Sensitivity to movement-evoked pain, central sensitivity symptoms, and pro-nociceptive profiles in people with chronic shoulder pain: A parallel-group cross-sectional investigation.

OBJECTIVE: To investigate whether sensitivity to movement-evoked pain (SMEP), central sensitivity symptom burden, and quantitative sensory testing (QST) outcomes differ between healthy controls and people with chronic shoulder pain. METHODS: People with chronic shoulder pain (n = 39) and healthy controls (n = 26) completed validated questionnaires measuring demographic, pain characteristics, psychological factors, social support, sleep quality, central sensitivity inventory (CSI), and physical activity levels. A blinded assessor administered QST measuring pressure pain threshold, temporal summation, conditioned pain modulation, and cold hyperalgesia. All participants performed repeated lifting of weighted canisters and reported severity of pain over successive lifts of the weighted canisters. Between-group differences in the QST, SMEP and CSI scores were investigated. Demographic and psychosocial variables were adjusted in the analyses. RESULTS: Dynamic mechanical allodynia, mechanical temporal summation, movement-evoked pain scores, SMEP index, and CSI scores were significantly (p ≤ 0.05) higher in the chronic shoulder pain group than in healthy controls. A significant proportion of people with chronic shoulder pain presented with pro-nociceptive profiles and experienced higher pain severity, interference, and disability. CONCLUSIONS: People with chronic shoulder pain displayed symptoms and signs of central sensitization. Future research should investigate the predictive role of central sensitization on clinical outcomes in shoulder pain.

Implementation of the Diabetes Community Exercise and Education Programme (DCEP) for the management of type 2 diabetes: qualitative process evaluation.

OBJECTIVES: To examine context-specific delivery factors, facilitators and barriers to implementation of the Diabetes Community Exercise and Education Programme (DCEP) for adults with type 2 diabetes (T2D) using the Reach, Effectiveness, Adoption, Implementation and Maintenance framework. DESIGN: A qualitative evaluation embedded within the DCEP pragmatic randomised controlled trial. Data collected via focus groups and interviews and analysed thematically. SETTING: Community-based in two cities (Dunedin and Invercargill) in the lower south island of New Zealand. PARTICIPANTS: Seventeen adults diagnosed with T2D attending DCEP and 14 healthcare professionals involved in DCEP delivery. INTERVENTION: DCEP is a twice weekly session of exercise and education over 12 weeks, followed by a twice weekly ongoing exercise class. RESULTS: While our reach target was met (sample size, ethnic representation), the randomisation process potentially deterred Maori and Pasifika from participating. The reach of DCEP may be extended through the use of several strategies: promotion of self-referral, primary healthcare organisation ownership and community champions. DCEP was considered effective based on perceived benefit. The social and welcoming environment created relationships and connections. People felt comfortable attending DCEP and empowered to learn. Key to implementation and adoption was the building of trusting relationships with local health providers and communities. This takes time and care and cannot be rushed. Training of staff and optimising communication needed further attention. To maintain DCEP, delivery close to where people live and a generic approach catering for people with multiple chronic conditions may be required. CONCLUSIONS: For success, lifestyle programmes such as DCEP, need time and diligence to build and maintain networks and trust. Beyond frontline delivery staff and target populations, relationships should extend to local healthcare organisations and communities. Access and ongoing attendance are enabled by healthcare professionals practicing in a nuanced person-centred manner; this, plus high staff turnover, necessitates ongoing training. TRIAL REGISTRATION NUMBER: ACTRN12617001624370.

The experiences of Indian people living in New Zealand with stroke.

