Shoulder Orthopedic Special Tests (OSTs) are used to assist with diagnosis in shoulder disorders. Issues with reliability and validity exist, making their interpretation challenging. Exploring OST results on repeated testing within... more
Shoulder Orthopedic Special Tests (OSTs) are used to assist with diagnosis in shoulder disorders. Issues with reliability and validity exist, making their interpretation challenging. Exploring OST results on repeated testing within Mechanical Diagnosis and Therapy (MDT) shoulder classifications may offer insight into the poor performance of these tests. To investigate in patients with shoulder complaints, whether MDT classifications affect the agreement of OST results over the course of treatment. An international group of MDT clinicians recruited 105 patients with shoulder problems. Three commonly used OSTs (Empty Can, Hawkins-Kennedy, and Speed's tests) were utilized. Results of the OSTs were collected at sessions 1, 3, 5 and 8, or at discharge from an MDT classification-based treatment. The Kappa statistic was utilized to determine the agreement of the OST results over time for each of the MDT classifications. The overall Kappa values for Empty Can, Hawkins-Kennedy and Speed&...
The primary objective was to determine if the pain and function response to the McKenzie system of Mechanical Diagnosis and Therapy (MDT) differs by MDT classification category at two and four weeks following the start of MDT treatment... more
The primary objective was to determine if the pain and function response to the McKenzie system of Mechanical Diagnosis and Therapy (MDT) differs by MDT classification category at two and four weeks following the start of MDT treatment for shoulder complaints. The secondary objective was to describe the frequency of discharge over time by MDT classification. International, MDT-trained study collaborators recruited 93 patients attending physiotherapy for rehabilitation of a shoulder problem. The Numeric Pain Rating Scale (NPRS) and the Upper Extremity Functional Index (UEFI) were collected at the initial assessment and two and four weeks after treatment commenced. A two-way mixed model analysis of variance with planned pairwise comparisons was performed to identify where the differences between MDT classification groups actually existed. The Derangement and Spinal classifications had significantly lower NPRS scores than the Dysfunction group at week 2 and week 4 ( < 0.05). The Derangement and Spinal classifications had significantly higher UEFI scores than the Dysfunction group at week 2 and week 4 ( < 0.05). The frequency of discharge at week 2 was 37% for both Derangement and Spinal classifications, with no discharges for the Dysfunction classification at this time point. The frequency of discharge at week 4 was 83, 82 and 15% for the Derangement, Spinal and Dysfunction classifications, respectively. Classifying patients with shoulder pain using the MDT system can impact treatment outcomes and the frequency of discharge. When MDT-trained clinicians are allowed to match the intervention to a specific MDT classification, the outcome is aligned with the response expectation of the classification.: 2b.
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Few studies have addressed whether firefighters are fitter than the general population and possess sufficient levels of aerobic capacity and muscle strength to perform on-duty tasks in a safe and efficient manner, considering age and... more
Few studies have addressed whether firefighters are fitter than the general population and possess sufficient levels of aerobic capacity and muscle strength to perform on-duty tasks in a safe and efficient manner, considering age and gender. We aimed to evaluate the fitness levels of Hamilton firefighters, and to determine the effects of age and gender. In total, 89 participants were recruited. The modified Canadian aerobic fitness test was used to determine participants' estimated maximal oxygen consumption (VO2max) levels. For upper and lower body strength levels, a calibrated J-Tech hand-held dynamometer and a National Institute for Occupational Safety and Health (NIOSH) lifting device was used respectively. Firefighters' mean (SD) VO2max level was 40.30 ± 6.25 ml·kg-1·min-1. Age proved to have a statistically significant impact on VO2max (p < 0.001). Gender displayed statistically significant effects on strength levels. Firefighters' age was the only statistically significant independent variable, and accounted for 61.00% of the variance in firefighters' aerobic capacity levels. Firefighters possessed somewhat similar aerobic capacities but much higher levels of body strength when compared with the general population. With age, firefighters' aerobic capacities decreased; however, their upper and lower body strength levels remained the same.
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OBJECTIVES:To update a previous clinical practice guideline on suctioning in adult patients, published in the Canadian Respiratory Journal in 2001.METHODS:A primary search of the MEDLINE (from 1998), CINAHL, EMBASE and The Cochrane... more
OBJECTIVES:To update a previous clinical practice guideline on suctioning in adult patients, published in the Canadian Respiratory Journal in 2001.METHODS:A primary search of the MEDLINE (from 1998), CINAHL, EMBASE and The Cochrane Library (all from 1996) databases up to November 2007, was conducted. These dates reflect the search limits reached in the previous clinical practice guideline. A secondary search of the reference lists of retrieved articles was also performed. Two reviewers independently appraised each study before meeting to reach consensus. Study quality was evaluated using the Jadad and PEDro scales. When sufficient data were available, a meta-analysis was conducted using a random effects model. Data are reported as ORs, weighted mean differences and 95% CIs. When no comparisons were possible, qualitative analyses of the data were completed.RESULTS:Eighty-one studies were critically appraised from a pool of 123. A total of 28 randomized controlled trials or randomized crossover studies were accepted for inclusion. Meta-analysis was possible for open versus closed suctioning only. Recommendations from 2001 with respect to hyperoxygenation, hyperinflation, use of a ventilator circuit adaptor and subglottic suctioning were confirmed. New evidence was identified with respect to indications for suctioning, open suction versus closed suction systems, use of medications and infection control.CONCLUSIONS:While new evidence continues to be varied in strength, and is still lacking in some areas of suctioning practice, the evidence base has improved since 2001. Members of the health care team should incorporate this evidence into their practice.
