Free Research Papers on contemporary physiotherapy research

Anterior knee pain in youth as a precursor to subsequent patellofemoral osteoarthritis: A systematic reviewMJ Thomas, L Wood, G Peat, Arthritis Research Campaign National Primary Care Centre, Keele University

The Effect of Tibialis Anterior Fatigue on Minimum Toe ClearanceN.Tabaton, A.Kerr & D.Rafferty, School of Health, Glasgow Caledonian University

What makes an ‘ideal’ physiotherapy service for people with Parkinson’s disease?R Young(1), D Jones(2), K Baker(2),(1)Physiotherapy Department, Wansbeck General Hospital, Northumbria Healthcare NHS Foundation Trust; (2). School of Health, Community and Education Studies, Northumbria University

A Comparison of Early Hip Strengthening to Early Quadriceps Strengthening in the Treatment of Females with Patellofemoral Pain SyndromeJM Medina McKeon*, K Dolak†, CL Silkman*, R Hosey‡, C Lattermann‡, TL Uhl** Department of Rehabilitation Sciences, University of Kentucky, † Department of Athletics, Endicott College, Beverly, Massachusetts, ‡ Department of Orthopaedic Surgery & Sports Medicine, University of Kentucky

Development and validation of an activity monitor to measure the physical activity of wheelchair usersEH Coulter1, PM Dall1, L Rochester2, J Hasler3 and MH Granat1

1School of Health, Glasgow Caledonian University,2Institute for Ageing and Health, Newcastle University, 3Queen Elizabeth National Spinal Injuries Unit, Southern General Hospital, Glasgow

Is gait affected by the urgent need to void?J Booth1,L Paul2, D Rafferty1, C MacInnes1.1School of Health, Glasgow Caledonian University. 2Nursing and Health Care – Faculty of Medicine, University of Glasgow

Promoting physical activity in a low socioeconomic area: Results from an intervention targeting stair climbingCG Ryan(a), J Ryan(a), K Lyon (a),OJ Webb (b),FF Eves (c).(a)School of Health, Glasgow Caledonian University (b) School of Sport, Exercise and Health Sciences, Loughborough University.(c) School of Sport and Exercise Sciences, University of Birmingham

Physiotherapy practice for knee OsteoarthritisAl-Khlaifat L, Jones R, and Tyson S, University of Salford

Effect of foot/pedal position on gastrocnemius and tibialis anterior activity during static cyclingK. Rae, A. Kerr, School of Health, Glasgow Caledonian University

The impact of subacromial impingement syndrome on muscle activity patterns of the shoulder complex: a systematic review of electromyographic studiesR Chester1, TO Smith1, L Hooper1, J Dixon2, 1Institute of Health and Social Sciences Research, Faculty of Health, University of East Anglia, 2School of Health & Social Care, Teesside University

Measurement of foot placement and clearance during stair descentMuhaidat J1, Skelton DA1, Kerr A1, Evans JJ2, Rafferty D1,1HealthQwest, School of Health, Glasgow Caledonian University, 2Section of Psychological Medicine, University of Glasgow

Patient Reported Outcome Measures (PROMS) do not fully represent physical function following total knee arthroplastyD Hamilton (1), AHRW Simpson (1), P Gaston (2),(1) University of Edinburgh, Edinburgh, (2) Royal Infirmary of Edinburgh

Free Research Poster Presentations on contemporary physiotherapy researchSitting patterns at work: objective measurement of adherence to current recommendationsCG Ryan, PM Grant, PM Dall, MH Granat, School of Health, Glasgow Caledonian University

Sequence of head and upper trunk rotations during head turns in people with stroke while sitting: A pilot studyRY Ahmad, G Verheyden, A Ashburn, School of Health Sciences, University of Southampton

An investigation of the effect of elbow position on grip strengthJ Kent, S Bohan, Teesside University

Repeatability and inter-tester reliability of a new tool to assess isometric neck strength in adolescentsDF. Hamilton (1), RJ. Wallace (1), WD. Mackay (2), AHRW. Simpson (1), D. Gatherer (2), (1) Orthopaedic Engineering Collaboration, University of Edinburgh, (2) Gatherer Ltd, Aylesbury, Bucks

Use of Standardized Functional Outcome Measures in Children with Cerebral Palsy undergoing Physiotherapy: Perceptions & ApplicationsR Dharmadhikari, M Lindley, Sheffield Hallam University

A modified technique for measuring hamstring length by the Passive Knee Extension Angle (PKEA) testJR Riches; N Bryson; JGB Maclean, Department of Orthopaedic and Trauma Surgery, NHS Tayside, Perth Royal Infirmary

Anterior knee pain in youth as a precursor to subsequent patellofemoral osteoarthritis: A systematic review

Martin J Thomas, Laurence Wood, George Peat, Arthritis Research Campaign National Primary Care Centre, Keele University

Objective: Systematic review to investigate the link between anterior knee pain (AKP) in youth and subsequent patellofemoral osteoarthritis (PFOA).

Methods: The search strategy included electronic databases (Pubmed, EMBASE, AMED, CINAHL, Cochrane, PEDro, SportDiscus: inception to December 2009), bibliographies of potentially eligible studies and selected reviews. Full text articles in any language, – identified via English titles and abstracts, were included if they were retrospective or prospective in design and contained quantitative data regarding structural changes indicative of PFOA, incident to original idiopathic AKP. Eligibility criteria were applied to titles, abstracts and full-texts by two independent reviewers. Data extraction included study location, design, date, sampling procedure, sample characteristics, AKP/PFOA definitions, follow-up rate and duration and main findings. Foreign language articles were translated into English prior to examination.