PURPOSE: Stroke can cause lifelong disability and participatory limitations. Stroke survivors thus manage their recovery long term. Health professionals can support self-management, tailoring this support to be culturally appropriate. This study explored the unique culture and ethnicity specific experiences of Indian people living in New Zealand with stroke, focussing on self-management and facilitators and challenges to recovery. METHODS: Eight individuals with stroke took part in semi-structured interviews. Data were analysed using the General Inductive Approach. RESULTS: Four themes were identified: (1) helping myself, in any way that I can, (2) family and support, (3) social connections, and (4) ethnicity was not a barrier. CONCLUSION: All participants felt well looked after within the New Zealand healthcare context but highlighted the need for long term support. Self-management strategies participants considered important included changes to their diet, acceptance by oneself and society, returning to work, the role of family, and the use of technology and social media. Health professionals should consider these factors when providing self-management support to individuals of Indian ethnicity.IMPLICATIONS FOR REHABILITATIONAdvice and help around diet, lifestyle, and return to work were important priorities identified by our Indian stroke survivor participants.Our Indian stroke survivor participants requested more long-term specialist support and stroke information.Although the family willingly take increased responsibility for the wellbeing of the individual with stroke, it is not a substitute for professional input which needs to be tailored and offered proactively.

Exergaming to improve balance and decrease the risk of falling in adults with knee osteoarthritis: a mixed-methods feasibility study.

BACKGROUND: Exergaming (exercise and gaming) is useful in improving balance in various health conditions, yet there is limited research regarding its application in individuals with knee osteoarthritis (OA). OBJECTIVES: The primary aim of this study was to investigate the feasibility and acceptability of exergaming using Nintendo Wii Fit™ to improve balance and reduce the risk of falls in individuals with knee OA. METHODS: A mixed-methods explanatory sequential study design was utilized in this study. Participants with knee OA and history of falling participated in a single-group pre-post experimental study design: eight weeks of usual care followed by eight weeks of an exergaming program. This was followed by semi-structured focus groups to determine the acceptability of the study. RESULTS: The pre-defined feasibility criteria such as recruitment, retention rate (83%), and compliance (78%) were successfully met. The participants found the frequency and duration of the assessment and intervention sessions acceptable. Participants reported enjoying the exergaming, finding it motivating and interactive despite some barriers with technology. No adverse events were reported. There were encouraging results in the clinical outcome measures such as knee muscle strength, balance, fear of falling, and performance of physical function. CONCLUSION: The study found that it is feasible and acceptable to use Nintendo Wii Fit™ as an exergaming tool to improve balance and decrease the risk of falling in adults with knee OA. Findings from this feasibility study are encouraging and support the need to conduct a fully powered randomized controlled trial study.

Sensory organization for postural control in children with strabismus-A systematic review and meta-analysis.

BACKGROUND: Postural control requires the interaction of somatosensory, vestibular and visual systems to prevent disequilibrium. Children with strabismus have an impaired visual input which can lead to postural control deficits. RESEARCH QUESTION: Does strabismus affect sensory organization for postural control in children? METHODS: A systematic comprehensive search of multiple electronic databases for relevant articles was performed using a predetermined search strategy. Peer-reviewed journal publications that assessed sensory organization and postural performance in children with strabismus were included in this review. Methodological quality of the articles was evaluated using the modified Downs and Black quality assessment tool. A total of 10 articles were included in this review. RESULTS: Eight of the 10 articles reviewed were included in the meta-analysis. Meta-analysis for Centre of Pressure CoP velocity (n = 3) (eyes open, stable support), was statistically significant (P = 0.01) in favor of controls over children with strabismus (MD, 3.08; 95 % CI -0.66, 5.51). Meta-analysis for CoP surface area (n = 5) (eyes open, stable support) was also statistically significant (P < 0.001) in favor of the control group (MD, 130.14; 95 % CI 70.01, 190.260). Meta-analysis with standardized mean difference (n = 6) for eyes open vs closed, stable support was statistically significant (P = 0.02) in favor of eyes open (MD, -0.94; 95 % CI, -1.74, -0.15). Overall, there was a high level of heterogeneity throughout the studies. SIGNIFICANCE: This is the first systematic review of its kind to collate and synthesize evidence on the effect of strabismus on postural control in children. This review suggests that postural control performance in children with strabismus is inferior to that of age-matched control children. Further investigation is needed to understand the influence of the three sensory systems.

