Enhanced ventricular-arterial coupling during a 2-year physical activity programme in patients with rheumatoid arthritis: a prospective substudy of the physical activity in rheumatoid arthritis 2010 trial.

OBJECTIVE: To establish how guided physical activity in patients with rheumatoid arthritis (RA) without known cardiovascular disease affected vascular and cardiac function, and how these two entities were prospectively interconnected in this patient group. METHODS: Prospective substudy of 29 participants in the Physical Activity in RA (PARA) 2010 trial. All subjects were examined at baseline, at year 1 and 2 with measures of pulse wave velocity and arterial augmentation index, as well as echocardiographic evaluation of diastolic parameters and ventricular-arterial coupling. Muscle strength and aerobic exercise capacity were assessed at baseline and yearly. All participants performed physiotherapist-guided aerobic and muscle strength exercise during 2 years and were reminded through SMS to report physical activity progress. RESULTS: This cohort of patients with RA exhibited increased vascular stiffness despite normal blood pressure. At baseline, lower muscle strength was associated with increased vascular stiffness (ß = 0.68; P = 0.004), whereas lower aerobic working capacity was associated with left ventricular diastolic dysfunction (ß = 0.85; P = 0.03). There was a significant positive correlation between vascular stiffness and diastolic dysfunction at baseline (R2  = 0.64) and for the changes in those parameters observed during 2 years of guided physical activity. Finally, a significant improvement in ventricular-arterial coupling was observed after exercise (P < 0.001). CONCLUSION: These results indicate that although differentially associated with physical capacity parameters, improved vascular stiffness and improved diastolic dysfunction are interrelated, and that an optimization of the ventricular-arterial coupling may contribute to the beneficial effects of physical activity in patients with RA.

Fear-avoidance beliefs about physical activity in adults with rheumatoid arthritis.

OBJECTIVES: The aim of this study was to describe fear-avoidance beliefs about physical activity and explore how these beliefs correlate with sociodemographic, disease-specific, and psychosocial factors in adults with rheumatoid arthritis (RA). METHOD: This cross-sectional study is part of the Physical Activity in Rheumatoid Arthritis (PARA) 2010 study. The study participants (n = 2351) were identified through the Swedish Rheumatology Quality (SRQ) registries from six rheumatology clinics in Sweden. Univariate and backwards stepwise logistic regressions were performed. RESULTS: Stepwise logistic regressions showed that male gender [odds ratio (OR) 1.55, 95% confidence interval (CI) 1.26-1.91] and having a below average income (OR 1.35, 95% CI 1.12-1.63) were associated with an increased risk of high scores on the modified Fear Avoidance-Belief Questionnaire (mFABQ). The two disease-specific factors most indicative of high mFABQ scores were high level of pain (OR 1.99, 95% CI 1.40-2.84) and poor health (OR 1.59, 95% CI 1.10-2.29). With regard to psychosocial factors, low health-related quality of life (HRQoL; OR 0.44, 95% CI 0.35-0.55) and a low score on the Exercise Self-Efficacy Scale (ESES; OR 0.66, 95% CI 0.52-0.82) were significantly associated with a high mFABQ score. The model fit was 0.27 (Nagelkerke's R(2)). CONCLUSIONS: High fear-avoidance beliefs about physical activity in patients with RA were found to be associated with being male and having a below average income, a high level of pain, poor health, a low HRQoL, and low ESES score. Additional research is warranted for adults with RA to capture the multiple potential correlates to fear-avoidance beliefs about physical activity.

Enhancing meaningful learning and self-efficacy through collaboration between dental hygienist and physiotherapist students - a scholarship project.

