Assessing activity participation in the ACL injured population: a systematic review of activity rating scale measurement properties

Background: Participation is an important factor in assessing both the requirement for and outcome from anterior cruciate ligament reconstruction. Many patient-reported rating scales exist; however, measurement properties have not been well established. Objective: To provide a systematic review to identify currently available activity rating scales for anterior cruciate ligament injured subjects and to evaluate current knowledge of their measurement properties. Methods: Systematic searches of four databases (Medline, AMED, EMBASE, and CINAHL) without date or language restriction, using terms structured around the PICOS system were completed on 1st March 2011. Citation tracking, reference screening and contact with lead authors of key papers completed the search strategy. Studies using participation rating scales were identified to assess frequency of reporting and cited validation. Studies assessing one or more psychometric properties of the identified rating scales were subject to independent data extraction and critical appraisal by two independent authors using published tools. Results: Thirty-one rating scales were identified from 241 outcome studies. Most scales were inadequately developed or validated prior to use. Only three scales (Tegner, CSAS, and Marx) had psychometric analysis in eight studies of mixed quality. Only the Tegner scale has adequate assessment of reliability, validity, and responsiveness. The use of type, intensity, and frequency variables in the identified scales is discussed. Conclusions: The Tegner scale has been adequately validated; however, other rating scales require further validation. A comprehensive comparative analysis of clinical applicability and psychometric testing of existing scales, including clinically useful statistics, is required

Augmented feedback approach to double-leg squat training for patients with knee osteoarthritis: a preliminary study

The aim of this preliminary study was to explore the effects of two types of augmented feedback on the strategy used by healthy participants and patients with knee osteoarthritis (OA) to perform a double-leg squat. Seven patients with knee OA and seven healthy participants performed three sets of eight double-leg squats: one without feedback, one with real-time kinematic feedback and one with real-time kinetic feedback. Kinematic and kinetic outcome measures (peak knee flexion angle, peak knee extensor moment, and symmetry of the support knee moment between the injured and non-injured knees) demonstrate the potential influence of real-time kinetic feedback on the motor strategy used to perform a double-leg squat in both groups. This feedback could be used to develop more efficient and effective motor strategies for squatting in patients with knee OA and further evaluation is warranted

Spinal position sense and trunk muscle activity during sitting and standing in non-specific chronic low back pain: classification analysis

Study Design. A cross-sectional study between subgroups of nonspecific chronic low back pain (NSCLBP) and asymptomatic controls. Objective. To investigate NSCLBP subgroup differences in spinal position sense and trunk muscle activity when repositioning thoracic and lumbar spine into neutral (midrange) spinal position during sitting and standing. Summary of Background Data. Patients with NSCLBP report aggravation of symptoms during sitting and standing. Impaired motor control in NSCLBP, associated with sitting and standing postures nearer the end range of spinal motion, may be a contributing factor. Rehabilitation improving neutral (midrange) spinal position control is advocated. Postural and motor control alterations vary in different NSCLBP subgroups, potentially requiring specific postural interventions. There is limited evidence on whether subgroup differences exist when performing neutral spine position tasks. Methods. Ninety patients with NSCLBP and 35 asymptomatic controls were recruited. Two blinded practitioners classified NSCLBP into subgroups of active extension pattern and flexion pattern. Participants were assisted into neutral spine position and asked to reproduce this position 4 times. Absolute, variable, and constant errors were calculated. Three-dimensional thoracic and lumbar kinematics quantified the repositioning accuracy and surface electromyography assessed back and abdominal muscles activity bilaterally. Results. Irrespective of subclassification, patients with NSCLBP produced significantly greater error magnitude and variability than the asymptomatic controls, but subgroup differences were detected in the error direction. Subgroup differences in the trunk muscle activity were not consistently identified. Although both subgroups produced significantly higher abdominal activity, subclassification revealed difference in superficial multifidus activity during standing, with flexion pattern producing significantly greater activity than the asymptomatic controls. Conclusion. Subgroups of NSCLBP had similar neutral spinal position deficits regarding error magnitude and variability, but subclassification revealed clear subgroup differences in the direction of the deficit. The trunk muscle activation was shown to be largely nondiscriminatory between subgroups, with the exception of superficial lumbar multifidus

Measuring functional activities of patients in a stroke unit: Comparison of a sensor based Real Time Location System with the Observational Behaviour Mapping Technique [Poster Abstract]