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Background Exercise training is commonly recommended for adults with fibromyalgia. We defined flexibility exercise training programs as those involving movements of a joint or a series of joints, through complete range of motion, thus... more
Background
Exercise training is commonly recommended for adults with fibromyalgia. We defined flexibility exercise training programs as those involving movements of a joint or a series of joints, through complete range of motion, thus targeting major muscle-tendon units. This review is one of a series of reviews updating the first review published in 2002.
Objectives
To evaluate the benefits and harms of flexibility exercise training in adults with fibromyalgia.
Search methods
We searched the Cochrane Library, MEDLINE, Embase, CINAHL (Cumulative Index to Nursing and Allied Health Literature), PEDro (Physiotherapy Evidence Database), Thesis and Dissertation Abstracts, AMED (Allied and Complementary Medicine Database), the World Health Organization International Clinical Trials Registry Platform (WHO ICTRP), and ClinicalTrials.gov up to December
2017, unrestricted by language, and we reviewed the reference lists of retrieved trials to identify potentially relevant trials.
Selection criteria
We included randomized trials (RCTs) including adults diagnosed with fibromyalgia based on published criteria. Major outcomes were health-related quality of life (HRQoL), pain intensity, stiffness, fatigue, physical function, trial withdrawals, and adverse events.
Data collection and analysis
Two review authors independently selected articles for inclusion, extracted data, performed ’Risk of bias’ assessments, and assessed the certainty of the body of evidence for major outcomes using the GRADE approach. All discrepancies were rechecked, and consensus was achieved by discussion.
Main results
We included 12 RCTs (743 people). Among these RCTs, flexibility exercise training was compared to an untreated control group, landbased aerobic training, resistance training, or other interventions (i.e. Tai Chi, Pilates, aquatic biodanza, friction massage, medications). Studies were at risk of selection, performance, and detection bias (due to lack of adequate randomization and allocation concealment, lack of participant or personnel blinding, and lack of blinding for self-reported outcomes). With the exception of withdrawals and adverse events, major outcomes were self-reported and were expressed on a 0-to-100 scale (lower values are best, negative mean differences (MDs) indicate improvement). We prioritized the findings of flexibility exercise training compared to land-based aerobic training and present them fully here. Very low-certainty evidence showed that compared with land-based aerobic training, flexibility exercise training (five trials with 266 participants) provides no clinically important benefits with regard to HRQoL, pain intensity, fatigue, stiffness, and physical function. Low-certainty evidence showed no difference between these groups for withdrawals at completion of the intervention (8 to 20 weeks). Mean HRQoL assessed on the Fibromyalgia Impact Questionnaire (FIQ) Total scale (0 to 100, higher scores indicating worse HRQoL) was 46 mm and 42 mm in the flexibility and aerobic groups, respectively (2 studies, 193 participants); absolute change was 4% worse (6% better to 14% worse), and relative change was 7.5% worse (10.5% better to 25.5% worse) in the flexibility group. Mean pain was
57 mm and 52 mm in the flexibility and aerobic groups, respectively (5 studies, 266 participants); absolute change was 5% worse (1% better to 11% worse), and relative change was 6.7% worse (2% better to 15.4% worse). Mean fatigue was 67 mm and 71 mm in the aerobic and flexibility groups, respectively (2 studies, 75 participants); absolute change was 4% better (13% better to 5% worse), and
relative change was 6% better (19.4% better to 7.4% worse). Mean physical function was 23 points and 17 points in the flexibility and aerobic groups, respectively (1 study, 60 participants); absolute change was 6% worse (4% better to 16% worse), and relative change was 14% worse (9.1% better to 37.1% worse). We found very low-certainty evidence of an effect for stiffness. Mean stiffness was 49 mm to 79 mm in the flexibility and aerobic groups, respectively (1 study, 15 participants); absolute change was 30% better (8% better to 51% better), and relative change was 39% better (10% better to 68% better). We found no evidence of an effect in all-cause withdrawal between the flexibility and aerobic groups (5 studies, 301 participants). Absolute change was 1% fewer withdrawals in the flexibility group (8% fewer to 21% more), and relative change in the flexibility group compared to the aerobic training intervention group was 3% fewer (39% fewer to 55% more). It is uncertain whether flexibility leads to long-term effects (36 weeks after a 12-week intervention), as the evidence was of low certainty and was derived from a single trial. Very low-certainty evidence indicates uncertainty in the risk of adverse events for flexibility exercise training. One adverse effect was described among the 132 participants allocated to flexibility training. One participant had tendinitis of the Achilles tendon (McCain
1988), but it is unclear if the tendinitis was a pre-existing condition.