Results: Seven articles satisfied eligibility (5 English, 2 German). Only one case-control study directly investigated a link between PFOA and prior AKP, providing level III evidence for an association (OR 4.4; 95%CI 1.8, 10.6). Rough estimates of the annual risk of PFOA from the remaining six small, uncontrolled, observational studies (mean follow-up range: 5.7 to 23 years) ranged from 0% to 3.4%. This was not the primary aim of these studies, and limitations in design and methodology mean this data should be interpreted with caution.

Conclusions: There is a paucity of good-quality evidence reporting a link between AKP and PFOA. Further research is needed to establish whether AKP is a risk factor for incident PFOA. Existing cohort studies may be capable of addressing this question.

Support

This work was funded by a Programme Grant awarded by the Arthritis Research Campaign (18174) and a Nursing, Midwifery, and Allied Health Professionals Research Training Award (NMAHP/RTS/09/15) from West Midlands Strategic Health Authority to Martin Thomas.

The Effect of Tibialis Anterior Fatigue on Minimum Toe Clearance

N.Tabaton, A.Kerr and D.Rafferty, School of Health, Glasgow Caledonian University

Background: Most falls amongst older adults occur as a result of tripping, (1) suggesting minimum toe clearance (MTC) during swing, is an important measurement parameter of gait. MTC is controlled primarily through ankle dorsiflexion for which the tibialis anterior (TA) muscle is largely responsible. TA weakness, which may be associated with fatigue, has been implicated as a major causal factor in falls (2). However, the underlying biomechanical reason for this is unclear and there have been no studies that have observed the direct relationship between TA and MTC.

Aim: To determine if fatiguing TA amongst young healthy adults has an effect on MTC.

Methods: Following ethical approval, fifteen healthy female subjects (mean age 24.1 ± 2.9 years) were recruited. A motion capture system was used to measure MTC. Each subject performed nine gait trials at three self selected speeds (normal, slow and fast) before and after a TA fatigue protocol that consisted of multiple repetitions of a resistance exercise until subjects reported discomfort.

Results: TA fatigue significantly (p< 0.000) reduced MTC height by around 3mm. At normal walking speed this changed from 10.22 ± 5.41mm to 7.08 ± 4.96, slow7.71 ± 5.63mm to 5.79 ± 4.92mm and fast 11.93 ± 6.60mm to 8.61 ± 5.22mm.

Conclusion: This experimental study has demonstrated, for the first time, the negative effect a fatigued TA can have on MTC and consequently on the risk of a trip fall. This finding has many clinical implications but must be tested first on a clinical population.

References1. Berg, W.P., Alessio, H.M., Mills, E.M. & Tong, C., 1997. Circumstances and

consequences of falls in independent community-dwelling older adults. Age and Ageing, 26(4), 261-268.

2. Daubney, M.E. & Culham, E.G., 1999. Lower-extremity muscle force and balance performance in adults aged 65 years and older. Physical Therapy, 79(12), 1177-1185.

What makes an ‘ideal’ physiotherapy service for people with Parkinson’s disease?

Young R (1), Jones D (2), Baker K (2),(1)Physiotherapy Department, Wansbeck General Hospital, Northumbria Healthcare NHS Foundation Trust; (2). School of Health, Community and Education Studies, Northumbria University

Background and aims: Physiotherapy within a multidisciplinary team context is recommended for the management of Parkinson’s disease (PD)(1,2), however the results of a recent survey reveal access to physiotherapy remains inadequate(3). Research into physiotherapy and PD has largely focussed on the effectiveness of interventions; fewer studies have involved service users’ views. This study aimed to explore an ‘ideal’ physiotherapy service, building on the experiences of physiotherapy of people with PD.

Methods: An Appreciative Inquiry (AI)(4) approach was employed with 5 participants purposively sampled from a regional branch of the Parkinson’s Disease Society. A focus group was undertaken, with questioning based on the ‘discovery’ and ‘dreaming’ stages of the AI model. Data were digitally recorded, transcribed verbatim, and analysed using thematic analysis combining a long table approach and a method of constant comparison. Emergent themes were verified by participants.

Results: The theme of a Patient centred service, with individualised treatment, involvement in decision making and choice, was central to the ideal model. Service ideals encompassed ongoing support and access, recognition of motivational needs, use of outcome measures and goal setting, and team involvement; knowledge and understanding were essential Skills; and the Setting provided a positive environment, was closely linked to the community and took account of transport issues.

Conclusions: Study findings showed a strong relationship between what service users wanted and what guidelines (both government and physiotherapy specific(5)) recommend for practice. Guideline implementation should provide a service which is more patient centred and reflects the aspirations of those with PD.

References1. National Institute of Health and Clinical Excellence (2006) Parkinson’s Disease: Diagnosis and Management in Primary and Secondary Care. London: National Institute of Health and Clinical Excellence.2. Department of Health (2005) The National Service Framework for Long Term (Neurological) Conditions. London: Department of Health.3. Parkinson\'s Disease Society (PDS) (2008) Life with Parkinson’s today- room for improvement. London: Parkinson’s Disease Society.4. Reed, J. (2007) Appreciative Inquiry : Research for Change. London: SAGE.5. Keus, S. H. J., Hendriks, H. J. M., Bloem, B. R., Bredero-Cohen, A. B., de Goede, C. J. T., van Haaren, M., Jaspers, M., Kamsma, Y. P. T., Westra, J., de Wolff, B. Y. & Munneke, M. (2004) \'KNGF Guidelines for physical therapy in patients with Parkinson\'s disease\', Dutch Journal of Physiotherapy, 114 (supplement 3) (1-86).

