The efficacy of virtual reality assisted versus traditional rehabilitation intervention on individuals with functional ankle instability: a pilot randomized controlled trial.

PURPOSE: Virtual reality (VR) training, a virtual environment commonly generated by computer systems, may enhance the therapeutic efficacy of functional rehabilitation programmes. The aim of this study was to investigate the efficacy of a VR assisted intervention (VRAI) versus traditional rehabilitation intervention (TRI) on functional ankle instability (FAI). METHODS: A single-blind randomized controlled study was conducted with 10 subjects for each group. The VRAI was conducted with the Nintendo Wii Fit Plus, whilst the TRI was conducted with a series of exercises with theraband. The muscle strength change of the two groups and the difference between pre and post interventions for each group were compared. RESULTS: The VRAI group had less improvement in the muscle strength of all ankle motions than did the TRI group (p > .05). The VRAI group had a greater improvement in muscle strength of plantar flexion than other motions, whilst the TRI group had an improvement in muscle strength of all ankle motions (p < .05). CONCLUSIONS: The effects of VR training for the condition of FAI were not comparable to conventional training. However, VR training may be added to the conventional training programme as an optional for the condition of FAI. Implications for Rehabilitation Functional ankle instability (FAI) is subjective feelings of ankle instability resulting from proprioceptive and neuromuscular deficits in which individuals may experience "giving way" condition of the ankle. Therapeutic applications of virtual reality (VR) may be comparable to traditional rehabilitation interventions (TRI) in the rehabilitation of individuals with FAI. However, there is no definitive evidence for the issue. Integrating low-cost VR into functional rehabilitation programme can provide insight into an issue of whether it can be replaced with traditional therapeutic approaches. Although, the efficacy of VR application on strengthening muscles is unable to compare to traditional strengthening programmes, it may be considered an optional treatment based on the proprioceptive improvements.

Cross-cultural adaptation and construct validity of the Korean version of a physical activity measure for community-dwelling elderly.

[Purpose] This study aimed to cross-cultural adapt and validate the Korean version of an physical activity measure (K-PAM) for community-dwelling elderly. [Subjects and Methods] One hundred and thirty eight community-dwelling elderlies, 32 males and 106 female, participated in the study. All participants were asked to fill out a fifty-one item questionnaire measuring perceived difficulty in the activities of daily living (ADL) for the elderly. One-parameter model of item response theory (Rasch analysis) was applied to determine the construct validity and to inspect item-level psychometric properties of 51 ADL items of the K-PAM. [Results] Person separation reliability (analogous to Cronbach's alpha) for internal consistency was ranging 0.93 to 0.94. A total of 16 items was misfit to the Rasch model. After misfit item deletion, 35 ADL items of the K-PAM were placed in an empirically meaningful hierarchy from easy to hard. The item-person map analysis delineated that the item difficulty was well matched for the elderlies with moderate and low ability except for high ceilings. [Conclusion] Cross-cultural adapted K-PAM was shown to be sufficient for establishing construct validity and stable psychometric properties confirmed by person separation reliability and fit statistics.

Comparison of scapular posterior tilting exercise alone and scapular posterior tilting exercise after pectoralis minor stretching on scapular alignment and scapular upward rotators activity in subjects with short pectoralis minor.

OBJECTIVES: To compare scapular posterior tilting exercise alone and scapular posterior tilting exercise after pectoralis minor (PM) stretching on the PM index (PMI), scapular anterior tilting index, scapular upward rotation angle, and scapular upward rotators' activity in subjects with a short PM. PARTICIPANTS: Fifteen subjects with a short PM participated in this study. MAIN OUTCOME MEASURES: The PMI, scapular anterior tilting index, and scapular upward rotation angle were measured after scapular posterior tilting exercise alone and scapular posterior tilting exercise after PM stretches. Scapular upward rotators' activities were collected during scapular posterior tilting exercise alone and scapular posterior tilting exercise after PM stretches. RESULTS: The PMI and scapular upward rotation angle, as well as the activity of the upper trapezius, lower trapezius, and serratus anterior muscles, were significantly greater for scapular posterior tilting exercise after PM stretching and the scapular anterior tilting index was significantly lower for scapular posterior tilting exercise after PM stretching than the scapular posterior tilting exercise alone. CONCLUSIONS: Scapular posterior tilting exercise after PM stretching in subjects with a short PM could be an effective method of modifying scapular alignment and scapular upward rotator activity.

Measurement precision for Oswestry Back Pain Disability Questionnaire versus a web-based computer adaptive testing for measuring back pain.

