Gore-tex bags versus traditional hand bandaging: a comparison of range of motion, sensation and function in healthy subjects.

INTRODUCTION: Little evidence exists evaluating the possible effect of dressings on the recovery of function, sensation and joint motion following a hand burn. Hand burns are traditionally covered by a layer of non-adherent dressing followed by gauze and bandages. However, there is no evidence for the efficacy of this type of coverage relative to a functional recovery. The Gore-tex bag has a small body of research supporting its ability to provide a superior healing atmosphere, however there is no literature directly comparing it with the traditional dressing. METHOD: A randomised cross-over design was implemented to compare Gore-tex bags and traditional dressings in 30 healthy volunteers. Seven outcome measures of function, sensation, joint range of movement and subject perceptions were recorded before dressing, during both Gore-tex and traditional dressing interventions and between dressings. RESULTS: Statistically significant differences were found between the traditional dressings and Gore-tex bags. The Gore-tex bag dressings proved better for digit range of motion, 1st CMC joint motion and sensation. The traditional dressings were significantly better when perceived comfort was tested and there was no significant difference between the traditional dressing and Gore-tex bag regarding function and perceived function. CONCLUSION: The results of this study suggest that traditional dressings may detrimentally affect movement and reduce sensation but not necessarily affect function or comfort. Further investigation in a patient cohort with burnt hands is recommended.

Validity and inter-rater reliability of the Lindop Parkinson's Disease Mobility Assessment: a preliminary study.

OBJECTIVES: To assess the validity and inter-rater reliability of the Lindop Parkinson's Disease Mobility Assessment (LPA); a scale developed to gather objective information on gait and bed mobility in patients with Parkinson's disease. DESIGN: Two therapists scored a group of patients with Parkinson's disease using the motor examination section of the Unified Parkinson's Disease Rating Scale (UPDRS-ME) and the LPA scale. The association between scores obtained using the two scales was calculated, and the scores obtained by the therapists using each scale were compared. SETTING: A Parkinson's disease clinic in a day hospital in a district general hospital. PARTICIPANTS: Forty-nine subjects with Parkinson's disease were recruited (33 males, 16 females, mean age 75.84+/-7.16 years). RESULTS: There was a significant association between the LPA and UPDRS-ME data for both raters (Rater A, rho -0.67; Rater B, rho -0.63; P<0.001). The limits of agreement showed that the two raters scored within two scale points of each other on 95% of occasions, and that there was no systematic bias between raters. Percentage agreement between raters ranged from 82% to 100% for the LPA. The LPA took significantly less time to complete [mean 7.7 (standard deviation 2.9) minutes] than the UPDRS-ME [mean 10.5 (standard deviation 2.2) minutes; P<0.001]. CONCLUSIONS: The results suggest that the LPA is a valid measure with good inter-rater reliability. It is quick and easy to administer, and provides objective information about the gait and bed mobility of elderly patients with Parkinson's disease.

Relative impact of radiographic osteoarthritis and pain on quadriceps strength, proprioception, static postural sway and lower limb function.

OBJECTIVE: To investigate the relative impact of radiographic osteoarthritis (ROA) and current knee pain on lower limb physical function, quadriceps strength, knee joint proprioception, and postural sway. METHODS: Using a 2x2 factorial design, 142 community derived subjects aged over 45 were divided into four subgroups based on the presence or absence of ROA (Kellgren & Lawrence>grade 2) and knee pain (as assessed by NHANES questions and a 100 mm visual analogue scale). Maximum isometric contraction of the quadriceps, knee joint proprioceptive acuity, static postural sway, and WOMAC index (both whole and function subscale) were assessed in all subjects. RESULTS: Compared with normal subjects, reported disability was greater for all other subgroups (p<0.01). Subjects with both ROA and knee pain reported the greatest disability, and those with knee pain only had greater disability than those with ROA only. Quadriceps weakness was observed in all groups compared with normal subjects (p<0.01), though they were no significant intergroup differences. Subjects with knee pain had a greater sway area than those without (p<0.05) but the presence of ROA was not associated with increased postural sway. No differences in proprioceptive acuity were observed between groups. CONCLUSIONS: The presence of knee pain has a negative association with quadriceps strength, postural sway, and disability compared with ROA. However, the presence of pain-free ROA has a significant negative influence on relative quadriceps strength and reported disability.