INTRODUCTION: Within the field of Dental Hygiene (DH) and Physiotherapy (PT), students are taught to use an evidence-based approach. Educators need to consider the nature of evidence-based practice from the perspective of content knowledge and learning strategies. Such effort to seek best available evidence and to apply a systematic and scholarly approach to teaching and learning is called scholarship of teaching and learning. OBJECTIVES: To evaluate the application of the scholarship model including an evidence-based approach to enhance meaningful learning and self-efficacy among DH and PT students. METHODS: Based on the research on student learning, three central theories were identified (constructivism, meaningful learning and self-efficacy). These were applied in our context to support learner engagement and the application of prior knowledge in a new situation. The DH students performed an oral health examination on the PT students, and the PT students performed an individual health test on the DH students; both groups used motivational interviewing. Documentation of student's learning experience was carried out through seminars and questionnaires. RESULTS: The students were overall satisfied with the learning experience. Most appreciated are that it reflected a 'real' professional situation and that it also reinforced important learning from their seminars. CONCLUSION: The scholarship model made the teachers aware of the importance of evidence-based teaching. Furthermore, the indicators for meaningful learning and increased self-efficacy were high, and the students became more engaged by practising in a real situation, more aware of other health professions and reflected about tacit knowledge.

Recombinant canarypoxvirus vaccine carrying the prM/E genes of West Nile virus protects horses against a West Nile virus-mosquito challenge.

An ALVAC (canarypoxvirus)-based recombinant (vCP2017) expressing the prM and E genes derived from a 1999 New York isolate of West Nile virus (WNV) was constructed and assessed for its protective efficacy in horses in two different experiments. In the first trial, a dose titration study was conducted to evaluate both serum neutralising antibody responses to WNV and duration of immunity. In the second trial the onset of protection was determined. Twenty-eight adult horses received two doses of vCP2017 administered intramuscularly at 5-week intervals and sixteen horses comprised age-matched non-vaccinated controls. Individual sera were taken periodically and tested for neutralising antibodies against WNV. Horses were challenged by allowing WNV-infected Aedes albopictus mosquitoes to feed on them two weeks (second trial) or one year (first trial) after the second vaccination. After challenge, horses were monitored for clinical signs of disease, and blood samples were collected for detection of WNV viremia and antibody. In both trials, all vaccinated horses developed neutralising antibodies against WNV. None of the vaccinated or control horses developed clinical signs of WNV disease upon challenge. None of the nine horses challenged 2 weeks after primary vaccination and only one of the ten vaccinated horses challenged 1 year after vaccination developed detectable viremia after challenge, whereas more than 80% of the controls became infected. Results from these studies demonstrated that a primary course of two doses of vCP2017 provides both antibody response and an early immunity in horses against WNV viremia.

Evaluation of grip strength measurements after Colles' fracture: a methodological study.

Maximal isometric grip strength during short and sustained contractions was registered in 28 females and five males with displaced Colles' fracture involving the distal radio-ulnar joint. After reduction the patients were immobilized with plaster cast or with external fixation. The reliability of the measurements of the uninjured side was high and stable over a two-year follow-up period. The between-occasion reliability of the injured side was lower than that of the uninjured side. At each session the intensity of pain was measured. There was a reduction in pain after two years. The discriminatory ability of the measurements was satisfactory. It is suggested that the measurement methods and the present findings may serve as guidance in physiotherapy for these patients, especially if the uninjured side is used as reference.

Recovery of isometric grip strength after Colles' fracture: a prospective two-year study.

Grip strength during short and sustained maximal voluntary isometric contractions was measured in 28 females and 5 males with displaced Colles' fracture involving the distal radio-ulnar joint. The patients were randomized into two groups, treated either through immobilization with plaster cast or with external fixation. The recovery of isometric grip strength was followed over a two-year period. A significant difference was registered between women with plaster casts and women with external fixators six weeks after the fracture. Regaining of grip strength occurred up to one year after the fracture. The pattern of recovery was slower for women with primary external fixation. Neither the dominant nor the non-dominant injured side regained short or sustained maximal voluntary isometric contraction. The dominant injured side showed no significant difference between sides but the non-dominant injured side remained significantly weaker. It is thus important to identify hand dominance. Pain during measurements was reduced after two years, but about one-fifth of the patients still perceived pain. The present findings may serve as guidance in physiotherapy for these patients.