Authors’ conclusions
When compared with aerobic training, it is uncertain whether flexibility improves outcomes such as HRQoL, pain intensity, fatigue,
stiffness, and physical function, as the certainty of the evidence is very low. Flexibility exercise training may lead to little or no difference for all-cause withdrawals. It is also uncertain whether flexibility exercise training has long-term effects due to the very low certainty of the evidence. We downgraded the evidence owing to the small number of trials and participants across trials, as well as due to issues related to unclear and high risk of bias (selection,
performance, and detection biases). While flexibility exercise training appears to be well tolerated (similar withdrawal rates across groups), evidence on adverse events was scarce, therefore its safety is uncertain.
Exercise training is commonly recommended for adults with fibromyalgia. We defined flexibility exercise training programs as those involving movements of a joint or a series of joints, through complete range of motion, thus targeting major muscle-tendon units. This review is one of a series of reviews updating the first review published in 2002.
Objectives
To evaluate the benefits and harms of flexibility exercise training in adults with fibromyalgia.
Search methods
We searched the Cochrane Library, MEDLINE, Embase, CINAHL (Cumulative Index to Nursing and Allied Health Literature), PEDro (Physiotherapy Evidence Database), Thesis and Dissertation Abstracts, AMED (Allied and Complementary Medicine Database), the World Health Organization International Clinical Trials Registry Platform (WHO ICTRP), and ClinicalTrials.gov up to December
2017, unrestricted by language, and we reviewed the reference lists of retrieved trials to identify potentially relevant trials.
Selection criteria
We included randomized trials (RCTs) including adults diagnosed with fibromyalgia based on published criteria. Major outcomes were health-related quality of life (HRQoL), pain intensity, stiffness, fatigue, physical function, trial withdrawals, and adverse events.
Data collection and analysis
Two review authors independently selected articles for inclusion, extracted data, performed ’Risk of bias’ assessments, and assessed the certainty of the body of evidence for major outcomes using the GRADE approach. All discrepancies were rechecked, and consensus was achieved by discussion.
Main results
We included 12 RCTs (743 people). Among these RCTs, flexibility exercise training was compared to an untreated control group, landbased aerobic training, resistance training, or other interventions (i.e. Tai Chi, Pilates, aquatic biodanza, friction massage, medications). Studies were at risk of selection, performance, and detection bias (due to lack of adequate randomization and allocation concealment, lack of participant or personnel blinding, and lack of blinding for self-reported outcomes). With the exception of withdrawals and adverse events, major outcomes were self-reported and were expressed on a 0-to-100 scale (lower values are best, negative mean differences (MDs) indicate improvement). We prioritized the findings of flexibility exercise training compared to land-based aerobic training and present them fully here. Very low-certainty evidence showed that compared with land-based aerobic training, flexibility exercise training (five trials with 266 participants) provides no clinically important benefits with regard to HRQoL, pain intensity, fatigue, stiffness, and physical function. Low-certainty evidence showed no difference between these groups for withdrawals at completion of the intervention (8 to 20 weeks). Mean HRQoL assessed on the Fibromyalgia Impact Questionnaire (FIQ) Total scale (0 to 100, higher scores indicating worse HRQoL) was 46 mm and 42 mm in the flexibility and aerobic groups, respectively (2 studies, 193 participants); absolute change was 4% worse (6% better to 14% worse), and relative change was 7.5% worse (10.5% better to 25.5% worse) in the flexibility group. Mean pain was
57 mm and 52 mm in the flexibility and aerobic groups, respectively (5 studies, 266 participants); absolute change was 5% worse (1% better to 11% worse), and relative change was 6.7% worse (2% better to 15.4% worse). Mean fatigue was 67 mm and 71 mm in the aerobic and flexibility groups, respectively (2 studies, 75 participants); absolute change was 4% better (13% better to 5% worse), and
relative change was 6% better (19.4% better to 7.4% worse). Mean physical function was 23 points and 17 points in the flexibility and aerobic groups, respectively (1 study, 60 participants); absolute change was 6% worse (4% better to 16% worse), and relative change was 14% worse (9.1% better to 37.1% worse). We found very low-certainty evidence of an effect for stiffness. Mean stiffness was 49 mm to 79 mm in the flexibility and aerobic groups, respectively (1 study, 15 participants); absolute change was 30% better (8% better to 51% better), and relative change was 39% better (10% better to 68% better). We found no evidence of an effect in all-cause withdrawal between the flexibility and aerobic groups (5 studies, 301 participants). Absolute change was 1% fewer withdrawals in the flexibility group (8% fewer to 21% more), and relative change in the flexibility group compared to the aerobic training intervention group was 3% fewer (39% fewer to 55% more). It is uncertain whether flexibility leads to long-term effects (36 weeks after a 12-week intervention), as the evidence was of low certainty and was derived from a single trial. Very low-certainty evidence indicates uncertainty in the risk of adverse events for flexibility exercise training. One adverse effect was described among the 132 participants allocated to flexibility training. One participant had tendinitis of the Achilles tendon (McCain
1988), but it is unclear if the tendinitis was a pre-existing condition.
