for measurements between-days for any metric or task. PL had the highest discriminatory value between the 8 tasks. CONCLUSIONS: The sacral mounted accelerometer reliably measured balance performance within- and between-days. The PL is the recommended metric as it was the most reliable, most discriminatory and most sensitive to change

Spatiotemporal gait parameters for older adults – An interactive model adjusting reference data for gender, age, and body height

Introduction Since it is well documented that spatiotemporal gait parameters are affected by body size, it is of limited clinical value to compare individual scores against reference values without taking body size into consideration. For older adults, reference values have been presented in recent reports, but unfortunately the effect of body size on gait characteristics was not taken into account and neither prediction intervals nor percentile ranks were included. It is the aim of this study to present and assess a model where individual spatiotemporal gait parameter values for older adults can be compared to reference values adjusted for gender, age, and body height. Methods Reference gait data were collected from l464 older adults aged 69–80 years with no impairments believed to affect gait, stratified by gender, intermediately adjusted to a common body height using a pendulum model and entered into a simple regression model for each parameter with age as predictor. From the regression coefficients predicted gait parameter values could be back transformed to the individual body height of a new subject. Calculations were done using spreadsheet formulae and equations. Results A spreadsheet based graphical user interface (GUI) has been developed in Microsoft Excel® where individual spatiotemporal gait data is entered for comparison with reference data taking gender, age and body height into account, and returning predicted point estimates with confidence intervals, prediction intervals, and percentile ranks. Significance A GUI solution where individual spatiotemporal gait data is compared to reference data is feasible to researchers and for clinical use. To the best of our knowledge, this is the first model presented for comparison of basic gait parameters between individuals and reference data from older adults where gender, age, and body height are taken into account.publishedVersio

HUBUNGAN ANTARA IMPLEMENTASI PERPADUAN SISTEM PENDIDIKAN PESANTREN MODERN DAN TRADISIONAL DENGAN MOTIVASI DAN PRESTASI BELAJAR SANTRI (Studi Kasus di Pesantren Sabilunnajat KecamatanRancahKabupaten Ciamis)

Aip Syarifudin NIM 505810002: Hubungan Implementasi Pola Pendidikan Pesantren Tradisional dan Modern dengan Motivasi Belajar dan Prestasi Belajar Santri di Pesantren Sabilunnajat Rancah Kabupaten Ciamis Berdasarkan studi pendahuluan yang penulis lakukan di Pesantren Sabilunnajat Rancah Kabupaten Ciamis telah menerapkan perpaduan pola pendidikan pesantren tradisional dan modern. Implementasi ini dilakukan dengan memasukan kurikulum pendidikan umum yang dikolaborasikan dengan pendidikan agama. Implementasi perpaduan ini juga dilakukan dengan mendirikan lembaga pendidikan formal mulai dari tingkat RA sampai SMK. Dalam praktiknya, pola ini masih harus diuji dan dibuktikan pengaruhnya terhadap peningkatan motivasi dan prestasi belajar santri. Tujuan dari penelitian ini adalah untuk: 1). Menjelaskan implementasi perpaduan pola pendidikan pesantren tradisional dan pesantren; 2). Menjelaskan motivasi dan prestasi Belajar Santri di Pesantren Sabilunnajat Rancah Kabupaten Ciamis; dan 3). Mengetahui seberapa besar hubungan Implementasi Pola Pendidikan Pesantren Tradisional dan Modern dengan Motivasi Belajar dan Prestasi Belajar Santri di Pesantren Sabilunnajat Rancah Kabupaten Ciamis. Dasar pemikiran penelitian ini adalah isu pembaharuan pendidikan di pesantren yang selama ini di kenal dengan pesantren tradisional (salafy) sudah mulai marak. Pembaharuan ini dilakukan dengan pertimbangan semakin pesatnya zaman menuntut lembaga pendidikan untuk merespons dengan penerapan kurikulum berbasis pasar. Hal ini mendorong beberapa pesantren tradisional untuk melakukan inovasi dengan mengkombinasikan pendidikan tradisional khas pesantren dan modern yang banyak mengadopsi dari pendidikan formal. Metode yang digunakan dalam penelitian ini adalah metode observasi, angket dan studi dokumentasi. Metode survey adalah penelitian yang dilakukan pada populasi besar maupun kecil, tetapi data yang dipelajari adalah data dari sampel yang diambil dari populasi tersebut. Metode survey biasanya digunakan untuk menjelaskan hubungan-hubungan korelasional antara satu variabel dengan variabel lainnya (corelational relationship), disamping untuk menguji hipotesis dan signifikansinya Hasil Penelitian ini yaitu; [1] implementasi perpaduan pola pendidikan pesantren tradisional dan modern di Pesantren Sabilunnajat Rancah Kabupaten Ciamis berdasarkan hasil angket termasuk dalam Kriteria baik. Hal ini dapat diketahui dari pola pendidikan yang ada terbukti telah berjaalan dengan baik. [2] Motivasi belajar belajar santri di Pesantren Sabilunnajat Rancah Kabupaten Ciamis berdasarkan angket termasuk dalam kriteria baik. Dimana 80% santri memiliki nilai rata-rata 90. [3] Hubungan Motivasi Belajar santri dan Prestasi Belajar Santri dengan pola pendidikan di Pesantren Sabilunnajat Rancah Kabupaten Ciamis terdapat korelasi yang signifikan (0,517) dengan kisaran hubungan korelasional sebesar 26%. Hasil pengujian hipotesis antar variabel Motivasi Belajar dan Prestasi Belajar Santri berhubungan positif dan signifikan

