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Objective To compare problem-based learning (PBL) versus lecture-based learning (LBL) in the teaching of rehabilitation medicine in China.Methods All Chinese articles on PBL and LBL in teaching of rehabilitation medicine courses indexed in CBMdisc,Wanfang database,CNKI database,and Google academic search published prior to October 2017 were included.The methodological quality of the selected studies was assessed with'Cochrane Quality Evaluation Standard'.Meta analyses were performed using RevMan 5.3.Results After exclusion of non-eligible citations,a total of 18 documents involving 1943 subjects were satisfied the criteria and were included in this review.Meta-analyses revealed that PBL had a significant improvements on theoretical knowledge examination scores (MD=9.26,95％CI=5.24 to 13.29),practical skills examination scores (MD=12.11,95％CI=5.17 to 19.06),performance excellent rate (RR=3.90,95％CI=2.10 to 7.26),and patient satisfaction rate (RR=8.98,95％CI=4.23 to 19.07) (P＜0.05) among students compared with LBL in teaching of rehabilitation.Conclusion In this meta analysis,PBL is superior to LBL and worthy popularizing in teaching of rehabilitation.
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Objective To evaluate the effects of whole-body vibration (WBV) training on low extremity muscle strength and mobility in older adults by a meta-analysis. Methods Articles were searched from Cochrane Central Register of Controlled Trials, PubMed, EMbase, Elsevier, CBMdisc, Wanfang database and CNKI database, and the reference list of each eligible article were also included. Randomized controlled trials which investigated the effect of WBV on mobility and low extremity muscle strength were included in this article. The meth-odological quality of each selected article was rated by the Jadad Scale. The data on patients' characteristics, type of WBV intervention and outcomes were extracted. A meta-analysis was then performed. Results 15 randomized controlled trials involving 803 subjects were includ-ed finally. 8 were considered to have good or excellent methodological quality and the rest was rated as fair. Meta-analyses revealed that WBV had a significant treatment effect on leg extension isometric strength (MD=10.11, 95%CI 0.46-19.76), knee extension dynamic strength (MD=7.98, 95%CI 2.60-13.36), and functional measures of mobility such as performance in Timed-Up-and-Go test (MD=1.39, 95%CI 0.73-2.04), and performance in five times sit to stand test (MD=1.62, 95%CI 0.25-2.98) (P0.05), among older adults compared with the control group. Conclusion WBV may be effective on improving the low extremity muscle strength and mobility among older adults.
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@#Whole-body vibration (WBV) training is a kind of new technology on the practice of rehabilitation medicine and is used to improve muscle strength, mobility, balance, osteoporosis, sarcopenia, metabolic syndrome and osteoarthritis in aging adults. The definition, safety, effectiveness, and biomechanics of WBV training were reviewed in this paper.
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Whole-body vibration (WBV) training is a kind of new technology on the practice of rehabilitation medicine and is used to improve muscle strength, mobility, balance, osteoporosis, sarcopenia, metabolic syndrome and osteoarthritis in aging adults. The definition, safety, effectiveness, and biomechanics of WBV training were reviewed in this paper.
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Objective To evaluate the difference in isokinetic strength of the knee muscles between knee osteoarthritis (KOA) patients aged 80 years and over and matched healthy controls,and to establish the association of isokinetic strength with pain and functional status in patients with KOA.Methods The study enrolled 32 patients aged 80 and over diagnosed with unilateral knee OA and 10 matched controls.Pain was evaluated by the visual analogue scale (VAS),the pain intensity scale and the Lequesne index for patients with knee OA.Functional status was assessed by the Timed Up and Go Test (TUGT),the Five Times Sit to Stand Test (FTSST) and the Timed 10 Meter Walk Test (TWT).Muscle strength was measured using the isokinetic dynamometer Biodex System 4 Pro.Bilateral isokinetic (concentric) knee flexion and extension with the protocol of 60 degrees/sec,180 degrees/sec was also performed.Results The difference in two angular velocities of extensor and flexor peak torques between the knee OA group and the control group was statistically significant (t=2.747,P＜ 0.05).The extensor peak torque was negatively correlated with age,Liquesce index scores,FTSST,TUGT and TWT (r=-0.39～～-0.75,P＜0.05),but had no correlation with the VAS score or the Lequesne index pain score (r=-0.23～ 0.31,P＞0.05).The regression analysis results suggested that the extensor peak torque and the VAS score together were important predictors for the Liquesce index (adjusted R2 =0.41).Conclusions The degree of knee muscle damage is closely related to the functional performance of the muscles in knee OA patients aged 80 years or over.The strength of the quadriceps and the intensity of pain are important predictors of disability for those patients.