Evidence-based recommendations for the role of exercise in the management of osteoarthritis of the hip or knee--the MOVE consensus.

OBJECTIVES: Exercise is an effective and commonly prescribed intervention for lower limb osteoarthritis (OA). Many unanswered questions remain, however, concerning the practical delivery of exercise therapy. We have produced evidence-based recommendations to guide health-care practitioners. METHODS: A multidisciplinary guideline development group was formed from representatives of professional bodies to which OA is of relevance and other interested parties. Each participant contributed up to 10 propositions describing key clinical points regarding exercise therapy for OA of the hip or knee. Ten final recommendations were agreed by the Delphi technique. The research evidence for each was determined. A literature search was undertaken in the Medline, PubMed, EMBASE, PEDro, CINAHL and Cochrane databases. The methodological quality of each retrieved publication was assessed. Outcome data were abstracted and effect sizes calculated. The evidence for each recommendation was assessed and expert consensus highlighted by the allocation of two categories: (1) strength of evidence and (2) strength of recommendation. RESULTS: The first round of the Delphi process produced 123 propositions. This was reduced to 10 after four rounds. These related to aerobic and strengthening exercise, group versus home exercise, adherence, contraindications and predictors of response. The literature search identified 910 articles; 57 intervention trials relating to knee OA, 9 to hip OA and 73 to adherence. The evidence to support each proposition is presented. CONCLUSION: These are the first recommendations for exercise in hip and knee OA to clearly differentiate research evidence and expert opinion. Gaps in the literature are identified and issues requiring further study highlighted.

Effect of pain reduction on postural sway, proprioception, and quadriceps strength in subjects with knee osteoarthritis.

OBJECTIVE: To investigate whether alleviation of knee pain influences quadriceps function, proprioceptive acuity, and postural stability in patients with knee osteoarthritis (OA). METHODS: A crossover, within-subject, double blind study design involving 68 subjects with painful knee OA. Each subject received an intra-articular injection into one or both knees (both if symptomatic) of either 5 ml 0.5% bupivacaine or 5 ml 0.9% saline. Two weeks later they received an injection of the alternative agent. Subjects and observer were unaware of the order of injection, which was randomly assigned. Knee pain (100 mm visual analogue scale), static postural sway, knee proprioceptive acuity, maximum voluntary contraction (MVC), and percentage activation of the quadriceps were assessed immediately before and one hour after each injection. RESULTS: Significant pain reduction was achieved one hour post-bupivacaine (mean difference as a percentage change 56.85, 95% CI 31.01 to 73.65; p<0.001) and post-saline (mean difference as a percentage change 41.94, 95% CI 11.57 to 76.66; p< 0.001), with no significant difference between the two. Both MVC and activation increased significantly post-bupivacaine (mean percentage differences 18.83, 95% CI -31.79 to -0.26, and -11.90, 95% CI -39.53 to 2.97, respectively; both p<0.001) and post-saline (mean percentage differences -7.64, 95% CI -21.96 to 4.73, and -10.71, 95% CI -25.19 to 2.60 respectively; both p<0.001). Proprioception worsened after bupivacaine (mean percentage difference -28.15%, 95% CI -83.47 to 19.74; p=0.009), but there was no effect on postural sway; saline injection had no effects. There was no order effect, and comparison of median percentage changes showed no significant differences between injections for change in MVC, activation, proprioception, or sway. CONCLUSION: Reduction in knee pain through either peripheral (local anaesthetic) or central (placebo) mechanisms resulted in increased MVC. This increase, however, did not result in improvements in proprioception or static postural stability, suggesting that other mechanisms play a part in these functions, at least in this acute model.