Relationships Between Psychological, Sleep, and Physical Activity Measures and Somatosensory Function in People With Peripheral Joint Pain: A Systematic Review and Meta-Analysis.

OBJECTIVE: Alteration in somatosensory function has been linked to pain experience in individuals with joint pain. In this systematic review we aimed to establish the level of evidence of associations between psychological, social, physical activity, and sleep measures and somatosensory function that were assessed via quantitative sensory testing (QST) among individuals with joint pain. METHODS: A comprehensive literature search was conducted in 6 electronic databases from their inception to July 2019. Two reviewers independently assessed the methodological quality using a modified Quality in Prognostic Studies (QUIPS) tool and supplemented with recommendations from the Critical Appraisal and Data Extraction for Systematic Review of Prediction Modelling Studies (CHARMS) checklist and the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool. The level of evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) system. Data were pooled to evaluate the strength of the relationships of interest. RESULTS: Seventeen studies related to joint pain were included. Pain catastrophizing, depression, anxiety, and physical activity level have been shown to have a significant (small to fair) association with several QST measures. Pressure pain threshold (PPT) is the only measure that was found to be consistently correlated with all the domains. The overall quality of evidence for all factors ranged from very low to moderate. Subgroup analysis revealed a stronger association for depression and pain catastrophizing and PPT and temporal pain summation in individuals with shoulder pain. CONCLUSION: Psychological factors and physical activity levels are associated with somatosensory function in people with joint pain. These factors need to be adjusted when establishing predictive relationships between somatosensory function and pain outcomes in individuals with joint pain.

Perspectives of participants with rotator cuff-related pain to a neuroscience-informed pain education session: an exploratory mixed method study.

Purpose: To explore perceptions and initial outcomes of patients with rotator cuff-related pain to a pain education session.Materials and Methods: Ten individuals with persistent rotator cuff-related pain (≥3 months duration) attended an individual pain education session. They completed patient-reported outcomes measures on a weekly basis, three weeks prior and three weeks following the session. Individual semi-structured interviews were conducted three weeks following the pain education. Interviews were recorded, transcribed verbatim, and analyzed using the General Inductive Approach.Results: There were two over-arching key themes: firstly, 'Participants' Perspectives' of the session generated four themes: Improved understanding of 'the whole'; Mindful self-awareness; Taking charge; "The pain is still there". Their understanding of pain was reconceptualised, evident by their ability to describe the role of neurophysiological mechanisms, stress and general well-being towards their pain. The second over-arching key theme, 'Participants' Recommendations', had two themes: Integrating neuroscience with pathoanatomical knowledge and Educating other health professionals. Pain levels decreased post-pain education compared to pre-pain education.Conclusions: Following the pain education session, participants had greater understanding of factors influencing their shoulder pain. Pain education, in addition to pathoanatomical information may be useful as part of treatment for persistent rotator cuff-related pain.

Relationships Between Psychological, Social, Physical Activity, and Sleep Measures and Somatosensory Function in Individuals With Spinal Pain: A Systematic Review and Meta-analysis.

OBJECTIVE: Somatosensory abnormalities are linked to clinical pain outcomes in individuals with spinal pain. However, a range of factors might confound the relationship between altered somatosensory function and clinical pain outcomes. This systematic review aimed to evaluate the literature to assess the level of evidence of associations between psychological, social, physical activity, and sleep measures and somatosensory function (assessed via sensory psychophysical testing) among individuals with spinal pain. METHODS: A comprehensive literature search was performed in 6 electronic databases from their inception to June 2018. Two reviewers independently assessed the methodological quality using a modified Quality in Prognostic Studies (QUIPS) tool and supplemented with recommendations from the Critical Appraisal and Data Extraction for the Systematic Review of Prediction Modelling Studies (CHARMS) checklist and the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool. The level of evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) system. Data were pooled to evaluate the strength of the relationships of interest. RESULTS: Among the 17 factors identified in the included studies, pain catastrophizing, depression, and pain-related fear have significant negative (small to fair) associations with pain thresholds. A "very low" to "moderate" quality of evidence was found for all the investigated factors. Subgroup analysis showed a smaller effect size for pain catastrophizing/fear of movement and pain thresholds in individuals with low back pain. CONCLUSIONS: Psychological factors are associated negatively with pain thresholds and they need to be adjusted when establishing predictive relationships between somatosensory function and pain outcomes in individuals with spinal pain.

