Validity of submaximal exercise testing in adults with athetospastic cerebral palsy.

OBJECTIVE: To examine the validity of the multistage submaximal cycle ergometer test for adults with athetospastic cerebral palsy. DESIGN: Cross-sectional and correlative study. Oxygen uptake and heart rates were recorded while the participants underwent the maximal cycle ergometer test and the multistage submaximal cycle ergometer test. Peak oxygen consumption (Vo(2)peak) was achieved by the maximal cycle test. Maximum oxygen consumption (VO(2)max) was predicted by the multistage submaximal cycle ergometer test. SETTING: Research laboratory setting. PARTICIPANTS: Adults with athetospastic cerebral palsy (N=16; 10 women and 6 men; mean age ± SD, 43.7±14.5y). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: Peak VO(2) was compared with the predicted VO(2)max. RESULTS: Mean VO(2)peak and the predicted VO(2)max ± SD were 866.9±202.9 mL/min(-1) and 857.4±248.4 mL/min(-1), respectively. There was not a significant difference between VO(2)peak values and the predicted VO(2)max values (r=.28). And there was a significant correlation between VO(2)peak values and the predicted VO(2)max values (r=.94, P<.001). SE of the estimate (or SE for X to Y) was 71.2 mL/min(-1), equivalent to 7.4%. CONCLUSIONS: The multistage submaximal cycle ergometer test may provide a valid VO(2)max estimate of adults with athetospastic cerebral palsy.

Relationship between changes in physical function parameters and Roland-Morris disability questionnaire score after decompression surgery for lumbar spinal canal stenosis.

Although decompression surgery for lumbar spinal canal stenosis (LSS) improves leg symptoms, low back pain (LBP), and disability, the factors related to the improvement of subjective disability have not been studied sufficiently. The purpose of the study was to clarify the relationship between subjective disability and objective physical function parameters. A total of 51 patients who underwent decompression were included and evaluated preoperatively and 6 and 12 months postoperatively. Patient-reported outcomes related to activity limitation due to LBP were evaluated using Roland-Morris disability questionnaire (RDQ) and VAS (Visual Analog Scale). Physical function was assessed using 6-min walk distance (6MWD) and trunk muscle strength. Univariate analysis and multivariable linear regression analysis were performed to identify significant factors for RDQ score change. The 6- and 12-month postoperative RDQ scores, VAS scores, and trunk extensor strength significantly improved relative to the preoperative values. In the univariate analysis, age, changes in VAS (LBP, leg pain, and numbness) scores, and change in 6MWD were associated with the RDQ score change (p < 0.05). Multivariable linear regression showed that 6MWD changes were significantly associated with RDQ score changes, explaining 41% of the variance in the RDQ score change. This study showed the change in 6MWD was significantly associated with the RDQ score change. Our results suggest that improving 6MWD may reduce disability in activities of daily living.

Predictors of walking ability after surgery for lumbar spinal canal stenosis: a prospective study.

BACKGROUND CONTEXT: Few studies have investigated predictors of objective walking distance in patients with lumbar spinal stenosis (LSS). PURPOSE: This study aimed to clarify objective predictors of postoperative 6-minute walk distance (6MWD) in patients with LSS and to develop prediction equations. STUDY DESIGN: This was a prospective study. Data were analyzed by multiple linear regression analyses. PATIENT SAMPLE: Patients with LSS were enrolled. OUTCOME MEASURES: Predictors of 6MWD after surgery were evaluated, including patient characteristics (sex, age, height, and body weight), pain (visual analog scale; low back pain, lower limb pain, and lower limb numbness), surgical factors (number of operation segments [1 or ≥2], surgery type [fusion or decompression], and minimum area of the dural sac), and objective physical function (6MWD and trunk muscle strength). METHODS: Patients with LSS were consecutively included and assessed preoperatively (n=113) and 6 months postoperatively (n=78). Simple and multiple linear regression analyses were performed with 6MWD at 6 months postoperation as the dependent variable. We have study funding sources (Nagono Medical Foundation) and no study-specific conflicts of interest-associated biases. RESULTS: At 6-month follow-up, 6MWD (457.7±105.5 m) improved significantly compared with preoperative 6MWD (275.0±157.2 m; p<.01). Trunk muscle strength and pain improved significantly compared with the preoperative score (p<.01). The predictors of postoperative 6MWD were age, body weight, number of operation segments (1 or ≥2), surgery type (fusion or decompression), preoperative trunk extensor strength, and preoperative 6MWD (adjusted R2=0.65, p<.01). The proposed prediction equation was as follows: postoperative 6MWD (m)=549.5-5.3×age (years)-1.8×body weight (kg)-68.3×surgery type (0: decompression, 1: fusion)-58.6×operation segment (0: one segment, 1: ≥2 segments)+3.5×trunk extensor strength (kg)+0.2×preoperative 6MWD (m). CONCLUSIONS: Younger age, lower body weight, one level operative segment, decompression surgery, and better preoperative scores for trunk extensor strength and 6MWD predicted better scores for 6 months postoperative 6MWD. Preoperative reduction in body weight and increase of trunk extensor strength might be associated with improved postoperative 6MWD scores.