Authors’ conclusions
When compared with aerobic training, it is uncertain whether flexibility improves outcomes such as HRQoL, pain intensity, fatigue,
stiffness, and physical function, as the certainty of the evidence is very low. Flexibility exercise training may lead to little or no difference for all-cause withdrawals. It is also uncertain whether flexibility exercise training has long-term effects due to the very low certainty of the evidence. We downgraded the evidence owing to the small number of trials and participants across trials, as well as due to issues related to unclear and high risk of bias (selection,
performance, and detection biases). While flexibility exercise training appears to be well tolerated (similar withdrawal rates across groups), evidence on adverse events was scarce, therefore its safety is uncertain.
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What is fibromyalgia and what is mixed exercise? Fibromyalgia is a condition causing chronic pain and soreness throughout the body. People with this condition often feel depressed, tired, and stiff, and have difficulty sleeping. Mixed... more
What is fibromyalgia and what is mixed exercise?
Fibromyalgia is a condition causing chronic pain and soreness throughout the body. People with this condition often feel depressed,
tired, and stiff, and have difficulty sleeping. Mixed exercise is defined as regular sessions of two or more types of exercise including
aerobic (walking or cycling), strengthening (lifting weights or pulling against resistance bands), or flexibility (stretching) exercise.
Study characteristics
Reviewers searched for studies until December 2017, and found 29 studies (2088 people) conducted in 12 different countries. The
average age of study participants was 51 years, and 98% were female. The average exercise programme was 14 weeks long with three
sessions of 50 to 60 minutes per week. All exercise programmes were fully or partially supervised. Reviewers were most interested in
comparing mixed exercise groups to control groups (19 studies; 1065 people). People in control groups either received no treatment or
continued their usual care.
Key results - mixed exercise vs control
Each outcome below is measured on a scale that goes from 0 to 100, where lower scores are better.
Health-related quality of life (HRQL)
After 5 to 26 weeks, people who exercised were 7% better (3% better to 11% better) or improved by 7 points on a 100 point scale.
People who exercised rated their HRQL at 49 points.
People in the control group rated their HRQL at 56 points.
Pain
After 5 to 26 weeks, people who exercised had 5% less pain (1% better to 9% better) or improved by 5 points on a 100 point scale.
People who exercised rated their pain at 53 points.
People in the control group rated their pain at 58.6 points.
Tiredness
After 14 to 24 weeks, people who exercised were 13% less tired (8% better to 18% better) or improved by 13 points on a 100 point
scale
People who exercised rated their tiredness at 59 points.
People in the control group rated their tiredness at 72 points.
Stiffness
After 16 weeks, people who exercised were 7% less stiff (1% better 1 to 12% better) or improved by 7 points on a 100 point scale.
People who exercised rated their stiffness at 61 points.
People in the control group rated their stiffness at 68 points.
Ability to do daily activities (physical function)
After 8 to 24 weeks, people who exercised were 11% better (7% to 15%) or improved by 11 points on a 100 point scale.
People who exercised rated their physical function at 38 points.
People in the control group rated their physical function at 49 points.
Harms - Some participants experienced increased pain, soreness, or tiredness during or after exercise. Studies reported no injuries or
other harms. However, reporting of harms was missing or incomplete in many studies. We are uncertain whether risk is increased with
exercise.
Leaving the study early - 11% of control participants left the study early compared with 12% of exercisers.
Long-term effects - Analysis of long-term effects of HRQL showed maintenance of mixed exercise effects at 6 to 12 weeks and at 13 to
26 weeks but not at 27 to 52 weeks. Very low-quality evidence suggests that it is uncertain whether mixed exercises improve HRQL in
the long term. Withdrawals and adverse events were not measured.
Other - Reviewers found no evidence that the benefits and harms of mixed exercise were any different from education programmes,
cognitive-behavioural training, biofeedback, medication, or other types of exercise.
Conclusions and quality of evidence
Mixed exercise may improve HRQL and the ability to do daily activities, may decrease pain and tiredness, and may be acceptable to
individuals with fibromyalgia. Low-quality evidence suggests that mixed exercise may slightly improve stiffness. When compared to
other exercise or non-exercise interventions, we are uncertain about the effects of mixed exercise. Although mixed exercise appears to
be well tolerated (similar numbers of people leaving the study across groups), evidence on harms was scarce, so we are uncertain about
its safety. Reviewers considered the quality of evidence to be low to moderate because of small numbers of people in the studies, some
issues involving study design, and the low quality of results.