Effect of exercise on the inter-rectus distance in pregnant women with diastasis recti abdominis: an experimental longitudinal study

Objective: To investigate the effect of acute contraction of the pelvic floor muscles (PFM) and abdominal exercises on the inter-rectus distance (IRD) compared to resting values, and differences between gestation weeks 27 and 37, in pregnant women with diastasis recti abdominis (DRA). Design: Experimental longitudinal design. Setting: Physiotherapy clinic, primary health care. Participants: Thirty-eight pregnant women with DRA ≥ 2.8 cm. Interventions: Two-dimensional ultrasound images of IRD 2 cm above and below the umbilicus were taken at rest and during PFM and abdominal exercises at gestation week 27 and 37. Repeated measures analyses of variance (ANOVAs) with post hoc tests was performed for each exercise for both locations and timepoints. Main Outcome measures: Change in IRD. Results: There was a mean increase of the IRD from rest during a PFM contraction (2 mm, 95% CI: 2, 3), drawing-in (4 mm, 95% CI: 3, 5) and a combination of these (5 mm, 95% CI: 4, 6) There was a mean decrease of the IRD from rest during the headlift (-3 mm, 95% CI: -4, -2), the curl-up (-3 mm, 95% CI: -4, -2) and the diagonal curl up (-4 mm, 95% CI: -5, -3). Effect of time from gestation week 27 to 37 was a mean increase of 8 mm (95% CI: 6, 9). Conclusion: Pelvic floor and drawing-in exercise increased the IRD, whilst headlift, curl up and diagonal curl up decreased the IRD in pregnant women with DRA at gestation week 27 and 37.publishedVersio

Pain pressure threshold algometry in knee osteoarthritis: intra- and inter-rater reliability