Relation of falls efficacy scale (FES) to quality of life among nursing home female residents with comparatively intact cognitive function in Japan.

The purpose of this study was to investigate the relation of the Falls Efficacy Scale (FES) to quality of life (QOL) among nursing home residents. The subjects were 133 institutionalized women aged 70 years or older. They had comparatively intact cognitive function, with a Mini-Mental State Examination (MMSE) score of 15 or more, and could provide sufficient informed consent for a questionnaire survey. We evaluated their age, height, weight, body-mass index, history of hip fracture, history of fall(s) within the past year, complicating conditions, MMSE, Medical Outcomes Study 8-Item Short-Form Health Survey (SF-8), FES, and their subscores for Functional Independence Measure (FIM) motor items (self care, sphincter control, transfer, locomotion). There was a significant relationship between the Physical Component Summary (PCS) of SF-8 and FES. In each subscale, FES showed significant relations that were especially close in physical functioning (PF) and role physical (RP), with those relations proving stronger than those of the subscores of transfer and locomotion. In conclusion, the present results suggested that taking account of mental confidence is important for physical QOL, and that falls self-efficacy, including not only physical activity per se but also mental confidence, should be given prominence in the physical QOL of the institutionalized elderly.

Comparison of patellar mobility in female adults with and without patellofemoral pain.

STUDY DESIGN: Case control study. OBJECTIVE: To compare the patellar mobility of female adult subjects with and without patellofemoral pain (PFP). BACKGROUND: Although abnormal patellar mobility is believed to be one of the causes of PFP, there is currently no published evidence to support this contention. In part, this lack of evidence is because a reliable clinical measurement method to measure patellar mobility and objective criteria to define abnormal patellar mobility have not been established. METHODS AND MEASURES: The study sample was comprised of 22 females with PFP (PFP group) and 22 females who had no knee pain (control group), matched by age, height, and body mass index to the subjects with PFP. Patellar mobility was measured objectively using a specially designed apparatus. Measurements of lateral and medial patellar displacement, patellar mobility balance (lateral minus medial patellar displacement), lateral patellar mobility index (lateral patellar displacement divided by patellar width), and medial patellar mobility index (medial patellar displacement divided by patellar width) were used. RESULTS: Lateral and medial patellar mobility values were not significantly different between the individuals in the PFP and control groups. When normal patellar mobility was arbitrarily defined as the average mobility +/- 2 SDs, based on the data from the control group, normal lateral patellar displacement was within a range of 7.2 to 17.6 mm and normal medial patellar displacement was within a range of 6.8 to 14.0 mm. The intraclass correlation coefficient for intratester and intertester reliability of lateral and medial patellar displacement measurements varied from 0.80 to 0.97. CONCLUSION: Although there were no significant differences in patellar mobility between females with and without PFP, these measurements give reference information about normal patellar mobility for this group. LEVEL OF EVIDENCE: Diagnosis, level 5.

The role of shoulder maximum external rotation during throwing for elbow injury prevention in baseball players.

The objective of the present study was to examine whether the passive range of shoulder external rotation (ER), the maximum shoulder external rotation angle (MER) during throwing, and the ratio of MER to ER are related to the incidence of the elbow injury. A mixed design with one between-factor (a history of the elbow injury) and two within-factors (ER and MER) was used to analyze the difference between baseball players with and without a history of medial elbow pain. Twenty high school baseball players who had experienced the medial elbow pain within the previous month but who were not experiencing the pain on the day of the experiment were recruited (elbow-injured group). Another twenty baseball players who had never experienced the medial elbow pain were also used for testing (control group). MER during throwing, ER, and the ratio of MER to ER were obtained in both of the group. A Mann-Whitney test was used for the group comparison (p < 0.05). The ratio of MER to ER was significantly greater in the elbow-injured group (1.52 ± 0.19) than that in the control group (1.33 ± 0.23) (p = 0.008). On the other hand, there was no statistical significance in MER and ER between two groups. The findings of the study indicate that MER/ER relation could be associated with the incidence of the elbow injury in baseball players. Key pointsIt is accepted that the greatest elbow valgus stress appears at the position of shoulder maximum external rotation (MER) in the acceleration phase of the throwing movement. As a consequence, shoulders with restricted range of motion of external rotation (ER) compensate with a valgus stress on their elbow joints.In this study, we evaluated the relation between MER and ER of shoulder in players with/without elbow injuries.The result of this study demonstrated that the elbow injured group showed significantly greater MER/ER relation than the control group.The current finding suggests that great MER combined with the ROM restriction may be one of the risk factors to cause medial elbow pain in baseball players.