Fibromyalgia is a condition causing chronic pain and soreness throughout the body. People with this condition often feel depressed,
tired, and stiff, and have difficulty sleeping. Mixed exercise is defined as regular sessions of two or more types of exercise including
aerobic (walking or cycling), strengthening (lifting weights or pulling against resistance bands), or flexibility (stretching) exercise.
Study characteristics
Reviewers searched for studies until December 2017, and found 29 studies (2088 people) conducted in 12 different countries. The
average age of study participants was 51 years, and 98% were female. The average exercise programme was 14 weeks long with three
sessions of 50 to 60 minutes per week. All exercise programmes were fully or partially supervised. Reviewers were most interested in
comparing mixed exercise groups to control groups (19 studies; 1065 people). People in control groups either received no treatment or
continued their usual care.
Key results - mixed exercise vs control
Each outcome below is measured on a scale that goes from 0 to 100, where lower scores are better.
Health-related quality of life (HRQL)
After 5 to 26 weeks, people who exercised were 7% better (3% better to 11% better) or improved by 7 points on a 100 point scale.
People who exercised rated their HRQL at 49 points.
People in the control group rated their HRQL at 56 points.
Pain
After 5 to 26 weeks, people who exercised had 5% less pain (1% better to 9% better) or improved by 5 points on a 100 point scale.
People who exercised rated their pain at 53 points.
People in the control group rated their pain at 58.6 points.
Tiredness
After 14 to 24 weeks, people who exercised were 13% less tired (8% better to 18% better) or improved by 13 points on a 100 point
scale
People who exercised rated their tiredness at 59 points.
People in the control group rated their tiredness at 72 points.
Stiffness
After 16 weeks, people who exercised were 7% less stiff (1% better 1 to 12% better) or improved by 7 points on a 100 point scale.
People who exercised rated their stiffness at 61 points.
People in the control group rated their stiffness at 68 points.
Ability to do daily activities (physical function)
After 8 to 24 weeks, people who exercised were 11% better (7% to 15%) or improved by 11 points on a 100 point scale.
People who exercised rated their physical function at 38 points.
People in the control group rated their physical function at 49 points.
Harms - Some participants experienced increased pain, soreness, or tiredness during or after exercise. Studies reported no injuries or
other harms. However, reporting of harms was missing or incomplete in many studies. We are uncertain whether risk is increased with
exercise.
Leaving the study early - 11% of control participants left the study early compared with 12% of exercisers.
Long-term effects - Analysis of long-term effects of HRQL showed maintenance of mixed exercise effects at 6 to 12 weeks and at 13 to
26 weeks but not at 27 to 52 weeks. Very low-quality evidence suggests that it is uncertain whether mixed exercises improve HRQL in
the long term. Withdrawals and adverse events were not measured.
Other - Reviewers found no evidence that the benefits and harms of mixed exercise were any different from education programmes,
cognitive-behavioural training, biofeedback, medication, or other types of exercise.
Conclusions and quality of evidence
Mixed exercise may improve HRQL and the ability to do daily activities, may decrease pain and tiredness, and may be acceptable to
individuals with fibromyalgia. Low-quality evidence suggests that mixed exercise may slightly improve stiffness. When compared to
other exercise or non-exercise interventions, we are uncertain about the effects of mixed exercise. Although mixed exercise appears to
be well tolerated (similar numbers of people leaving the study across groups), evidence on harms was scarce, so we are uncertain about
its safety. Reviewers considered the quality of evidence to be low to moderate because of small numbers of people in the studies, some
issues involving study design, and the low quality of results.
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To determine the effects of adding stages of change-based counseling to an exercise prescription for older, sedentary adults in family practice. The Step Test Exercise Prescription Stages of change counseling study was a 12-month cluster... more
To determine the effects of adding stages of change-based counseling to an exercise prescription for older, sedentary adults in family practice. The Step Test Exercise Prescription Stages of change counseling study was a 12-month cluster randomized trial. Forty family practices in 4 regions of Canada. Healthy, community-dwelling men (48%) and women (52%) with a mean (SD) age of 64.9 (7.1) years (range 55 to 85 years). There were a total of 193 participants in the intervention group and 167 in the control group. Intervention physicians were trained to deliver a tailored exercise prescription and a transtheoretical behaviour change counseling program. Control physicians were trained to deliver the exercise prescription alone. Predicted cardiorespiratory fitness, measured by predicted maximal oxygen consumption (pVO2max), and energy expenditure, measured by 7-day physical activity recall. Mean increase in pVO2max was significant for both the intervention (3.02 [95% confidence interval ...