Clinical symptoms related to musculoskeletal neck-shoulder pain and mobility in the cervico-thoracic spine.

In a cross-sectional study 142 male and 139 female workers participated in a self-report questionnaire and a clinical examination. The aim of this study was to use the cervico-thoracic ratio (CTR), a clinical method for measuring segmental mobility between C7 and T5, to evaluate the influence of segmental mobility in neck-shoulder pain and different subjectively experienced symptoms. The study showed that reduced relative mobility at levels C7-T1 and T1-T2 significantly predicted neck-shoulder pain and the symptom weakness in the hands. The strongest relationship between segmental mobility and symptoms was found among subjects classified as having an inverse C7-T1 function, defined as equal or less mobility in motion segment C7-T1 compared to T1-T2. Reduced mobility explained 14% of neck-shoulder pain and 15% of weakness in the hands. It is suggested that deviation from synchronous distribution of mobility between motion segments C7-T1 and T1-T2 might be a factor provoking joint mechano receptors.

On the reliability and usefulness of methods for grip strength measurement.

The purposes of this investigation were to assess the accuracy of a grip strength measuring instrument, the Grippit, to modify previously developed methods for measuring maximal isometric grip strength (12) and to evaluate the reliability of these methods, with the use of the Grippit. Grip strength during short (maximal voluntary isometric strength, MVC) and sustained (SMVC) contractions was measured. The modifications concerned the definitions of MVC and SMVC, the measuring position, the intervals between trials and sessions, and the recording procedure. The intra-observer reliability study comprised 29 healthy subjects, and the inter-observer study 10 other healthy subjects. The Grippit had very high precision. The intra-observer reliabilities of MVC and SMVC measurements were improved compared to those with the previous methods (12). The inter-observer reliability was very high.

Postpolio muscular dysfunction: relationships between muscle energy metabolism, subjective symptoms, magnetic resonance imaging, electromyography, and muscle strength.

Eleven patients with previous polio were studied. The concentration of energy-related metabolites and energy charge was measured from the vastus lateralis muscle, as was isometric muscle strength of knee extension. Cross-sectional area of the quadriceps femoris muscle was calculated from magnetic resonance imaging. Reinnervation was studied using macroelectromyography. Muscle weakness, pain, and newly acquired muscle weakness in the legs was estimated by the patients. The findings in the legs in which the patients experienced new loss of muscle function were compared with the stable legs. There were no significant differences between these groups in any of the objectively measured variables. Only hip pain correlated with new loss of muscle function. Creatine phosphate was decreased in 5 patients. The symptoms and subjective muscle strength did not correlate with any of the objective measurements. There were no significant relationships between energy-related metabolites and postpolio symptoms.

Reduced mobility in the cervico-thoracic motion segment--a risk factor for musculoskeletal neck-shoulder pain: a two-year prospective follow-up study.

The aim of this study was to evaluate the variations in C7-T1 mobility in order to decide whether inverse C7-T1 function, defined as equal or less mobility in motion segment C7-T1 compared with T1-T2, could be used for prediction of neck-shoulder pain (NSP). One hundred and sixty-one female laundry workers participated in a prospective two-year follow-up study which included a self-report questionnaire and clinical examinations. The present study showed that the incidence of inverse C7-T1 function was 33% per year and subjects classified as having an inverse C7-T1 function three or more times during the follow-up period had an elevated risk of NSP (RR 3.1, CI 95% 1.1-6.9). According to the authors' interpretation, lack of synchronous mobility distribution between adjacent motion segments might be a provoking factor. Inverse C7-T1 function predicts NSP related to the cervico-thoracic articulations and yields a positive predictive value of 84%. Assessments must be repeated, however.