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@# Whole-body vibration (WBV) training is a kind of new technology on the practice of rehabilitation medicine and is used to improve muscle strength, mobility, balance, osteoporosis, sarcopenia, metabolic syndrome and osteoarthritis in aging adults. The definition, safety, effectiveness, and biomechanics of WBV training were reviewed in this paper.
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@#Whole-body vibration therapy (WBVT), in which energy produced by a forced oscillation is transferred to the muscle and bone of an individual from a mechanical vibration platform, has been proposed as an alternative or adjunctive intervention for osteoporosis. In this review, the safety, effectiveness and the biomechanics of WBVT for the prevention and treatment of osteoporosis were discussed.
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Whole-body vibration therapy (WBVT), in which energy produced by a forced oscillation is transferred to the muscle and bone of an individual from a mechanical vibration platform, has been proposed as an alternative or adjunctive intervention for osteoporosis. In this review, the safety, effectiveness and the biomechanics of WBVT for the prevention and treatment of osteoporosis were discussed.
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Objective To explore the effect of different resistance amount on the reliability of the lumbar muscles' coordination test. Methods 30 young male adults participated the lumbar muscles' coordination test twice within 1 week by the same tester. In each test, the subjects took 5 kg, 10 kg and 15 kg of resistance randomly. The index included mean of concentric motion, deviation of concentric motion, mean of eccentric motion and deviation of eccentric motion. Intra-class correlation coefficient (ICC) for these 4 test results were applied to evaluate the reliability of those tests. Results The ICCs of the 4 test results were 0.303, 0.500, 0.358 and 0.360 respectively in the 5 kg of re-sistance group, 0.449, 0.382, 0.365 and 0.272 respectively in the 10 kg of resistance group, and 0.453, 0.442, 0.614 and 0.411 respectively in the 15 kg of resistance group. Conclusion The test-retest reliability can be satisfied in the lumbar muscles' coordination test with 15 kg of re-sistance.
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Objective To observe the influences of modified constraint-induced movement therapy (mCIMT)on lower-extremity walking ability and femoral artery blood flow among elderly patients with stroke. Methods Totally 67 patients with stroke were randomly divided into mCIMT group(n =35) aged ( 73.2 ± 5.2 ) years and neurodevelopmental treatment (NDT) group ( n =32) as control aged(76.4 ± 3.8) years.Patients in control group exercised by NDT 2 h/time,2 times/d,5 d/week for 6 weeks. Patients in mCIMT group exercised including: up and down exercise,100-120 times/d; movement flatbed exercise for 16-20 min/d; upstairs and downstairs exercise,balance training,standing in a single leg exercise,mandatory exercise time of lower-extremity about 4 h/d,5 d/week for 6 weeks.The patients were assessed for lower-extremities motor function using maximum walking speed (MWS),Berg balance scale (BBS),timed up to go test (TUGT) and Fugl-Meyer(FMA-L) at pre-treatment and post-treatment.The change of femoral artery blood flow velocity and lumen diameter on the affected lower limb were observed by color Doppler. Results There were no differences in the above scores,lumen diameter and blood flow velocity before treatment between the two groups (P＞ 0.05).After treatment,the scores of MWS (56.68 ± 6.57vs.45.61 ± 5.34),BBS(46.84 ± 4.05vs.29.84 ± 4.05),TUGT ( 14.55 ± 8.25vs.25.35 ± 8.70)were higher in mCIMT group than in NDT control group (t=15.09,17.38,15.25,all P=0.001)while no difference in FMA-L score between the two groups was found (35.24 ± 7.62 vs.31.32 ±3.28,t=19.99,P＞0.05).Lumen diameter of femoral artery [(9.05±1.15) mm vs.(8.05±0.68)mm,t=6.72,P=0.001] and blood flow velocity[(92.55±18.25)cm/s vs.(69.35 8.7)cm/s,t=6.83,P=0.001] were increased in mCIMT group as compared with NDT group. Conclusions The mCIMT therapy is better in improving the lower-extremity walking function and blood flow velocity of femoral artery.
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@#Objective To determine the value of accommodation quotient (AQ) on dysphagia evaluation in the elderly. Methods 40 old cases with dysphagia were assessed with AQ, Kubota Water Swallow Test (WST) and Swallowing Evaluation (SE) before and after 3 weeks of treatment. The patients were divided into 2 groups based on the first AQ assessment: mild group (AQ=1.5~2.5) and serious group (AQ< 1.5). Results There was not significant difference in scores of WST between both groups (P>0.05) but SE (P<0.05). The AQ before treatment moderately correlated with the scores of WST and SE before treatment and improvement (P<0.001), and SE after treatment (P<0.001), but did not correlate with the score of WST after treatment (P>0.05). Conclusion The AQ may indicate the function of swallowing in the elderly, and predict the outcome of dysphagia.