Introduction: Synovitis and effusion can cause pain sensitization in persons with knee osteoarthritis (KOA). Pain Pressure Threshold (PPT) algometry is a means to quantify somatosensory abnormalities, including inflammatory-mediated pressure hyperalgesia. We investigated the reliability of PPT algometry with three raters. Methods: Twenty-seven persons (50 knees) with KOA, according to the American College of Rheumatology criteria, were included. The PPT of the most tender spot in the joint line of each knee, identified by palpation, was assessed using a digital pressure algometer with a round 1 cm2 rubber tip. The algometer was applied three times with at least twenty-second intervals by three physiotherapists each in a single session. Two of the physiotherapists had no experience with the procedure prior to the study. We estimated the Intraclass Correlation Coefficient (ICC) model 2.1, 95% within-subject standard deviation (sw), and Minimal Detectable Difference (MDD). Results: The mean PPTs ranged from 39.94 to 41.81 Newton (N), the intra-rater ICC ranged from 0.909 to 0.956, the sw ranged from 6.44 to 10.77 N, and the related MDD ranged from 9.11 to 15.23 N. The three raters achieved an inter-rater ICC of 0.707, an sw of 17.68 N, and an MDD of 25.01 N. The results were homoscedastic. Conclusions: Our results indicate that PPT algometry is a suitable method for assessment of pain in osteoarthritic knees. After a short session of PPT procedure training, good intra-rater and acceptable inter-rater ICCs were achieved.publishedVersio

Effect of a specific exercise programme during pregnancy on diastasis recti abdominis: study protocol for a randomised controlled trial

Introduction: Diastasis recti abdominis (DRA) is a common condition in pregnant and postpartum women. Evidence for the treatment of DRA is both sparse and weak. As this condition occurs during the last two trimesters of pregnancy and there is a paucity of high-quality studies on a pregnant population, we will conduct a randomised trial on the effect of a specific exercise programme during pregnancy on DRA. Methods and analysis: This is an exploratory, assessor-blinded, randomised parallel group trial carried out in a primary healthcare setting in a Norwegian city. 100 pregnant women, both primigravida and multigravida, in gestation week 24 presenting with DRA of ≥28 mm will be included. Participants will be allocated to either an intervention group or a control group by block randomisation. The intervention group will participate in a 12-week specific exercise programme. The control group will not participate in any exercise intervention. Data collection will take place prior to intervention, postintervention at gestation week 37, and 6 weeks, 6 and 12 months postpartum. The primary outcome measure will be change in the inter-recti distance, measured by two-dimensional ultrasonography. Data will be analysed and presented in accordance with international Consolidated Standards of Reporting Trials guidelines and analysed according to the intention-to-treat principle. Ethics and dissemination: Ethical approval has been obtained by the regional ethical committee (76296), and all procedures will be performed in adherence to the Helsinki declaration. The study has been registered with ClinicalTrials.gov. Results from this study will be presented at scientific conferences and in peer-reviewed scientific journals.publishedVersio

Peak oxygen uptake and breathing pattern in COPD patients – a four-year longitudinal study

Background: Activities of daily living in patients with chronic obstructive pulmonary disease (COPD) are limited by exertional dyspnea and reduced exercise capacity. The aims of the study were to examine longitudinal changes in peak oxygen uptake (V̇O2peak), peak minute ventilation (V̇Epeak) and breathing pattern over four years in a group of COPD patients, and to examine potential explanatory variables of change. Methods: This longitudinal study included 63 COPD patients, aged 44-75 years, with a mean forced expiratory volume in one second (FEV1) at baseline of 51 % of predicted (SD = 14). The patients performed two cardiopulmonary exercise tests (CPETs) on treadmill 4.5 years apart. The relationship between changes in V̇ O2peak and V̇Epeak and possible explanatory variables, including dynamic lung volumes and inspiratory capacity (IC), were analysed by multivariate linear regression analysis. The breathing pattern in terms of the relationship between minute ventilation (V̇E) and tidal volume (VT) was described by a quadratic equation, VT = a + b∙V̇ E + c∙V̇E2, for each test. The VTmax was calculated from the individual quadratic relationships, and was the point where the first derivative of the quadratic equation was zero. The mean changes in the curve parameters (CPET2 minus CPET1) and VTmax were analysed by bivariate and multivariate linear regression analyses with age, sex, height, changes in weight, lung function, IC and inspiratory reserve volume as possible explanatory variables. Results: Significant reductions in V̇ O2peak (p < 0.001) and V̇ Epeak (p < 0.001) were related to a decrease in resting IC and in FEV1. Persistent smoking contributed to the reduction in V̇O2peak. The breathing pattern changed towards a lower VT at a given V̇ E and was related to the reduction in FEV1. Conclusion: Increasing static hyperinflation and increasing airway obstruction were related to a reduction in exercise capacity. The breathing pattern changed towards more shallow breathing, and was related to increasing airway obstruction.publishedVersio