Protocol for a randomised controlled trial to evaluate the effectiveness of the diabetes community exercise and education programme (DCEP) for long-term management of diabetes.

INTRODUCTION: Type 2 diabetes is common in Maori and Pacific peoples and in those living in areas of high socioeconomic deprivation in New Zealand (NZ). People with type 2 diabetes often have multimorbidity, which makes their diabetes management more complex. The Diabetes Community Exercise and Education Programme (DCEP) is an interprofessional, patient-centred, whanau (family)-supported package of care specifically developed to engage with Maori and Pacific people and those living in deprived areas. We have previously demonstrated the feasibility and acceptability of the DCEP. This study aims to determine the effectiveness and cost-effectiveness of the DCEP through a pragmatic randomised controlled trial (RCT). METHODS AND ANALYSIS: 220 adults (age ≥35 years) with type 2 diabetes will be recruited from general practices in the lower South Island of NZ (Dunedin and Invercargill) to participate in an RCT. Participants will be randomised to intervention (DCEP) and control (usual care) groups. The DCEP participants will have their exercise goals agreed on with a physiotherapist and nurse and will attend two 90 min exercise and education sessions per week for 12 weeks. The primary outcome measure is blood glucose control (glycated haemoglobin). Secondary outcome measures include quality of life assessed using the Audit of Diabetes-Dependent Quality of Life questionnaire. Data will be collected at four time points: baseline, end of the 12-week intervention (3 months), 6 months postintervention (9 months) and 12 months after the intervention ends (15 months). We will also conduct a cost-effectiveness analysis and a qualitative process evaluation. ETHICS AND DISSEMINATION: The study has been approved by the Health and Disability Ethics Committee, Ministry of Health (HDEC17/CEN/241/AM01). A key output will be the development of an evidence-based training package to facilitate implementation of the DCEP in other NZ regions. TRIAL REGISTRATION NUMBER: ACTRN 12617001624370 p; Pre-results.

Risk Factors for Falls in Adults with Knee Osteoarthritis: A Systematic Review.

OBJECTIVE: To examine the evidence of risk factors for falls in adults with knee osteoarthritis (OA). TYPE: Systematic Review. METHODOLOGY: A systematic literature search was performed in 9 electronic databases from inception to July 2016. Two reviewers screened articles using set inclusion and exclusion criteria. Observational study designs that included participants with knee OA and history of falls were considered. Results reported as odds ratios, relative risks, prevalence ratios, or hazard ratios were extracted to identify the potential risk factors for falls. Included articles were assessed for methodological quality and level of evidence. SYNTHESIS: The electronic data search yielded 4382 studies related to falls and knee OA. A total of 11 studies were included in the review. The risk factors for falls in individuals with knee OA included impaired balance, muscle weakness, presence of comorbidities, and increasing number of symptomatic joints. The presence of knee pain was also identified as a risk factor for falls; however, the strength of evidence was rated as "conflicting" because of the inconsistency of the findings. Limited evidence was found for knee instability, impaired proprioception, and use of walking aids. CONCLUSION: This review provides evidence of risk factors for falls in individuals with knee OA. Despite the limited to moderate evidence, identification of these risk factors may be valuable for both clinicians and fall prevention program developers. Further studies are warranted to determine which of these risk factors for falls are modifiable in a knee OA population. LEVEL OF EVIDENCE: I.

Comparison of self-reported physical activity levels and quality of life between individuals with dysvascular and non-dysvascular below-knee amputation: A cross-sectional study.