A Comparison of Early Hip Strengthening to Early Quadriceps Strengthening in the Treatment of Females with Patellofemoral Pain Syndrome

Medina McKeon JM*, Dolak K†, Silkman CL*, Hosey R‡, Lattermann C‡, Uhl TL** Department of Rehabilitation Sciences, University of Kentucky, Lexington, Kentucky, USA, † Department of Athletics, Endicott College, Beverly, Massachusetts‡ Department of Orthopaedic Surgery & Sports Medicine, University of Kentucky, Lexington, Kentucky, USA

Purpose: To compare hip-strengthening to quadriceps-strengthening for improving pain, function, and strength in female patients with patellofemoral pain syndrom(PFPS). RELEVANCE: Although rehabilitation protocols for patients with PFPS typically include quadriceps strengthening[1], these exercises often increase pain, making compliance challenging.

Methods: Thirty-three females with PFPS were randomly assigned to a hip-strengthening or quadriceps-strengthening group. Four weeks of isolated hip or quadriceps strengthening were followed by 4 weeks of functional training. Testing was conducted at baseline, week-4, and week-9 for all dependent variables. Ethical approval was granted for this study. Dependent variables were: Pain: 10cm Visual Analog Scale(VAS)[2] Self-reported function: Lower Extremity Functional Scale(LEFS)[3] Strength: Hip abductors(ABD), hip external rotators(ER) knee extensors(EXT) ANALYSIS: Repeated measures ANOVAs were used to identify group differences over time.

Results: Pain decreased at week-9 for all subjects(43.1±16.9%; P=0.002). At week-4, the hip group had significantly less pain than the quadriceps group(VAS_quad= 4.2±2.5 v. VAS_hip= 2.4±2.0; P=0.035). LEFS scores improved at week-9 for all subjects(19.5±13.5%; P<0.001). Hip abductor strength improved at week-9 for the hip group(26.8±21.1%; P=0.04). External rotation strength improved for all subjects(17.6±13.0%; P=0.004). Knee extensor strength did not improve significantly for either group(10.3±10.4%; P=0.12).

Conclusions: After 8 weeks of rehabilitation, females with PFPS demonstrated improvements in strength, pain, and function. However, patients in the hip-strengthening program experienced greater pain reduction in the first 4 weeks compared to the quadriceps-strengthening group. Results indicate that hip-strengthening may be more effective in the early phases of PFPS rehabilitation, encouraging muscular strengthening while preventing exacerbation of symptoms.

Support: Funding in part by an Osternig Master’s Research Grant awarded from the National Athletic Trainers’ Association Research and Education Foundation

1. Crossley K, Bennell K, Green S, Cowan S, McConnell J. Physical therapy for patellofemoral pain: a randomized, double-blinded, placebo-controlled trial. Am J Sports Med. 2002;30:857-865.

Development and validation of an activity monitor to measure the physical activity of wheelchair users

EH Coulter1, PM Dall1, L Rochester2, J Hasler3 and MH Granat1

1School of Health, Glasgow Caledonian University, Glasgow, UK; 2Institute for Ageing and Health, Newcastle University, Newcastle, UK; 3Queen Elizabeth National Spinal Injuries Unit, Southern General Hospital, Glasgow, UK

Purpose: Keeping physically active is equally important for people who mobilise using a wheelchair as for the general population. However, current tools to measure physical activity in the wheelchair are either not validated1 or are limited in their application2, 3, 4. The purpose of this study was to develop and validate a monitoring system to measure wheelchair movement.

Methods: The system developed consisted of a tri-axial accelerometer placed on the wheel and newly developed analysis software to interpret the acceleration signal. The two accelerometer outputs in the plane of the wheel were used to calculate the angle of the wheel. From this, outcome measures of wheel revolutions, absolute angle, and duration of movement were derived. The direction of movement (forwards or backwards) could be distinguished. Following ethical approval concurrent validity was assessed in comparison with video analysis in 14 people with spinal cord injury who propelled their wheelchair on an indoor track and outdoor wheelchair skills course. Validity was assessed using Intraclass-Correlation Coefficients (ICC (2,1)) and Bland Altman plots5.

Results: The monitoring system demonstrated excellent validity for wheel revolutions, absolute angle, and duration of movement (ICC (2,1) >0.999, 0.999, 0.981, respectively) in both manual and electric wheelchairs, when the wheelchair was propelled forwards and backwards, and for movements of various durations.

Conclusion: This study has found the tri-axial accelerometer and analysis program to be an accurate and objective tool for measuring detailed information on wheelchair propulsion and manoeuvring regardless of the propulsion technique, direction and speed.

References1. Wilson SK, Hasler JP, Dall PM, Granat MH. Objective Assessment of Mobility of the Spinal Cord Injured in a Free-Living Environment. Spinal Cord. 2008; 46(5): 352-357. 2. Postma K, Berg-Emons HJG, Bussmann JBJ, Sluis TAR, Bergen MP, Stam HJ. Validity of the detection of wheelchair propulsion as measured with an activity monitor in patients with spinal cord injury. Spinal Cord. 2005; 43: 550-557.3. Tolerico ML, Ding D, Cooper RA, Spaeth DM, Fitzgerald SG, Copper R, Kelleher A, Boninger ML. Assessing mobility characteristics and activity levels of manual wheelchair users. Journal of Rehabilitation Research and Development. 2007; 44(4): 561-572.4. Warms CA and Belza BL. Actigraphy as a measure of physical activity for wheelchair users with spinal cord injury. Nursing Research. 2004; 53(2): 136-143.

5. Bland JM, Altman DG. Statistical methods for assessing agreement between two methods of clinical measurement. Lancet. 1986; i: 307-310.

Is gait affected by the urgent need to void?