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Pharmacology, Bioinformatics, Evolutionary Biology, Pathology, Oncology, and 23 moreRadiology, Pharmacy, Informatics, Genomics, Phylogenetics, Computational Biology, Biotechnology, Cancer, Biomarkers, Environmental Health, Biology, Proteomics, Biomedical informatics, Medicine, Bioscience, Phylogeny, Scientific, Microarray, Clinical Medicine, Biological, Genetic modification, Public health systems and services research, and Evidence Based
Anthropometric (AP) and computed tomographic (CT) methods of determining limb and muscle-plus-bone cross-sectional area (CSA) and volume (Vol) were compared in 13 young (M = 24.5 yrs) and 11 old (M = 71.0 yrs) men. CSA of total thigh,... more
Anthropometric (AP) and computed tomographic (CT) methods of determining limb and muscle-plus-bone cross-sectional area (CSA) and volume (Vol) were compared in 13 young (M = 24.5 yrs) and 11 old (M = 71.0 yrs) men. CSA of total thigh, muscle-plus-bone, quadriceps, and hamstring muscle compartments and muscle were measured from CT scans. Corresponding muscle Vol were estimated from anthropometric equations. Prediction equations for CT measures were developed from AP measures using multiple linear regression. AP and CT techniques produced different values for thigh component CSA and Vol, especially in the old men. AP overestimated muscle-plus-bone CSA and Vol (4-6%) and underestimated skin and subcutaneous tissue CSA and Vol (17-33%). Prediction equations for quadriceps CSA and Vol (R2 = 80-96%) were more accurate than equations for hamstrings (R2 = 42-65%). Specific thigh muscle CSA and Vol can be predicted from AP measures (SEE 5-15%). These findings may have clinical significance when normalizing strength per unit of muscle size.
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Abstract The aim of this article is to present the “Patient-related Tennis Elbow Evaluation (PRTEE) Questionnaire”. In multiple, independently carried out studies, the PRTEE proved itself as an easy to use and reliable test for the... more
Abstract The aim of this article is to present the “Patient-related Tennis Elbow Evaluation (PRTEE) Questionnaire”. In multiple, independently carried out studies, the PRTEE proved itself as an easy to use and reliable test for the assessment of a chronic lateral epicondylopathy. It was at least as significant as other known questionnaires. Due to its simplicity, it can be developed
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Fibromyalgia (FM) is a syndrome expressed by chronic widespread pain often associated with reduced physical function. Exercise is a common recommendation in management of FM. We evaluated the effects of exercise training on global... more
Fibromyalgia (FM) is a syndrome expressed by chronic widespread pain often associated with reduced physical function. Exercise is a common recommendation in management of FM. We evaluated the effects of exercise training on global well-being, selected signs and symptoms, and physical function in individuals with FM. We searched Medline, Embase, CINAHL, SportDiscus, PubMed, PEDro, and the Cochrane Central Register for Controlled Trials to July 2005 and included randomized trials evaluating cardiorespiratory endurance, muscle strength, and flexibility. Methodological quality was assessed using the van Tulder and Jadad instruments. Training protocols were evaluated using American College of Sports Medicine (ACSM) guidelines. Clinical heterogeneity limited metaanalysis to 6 aerobic and 2 strength studies. There were 2276 subjects across the 34 studies; 1264 subjects were assigned to exercise interventions. Metaanalysis of 6 studies provided moderate-quality evidence that aerobic-only ex...
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It has been reported recently that follow-up FIM trade mark scores have been obtained from stroke patients via telephone interviews with either the former patient or proxy caregivers. We studied the validity and sensitivity of change of a... more
It has been reported recently that follow-up FIM trade mark scores have been obtained from stroke patients via telephone interviews with either the former patient or proxy caregivers. We studied the validity and sensitivity of change of a "phone FIM" score in a sample of hip fracture patients after rehabilitation. We compared FIM scores among hip fracture patients in a specialized musculoskeletal rehabilitation program. Sample size estimate of 27 was determined before the study. Patients included those with hip fracture returning to independent living in their own home. Twenty-nine patients were identified as a convenience sample of admitted patients. The phone FIM score at 8 wk was a valid predictor of the discharge FIM score and the observed FIM and phone FIM scores at 8 wk were similar. The sensitivity to change over 8 wk was similar between observed and phone FIM scores compared with the discharge FIM score. The phone FIM instrument presents a useful clinical instrumen...
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Communication, Psychometrics, Methodology, Fracture, Treatment, and 21 moreSelf Care, Locomotion, Activities of Daily Living, Humans, Physical Rehabilitation, Female, Male, Hip Fractures, Social Adjustment, Clinical Sciences, Aged, Questionnaires, Telephone, Reproducibility of Results, Muscle contraction, Sensitivity and Specificity, Test Reliability, Predictive value of tests, Motor activity, Severity of Illness Index, and Recovery of Function
Computed tomography (CT) was used to quantify components of the thigh in young (n = 13) and elderly (n = 11) men. Cross-sectional areas (CSA) of the total limb, total muscle plus bone, quadriceps compartment, hamstring compartment and... more
Computed tomography (CT) was used to quantify components of the thigh in young (n = 13) and elderly (n = 11) men. Cross-sectional areas (CSA) of the total limb, total muscle plus bone, quadriceps compartment, hamstring compartment and bone were measured at each of five scan sites along the length of the thigh. Non-muscle tissue (NMT) areas within the muscle compartments were measured using changes in density based on Hounsfield units. Skin plus subcutaneous fat areas and quadriceps and hamstring lean muscle areas were calculated by subtraction. Geometric formulae were used to calculate related volumes for each thigh component. Volumes were also predicted from regression equations employing thigh length and component CSA from single mid-limb CT scans. The results showed that while total thigh CSA was not different in elderly men, they had significantly smaller total muscle plus bone (13.0%), and quadriceps (26.4%), and hamstring (17.9%) muscle areas. The elderly men also had signific...
