Anxiety characteristics in benign paroxysmal positional vertigo: first vs. recurrent episodes.

PURPOSE: To assess the difference in state and trait anxiety levels in patients with Benign Paroxysmal Positional Vertigo (BPPV) at the first episode (FE) versus recurrent episodes (RE), before and after vestibular physiotherapy. A secondary objective was to assess the difference in the prevalence of underlying health conditions between FE and RE BPPV patients. METHODS: Fifty-five patients with BPPV, aged 40-70, were recruited. The diagnosis of BPPV was confirmed based on subjective complaints of vertigo and positive results from the Dix-Hallpike and Supine Roll tests. Twenty-four patients were in their FE, and 31 had RE. All patients completed the State-Trait Anxiety Inventory (STAI) questionnaire three times; before, immediately after, and a week after vestibular physiotherapy treatment. RESULTS: The RE group demonstrated higher trait anxiety than the FE group in all testing points: before treatment (median value of 38 versus 29, p-value = 0.02), immediately after treatment (median value of 36 versus 28, p-value < 0.01) and a week later (median value of 38 versus 28, p-value < 0.01). State anxiety decreased immediately after treatment in both groups, but at the second session, it was significantly higher in the RE than in the FE group (median value of 38 versus 28.5, p-value = 0.03). Hypothyroidism was significantly more frequent in the RE group (RE 16%, FE 0%, p-value = 0.04). CONCLUSIONS: Based on the current study's findings, we recommend assessing anxiety levels in patients with recurrent BPPV and consider referring them for appropriate treatment when necessary.

Self-measurement of upper extremity volume in women post-breast cancer: reliability and validity study.

BACKGROUND: Secondary lymphedema is a chronic swelling of the upper limb that may occur after treatment for breast cancer. During the acute phase, intensive treatment with a therapist is provided, while during the maintenance phase the patient needs to detect any re-swelling by self-examination. OBJECTIVE: To assess the test-retest reliability and the concurrent validity of self-measurement upper limb volume among women post-breast cancer. DESIGN: A cross-sectional study of 17 women post-breast cancer that experience a period of intensive unilateral upper limb lymphedema treatment in the past. METHODS: On day 1 and day 10 at the clinic, the physiotherapist measured the volume of the upper limbs with the water displacement method (i.e. the "gold standard" for volume measure) as well as with the more common method of plastic tape. The participants performed self-measurement twice with the paper tape under the supervision of a physiotherapist in the clinic. After a week the participants performed self-measurement at home with the paper tape. RESULTS: The intra-class correlations measures indicated excellent values for the self-measure tape measurements on the operated side (0.97-0.99) as well as on the opposite arm (0.96-0.99). The self-measurement revealed a moderate association with the criterion measure, the water displacement (rp 0.59-0.68, (p < 0.05)), and strong concurrent validity with therapist tape measurements (rp 0.88-0.95, (p < 0.05)). CONCLUSIONS: Women post-breast cancer can self-measure upper limb volume using a paper tape which is both, reliable and valid.

An aerobic walking programme versus muscle strengthening programme for chronic low back pain: a randomized controlled trial.

OBJECTIVE: To assess the effect of aerobic walking training as compared to active training, which includes muscle strengthening, on functional abilities among patients with chronic low back pain. DESIGN: Randomized controlled clinical trial with blind assessors. SETTING: Outpatient clinic. SUBJECTS: Fifty-two sedentary patients, aged 18-65 years with chronic low back pain. Patients who were post surgery, post trauma, with cardiovascular problems, and with oncological disease were excluded. INTERVENTION: Experimental 'walking' group: moderate intense treadmill walking; control 'exercise' group: specific low back exercise; both, twice a week for six weeks. MAIN MEASURES: Six-minute walking test, Fear-Avoidance Belief Questionnaire, back and abdomen muscle endurance tests, Oswestry Disability Questionnaire, Low Back Pain Functional Scale (LBPFS). RESULTS: Significant improvements were noted in all outcome measures in both groups with non-significant difference between groups. The mean distance in metres covered during 6 minutes increased by 70.7 (95% confidence interval (CI) 12.3-127.7) in the 'walking' group and by 43.8 (95% CI 19.6-68.0) in the 'exercise' group. The trunk flexor endurance test showed significant improvement in both groups, increasing by 0.6 (95% CI 0.0-1.1) in the 'walking' group and by 1.1 (95% CI 0.3-1.8) in the 'exercise' group. CONCLUSIONS: A six-week walk training programme was as effective as six weeks of specific strengthening exercises programme for the low back.

Aqua lymphatic therapy in women who suffer from breast cancer treatment-related lymphedema: a randomized controlled study.

BACKGROUND: Lymphedema is an adverse effect of breast cancer surgery. Aqua lymphatic therapy (ALT) is a novel treatment for limb volume reduction. OBJECTIVE: The aim of this study was to examine whether ALT is a safe method and whether there are differences in adherence, limb volume, and quality of life between women who perform only self-management treatment and women who participate as well in ALT. DESIGN: Design of the study was single-blind randomized clinical trial. SETTING: The setting was in a hydrotherapy pool, 1.2 m depth, and a temperature of 32-33 degrees capital ES, Cyrillic. PATIENTS: Forty-eight women (56 +/- 10 years), with a 12.8% lymphedema relative volume, participated in the study. INTERVENTION: The control group was instructed to perform the self-management treatment. The study group joined a weekly session of ALT for 3 months in addition to the self-management therapy. MEASUREMENTS: Adherence was assessed by a self-reported diary, limb volume by a water displacement device, quality of life by the Upper Limb Lymphedema Questionnaire (ULL27), prior to, and after the intervention period. RESULTS: There was no episode of arm infection or aggravation in limb volume during the study period. ALT had a positive, statistically and clinically significant immediate effect on limb volume but no long-term effect was noted. The adherence rate to ALT was significantly higher than the adherence to self-management therapy. QOL improved in the study group. CONCLUSION: ALT was found to be a safe method, with high adherence, in treating women who suffer from mild to moderate lymphedema. A significant immediate and insignificant long-term effect on limb volume was noted.

Cognitive and functional outcomes of terror victims who suffered from traumatic brain injury.

PRIMARY OBJECTIVE: To describe the outcomes of terror victims suffered from traumatic brain injury (TBI). RESEARCH DESIGN: Retrospective chart review of 17 terror and 39 non-terror TBI patients treated in a rehabilitation department during the same period. METHODS AND PROCEDURE: Variables include demographic data, Injury Severity Scale (ISS), length of stay (LOS) and imaging results. ADL was measured using the Functional Independence Measurement (FIM), cognitive and memory functions were measured using the Loewenstein Occupational Therapy Cognitive Assessment (LOTCA) battery and the Rivermead Battery Memory Test (RBMT), respectively. MAIN OUTCOME AND RESULTS: Terror TBI patients were significantly younger, had higher ISS score and higher rates of intracerebral haemorrhage (ICH), brain surgery and penetrating brain injuries than the non-terror TBI group. There was no difference in mean LOS, mean FIM values, mean FIM gain and mean cognitive and memory improvement between groups. Terror victims suffered from a higher percentage of post-traumatic epilepsy (35% vs. 10%, p=0.05), whereas the rate of PTSD and the rate of return to previous occupation were similar between groups. CONCLUSIONS: Although TBI terror victims had more severe injury, they gained most of ADL functions and their rehabilitation outcomes were similar to non-terror TBI patients. These favourable results were achieved due to a comprehensive interdisciplinary approach to terror victims and also by national support which allowed an adequate period of treatment and sufficient resources as needed.