Dr Jo Booth1, Dr Lorna Paul2, Mr Daniel Rafferty1, Miss Carolyn MacInnes1.1School of Health, Glasgow Caledonian University. 2Nursing and Health Care – Faculty of Medicine, University of Glasgow

Introduction Most people have experienced the urgent desire to pass urine. At these times it is not unreasonable to suggest that the gait pattern is modified as attention is divided by trying to maintain bladder control whilst at the same time maintaining a safe, if altered, gait pattern. From the perspective of an older adult this may explain to some extent the increased risk of falls reported at night when going to the bathroom. The aim of this study was to explore if walking with a full bladder did change gait characteristics.

Methods Ethical approval was granted by Glasgow Caledonian University’s School of Health. Thirty seven females were recruited with no history of urinary incontinence or lower urinary tract symptoms. Each participant was required to walk across a GAITRite mat three times on the three occasions: bladder empty, first desire to void (First), and perceived maximum volume (PMV). The temporal and spatial parameters of gait recorded were analysed using a two way ANOVA, Tukey post hoc analysis was conducted on condition.

Results There was no statistically significant change in velocity across the three conditions. Subjects tended to walk with a shortened stride length (6cm) when at PMV in comparison to both first and empty bladder conditions (p<0.0002). No statistical difference existed in stride times between conditions.

Conclusion These results show a significant effect on the gait control when experiencing an urgent desire to urinate, possibly explaining the increased risk of falls at such times. Further research is required.

Promoting physical activity in a low socioeconomic area: Results from an intervention targeting stair climbing

Cormac G.Ryan (a), Jacquelyn Ryan(a),Katie Lyon (a),Oliver J. Webb (b),Frank F. Eves (c).(a)School of Health, Glasgow Caledonian University, Glasgow, G4 0BA, UK. (b) School of Sport, Exercise and Health Sciences, Loughborough University, Leicestershire, LE11 3TU, UK.(c) School of Sport and Exercise Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK

Objective: Self report data suggests individuals from low socioeconomic (SE) groups take less physical activity than those from high SE groups. There is no objective data to support this claim. This study aimed to compare baseline rates of objectively measured stair climbing in a high and low SE area, and to assess the efficacy of a stair climbing intervention in each respective area.

Methods: From March-May 2009 ascending stair/escalator choices (N=20,315) were observed in two underground train stations, which were respectively located in a high, and low, SE area of Glasgow. At both sites, baseline observations were followed by a four week intervention in which posters, promoting stair choice, were installed. Follow-up observations were collected one week after poster removal. Ethical approval was obtained from Glasgow Caledonian University, School of health research and ethics committee.

Results: Overall, pedestrians at the high SE station were around twice as likely to climb the stairs as those at the low SE station (odds ratio [OR]=1.912, 95% confidence interval [CI]=1.704-2.145). Across sites, the rate of stair climbing was significantly higher during the intervention relative to baseline (OR=1.477, CI=1.341-1.628), and remained elevated at follow-up (OR=1.241, CI=1.110-1.388). The increase in stair climbing was similar at both stations (high SE station, +4.7%; low SE station, +4.5%), indicating that posters had equivalent effects in each area.

Conclusion: Pedestrians in lower SE areas are, overall, less likely to climb stairs than pedestrians in high SE areas. Nevertheless, stair climbing interventions are equally effective in both areas.

Physiotherapy practice for knee Osteoarthritis

Al-Khlaifat L, Jones R, and Tyson S, University of Salford

Purpose: To describe current physiotherapy practice for the management of knee osteoarthritis (OA) and compare it with the recommended guidelines. Relevance: Knee OA is a common musculoskeletal condition with major social, psychological and economic cost1. In the absence of cure, physiotherapy is a key element of its management. Exploring current physiotherapy practice and the gaps in the service is vital to understand physiotherapists’ reasoning and improve services.

Method: A questionnaire was devised from literature review and the research team’s clinical experience. After receiving ethical approval, it was sent with self addressed envelops to physiotherapy managers in primary care trusts and National Health Service trusts in Greater Manchester. They distributed them to their staff. Private practitioners were contacted using PhysioFirst. Reminders were sent three weeks later. Frequencies and percentages were calculated.

Results: Strengthening (n=67, 84%), range of motion (n=46, 58%) exercises and education (n=17, 21%) were the most frequent treatments followed by advice, acupuncture, heat/ice, manual therapy and hydrotherapy. Aerobic and balance exercises, massage, electrotherapy, cognitive behavioural therapy, walking aids and orthotics were rarely used. Few (24%) used outcome measures to assess treatment effectiveness, the majority depended on self-report (n=70, 88%). Resource limitations and physiotherapists’ beliefs and reasoning processes affected the service provided.

Conclusions: Exercise and education are the basis of physiotherapy management of OA knee which is in line with the national guidelines. However, they also use non-evidence based treatments and avoid some recommended ones. Increasing physiotherapists’ awareness and overcoming the restrictions might provide better services for knee OA patients.

References

1. Bijlsma J. and Knahr K. (2007) Strategies for the prevention and management of osteoarthritis of the hip and knee. Best Practice & Research Clinical Rheumatology 21(1): 59-76.

Effect of Foot/Pedal Position on Gastrocnemius and Tibialis Anterior Activity During Static Cycling

K. Rae, A. Kerr, School of Health, Glasgow Caledonian University

Background: The recruitment pattern of lower limb muscles during cycling is known to alter due to changes in workload and seat height. The effect of foot/pedal position is not as well understood but may be useful in the prevention and management of injury.