BACKGROUND: Decreased physical ability of individuals with a dysvascular amputation when compared with non-dysvascular counterpart may impact on their ability to participate in regular physical activity and concomitant quality of life. OBJECTIVE: To compare physical activity, quality of life (QoL), and perceptions towards exercise between individuals with dysvascular and individuals with non-dysvascular amputation. METHODS: A random sample of individuals identified from the New Zealand Artificial Limb Service database, aged 18 years and over, with a unilateral below-knee amputation due to a dysvascular condition (n = 61) and trauma (n = 116) completed the self-reported survey. Main constructs measured were: self-reported physical activity levels (MET-hours/day); quality of life (EuroQoL); perceptions towards exercise (Exercise Barriers and Benefits Scale [EBBS]); mobility capability (Locomotor Capability Index [LCI]) and a customized screening questionnaire. RESULTS: Significant differences (p ≤ 0.05) were observed between dysvascular and non-dysvascular groups for total MET-hours/day [13.2 ±â€¯12.7; 27.0 ±â€¯23.2], LCI [36.3 ±â€¯17.7; 49.9 ±â€¯13.7], EuroQoL [72.1 ±â€¯21.7; 80.9 ±â€¯19.3] and EBBS [78.5 ±â€¯10.3; 85.0 ±â€¯14.3]. Cause of amputation, age, experience with the prosthesis, presence of co-morbidities and LCI were significant (p ≤ 0.008) correlates (simple linear regression) of MET-hours/day. Age was the only significant correlate in multivariable model with 0.43 MET-hours/day [F (5,161) = 9.28; p < 0.001], for each 1-year increase in age. CONCLUSION: Physical activity levels and quality of life of individuals with dysvascular amputation were lower when compared with non-dysvascular amputation. Person-centred behavioural interventions to increase physical activity levels are needed to decrease the risk for developing long-term co-morbidities and to lessen the effects of co-morbidities already present in this population.

Peripheral sensory information and postural control in children with strabismus.

BACKGROUND: Sensory feedback from the visual system along with the vestibular and somatosensory systems is essential for the regulation of normal postural control. Children with strabismus and, therefore, with abnormal binocular vision, may have an altered perception of space and use different sets of cues to determine depth perception when compared with children without strabismus. OBJECTIVE: To explore the postural control of children with and without strabismus, when the three sensory systems are challenged. METHOD: Forty-six children (21 with strabismus and 25 age-matched controls) aged between 5 and 10 years completed ophthalmic screening and then underwent assessment for postural control, which included Paediatric Balance Scale (PBS) and six conditions of the Sensory Organization Test (SOT). Four primary outcome measures were: PBS summary score, Equilibrium Score (ES), Strategy Score (SS) and Sensory Analysis Score of the SOT. RESULTS: A significant difference (P < 0.05) was observed between the strabismus and non-strabismus group in the PBS and, ES and SS of SOT condition 1. The Sensory Analysis scores were significantly different (P = 0.03) between the groups for 'Somatosensory'. Simple linear regression analysis suggested that the strabismus condition was significantly (P ≤ 0.02) associated with the PBS and, the ES and SS of condition 1, with a variance of 14.6%, 16.1% and 12.8%, respectively. Subgroup analysis suggested that age was a significant (P ≤ 0.001) correlate for balance scores in non-strabismus group (R2 ranged from 32% to 58.4%), but not for the strabismus group. SIGNIFICANCE: Postural control in children with strabismus is not equivalent to that of children without strabismus, when their somatosensory system is challenged. Additionally, the functional balance performance of children with strabismus is lower than their counterparts without strabismus. Collectively, the results suggest that the usual improvement in balance performance with increasing age is observed in children without strabismus but not in children with strabismus.

Effect of Land-Based Generic Physical Activity Interventions on Pain, Physical Function, and Physical Performance in Hip and Knee Osteoarthritis: A Systematic Review and Meta-Analysis.

