RESUMO
OBJECTIVE: To determine the reliability of the minimum sit-to-stand height test, its responsiveness and its relationship to leg muscle strength among rehabilitation unit inpatients and outpatients. DESIGN: Reliability study using two measurers and two test occasions. Secondary analysis of data from two clinical trials. SETTING: Inpatient and outpatient rehabilitation services in three public hospitals. SUBJECTS: Eighteen hospital patients and five others participated in the reliability study. Seventy-two rehabilitation unit inpatients and 80 outpatients participated in the clinical trials. METHODS: The minimum sit-to-stand height test was assessed using a standard procedure. For the reliability study, a second tester repeated the minimum sit-to-stand height test on the same day. In the inpatient clinical trial the measures were repeated two weeks later. In the outpatient trial the measures were repeated five weeks later. Knee extensor muscle strength was assessed in the clinical trials using a hand-held dynamometer. RESULTS: The reliability for the minimum sit-to-stand height test was excellent (intraclass correlation coefficient (ICC) 0.91, 95% confidence interval (CI) 0.81-0.96). The standard error of measurement was 34 mm. Responsiveness was moderate in the inpatient trial (effect size: 0.53) but small in the outpatient trial (effect size: 0.16). A small proportion (8-17%) of variability in minimum sit-to-stand height test was explained by knee extensor muscle strength. CONCLUSIONS: The minimum sit-to-stand height test has excellent reliability and moderate responsiveness in an inpatient rehabilitation setting. Responsiveness in an outpatient rehabilitation setting requires further investigation. Performance is influenced by factors other than knee extensor muscle strength.
Assuntos
Articulação do Joelho/fisiologia , Perna (Membro)/fisiologia , Força Muscular/fisiologia , Idoso , Idoso de 80 Anos ou mais , Ensaios Clínicos como Assunto , Feminino , Hospitais Públicos , Humanos , Pacientes Internados/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Dinamômetro de Força Muscular , Músculo Esquelético/fisiologia , New South Wales , Pacientes Ambulatoriais/estatística & dados numéricos , Centros de Reabilitação , Reprodutibilidade dos TestesRESUMO
QUESTION: What is the feasibility and effectiveness of a novel weight-bearing strengthening program compared with that of a traditional non-weight-bearing strengthening program for older inpatients undergoing rehabilitation? DESIGN: Randomised, controlled trial with concealed allocation, assessor blinding, and intention-to-treat analysis. PARTICIPANTS: Eighty-eight inpatients (11% loss to follow-up) aged on average 82 years old from three rehabilitation units with no contraindications to exercise. INTERVENTION: Both the weight-bearing and non-weight-bearing strengthening programs were supervised by physiotherapists and were of similar intensities (10 to 15 RM) for two weeks. OUTCOME MEASURES: The primary outcomes were standing up performance measured as minimum chair height, and strength measured as maximum isometric knee extensor force of both legs. The secondary outcomes were other mobility measures such as standing-up rate, walking, standing and overall mobility, and other strength measures such as maximum isometric hip extensor, hip abductor, and knee flexor force of both legs. RESULTS: After the two-week intervention, the weight-bearing strengthening group had decreased their minimum chair height by 5.3 cm (95% CI 0.7 to 9.8) and increased their hip extensor strength on the weaker leg by 9 N (95% CI 1 to 17) more than the non-weight-bearing strengthening group. There were no clinically-worthwhile or statistically-significant differences between the groups for any other measures. CONCLUSION: This novel weight-bearing strengthening program was feasible and safe in an inpatient rehabilitation setting and had some additional benefits over a traditional non-weight-bearing strengthening program.
Assuntos
Exercício Físico/fisiologia , Força Muscular/fisiologia , Postura/fisiologia , Reabilitação/métodos , Suporte de Carga/fisiologia , Idoso , Idoso de 80 Anos ou mais , Envelhecimento/fisiologia , Feminino , Humanos , Articulação do Joelho/fisiologia , Masculino , Avaliação de Resultados em Cuidados de Saúde , Cooperação do Paciente , Aptidão Física/fisiologia , Método Simples-CegoRESUMO
OBJECTIVE: To establish the effects of group exercise on mobility and strength. DESIGN: Randomized controlled trial. SETTING: Two public hospital outpatient rehabilitation services. PARTICIPANTS: One hundred and seventy-three people (mean age 74.9 years, SD 10.8) with impaired mobility were randomized and 159 people (92%) completed the trial. INTERVENTIONS: Five-week, twice-weekly ;circuit-style' group exercise programme run by a physiotherapist (n = 85) and a no-intervention waiting list control group (n = 88). MAIN OUTCOME MEASURES: Three aspects of mobility: balance while standing and stepping (Step Test, semi-tandem and tandem stance times); sit-to-stand ability (rate and minimum height) and gait (6-metre and 6-minute walk tests). Lower limb muscle strength (knee flexion and extension). RESULTS: At retest, exercise participants had improved significantly more than their control counterparts on measures of balance while stepping, sit to stand and gait. Exercise participants averaged 1.6 more steps on the 15-second Step Test (95% confidence interval (CI) 0.5 to 2.8, P=0.005), walked an average of 0.12 m/s faster (95% CI 0.05 to 0.2, P=0.002) and took 2.5 fewer steps in 6 metres (95% CI -4.2 to -0.8, P=0.004). Exercise participants also averaged 0.04 more sit-to-stands/second, (95% CI 0.003 to 0.08, P=0.037) and walked an average of 30.9 metres further in 6 minutes (95% CI 9.4 to 52.4, P=0.005). There were no clinically important or statistically significant between-group differences at retest for the measures of strength (knee extension and flexion), balance while standing or minimal sit-to-stand height. CONCLUSION: This short-duration circuit class programme improved mobility, but not strength.