Methods: Seven healthy female subjects participated in the study. Three-foot positions on the pedal were tested in a random order; neutral, back and fore. Each subject cycled for five minutes at a set cadence and resistance during which 30 seconds of EMG data were recorded for gastrocnemius [Gast.] and Tibialis Anterior [TA]. An electrogoniometer was located across the knee to concurrently record pedal revolutions.

Analysis: To test the effect of position an ANOVA and Tukey Post-Hoc were used for Gast. however the data from the TA were not normally distributed, therefore a Kruskal-Wallis was used for this muscle instead.

Results: No statistically significant relationship was found between foot position and TA activity (P=0.128). However there was a significantly (P=0.000) lower level of activity in Gast. when the pedal was placed in the back foot position.

Conclusion: Altering the position of the foot on a pedal changes the muscle activity of Gast. This is likely to be caused by the change in moment arm and may be exploited as a strategy to progress resistance during a training programme or as a method of protecting the muscle during a period of recovery. These conclusions should be interpreted with some caution given the small sample size.

References:

Ericson MO, Nisell R, Arborelius UP and Ekholm J (1985), ‘Muscular activity during ergometer cycling’, Scandinavian Journal of Rehabilitation and Medicine, Vol. 17, p53-61.

The impact of subacromial impingement syndrome on muscle activity patterns of the shoulder complex: a systematic review of electromyographic studies

Rachel Chester MSc MCSP MMACP§, Toby O Smith MSc MCSP, Lee Hooper SRD PhD, John Dixon PhD, Institute of Health and Social Sciences Research, Faculty of Health, University of East Anglia, Norwich, Norfolk, NR4 7TJ, UK.

Background: Subacromial impingement syndrome (SIS) is a commonly reported cause of shoulder pain. The purpose of this study was to systematically review the literature to examine whether a difference in electromyographic (EMG) activity of the shoulder complex exists between people with SIS and healthy controls.

Methods: Medline, CINAHL, AMED, EMBASE, and grey literature databases were searched from their inception to November 2008. Inclusion, data extraction and trial quality were assessed in duplicate.

Results: Nine studies documented in eleven papers, eight comparing EMG intensity and three comparing EMG onset timing, representing 141 people with SIS and 138 controls were included. Between one and five studies investigated each muscle totalling between 20 and 182 participants. The two highest quality studies of five report a significant increase in EMG intensity in upper trapezius during scaption in subjects with SIS. There was evidence from 2 studies of a delayed activation of lower trapezius in patients with SIS. There was otherwise no evidence of a consistent difference in EMG activity between the shoulders of subjects with painful SIS and healthy controls.

Conclusions: A difference may exist in EMG activity within some muscles, in particular upper and lower trapezius, between people with SIS and healthy controls. These muscles may be targets for clinical interventions aiding rehabilitation for people with SIS. These differences should be investigated in a larger, high quality survey and the effects of therapeutically targeting these muscles in a randomised controlled trial.

Support:The authors wish to thank Dr Thomas Bandholm, Dr Margaret Finley and Dr Paula Ludewig for retrieving and sharing the raw data from their original study for inclusion within this review. There were no external courses of funding for this review.

References:[1] Van der Heijden GJ: Shoulder disorders: A state of the art review. Ballieres Clinical Rheumatology. 1999, 13:287-309[2] MacFarlane GJ., Hunt IM., Silman AJ: Predictors of chronic shoulder pain: a population based prospective study. Journal of Rheumatology. 1998, 25:1612-1615[3] Neer C and Walch RP: The shoulder in sports. Orthopaedic Clinic of North America. 1977, 8:583-591[4] Van der Windt DA., Koes BW., de Jong BA., Bouter LM: Shoulder disorders in general practice: incidence, patient characteristics, and management. Annals of Rheumatological Disorders. 1995, 54:959-64 [5] Roquelaure Y., Ha C., Leclerc A., Touranchet A., Sauteron M., Melchior M., Imbernon E., Goldberg M.: Epidemiologic Surveillance of Upper-Extremity Musculoskeletal Disorders in the Working Population. Arthritis & Rheumatism (Arthritis Care & Research). 2006, 55:765-778

[6] Bandholm T, Rasmussen L, AAgaard P, Jenson BR, Diederichsen L: Force steadiness, muscle activity, and maximal muscle strength in subjects with subacromial impingement syndrome. Muscle and Nerve 2006, 34:631-639