OBJECTIVE: The aim of this study was to evaluate the effects of land-based generic physical activity interventions on pain, physical function, and physical performance in individuals with hip/knee osteoarthritis, when compared with a control group that received no intervention, minimal intervention, or usual care. METHODS: A systematic search for randomized controlled trials on 11 electronic databases (from their inception up until April 30, 2016) identified 27 relevant articles. According to the compendium of physical activities, interventions were categorized into: recreational activities (tai chi/Baduajin-6 articles), walking (9 articles), and conditioning exercise (12 articles). RESULTS: Meta-analysis for recreational activity (n = 3) demonstrated significant mean difference (MD) of -9.56 (95% confidence interval [CI], -13.95 to -5.17) for physical function (Western Ontario and McMaster Universities Arthritis Index) at 3 mos from randomization. Pooled estimate for walking intervention was not significant for pain intensity and physical performance but was significant for physical function (n = 2) with a MD of -10.38 (95% CI, -12.27 to -8.48) at 6 mos. Meta-analysis for conditioning exercise was significant for physical function (n = 3) with a MD of -3.74 (95% CI, -5.70 to -1.78) and physical performance (6-minute walk test) with a MD of 42.72 m (95% CI, 27.78, 57.66) at 6 mos. The timed stair-climbing test (n = 2) demonstrated a significant effect at 18 mos with a MD of -0.49 secs (95% CI, -0.75 to -0.23). CONCLUSION: Very limited evidence to support recreational activity and walking intervention was found for knee osteoarthritis, in the short-term on pain and physical function, respectively.

A Narrative Synthesis of Nintendo Wii Fit Gaming Protocol in Addressing Balance Among Healthy Older Adults: What System Works?

BACKGROUND: Balance is crucial in performing functional tasks particularly among older adults. Exergaming is gaining attention as a novel approach to enhance balance in a number of clinical populations. OBJECTIVES: The aim of this review was to synthesize and present published evidence for Nintendo Wii Fit™ gaming system protocols. These include game preference, intervention setting, and exercise dosage for improving balance in healthy older adults. Commonly used outcome measures were also identified. METHODS: A literature search was developed using the PICOS strategy using keywords such as "older adult," "Nintendo Wii Fit," "exergaming," and "balance" in the databases: MEDLINE, PubMed, EMBASE, CINAHL, Scopus, Science Direct, and Web of Science. RESULTS: Sixteen articles were included with participants (n = 491) mostly female (69%), and mean age ranged between 71 and 85 years old. Participants were recruited mainly from the community. The most commonly used Wii Fit games were Table tilt, Soccer Heading, Ski Slalom, and Ski jump, performed three times per week, with a duration of 30 minutes per session for 6 weeks. Berg Balance Scale, Timed Up and Go Test, and Centre of Pressure were the most commonly used outcome measures. CONCLUSION: Wii Fit exergames can be a potential alternative to improve balance if safety and technical procedures are provided. With conflicting and mechanism-based evidence on dosage presented, exergaming parameters require further research before firm recommendations can be made. Clinically, effective dosage is an important component in any type of interventions, and exergaming should not be an exception.

Is knee pain information on YouTube videos perceived to be helpful? An analysis of user comments and implications for dissemination on social media.

OBJECTIVE: There is little research that characterises knee pain related information disseminated via social media. However, variances in the content and quality of such sources could compromise optimal patient care. This study explored the nature of the comments on YouTube videos related to non-specific knee pain, to determine their helpfulness to the users. METHODS: A systematic search identified 900 videos related to knee pain on the YouTube database. A total of 3537 comments from 58 videos were included in the study. A categorisation scheme was developed and 1000 randomly selected comments were analysed according to this scheme. RESULTS: The most common category was the users providing personal information or describing a personal situation (19%), followed by appreciation or acknowledgement of others' inputs (17%) and asking questions (15%). Of the questions, 33% were related to seeking help in relation to a specific situation. Over 10% of the comments contained negativity or disagreement; while 4.4% of comments reported they intended to pursue an action, based on the information presented in the video and/or from user comments. CONCLUSION: It was observed that individuals commenting on YouTube videos on knee pain were most often soliciting advice and information specific to their condition. The analysis of comments from the most commented videos using a keyword-based search approach suggests that the YouTube videos can be used for disseminating general advice on knee pain.