Relationship between maximum shoulder external rotation angle during throwing and physical variables.

The amount of stress imposed on shoulder and elbow appears to be directly correlated with the degree of maximum shoulder external rotation (MER) during throwing motions. Therefore, identifying risk factors contributing to the increase of MER angle may help to decrease the throwing injuries occurrence in baseball players. The purpose of the present study was to demonstrate the correlation between MER and the kinematic variables at stride foot contact (SFC) during the early cocking phase, the passive range of motion (ROM), and the shoulder strength. The subjects were 40 high school baseball players. Each subject carried out five throwing tasks with his maximum effort. A three-dimensional analysis was performed to obtain the MER, and the shoulder angles of external rotation (ER), extension and abduction at SFC in the early cocking phase. The ROM and muscle strength of the shoulder ER and internal rotation (IR) were also measured. Significant moderate linear correlations were found between the MER and the ER (r = -0.32, p = 0.04) at SFC, extension angle ( r= 0.35, p = 0.03) at SFC, IR strength (r = -0.30, p = 0.04) and passive ROM of ER (r = 0.46, p = 0.01). The shoulder IR and extension angles at SFC may determine the degree of the MER angle. Furthermore, weak IR muscle strength and excessive ROM of ER might be risk factors for shoulder and elbow injuries. The finding will enable us to establish better prevention and rehabilitation strategies for throwing injuries in baseball players. Key pointsIt has been reported that the amount of stress imposed on shoulder and elbow joints is correlated with the degree of maximum shoulder external rotation angle (MER) during throwing. Therefore, controlling MER within a normal range plays a key role in the prevention for throwing-related injuries in baseball players.Physical and biomechanical factors related to the degree of MER must be addressed to advance the current prevention and rehabilitation strategies for the shoulder and elbow injuries.The current finding demonstrated that there was a significant moderate leaner correlation between shoulder internal rotation angle at the initial foot contact in the early cocking phase and MER.

Validation of the Risk Score of the Mortality and Lower Limb Loss Considering Ambulatory Status after Surgical Revascularization in Maintaining Patients with Dialysis.

Surgical revascularization is performed to preserve limb and to maintain functional status of patients with critical limb ischemia (CLI). The PREVENT III risk score helps to predict the postoperative course of CLI. However, this score is not available to estimate the risk of amputation or death properly in patients with hemodialysis (HD) and tissue loss (HD: 4 points, Tissue loss: 3 points), because they are classified as a high-risk group. Therefore, we investigated 213 patients with revascularized HD for CLI and proposed prognosis amputation or death for patients with HD risk score (PAD for HD risk score). PAD for HD risk score (non-ambulation: 3 points, ulcer/gangrene: 2 points, GNRI<92: 2 points, CRP>0.3 mg/dl: 1 point, Age≥75: 1 point) is more accurate for the prediction of amputation or death than the PREVENT III risk score (area under the curve [AUC]: 0.79 [95% confidence interval: CI: 0.71-0.87], p<0.01 vs. AUC: 0.63 [95%CI: 0.56-0.71]). The patients were stratified into three groups by total score in ascending order. The rate of 1-year amputation-free survival and independent ambulatory status were significantly different among three groups. PAD for HD risk score is useful for rehabilitation planning in patients with HD and CLI. (This is a translation of J Jpn Coll Angiol 2016; 56: 85-91.).

Is latero-medial patellar mobility related to the range of motion of the knee joint after total knee arthroplasty?

Diminished range of motion (ROM) of the knee joint after total knee arthroplasty (TKA) is thought to be related to reduced patellar mobility. This has not been confirmed clinically due to a lack of quantitative methods adequate for measuring patellar mobility. We investigated the relationship between patellar mobility by a reported quantitative method and knee joint ROM after TKA. Forty-nine patients [osteoarthritis--OA: 29 knees; rheumatoid arthritis--RA: 20 knees] were examined after TKA. Respective medial and lateral patellar mobility was measured 1 and 6 months postoperatively using a patellofemoral arthrometer (PFA). Knee joint ROM was also measured in each of those 2 sessions. Although the flexion and extension of the knee joints improved significantly from 1 to 6 months after TKA, the medial and lateral patellar displacements (LPDs) failed to improve during that same period. Moreover, only the changes in knee flexion and medial patellar displacement (MPD) between the two sessions were positively correlated (r = 0.31, p < 0.05). However, our findings demonstrated that medial and lateral patellar mobility had no sufficient longitudinal relationship with knee ROM after TKA.