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Little is known about the pattern of injury in short track speed skating. To investigate the incidence and characteristics of injuries in short track speed skating. Retrospective study. Ninety-five of 150 elite-level skaters (63.3%) were... more
Little is known about the pattern of injury in short track speed skating. To investigate the incidence and characteristics of injuries in short track speed skating. Retrospective study. Ninety-five of 150 elite-level skaters (63.3%) were surveyed to collect information on training and competition load as well as on injuries sustained during the 1999-2000 competitive season. Injuries were characterized in terms of anatomic location, type of injury, time loss from training and competition, and circumstance of injury (acute onset during competition, on-ice practice, off-ice training, or insidious onset). Sixty-one of the 95 skaters (64.2%) reported sustaining at least one injury. The knee, ankle, spine, leg, and groin were the most commonly reported sites of injury. Skaters were also asked to list previous on-ice injuries. The two most common injuries occurring on-ice before the 1999-2000 season were lacerations from the knee down (11.1%) and ankle fractures (10.2%). The results of thi...
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Establishing the effect of fluctuating extracellular fluid (ECF) volume on muscle strength in people with end-stage renal disease (ESRD) on hemodialysis (HD) is essential, as inadequate hydration of the skeletal muscles impacts its... more
Establishing the effect of fluctuating extracellular fluid (ECF) volume on muscle strength in people with end-stage renal disease (ESRD) on hemodialysis (HD) is essential, as inadequate hydration of the skeletal muscles impacts its strength and endurance. Bioelectrical impedance spectroscopy (BIS) has been a widely used method for estimating ECF volume of a limb or calf segment. Magnetic resonance imaging (MRI)-acquired transverse relaxation times (T2) has also been used for estimating ECF volumes of individual skeletal muscles. The purpose of this study was to determine the association between T2 (gold standard) of tibialis anterior (TA), medial (MG), and lateral gastrocnemius (LG), and soleus muscles and calf BIS ECF, in healthy and in people with ESRD/HD. Calf BIS and MRI measures were collected on two occasions before and after HD session in people with ESRD/HD and on a single occasion for the healthy participants. Linear regression analysis was used to establish the association...
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Evaluation of patients with chronic obstructive pulmonary disease (COPD) often includes the use of post-bronchodilator reversibility testing to guide treatment decisions. Recommendations for reversibility testing differ and there is no... more
Evaluation of patients with chronic obstructive pulmonary disease (COPD) often includes the use of post-bronchodilator reversibility testing to guide treatment decisions. Recommendations for reversibility testing differ and there is no universally accepted method or outcome criterion. A survey of recent clinical trials with beta2-agonists in COPD illustrates the diversity of methods used to assess reversibility and highlights the difficulty of comparing data from such trials. Two recent studies demonstrated the benefits of treatment with the long-acting beta2-agonist bronchodilator formoterol (Foradil Aerolizer) in patients with COPD. When patients were classified according to their degree of reversibility as partially or poorly reversible, improvements were observed in both groups irrespective of the definition applied. These results suggest that bronchodilator reversibility testing should not be used as a rigid basis for treatment decisions with beta2-agonists in COPD patients. There is a pressing need for the role of reversibility testing to be clearly defined.
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The critical power (CP) of a muscle group or individual may represent the highest rate of work which can be performed for an extended period. We investigated this concept in young (n = 13, 24.5 years) and elderly (n = 12, 70.7 years)... more
The critical power (CP) of a muscle group or individual may represent the highest rate of work which can be performed for an extended period. We investigated this concept in young (n = 13, 24.5 years) and elderly (n = 12, 70.7 years) active men by first determining CP and then comparing responses elicited by 24 min of cycle exercise at power outputs (omega) corresponding to CP. Values from the final 2 min of the 24-min ride were expressed relative to maximal values established in a ramp test. CP for the elderly was only 65% that for the young, but on a relative basis, it was significantly higher both in terms of omega (67 vs 62% of omega max) and oxygen consumption (VO2) (91.5 vs 85.2% of maximum oxygen consumption). There were no group differences in relative values for ventilation (VE), heart rate or respiratory exchange ratio (R). During the 24-min ride, VO2 and R achieved a plateau in both groups, while VE, blood lactate and arterial PCO2 continued to change in the young. It was concluded that CP can be determined in active elderly men, but that CP may not represent a true non-fatiguing work rate in either young or elderly men.