The Role of Psychological Readiness in Return to Sport Assessment After Anterior Cruciate Ligament Reconstruction

Background: Knowledge about the predictive value of return to sport (RTS) test batteries applied after anterior cruciate ligament reconstruction (ACLR) is limited. Adding assessment of psychological readiness has been recommended, but knowledge of how this affects the predictive ability of test batteries is lacking. Purpose: To examine the predictive ability of a RTS test battery on return to preinjury level of sport and reinjury when evaluation of psychological readiness was incorporated. Study Design: Cohort study; Level of evidence, 2. Methods: A total of 129 patients were recruited 9 months after ACLR. Inclusion criteria were age ≥16 years and engagement in sports before injury. Patients with concomitant ligamentous surgery or ACL revision surgery were excluded. Baseline testing included single-leg hop tests, isokinetic strength tests, the International Knee Documentation Committee (IKDC) Subjective Knee Form 2000, a custom-made RTS questionnaire, and the Anterior Cruciate Ligament-Return to Sport after Injury (ACL-RSI) scale. The RTS criteria were IKDC 2000 score ≥85% and ≥85% leg symmetry index on hop and strength test. At a 2-year follow-up evaluation, further knee surgery and reinjuries were registered and the RTS questionnaire was completed again. Regression analyses and receiver operating characteristic analyses were performed to study the predictive ability of the test battery. Results: Out of the 103 patients who completed the 2-year follow-up, 42% returned to their preinjury level of sport. ACL-RSI 9 months after surgery (odds ratio [OR], 1.03) and age (OR, 1.05) predicted RTS. An ACL-RSI score <47 indicated that a patient was at risk of not returning to sport (area under the curve 0.69; 95% CI, 0.58-0.79), with 85% sensitivity and 45% specificity. The functional tests did not predict RTS. Six patients sustained ACL reinjuries and 7 underwent surgery for other knee complaints/injuries after RTS testing. None of the 29 patients who passed all RTS criteria, and were therefore cleared for RTS, sustained a second knee injury. Conclusion: ACL-RSI and age were predictors of 2-year RTS, while functional tests were not informative. Another main finding was that none of the patients who passed the 85% RTS criteria sustained another knee injury.publishedVersio

Fall risk in an active elderly population – can it be assessed?

BACKGROUND: Falls amongst elderly people are often associated with fractures. Training of balance and physical performance can reduce fall risk; however, it remains a challenge to identify individuals at increased risk of falling to whom this training should be offered. It is believed that fall risk can be assessed by testing balance performance. In this study a test battery of physiological parameters related to balance and falls was designed to address fall risk in a community dwelling elderly population. RESULTS: Ninety-four elderly males and females between 70 and 80 years of age were included in a one year follow-up study. A fall incidence of 15% was reported. The test battery scores were not different between the fallers and non-fallers. Test scores were, however, related to self-reported health. In spite of inclusion of dynamic tests, the test battery had low fall prediction rates, with a sensitivity and specificity of 50% and 43% respectively. CONCLUSION: Individuals with poor balance were identified but falls were not predicted by this test battery. Physiological balance characteristics can apparently not be used in isolation as adequate indicators of fall risk in this population of community dwelling elderly. Falling is a complex phenomenon of multifactorial origin. The crucial factor in relation to fall risk is the redundancy of balance capacity against the balance demands of the individuals levels of fall-risky lifestyle and behavior. This calls for an approach to fall risk assessment in which the physiological performance is evaluated in relation to the activity profile of the individual