BACKGROUND AND OBJECTIVES: Relative precision is to denote the ratio of the error variance of two sample designs. The aim of the present study was to compare measurement precisions of the Oswestry Back Pain Disability Questionnaire and a computer adaptive testing (CAT) method for measuring disability resulting from back pain. MATERIAL AND METHOD: A cross-sectional study was carried out with two independent convenient samples from two out-patient rehabilitation clinics for back pain (N = 42) and non-back pain groups (N = 42). Participants were asked to fill out the ODQ and CAT of International Classification of Functioning, Disability and Health ­ Activity Measure (ICF-AM). A series of Rasch analyses were performed to calculate person ability measures. RESULTS: The CAT measures had greater precision in discriminating the groups than did the ODQ measure in comparisons of the relative precision. CONCLUSIONS: The CAT measure appears to be more effective than the ODQ measure in terms of measurement precision. By administering test items calibrated in a way, CAT measures using item response theory may promise a means with measurement precision as well as efficiency.

The effect of scapular posterior tilt exercise, pectoralis minor stretching, and shoulder brace on scapular alignment and muscles activity in subjects with round-shoulder posture.

BACKGROUND: There are various methods for rehabilitating round-shoulder posture (RSP), including strengthening exercises, stretching, and using a shoulder brace or taping to correct the altered posture. However, no study has determined which intervention is the most effective of the three methods to decrease RSP (intervention #1: scapular posterior tilting exercise alone [hereafter, SPT], intervention #2: the scapular posterior tilting exercise after PM stretching [PM stretch+SPT], and intervention #3: the scapular posterior tilting exercise with use of a shoulder brace [SPT+brace]). OBJECTIVES: The purpose of this study was to compare the SPT, PM stretch+SPT, and SPT+brace on RSP, PM index (PMI), and lower trapezius (LT) and serratus anterior (SA) activity in subjects with RSP. METHODS: In total, fifteen young men with RSP, participated in the study (21.46 ± 2.30 years old). RSP was confirmed using a caliper measure. Surface electromyography (SEMG) data for LT and SA activity were collected during the three interventions, and the SEMG data are expressed as a percentage of the maximal voluntary isometric contraction (%MVIC). RESULTS: RSP was significantly less in the PM stretch+SPT and SPT+brace than in the SPT (P<0.05). PMI was significantly greater in the PM stretch+SPT and SPT+brace than in the SPT (P<0.05). LT activity was significantly greater in the PM stretch+SPT than in the SPT or SPT+brace in subjects with RSP (P<0.05). CONCLUSIONS: The PM stretching exercise and application of a shoulder brace may help correct RSP and restore the length of the PM. The posterior tilting exercise after PM stretching was the most effective method for eliciting greater LT muscle activation among the interventions tested.

Trunk muscle activation during different quadruped stabilization exercises in individuals with chronic low back pain.

BACKGROUND AND PURPOSE: The aim of this study was to compare the trunk muscle activities and the local/global activity ratios of the abdominal, back and trunk muscles during stabilization exercises such as one arm raise (AR), one leg raise (LR), and opposing arm/leg raise (ALR) in patients with chronic low back pain (LBP). METHOD: Ten individuals with chronic LBP (five men and five women) participated in this study. The external oblique abdominis, internal oblique abdominis, multifidus, thoracic part of the lumbar iliocostalis and the local/global activity ratio were assessed, while quadruped stabilization exercises were performed (AR, LR, and ALR); each exercise was carried out three times. RESULT: One-way repeated ANOVA was used to measure the differences in the trunk muscle activity and the local/global activity ratio. Post hoc analyses were performed (α = 0.05/3 = 0.017). In the right internal oblique, muscle activity during LR was significantly greater than that during AR. In the bilateral multifidus and lumbar iliocostalis, each ALR muscle activity was significantly greater than those of AR and LR. In addition, the local/global activity ratios of the back and trunk muscle in LR and ALR were significantly greater compared with AR. CONCLUSIONS: LR should be recommended over AR for individuals with chronic LBP. Moreover, the application of ALR should be approached carefully on the basis of progress and ability to stabilize the spine in this patient population.

Measurement qualities of a self-report and therapist-scored functional capacity instrument based on the Dictionary of Occupational Titles.

Studies provide convincing arguments to support the development of functional capacity instruments based on the Dictionary of Occupational Titles (DOT). The purpose of this study is to investigate the item-level measurement qualities of a newly developed DOT-based functional capacity instrument for clients undergoing rehabilitation treatment for back pain. Client and therapist ratings were collected on 124 clients from 27 rehabilitation sites using the newly developed Occupational Rehabilitation Data Base (ORDB) functional capacity instrument. Rasch analysis was used to investigate: (1) unidimensionality, (2) hierarchical item difficulty continuum, (3) rater severity, and 4) person-item match. Overall, the functional capacity scale of the ORDB showed good measurement qualities. All items, except the Handling item fit the Rasch measurement model. Because of high fit statistics and loading on factors independent from the remainder of the items, the "handling" item was removed, from further analyses. Separate client-rated and therapist-rated instruments retained good item-level psychometrics. While client and therapist items showed similar item-difficulty hierarchical structures, clients had a tendency to be more severe in their rating and the correlation between client and therapist ratings was relatively low, 0.32. These findings suggest that Handling items should not be included as a DOT measure for clients with back pain. While the above psychometric study supports using client or therapist ratings as independent instruments, the lack of concordance between these ratings requires further investigation.