Mobility in the cervico-thoracic motion segment: an indicative factor of musculo-skeletal neck-shoulder pain.

The aim of the study was first to evaluate whether mobility in the cervico-thoracic motion segment is an indicative factor of musculo-skeletal neck-shoulder pain and secondly to compare differences in individual factors between cases and controls for female and male subjects. One-hundred-and-forty-two male electricians and 139 female laundry workers participated in a cross-sectional study. An examination of the Cervico-Thoracic Ratio and a classification of mobility at level C7-T1 was done. All subjects answered a questionnaire about musculo-skeletal complaints. The analysis of relationship between relative flexion mobility in motion segments C7-T5 and neck-shoulder pain showed significant relationships between mobility in specific motion segments and neck-shoulder pain. The overall fit of the multiple regression analysis explained 10% of the variation in neck index (N1) for subjects classified as hypomobile at level C7-T1 and 18% for subjects classified as having an inverse C7-T1 function. Both female and male subjects classified as hypomobile at level C7-T1 showed elevated odds ratios of 2.7 and 2.2, respectively, to have had more than 7 days of neck pain during the previous 12 months, compared to subjects classified as having ordinary mobility at level C7-T1. The factor age showed that young subjects with hypoar hypermobility at level C7-T1 showed elevated odds ratios for neck pain compared to subjects with ordinary mobility in the same age group. In old subjects hypermobility at level C7-T1 was protective compared to subjects with ordinary mobility in the same age group. The factor number of working years showed significant difference between cases and controls among female subjects in the ordinary and hypermobile classes. The factor height showed no significant differences between female or male cases and controls; it did show significant correlation to C7-T1 mobility among female subjects, but not among male subjects. The factors exercise and smoking showed significant differences between cases and controls among female subjects in the ordinary mobility class. The conclusion was that relative flexion mobility is a factor related to the development of neck-shoulder pain rather than the cause of pain.

Measurements of movements during highly repetitive industrial work.

In the manufacturing industry highly repetitive movement patterns in the work situation are common. This work situation is often the cause of pain in the neck-arm region. To measure these movement patterns a new method has been developed by registering acceleration during ordinary industrial work. Three small accelerometers were fastened horizontally, transversely and vertically in a small box at the wrist. The data were fed into a computer memory at the work site and analysed later. The method can be used during ordinary work in a factory causing no interference to the work.

Methods for measuring maximal isometric grip strength during short and sustained contractions, including intra-rater reliability.

The purposes of this study were to develop methods for measuring maximal isometric grip strength during short and sustained contractions in a laboratory setting, and to evaluate the test-retest reliability of these methods in short- and long-term perspectives. Eleven healthy men and women were assessed on four occasions. Maximal voluntary isometric grip strength (MVC) was measured in standardized and optional positions, and sustained maximal isometric strength (SMVC) in the standardized position. The results indicated that three trials in a session might be insufficient to obtain a true measure of MVC. The within-session and test-retest reliability of the described multi-trial procedure was considered satisfactory. The mean score of the last three trials tended to show the highest short-term and long-term variability. There were no clear differences between scores obtained in standardized and optional positions. The standardized position seemed more consistently to yield higher test-retest reliability and lower variability over time. The described method for measuring SMVC, expressed as area and peak score, had high test-retest reliability and an acceptable degree of short-term and long-term variability. The time taken to reach the peak score was not a reliable measure.

A clinical method for measuring segmental flexion mobility in the cervico-thoracic spine and a model for classification.

Pain and limitation of spinal mobility are symptoms frequently reported by patients. Many methods have been used to assess the total range of mobility in the different parts of the spine, but there is no method for clinical examination of segmental mobility. The aim of this study was to describe such a technique concerning of segmental flexion mobility in the cervico-thoracic spine, C7-T5, and to present a model for classification of mobility. The results of this study show that the relative flexion mobility examined, according to the Cervico-Thoracic-Ratio technique (CTR), may become a valuable complement to conventional methods of assessing mobility in the cervical spine. The normalized CTR values are less influenced by the individual factors age, body weight, height and number of years at work and the classification model presented makes functional analysis of segmental flexion mobility in the cervico-junction and upper thoracic spine more substantial.