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Objective To observe the correlation of brain functional reorganization and motor functional restoration with application of single-photon emission computed tomography (SPECT) and regional cerebral blood flow ( rCBF) in modified constraint-induced movement therapy ( mCIMT) in cerebral infarction patients with hemiplegia.Methods Twelve patients with cerebral infarction with hemiplegia (7 males and 5 females, aged 62-75 ( 67.9 ± 6.5) years) were treated with mCIMT for eight weeks.No movement restriction was applied to the limbs at the intact sides.The affected sides exercised 4 h per day with 1 h on the upper limbs and 3 h on the lower limbs.At the same time, semi-quantitative analysis method of analyzing SPECT and rCBF was used to record changes in brain.Simple test for evaluating hand function (STEF), 10 m maximum walking speed ( MWS) , rCBF changes in the cerebral cortex ischemic lesion were respectively assessed in the pretreatment and post-treatment.Results After the treatment, STEF score of affected sides was 76.33 ± 17.13(t = -6.09) ; STEF score of intact was 86.25 ± 16.84(t = -5.86) ;The score of MWS was 6.78 ± 3.72 (t = 4.88); Ischemic score of radioactive counts was - 10.12 ± 7.25 (t = 5.33), improved from pre-treatment and the difference was statistically significant (all P ＜ 0.05 ) .Conclusions mCIMT markedly improved motor function in senile cerebral infarction patients with hemiplegia as shown on SPECT.It showed that this improvement is associated with changes in brain plasticity, suggesting that improved motor function may be related to the redistribution of regional cerebral blood flow in the cerebral cortex.
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@#Objective To assess the test-retest reliability of Tetrax posturographic balance assessment system in determining the balance function in elderly individuals. Methods 22 elderly subjects (66~84 years old) were measured with the stability index (ST), the spectrum analysis of postural sway and the weight distribution harmony between two foots or heels and toe parts in standing on solid surface with eyes open using Tetrax balance system. All tests were repeated 1 week after the initial test and each subject underwent the test under the same instructions and conditions. The intraclass correlation coefficients (ICC) were used to determine the test-retest reliability. Results ICC of all balance functional parameters ranged from 0.797~0.882 (P<0.01). Conclusion The posturographic balance assessment system has good test-retest reliability for determining the balance function in elderly people.
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@#Objective To explore the relationship between the somatosensory evoked potential (SEP) diversification during operation and the short term outcome of ossification of posterior longitudinal ligament (OPLL) of cervical spine. Methods 70 OPLL inpatients from February 2008 to February 2011were included in this study. All patients received anterior cervical operation. According to the diversification of the SEP during surgery, the patients were divided into 2 groups. The preoperative and postoperative JOA scores of the OPLL patients were collected. Results There were 35 patients in the SEP no change group and 30 in SEP improved group. There was no difference in the preoperative JOA scores between them (P>0.05), but was significantly different in the postoperative JOA scores (P>0.05). Conclusion There is some relationship between the SEP diversification during operation and the short term outcome of OPLL of cervical spine.
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@# Objective To explore if the treatments with the diclofenac diethylamine emulge import by pulsed ultrasound, massage therapy and quadriceps muscle strengthen training can promote the recovery of prorpioception in patients with knee osteoarthritis. Methods On the basis of health education, 30 elderly patients aged 60 or over with knee osteoarthritis were accepted treatments with 10 times of diclofenac diethylamine emulge import by pulsed ultrasound, 6 times of massage therapy in 2 weeks, and quadriceps muscle strengthen training once or twice a day. Results There were significant differences in the scores of Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), the maximum isometric extension strength of involved knees, the average isometric extension strength of involved knees and the reposition accuracy error mean of involved knees before and after the treatments (P<0.05). Conclusion The treatments with the diclofenac diethylamine emulge import by pulsed ultrasound, massage therapy and quadriceps muscle strengthen training can not only play a therapeutic effect and shorten the duration of treatment, but also promote the recovery of proprioception in subjects with knee osteoarthritis significantly.