Postural control in response to altered sensory conditions in persons with dysvascular and traumatic transtibial amputation.

OBJECTIVE: To compare the postural control of persons with a dysvascular transtibial amputation and traumatic transtibial amputation with able-bodied adults with and without a dysvascular condition in altered sensory testing conditions. DESIGN: Cross-sectional study. SETTING: University balance clinic. PARTICIPANTS: The study participants (N=35) included: participants with a dysvascular transtibial amputation (n=9), participants with a traumatic transtibial amputation (n=9), age-matched able-bodied adults without a dysvascular condition (n=9), and able-bodied adults with a dysvascular condition (n=8). INTERVENTIONS: Six Sensory Organization Test (SOT) conditions, which included standing with eyes open (condition 1) and closed (condition 2) on a static force platform with visual surround; standing with eyes open on a static force platform with movable visual surround (condition 3); standing with eyes open (condition 4) and closed (condition 5) on a movable force platform with static visual surround; and standing with eyes open on a movable force platform with movable visual surround (condition 6). MAIN OUTCOME MEASURES: Bilateral anteroposterior (AP) and mediolateral (ML) center of pressure variables, namely root mean square distance (RMSD) and mean velocity (mVel), for each of the 6 SOT conditions. RESULTS: The dysvascular transtibial amputation group demonstrated a higher AP RMSD (P≤.04) on the sound side than did the able-bodied adults without a dysvascular condition and the able-bodied adults with a dysvascular condition in SOT conditions 1 and 2, respectively. Both the dysvascular transtibial amputation group and the traumatic transtibial amputation group demonstrated a higher AP RMSD (P≤.002) than the able-bodied adults without a dysvascular condition in SOT conditions 3 and 4. The dysvascular transtibial amputation group showed higher AP mVel (P≤.002) on the sound side for SOT conditions 2 and 3, whereas both amputation groups showed higher AP mVel for SOT conditions 1 and 4 than the able-bodied adults with and without a dysvascular condition. CONCLUSIONS: Postural control of the dysvascular transtibial amputation group was not different than the traumatic transtibial amputation group in challenging sensory conditions. However, when compared with the groups of able-bodied adults with and without a dysvascular condition, postural strategies distinct with amputation etiology were observed.

Influence of a walking aid on temporal and spatial parameters of gait in healthy adults.

OBJECTIVE: To determine the effect of using a walking aid on temporal and spatial parameters of gait when used for balance versus support on the dominant and nondominant hand side. DESIGN: Repeated measures observational study design. SETTING: University gymnasium. PARTICIPANTS: Twenty-seven healthy male and female adults of mean ± standard deviation age 44.74 ± 10.00 years. METHODS: Five walking conditions (C) were completed by all participants on the GAITRite pressure mat. Normal walking (C1), walking with a cane in the dominant hand (C2) and nondominant hand (C3) as if using for balance, walking with a cane in the dominant hand (C4) and nondominant hand (C5) while allowing approximately 10% of the body weight through the cane. MAIN OUTCOME MEASUREMENTS: Temporal measurements (swing time, stance time, single limb support time, double limb support time) as percentage of a gait cycle and the base of support for the left and the right foot for all 5 walking conditions. RESULTS: A significant difference (P < .001) was observed between C1, C2, and C3 in percentage swing time and percentage stance time of the ipsilateral side, and in percentage single limb support time of the contralateral side. The double limb support time was significantly different (P ≤ .04) for both ipsilateral and contralateral sides. Comparisons among C1, C4, and C5 demonstrated significance (P < .001) for all variables. Post hoc analysis showed significance between C1 and C4, and C1 and C5 for all variables except percentage stance time of the ipsilateral side and percentage single limb support of the contralateral side. CONCLUSIONS: In healthy adults, use of a cane for balance modifies swing and stance parameters of the ipsilateral side and does not affect the base of support formed by the feet. When used for support, the cane alters the swing and stance parameters, and also the base of support formed by the feet.