A clinical method for measuring the distribution of segmental flexion mobility in the cervico-thoracic spine.

The aim of this study was to evaluate the validity and the repeatability of a new technique to assess segmental flexion mobility in the cervico-thoracic spine between segments C7 and T5. The new technique is referred to as the Cervico-Thoracic-Ratio (the CTR-technique). The radiological evaluation of skin distraction measurements showed that validity was high for the CTR-technique. A high correlation between vertebral flexion mobility and skin distraction was recognized individually and for the whole group. The evaluation of repeatability was found to be high for intratester and fair for intertester repeatability. The CTR-technique may become a valuable complement to other methods for assessing segmental flexion mobility in patients suffering from neck-shoulder pain in clinical practice.

Development of methods for registration of the force exerted by hand-fingers in industrial work.

In a manufacturing industry producing ground hard metal inserts, a small strain-gauge pressure transducer was built into the work prefix to measure the force exerted by the fingers. The procedure did not interfere with the work. The variation of force and of the time sequences between each force measurement were measured. The coefficient of variation (CV) was used as a measure of precision of the work.

Mechanical evaluation of muscle power in clinical practice with some aspects on training.

Effects of training treatment and rehabilitation during sickness/trauma involving the muscles are important factors to quantify. This involves an increasing need for muscle tests.

Stretchability of the rectus femoris muscle: investigation of validity and intratester reliability of two methods including X-ray analysis of pelvic tilt.

Validity and intratester reliability of two test methods designed to identify stretchability of the rectus femoris muscle (RFM) was investigated, combined with x-ray analysis of pelvic tilt in the sagittal plane. The first method is commonly used in clinical practice. The second is a new technique supposed to tilt the pelvis posteriorly and thus further separate the origin and insertion of the muscle. Investigation of validity and intratester reliability of the two methods was made by testing and retesting a random sample of 71 persons. The tests were performed with an equipment that automatically recorded the angle of knee flexion from a previously determined applied torque, indicating the end point of motion for that particular subject. Angle of knee flexion and subjective estimation of pain sensation due to stretch were recorded at each measurement. The pelvic tilt-analysis consisted of test-retest reliability of x-ray measurements, comparison between the methods in both starting and final position, and x-ray and electronic goniometer measurements. All applied torques were measured with a strain gauge. Two out of three criteria of validity favored the new method and the third pointed out the two methods as equal. The two methods as well as the x-ray measurements showed high reliability, and the hypothesis of a more posterior tilted pelvis in the new method was confirmed. The electronic goniometer was less sensitive than x-ray, but proposed to analyse pelvic tilt clinically. Methodology procedures for joint angle measurements are discussed.

Treatment of pelvic joint dysfunction in primary care--a controlled study.

The study evaluated the manual treatment of dysfunction of the pelvic joints. This is one of many condition causing low back pain. In 1987-1988 a general practitioner with special knowledge of physical examination and manual treatment of lumbar and pelvic dysfunctions made a survey of patients with acute or subacute low back pain as the main cause of the patient-to-doctor contact. Patients with defined criteria of pelvic joint dysfunction (n = 46) were randomized. After dropouts and exclusions, 18 patients with defined criteria of pelvic joint dysfunction received manual treatment, while 21 patients with similar dysfunction served as controls and received placebo treatment in a form of massage. Both groups were seen only once to evaluate whether a single treatment might be sufficient. After a period of three weeks, evaluation was made by an independent observer. Subjective pain measurement and a mobility test showed no significant difference. Sick-leave and consumption of analgesics (both decided by patient) were significantly less in the treatment group.