[7] Ludewig PM, Cook TM: Alterations in shoulder kinematics and associated muscle activity in people with symptoms of shoulder impingement. Physical Therapy 2000, 80:276-291[8] Michener LA, Walsworth MK, Burnet EN: Effectiveness of rehabilitation for patients with subacromial impingement syndrome: a systematic review. Journal of Hand Therapy. 2004, 17:152-64[9] Desmeules F, Côté CH, Frémont P: Therapeutic exercise and orthopaedic manual therapy for impingement syndrome: a systematic review. Clinical Journal of Sports Medicine 2003, 13:176-82.[10] Critical appraisal skills programme (CASP) Making sense of evidence. Cohort Studies Critical Appraisal Skills Public Health Resource Unit, Oxford. 2006 Accessed on 01.11.2008. Available from: http://www.phru.nhs.uk/pages/PHD/resources.htm[11] Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Ioannnidis JPA, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. Annals of Internal Medicine. 2009, 4:w1-w18[12] Brox JI, Røe C, Saugen E, Vøllestad NK: Isometric abduction muscle activation in patients with rotator cuff tendinosis of the shoulder. Archives of Physical Medicine and Rehabilitation 1997, 78:1260-1267[13] Clisby E, Bitter NL, Sandow MJ, Jones MA, Magarey ME, Jaberzadeh S: Relative contributions of the infraspinatus and deltoid during external rotation in patients with symptomatic subacromial impingement. Journal of Elbow and Shoulder Surgery. 2008, 17:87S-92S[14] Cools AM, Declercq GA, Mahieu NN, Witrouw EE:. Trapezius activity and intramuscular balance during isokinetic exercise in overhead athletes with impingement symptoms. Scandinavian Journal of Medicine and Science in Sports. 2007, 17:25-33[15] De Morais Faria CD, Fuscaldi Teixeira-Salmelda L, de Paula Goulart FR, de Souza Moraes GF: Scapular muscle activity with shoulder impingement during lowering of arms. Clinical Journal of Sports Medicine 2008, 18:130-136[16] Finley MA, McQuade MJ, Rodgers MM: Scapular kinematics during transfers in manual wheelchair users with and without shoulder impingement. Clinical Biomechanics 2005, 20:32-40[17] Reddy AS, Mohr KJ, Pink MM, Jobe FW: Electromyographic analysis of the deltoid and rotator cuff muscles in persons with subacromial impingement. Journal of Shoulder and Elbow Surgery. 2000, 9:519-523[18] Cools AM, Witvrouw EE, Declercq GA, Danneels LA, Cambier DC: Scapular muscle recruitment patterns: Trapezius muscle latency with and without impingement symptoms. The American Journal of Sports Medicine. 2003, 31:542-549[19] Moraes GFS, Faria CDCM, Fuscaldi Teixeira-Salmelda L, 2008. Scapular muscle recruitment patterns and isokinetic strength ratios of the shoulder rotator muscles in individuals with and without impingement syndrome. Journal of Elbow and Shoulder Surgery 2008, 17:48S-53S[20] Wadsworth DJS., Bullock-Saxton JE.,. Recruitment patterns of the scapular rotator muscles in freestyle swimmers with subacromial impingement. International Journal of Sports Medicine. 1997, 18: 618-624[21] Kasman GS, Cram JR, Wolf SL: Clinical Applications in Surface Electromyography: Chronic Musculoskeletal Pain. Gaithersburg, Aspen Publishers Inc 1998[22] Mayer F, Horstmann T, Bäurle W, Grau S, Handel M, Dickhuth HH: Diagnostics with isokinetic devices in shoulder measurements - potentials and limits. Isokinetics and Eexercise Science. 2001, 9:19-25[23] Sterling, M., Jull G., Wright A., 2001. The effect of musculoskeletal pain on motor activity and control. The Journal of Pain. 2001, 2:135-145[24] Steenbrink F, de Groot JH, Veeger HEJ, Meskers CGM, van de Sande MAJ, Rozing PM: Pathological muscle activation patterns in patients with massive rotator cuff tears, with and without subacromial anaesthetics. Manual Therapy 2006, 11: 231-237.

Measurement of foot placement and clearance during stair descent

Muhaidat J1, Skelton DA1, Kerr A1, Evans JJ2, Rafferty D1,1HealthQwest, School of Health, Glasgow Caledonian University, 2Section of Psychological Medicine, University of Glasgow

Background: Inappropriate foot placement and clearance during stair descent is a likely cause of falls (Simoneau et al. 1991).

Aim: To measure parameters of foot placement and clearance in healthy young adults.

Methods: Following ethical approval, 10 subjects (33.2±7.87 years) walked down a set of stairs at preferred speed. Reflective markers attached to both feet and the stairs were tracked using a 3D motion analysis system. This allowed foot placement on the step and foot clearance over the edge to be measured. Foot placement represented the percentage of the foot overhanging the step edge. Foot clearance represented heel clearance over the edge when the foot was landing on or passing over the step following the edge.

Analysis: Descriptive statistics were calculated for foot placement and clearance (mean, SD and coefficient of variation (CoV)).

Results: Landing clearance had a mean of 45.88 (±10.05mm) and CoV across seven trials of 0.21 (±0.07). Passing clearance had a mean of 107.25 (±5.59mm) and CoV across trials of 0.25 (±0.08). Foot placement was normalised to a percentage of foot length and had a mean of 16% (±6) with a CoV across trials of 0.28 (±0.15).

Conclusion: This study recorded foot clearance and placement in healthy adults. This study presents [for the first time] these potentially valuable variables which may be useful in the design of future studies as well as providing a normal set of data for comparison with populations at risk of falling.

Simoneau, Cavanagh, Ulbrecht, Leibowitz and Tyrrell (1991). The influence of visual factors on fall-related kinematic variables during stair descent by older women. Journal of Gerontology, 46 (6): 188-195.

Patient Reported Outcome Measures (PROMS) do not fully represent physical function following total knee arthroplasty

D Hamilton (1), AHRW Simpson (1), P Gaston (2),(1) University of Edinburgh, Edinburgh, (2) Royal Infirmary of Edinburgh

Introduction: Most studies now use Patient Reported Outcome Measures (PROMS) as the preferred and only method for assessing ‘functional outcome’ following surgery (1). We hypothesised that comprehensive functional examination would therefore correlate strongly with PROMS following total knee arthroplasty (TKA).

Methods: We prospectively assessed the function of 100 consecutive knee replacement patients, pre-operatively, then at 8, 26 and 52 weeks post-operatively. PROMS employed were the Oxford Knee Score (OKS), and the Short Form-12. Leg strength (Leg Extensor Power RigTM), a validated battery of timed functional tasks (Aggregated Locomotor Function) and pain scores (numerical rating scale) were also assessed. Significance was set as p = <0.05.

Results: 93 data sets were available for analysis. All the individual outcome measures showed significant improvement between each assessment period (paired sample t-test, p = <0.05). Strong correlation was observed between the two PROMS (r = 0.74). Comparatively small correlations were identified between the PROMS and physical assessments (r = < 0.41). The pain scores correlated comparatively well with the OKS (r = 0.61) but comparatively poorly with the physical assessments (r = < 0.37).