Introduction: To overcome the limitations of the current activity monitoring methods and to effectively investigate early stage functional activities post stroke, we are developing a new computerised Real Time Location System (RTLS).Having previously established excellent RTLS reliability (Intraclass Correlation Coefficients≥0.90), this study aims to determine its validity by comparing it to the Observational Behaviour Mapping Technique (OBMT). Methods: All rooms routinely accessed by patients are fitted with infra-red room locators which send their location codes to specialised Radio-Frequency Identification (RFID) tags. The RFID tags that have in-built motion sensors transmit their location and movement signals to a computer. All participating patients and staff members wear the tags and additional tags are attached to equipment like walking-aids and wheelchairs. Simultaneously, on various days, OBMT is being used to record patients’ location, interaction and activity every ten minutes. Descriptive statistics and Pearson’s Correlation Coefficients (PCCs) are being used for statistical analysis. Results: So far, we have analysed the results for the location category of three patients and have observed only small differences between the two systems for mean time spent in own room (diff=7min; OBMT=550, RTLS=557) and in therapy room (diff=4min; OBMT=90, RTLS=86). Further analysis will involve comparing the methods for time spent in categories like interacting with staff members, doing therapeutic and non therapeutic activities and using equipment. Conclusion: Based on results, we hope to determine that the RTLS is a valid system for continuous, unobtrusive patient activity measurement and can provide much needed quantifiable information about functional recovery post stroke

The clinical effectiveness of self-care interventions with an exercise component to manage knee conditions: a systematic review

Objective. Treatment of knee conditions should include approaches to support self-care and exercise based interventions. The most effective way to combine self-care and exercise has however not been determined sufficiently. Therefore the aim was to evaluate the clinical effectiveness of self-care programmes with an exercise component for individuals with any type of knee conditions. Methods. A keyword search of Medline, CINAHL, Amed, PsycInfo, Web of Science, and Cochrane databases was conducted up until January 2015. Two reviewers independently assessed manuscript eligibility against inclusion/exclusion criteria. Study quality was assessed using the Downs and Black quality assessment tool and the Cochrane Risk of Bias Tool. Data were extracted about self-care and exercise intervention type, control intervention, participants, length of follow-up, outcome measures, and main findings. Results. From the 7392 studies identified through the keyword search the title and abstract of 5498 were screened. The full text manuscripts of 106 studies were retrieved to evaluate their eligibility. Twenty-one manuscripts met the inclusion/exclusion criteria. Conclusion. The treatment potential of combined self-care and exercise interventions has not been maximised because of limitations in study design and failure to adequately define intervention content. Potentially the most beneficial self-care treatment components are training self-management skills, information delivery, and goal setting. Exercise treatment components could be strengthened by better attention to dose and progression. Modern technology to streamline delivery and support self-care should be considered. More emphasis is required on using self-care and exercise programmes for chronic condition prevention in addition to chronic condition management

A new computerised system can continuously measure functional activities of patients in a stroke rehabilitation unit

Background: To be able to measure patient activity in a continuous and unobtrusive manner we are developing a new automated system based on Real Time Location Technology. This would also allow us to overcome limitations of the current activity monitoring methods. Having established excellent reliability of the system (Intraclass Correlation Coefficients≥0.90) we validated it against Observational Behaviour Mapping Techniques and obtained a high level of agreement between the two methods. The mean differences for time spent in own room and physiotherapy room were 1.1 and 1.5 minutes respectively. To date, the system has measured continuous activity of 43 patients from admission to discharge. Methods: Each participant wore a Radio Frequency identification tag with an in-built motion sensor. This tag, worn on the unaffected wrist receives infra-red location signals from room locators fitted in all rooms accessed by the patients. The tag transmits the location and movement signals to a computer. Bespoke software programmes were developed to collect and process data. Descriptive statistics and charts were used for analysis. Results: Here we report the individual activity profiles of 2 patients. Summary charts (emailed separately) illustrate some individual differences in the activity of these patients. Both patients spent the majority of their time in their own rooms (mean 88.6% and 77.5%) where patient 2 was less active. Patients were most active whilst in physiotherapy (mean 98% and 95%). Conclusion: With further development of the software we are aiming to build a comprehensive picture of functional recovery. Therefore, the analysis of other key aspects such as time spent sitting in the chair, lying in bed, transfers or walking in the corridor will be added. This may also give more insight into the kind of activity undertaken in their own rooms. Ultimately, the aim is to generate a better understanding of early rehabilitation post stroke