Turning performance in persons with a dysvascular transtibial amputation.

BACKGROUND AND AIM: Turning is an inherent problem in all lower limb amputees and more so in older dysvascular amputees. This study aimed to compare the turning performance of dysvascular amputees with that of the traumatic amputees. TECHNIQUE: Six dysvascular transtibial amputees (69.83 ± 6.3 years) and six traumatic transtibial amputees (68.3 ± 6.6 years) completed the Step Quick Turn test of the NeuroCom(®) Balance Master and the Timed Up and Go Test. The measures used for comparison were as follows: turn time and turn sway of Step Quick Turn test, turning 180° to both the prosthetic and sound side and time taken to complete the Timed Up and Go Test. DISCUSSION: The Mann-Whitney U test demonstrated a significant difference (p < 0.05) between the dysvascular and traumatic groups in turn sway to the prosthetic (70.7 ± 14.2 and 43.3 ± 9.7) and sound sides (72.5 ± 16.1 and 43.5 ± 8.2). Similar results were observed in turn time to the prosthetic (4.1 ± 1.4 and 1.7 ± 0.46) and sound sides (4.0 ± 1.3 and 2.1 ± 0.5). No significant difference was observed for the Timed Up and Go Test. CLINICAL RELEVANCE: The observed differences suggest that dysvascular amputees are less able to adapt to the challenges associated with turning. More attention is required in the rehabilitation of dysvascular amputees in turning tasks particularly towards the prosthetic side.

Concurrent validity of the Sensory Organization Test measures in unilateral transtibial amputees.

BACKGROUND AND AIM: The physical asymmetries associated with a prosthesis raises the question of validity of the Sensory Organization Test (SOT) measures (equilibrium score (ES) and strategy score (SS)) in lower limb amputees. This study explores the validity of these measures in transtibial amputees by correlating with their corresponding centre of pressure (COP) excursion/velocity measures. TECHNIQUE: Fifteen transtibial amputees (69.5 ± 6.5 years) completed three trials for each of the six SOT conditions. DISCUSSION: The Spearman's rank correlation coefficients between ESs and global COP excursion/velocity measures ranged from 0.52 to 0.71 for Conditions 1, 4 and 5, 0.79 to 0.85 for Conditions 2 and 3, and 0.39 to 0.43 for Condition 6. The coefficients for SSs ranged between 0.78 and 0.97 for Conditions 1 to 5 and 0.55 to 0.67 for Condition 6. The corresponding sound and prosthetic side COP variables demonstrated varying strengths of association with ES and SS. Clinical relevance Of the two clinical measures examined, the SSs are strongly reflective of COP excursion/velocity measures and these findings have application in the interpretation of SOT when evaluating balance in transtibial amputees.

Instrumented measurement of balance and postural control in individuals with lower limb amputation: a critical review.

Measurement of balance and postural performance that underpins activities of daily living is important in the rehabilitation of individuals with a lower limb amputation (LLA), and there are a number of methods and strategies available for this purpose. To provide an evidence-based choice of approach, this review aims to critically review the tasks and outcome measures utilized in studies investigating static and dynamic balance using instrumented measurement devices in individuals with a LLA. A systematic search was conducted on multiple databases using keyword or subject headings appropriate to the respective database. Articles investigating static or dynamic balance in adults with LLA by means of instrumented measures were considered for the review. A total of 21 articles were included in the review. The static balance ability of individuals with an LLA has been investigated thoroughly, but their dynamic balance attributes remain relatively unexplored. Although the individual studies do provide valuable information on balance ability in the LLA, the heterogeneity in study designs and measures did not allow an overall analysis of the tasks and the outcome measures used. On the basis of these findings, this review provides an insight into the measurement of balance in amputees to inform novice researchers and clinicians working with individuals with an LLA.