Discussion: PROMS correlate well with pain, but less well with function following TKA. This suggests that PROMS may not fully represent actual physical function, but perhaps the perception of function. With the advancement of PROMS as the prime outcome measure of most studies, it is important to acknowledge that the assessment may be incomplete, and though a useful assessment of large cohorts, their limitation in assessing functional outcome should be recognised.

Support:This work forms part of a PhD award supported by an MRC doctoral training scholorship and Stryker UK

References:(1) Kennedy DM, Stratford. PW, Riddle. DL, et. al. (2008) Assessing recovery and establishing prognosis following total knee arthroplasty. Physical Therapy 88(1): 22–31

Sitting patterns at work: objective measurement of adherence to current recommendations

Cormac G Ryan, P Margaret Grant, Philippa M Dall, Malcolm H Granat.School of Health, Glasgow Caledonian University

Introduction: Long uninterrupted sedentary events are risk factors for long term health conditions such as cardiovascular disease independent of total time sedentary. Currently there is little or no objective normative data on sedentary patterns in the office environment and no studies have investigated compliance with current sitting guidelines.

Methods: The sitting behaviour of a group of UK office-based workers (n=83; age 40±10; BMI 24.9±3.8) were objectively monitored over a one week period whilst in the working environment. Sitting behaviour was quantified and adherence to three different current sitting recommendations (sitting for periods: <20minutes, <30minutes and <55minutes) were assessed.

Results: The total time sitting was 2042 hours, achieved in a total of 9,918 individual sitting events. Total sitting time was approximately 66% of total time spent working. Of that 5-20% of events, and 25-67% of time was accumulated in single duration events that lasted longer than recommended guidelines. The mean of the longest sitting event of each participant was 98±34 minutes, ranging from 43-201 minutes. None of the participants met the <20minutes or <30minutes recommendations on every day of the week but seven participants did meet the <55minutes recommendation.

Discussion: This study identified that exposure to harmful sedentary behaviour is high in the office-based working environment. Individuals spend a considerable period of their working day sitting and accumulate sitting time in periods longer than current health recommendations. Such information may serve to advise future sedentary behaviour workplace guidelines, and facilitate the development of interventions to reduce adverse sedentary behaviour.

Sequence of head and upper trunk rotations during head turns in people with stroke while sitting: A pilot study

Rufai Y Ahmad, Geert Verheyden, Ann AshburnSchool of Health Sciences, University of Southampton

Background: Turning the head to see the environment is a common activity of daily living which is usually accompanied by trunk movement (Land 2004). Aim: To compare the sequence of onset of head and upper trunk rotations during head turns while sitting between stroke participants and healthy controls.

Method: Ethical approval was obtained for the study. Participants were asked to look at visual targets placed at 90º to the right and left when a light in front of them went off (three trials for each task). Interval of onset latencies of the head and upper trunk rotations were obtained by CODAmotion analysis and reported as mean (SD) of the difference in latency between rotations of the two segments.

Results: Participants were three people with chronic first stroke (age range: 38-75years) and three healthy controls (age range: 37-91years). The head rotated before the upper trunk in all trials. The interval between onset latencies of head and upper trunk rotations was smaller in three people with stroke [range: 0.02(0.01)–0.07(0.04)] and an elderly healthy participant [0.01(0.04) and 0.03(0.16)] as compared to two healthy controls [range: 0.12(0.04)-0.35(0.05)]. There was no apparent difference between turning towards and away from the lesion in the stroke participants or to the right and left in the controls.

Conclusion: This study suggests that stroke and aging may affect the dissociation of head and upper trunk rotations. This calls for clinical attention in facilitating the normal sequence of upper body segments when turning in sitting.

Land MF (2004) The coordination of rotations of the eyes, head and trunk in saccadic turns produced in natural situations Exp Brain Res 159(2): 151-160

An investigation of the effect of elbow position on grip strength

Jillian Kent, Shane Bohan, Teesside University

Quantifiable: Measurement of grip strength in clinical practice is essential for accurate recording of the progression of patients in response to treatment. Patients present to physiotherapy with a variety of problems which may affect their ability to maintain desired positions when measuring grip strength. The aim of this study was to determine if change in elbow position affected grip strength.

Methods: Following ethical approval from a University Ethics Committee a convenience sample of 20 healthy individuals (11 male, 9 female age range 18 - 29 years) was recruited. Participants attended for one session of data collection and were placed in the testing position as recommended by the American Association of Hand Therapists. Grip strength of the dominant hand was measured using the Jamar dynamometer with the elbow in full extension, 90° flexion, and 135° flexion, identified using an electrogoniometer. Three measurements were taken in each position and the mean value analysed. A one way repeated ANOVA was used to evaluate differences between conditions.

Results: Mean (SD) values for strength were for 35.9 (8.3) Kg at full elbow extension, 33.4Kg (7.7Kg) at 90° flexion, and 30.5Kg (7.3Kg) at 135°flexion. The ANOVA demonstrated these differences were statistically significant (P<0.05)

Discussion: It is suggested that the differences found in grip strength are due in some part to the alteration in the muscle length tension relationship in the muscles of the forearm. This highlights the need for consistent positioning when measurements are taken allowing accurate reliable comparisons to be made.