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Hip fractures, fragility fractures, indicate an increased risk for further fragility fractures. Although the way to define osteoporosis, requiring antiresorptive therapy, is not clear, all patients who have had hip fractures should be... more
Hip fractures, fragility fractures, indicate an increased risk for further fragility fractures. Although the way to define osteoporosis, requiring antiresorptive therapy, is not clear, all patients who have had hip fractures should be prescribed calcium and vitamin D at a minimum. In a retrospective chart review, we have explored the effectiveness of incorporating a standing recommendation (but not a standing order) for calcium and vitamin D treatment in a hip fracture care pathway, comparing units where the pathway had been implemented with those where it had not yet been started. The pathway resulted in significantly more initiation of calcium and vitamin D compared to patients not on the pathway (72% vs. 13.5%, p < 0.01). However, a follow-up study after four years showed a marked decline in the frequency of the initiation of calcium and vitamin D, suggesting the need for ongoing encouragement for the intervention to continue to be successful.
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Primary care physicians are ideally positioned to affect a large population at risk for epidemics of sedentary lifestyle; however, it is unclear what type of counseling they provide. A questionnaire was used to obtain information on... more
Primary care physicians are ideally positioned to affect a large population at risk for epidemics of sedentary lifestyle; however, it is unclear what type of counseling they provide. A questionnaire was used to obtain information on primary care physicians' behaviors with respect to counseling and prescribing physical activity, physician demographics, and practice characteristics. Registered primary care physicians in Canada were contacted in all 10 provinces and 2 territories. Of 27 980 primary care physicians, 14 319 returned usable questionnaires and 13 166 were eligible for study participation (response rate, 51.2%). Respondents were predominantly male (61.1%), practiced in private office/clinic settings (73.4%), and had graduated from medical school more than 22 years earlier. Eighty-five percent of respondents reported asking patients about their physical activity levels, whereas only 26.2% assessed patient fitness as part of a physical examination or through a fitness test and only 10.9% referred patients to others for fitness assessment or appraisal. Most physicians (69.8%) reported using verbal counseling to promote physical activity, whereas only 15.8% used written prescriptions for a physical activity promotion program. Male and female physicians responded differently. Men more frequently assessed fitness than did women, whereas women more frequently asked and provided verbal and written directions. This large sample of Canadian primary care physicians regularly asked patients about physical activity levels and advised them using verbal counseling. Few respondents provided written prescriptions, performed fitness assessments, or referred patients. These results suggest possible opportunities to improve physicians' counseling and prescription efforts.
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Anthropometric (AP) and computed tomographic (CT) methods of determining limb and muscle-plus-bone cross-sectional area (CSA) and volume (Vol) were compared in 13 young (M = 24.5 yrs) and 11 old (M = 71.0 yrs) men. CSA of total thigh,... more
Anthropometric (AP) and computed tomographic (CT) methods of determining limb and muscle-plus-bone cross-sectional area (CSA) and volume (Vol) were compared in 13 young (M = 24.5 yrs) and 11 old (M = 71.0 yrs) men. CSA of total thigh, muscle-plus-bone, quadriceps, and hamstring muscle compartments and muscle were measured from CT scans. Corresponding muscle Vol were estimated from anthropometric equations. Prediction equations for CT measures were developed from AP measures using multiple linear regression. AP and CT techniques produced different values for thigh component CSA and Vol, especially in the old men. AP overestimated muscle-plus-bone CSA and Vol (4-6%) and underestimated skin and subcutaneous tissue CSA and Vol (17-33%). Prediction equations for quadriceps CSA and Vol (R2 = 80-96%) were more accurate than equations for hamstrings (R2 = 42-65%). Specific thigh muscle CSA and Vol can be predicted from AP measures (SEE 5-15%). These findings may have clinical significance when normalizing strength per unit of muscle size.
Research Interests:
Research Interests:
The authors compared heart-rate and blood-pressure responses to typical isometric (ISO) and isokinetic (90 degrees /s) eccentric (ECC) resistance-training protocols in older adults. Twenty healthy older adults (74 +/- 5 years old)... more
The authors compared heart-rate and blood-pressure responses to typical isometric (ISO) and isokinetic (90 degrees /s) eccentric (ECC) resistance-training protocols in older adults. Twenty healthy older adults (74 +/- 5 years old) performed randomly ordered ISO and isokinetic ECC exercise (3 sets of 10 repetitions) at a target intensity of 100 % of their peak ISO torque value. Heart rate and systolic (SBP) and diastolic (DBP) blood pressures were recorded continuously, and mean arterial pressure (MAP) and rate-pressure product (RPP) were calculated. ECC peak torque (139 +/- 33 N. m) was significantly greater than ISO peak torque (115 +/- 26 N. m; p <.001). All variables increased significantly (p <.001) during both ISO and ECC exercise. Changes in SBP, DBP, MAP, and RPP were significantly greater during ISO exercise than during ECC exercise (p <.001). Clinically, an isokinetic ECC exercise program enables older adults to work at the same torque output with less cardiovascular stress than ISO exercise.