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@#ObjectiveTo determine the static equilibrium of elderly individuals over the age of 60 and the correlation to the age. Methods142 elderly subjects (60～95 years old) were divided into 7 groups: 60～65 years old group, 66～70 years old group, 71～75 years old group, 76～80 years old group, 81～85 years old group, 86～90 years group, and >90 years old group, 24 cases 18～30 years old as the control. The static equilibrium was examined by measuring the stability index （ST） and the spectrum analysis of postural sway under following 4 conditions: standing on solid surface with eyes open （NO），standing on solid surface with eyes closed （NC）， standing on pillows with eyes open （PO）， and standing on pillows with eyes closed （PC） using Tetrax Balance System. ResultsThe ST and the intensity of postural sway increased in the elderly group compared with the control group. NO: there were significant differences (P<0.01) in ST, F1, F4, F6, F8 among the 81～85 years group, 86～90 years old group, >90 years old group and the control group. NC: there were significant differences (P<0.01) in ST, F1, F4 among all the elderly groups and the control group, and in F6, F8 among the >66 years groups and the control group（P<0.05）. PO: there were significant differences (P<0.01) in ST, F4, F6 among the >66 years old groups and the control group, and in F1, F8 among the >71 years old groups and the control group（P<0.05）. PC: there were significant differences (P<0.01) in ST, F4 among all the elderly groups and the control group, in F6 among the >66 years groups and the control group, in F8 among the >76 years old groups and the control group, and in F1 among the >80 years old groups and the control group（P<0.05）. The ST distributed as NOP<0.01）. There were similar changes in the intensity of postural sway of F1, F4, F6, F8 bands. ConclusionThere is the significant decline of the static equilibrium in the subjects aged 80 or over and no significant decline of the static equilibrium in the subjects aged 60～80 whose compensation in the static balance may decrease.
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Objective To determine the test-retest reliability of functional squat system (FSS) isometric muscle strength tests for patients with knee osteoarthritis. Methods The isometric muscle strength of thirty patientswith knee osteoarthritis (21 males and 9 females; age 45 to 89 years, mean age 68.73 ± 12.19 years) was tested twice within 1 week by the same tester. Three test results were obtained: maximum isometric extension strength, the time to initiate isometric extension and the average isometric extension strength. Intra-class correlation coefficients (ICCs) for the three tests were computed to evaluate their retest reliability. Results The ICCs of the maximum isometric extension strength and average isometric extension strength of the uninvolved and involved extremities were respectively 0.87, 0.88, 0.92 and 0.89. The ICCs of the initiation time for the uninvolved and involved legs were respectively 0.25 and 0.41. Conclusion In these tests of patients with knee osteoarthritis using the functional squat system, both the maximum isometric extension strength and the average isometric extension strength had very good test-retest reliability. These two test results could be used as reliable guidance for treatment and rehabilitation of osteoarthritic knees.
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@#Hand-grip strength is an important assessment of strength of upper extremity, which also can predict the clinical outcomes, such as postoperative complications, mortality, and disability and so on, especially for the elderly population. This article would review the advance of study on the measurement of grip strength, the norms and the application in elderly in recent years.
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@# ObjectiveTo examine the test-retest reliability and measurement error in using a Jamar dynamometer to determine grip strength for elder men. Methods40 elder men with a mean age of 82 years old volunteered to participate in this study. The grip strength was administered twice using a Jamar dynamometer by specially trained testers; subjects were re-tested at the same time of day a week later by the same testers. ResultsThe infraclass correlation coefficient（ICC） was 0.99. The standard error of measurement (SEM and SEM%) were 1.18～1.69 and 4.11%～6.41%. The smallest real difference (SRD and SRD%) were 3.27～4.68 and 11.39%～17.75%. The Bland-Altman analysis revealed no systematic errors between test and retest. ConclusionThe Jamar dynamometer is reliable and with acceptable measurement errors to determine grip strength for elder men.
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@#ObjectiveTo investigate the age-related changes in grip strength of the elderly men and compare with the norms of overseas. Methods112 subjects were divided into six groups: 65～69 years old, 70～74 years old, 75～79 years old, 80～84 years old, 85～89 years old, and 90～95 years old. The grip strength was measured with Jamar dynamometer. ResultsThe grip strength of both sides were significantly moderate negative correlated to age (r=-0.681 and -0.68, P<0.001) and stepwise regression analysis showed the age was important clinical factor to consider in determining grip strength in the elderly men （R2=0.468, F=47.951, P＜0.001). The grip strength was declined significantly during the 75～79 and 85～89 years old. ConclusionGrip strength had declined in the elderly men and these losses were significantly related to age. The highest loss in men was in the age over 75. The norms of grip strength overseas were not applicable to Chinese older adults.