Effect of total knee replacement surgery and postoperative 12 month home exercise program on gait parameters.

OBJECTIVE: To evaluate the effects of surgery and a postoperative progressive home exercise program on gait parameters among individuals operated with total knee arthroplasty. DESIGN: Single blinded randomized controlled trial. SUBJECTS: 108 patients (84 females, 24 males, mean age 69 years). INTERVENTIONS: Patients were equally randomized into an exercise group (EG) and control group (CG). The 12-months progressive home exercise program starting two months postoperatively was compared to usual care. METHODS: Gait analysis was performed using the Gaitrite electronic walkway system. In addition, knee extension and flexion strength were measured by a dynamometer preoperatively, and pain on visual analog scale (VAS) at two months and 14 months postoperatively. RESULTS: At the 12-month follow-up, maximal gait velocity (p=0.006), cadence (p=0.003) and stance time (p=0.039) showed a greater increase among EG than CG. All the other gait parameters improved among both groups, but with not statistically discernible difference between groups. Weak correlations were found between changes in maximal gait velocity and the knee extension (r=-0.31, p=0.002), flexion strength (r=0.28, p=0.004) and pain during loading (r=-0.27, p=0.005) values. CONCLUSION: The intervention produced statistically significant changes in maximal gait velocity, cadence and stance times in the exercise group compared to controls. Although the average change was small it is of importance that biggest changes occurred in those with low performance.

Associations between family characteristics and parental empowerment in the family, family service situations and the family service system.

BACKGROUND: Parental empowerment signifies parents' sense of confidence in managing their children, interacting with services that their children use and improving child care services. High empowerment is associated with parents' resilience to demands and their confidence to make decisions and take actions that positively affect their families. Most families with children access various healthcare and education services. Professionals working in these services are therefore ideally placed to reinforce parental empowerment. However, little is known about the characteristics associated with parental empowerment within a generic sample of parents or in the context of basic child care services. AIM: The aim of this study was to assess how family characteristics are associated with maternal and paternal empowerment in the family, in service situations and in the service system. METHOD: Parental empowerment was measured among 955 parents (mothers = 571; fathers = 384) of children aged 0-9 years using the Generic Family Empowerment Scale. Family characteristics were assessed through questions on children, parents and the life situation. Associations between empowerment and family characteristics were evaluated using one-way analysis of variance and t-test. Parental empowerment was predicted by multiple linear regression analysis. RESULTS: Parents' concerns related to their parenting, such as whether they possessed sufficient skills as a parent or losing their temper with children, as well as experiences of stress in everyday life, were negatively associated with all dimensions of maternal and paternal empowerment. Both determinants were more common and more significant in empowerment than child-related problems. CONCLUSION: Promoting parental self-confidence and providing appropriate emotional and concrete support for everyday functioning may reinforce parental empowerment, thereby enhancing families' well-being and coping, as well as improving their access to required services and timely support. Finally, it may facilitate the provision of better services to all families.

The validity and reliability of the Finnish Family Empowerment Scale (FES): a survey of parents with small children.

BACKGROUND: The Family Empowerment Scale (FES) is a widely used instrument which measures the parents' own sense of their empowerment at the level of the family, service system and community. It was originally developed for parents of children with emotional disabilities. AIM: The aims of this study were to evaluate the validity and reliability of the Finnish FES and to examine its responsiveness in measuring the empowerment of parents with small children. METHODS AND PARTICIPANTS: The English FES was translated into Finnish using back translation and modified so as to be generic and convenient for all families. The construct, convergent, discriminant and concurrent validities, reliability and responsiveness of the Finnish FES were examined. Participants (n = 955) were the parents of children aged 0-9 years who had been selected using stratified random sampling. RESULTS: Confirmatory factor analysis proved that the Finnish FES had three subscales based on the original FES. Convergent and discriminant validities confirmed and supported the same construct. The relationship between parents' participation and empowerment was tested for concurrent validity. As in previous FES studies, the participating parents were more empowered, which supported the concurrent validity. The reliability of the Finnish FES proved acceptable for both parents. The Finnish FES could also discriminate the responses of the parents. Participation in the activities organized by the family service system influenced parents' perceptions of empowerment more than did their background characteristics. CONCLUSIONS: The Finnish FES is a valid and reliable instrument and it is suitable for measuring the empowerment of parents. However, it is necessary to consider how the FES would identify in the best way the parents who perhaps need some help.

Exercise therapy is evidence-based treatment of shoulder impingement syndrome. Current practice or recommendation only.

BACKGROUND: Subacromial impingement syndrome is the most common indication for shoulder operation. However, exercise therapy for the conservative treatment is recommended in the first instance. AIM: To evaluate the implementation of exercise therapy in impingement syndrome. DESIGN: Retrospective study using structured postal questionnaire and data collected from hospital archive. METHODS: A total of 104 consecutive patients who had undergone shoulder surgery due to impingement syndrome. Patients were asked about therapy modalities that they had received before and after the operation as well as pain (VAS) and functional impairment (ASES) at one-year follow-up. RESULTS: Before surgery 49% of patients had not received advice for shoulder muscle exercises. After operation all patients had received mobility exercises, but one quarter of patients still reported that they had not received instructions about shoulder strength exercises. At the follow-up the means of the ASES index was 85 and use of NSAID had decreased by 75%. However, 15% of patients had moderate functional impairment (ASES under 60). CONCLUSION: About half of patients reported that they had not received advice for rotator cuff exercise therapy before surgery even though with it surgery would probably have been avoided in many cases. Although symptoms in most patients had decreased after operation, several patients still suffered from pain and decreased function. Still several patients had not received advice for shoulder strengthening exercises that are important to recovery. CLINICAL REHABILITATION IMPACT: The adherence to the current recommendations about exercise therapy is insufficient in clinical practice. Thus we recommend that it should be monitored in all institutions in which shoulder pain is treated.