Adams, J., Burridge, J., Mullee, M., Hammond, A., Cooper, C. (2004) Correlation between upper limb functional ability and structural hand impairment in an early rheumatoid population. Journal of Clinical Rehabilitation, 18 p.405-413

Repeatability and inter-tester reliability of a new tool to assess isometric neck strength in adolescents

DF. Hamilton (1), RJ. Wallace (1), WD. Mackay (2), AHRW. Simpson (1), D. Gatherer (2), (1) Orthopaedic Engineering Collaboration, University of Edinburgh, (2) Gatherer Ltd, Aylesbury, Bucks

Purpose: To investigate the repeatability and reliability of a new device (Gatherer) to assess isometric neck strength in adolescents. Relevance Reliable assessment of strength is essential when assessing and planning specific neuromusculoskeletal rehabilitative strategies. To our knowledge there are currently no alternative tools available to specifically assess neck strength. We have trialled this bespoke hand held device (based on a Tedea-Huntleigh load cell) extensively with adults; however the repeatability and inter-tester reliability is unknown in adolescents.

Methods: Ethical approval was granted and 20 healthy children with no history of neck injury aged 13-15 were assessed. Three assessments of isometric neck extension, flexion and left and right side flexion were made independently by two experienced physiotherapists on separate days. A standard assessment protocol was employed to ensure consistency of test position and procedure. Data was assessed by Pearson’s correlation coefficient and independent samples t-test for repeatability between attempts and by intra-class correlation coefficient (ICC) for consistency between assessors.

Results: Strong correlation between assessments was observed: extension p= 0.97, left side flexion p = 0.93, right side flexion p=0.96, flexion r = 0.84 (p = <0.001 in all cases). Further, no significant difference was observed between means of any test. Excellent ICCs (1) were observed between the assessments of extension 0.93 (CI: 0.82-0.97) left side flexion 0.89 (CI: 0.75-0.95) right side flexion 0.83. (CI: 0.62-0.92) Reasonable ICC was found for flexion 0.67 (CI: 0.33-0.85).Conclusion: This device demonstrates good repeatability and intra-tester reliability when assessing isometric neck strength in this cohort.

References:(1) Eliasziw M, Young SL, Woodbury MG, et al. Statistical methodology for concurrent assessment of interrater and intrarater reliability: using goniometric measurements as an example. Phys Ther 1994; 74: 777

Use of Standardized Functional Outcome Measures in Children with Cerebral Palsy undergoing Physiotherapy: Perceptions & Applications

Renuka Dharmadhikari, Melanie Lindley, Sheffield Hallam University

Abstract: Background: The importance of Standardized Functional Outcome Measures (SFOMs) for measuring the functional capabilities of children with Cerebral Palsy has become widely recognized. Outcome Measurement has been emphasised by various NHS reforms and policies in Physiotherapy practice. However there is lack of information about the use of these measures by paediatric physiotherapists in their routine practice.

Purpose: To determine the extent of use of SFOMs, challenges faced in using them and factors affecting their use in routine paediatric physiotherapy practice. Methodology: Qualitative study, semi structured web based interviews with the help of Skype software were performed with experienced Paediatric Physiotherapists, from India (n=6) and the UK (n=3). All interviews were transcribed and analysed using framework analysis to generate key themes.

Results: Six main themes emerged. GMFM was found to be commonly used SFOM by all of them in their practice. All the therapists in this study realised the importance of use of SFOMs. But different barriers like lack of time& training; difficulty in access and their use in the types of cerebral palsy limited their use in routine practice. The clinical decision making was dependent largely on individual need of the child & the family. Also it was according to the preferences and the experiences of the therapist.

Conclusion: In spite of the presence of a number of different SFOMs for assessing children with Cerebral palsy, paediatric physical therapists seem reticent to employ these in daily practice. Based on the perceived barrier changes in the practise management schemes is needed to augment their use.

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A modified technique for measuring hamstring length by the Passive Knee Extension Angle (PKEA) test

JR Riches; N Bryson; JGB Maclean, Department of Orthopaedic and Trauma Surgery, NHS Tayside, Perth Royal Infirmary

Purpose: To investigate the reliability of a modified Passive Knee Angle (PKEA) test for measuring hamstring length. RELEVANCE: PKEA is recognised as the gold standard measurement for hamstring length [1]. Standardisation for pelvic position is important [2]. Reproducibility and simplicity are essential for use in clinical practice.

Subjects: A group of five female subjects were tested (mean age 18 years).

Methods: After a standardised warm up the subject lay supine on a couch, a foam roll was placed under the contralateral knee and a strap was applied across the iliac crests immobilising the pelvis to the couch. Hip flexion of ninety degrees of the ipsilateral hip was maintained by an adjustable plinth and checked with a spirit level attached to a Gollehon goniometer. The knee was passively extended, with the foot in relaxed plantar flexion to a point where the examiner felt resistance. Each subject was tested twice by five examiners at 30 minute intervals.

Analysis: Pearson correlation test was used to evaluate inter tester reliability and analysis of variance for intra tester reliability.

Results: Inter tester reliability: The Pearson correlation between the 2 measurements was 0.99 (right) and 0.99 (left) and this was statistically significant (p < 0.001). Intra tester reliability was calculated using the analysis of variance as F=0.46 (p=0.767) right and F=1.34 (p=0.298) left.

Discussion: The method described ensures consistency of pelvic position and is reproducible as confirmed in a subsequent survey of 150 adolescents. It uses readily available equipment and is suitable for routine clinical practice.

1. Davis S, Quinn R, Whiteman T, Williams J, Young C, Concurrent Validity of Four Clinical Tests Used to Measure Hamstring Flexibility, J of Strength and Conditioning Research 2008:22(2):583-588.2. Fredricksen H, Dagfinrud H, Jacobsen V, Maehlum S, Passive knee extension test to measure hamstring muscle tightness, Scand J Med Sci Sports 1997:7:279-282.