Influence of elastic bandage on knee pain, proprioception, and postural sway in subjects with knee osteoarthritis.

OBJECTIVES: To investigate whether a "standard" sized (that is, a size that would be prescribed by a physiotherapist) elastic bandage (S-bandage) around the knee of subjects with knee osteoarthritis (OA) would, in the short term (a) reduce pain, (b) improve knee joint proprioception, and (c) decrease sway in comparison with a looser (L-bandage). METHODS: In a cross over, within-subject study, 68 subjects (49 women, 19 men; mean age 67.1, range 36-87) with symptomatic and radiographic knee OA were randomly assigned to either an S-bandage or an L-bandage. Two weeks later they were assigned to the opposite bandage size. Knee pain (10 cm visual analogue scale (VAS)), knee proprioception, and static postural sway were assessed for each bandage two weeks apart. During each visit assessments were performed at baseline, after 20 minutes of bandage application, and immediately after bandage removal. RESULTS: The S-bandage did not have any effect on knee pain, proprioception, or postural sway. The L-bandage reduced knee pain significantly (pre-bandage application: median VAS 4.36, IQR 3.84 -4.90; after 20 minutes of bandage application: median VAS 3.80, IQR 3.3-4.3, p<0.001), improved static postural sway (pre-bandage: median sway 4.50, IQ range 3.5-6.4; bandage applied: median sway 4.45, IQ range 3.4-6.3, p=0.027), but had no significant influence on knee proprioception. CONCLUSIONS: In subjects with knee OA application of an elastic bandage around the knee can reduce knee pain and improve static postural sway. This outcome depends on the size of applied bandage.

A case-control study to investigate the relation between low and moderate levels of physical activity and osteoarthritis of the knee using data collected as part of the Allied Dunbar National Fitness Survey.

BACKGROUND: Physical activity is being recommended as an intervention for seemingly almost universal improvements to health. A potential concern with this recommendation for increased exercise is that some believe increased levels of activity may lead to increased incidence of osteoarthritis of the knee (knee OA), as a result of accelerated "wear and tear" of the major joints. OBJECTIVE: To investigate the hypothesis that the occurrence of knee OA may be related to the duration of participation in some forms of sport and active recreation. METHODS: The relation between habitual exercise, reported by a cross section of people surveyed in England, and self reported knee OA was investigated. Data were derived from the Allied Dunbar National Fitness Survey (1990-91). A matched retrospective case-control design was used and a new exposure classification system which categorised different grades of activities for different time periods for each subject's lifetime participation in regular physical activities was developed. Additional data on knee injuries sustained and bodily composition were also included in a multivariate analysis. RESULTS: From 4316 people originally interviewed, 216 eligible cases (66 men, 150 women) were identified (mean age 57.1). Each case was matched to four controls. When habitual sport/exercise participation were examined during a subject's life, only exposure to regular long walks and being physically active between the ages of 20 and 24 suggested any association with developing knee OA later in life. The only strong association found was a greatly increased risk of knee OA having previously sustained a knee injury (p<0.01, odds ratio 8.0 (95% confidence interval 2.0 to 32.0)). CONCLUSIONS: There was little evidence to suggest that increased levels of regular physical activity throughout life lead to an increased risk of knee OA later in life. Previous knee injury was associated with an increased risk of knee OA. Additionally, most injuries were caused through participation in physical activities. Hence, when deciding on participation in activities, it is worth taking the likelihood of joint injury into consideration, as the chance of injury is greater in some activities than others.

Static postural sway, proprioception, and maximal voluntary quadriceps contraction in patients with knee osteoarthritis and normal control subjects.

OBJECTIVES: To investigate whether subjects with knee osteoarthritis (OA) have reduced static postural control, knee proprioceptive acuity, and maximal voluntary contraction (MVC) of the quadriceps compared with normal controls, and to determine possible independent predictors of static postural sway. METHODS: 77 subjects with symptomatic and radiographic knee OA (58 women, 19 men; mean age 63.4 years, range 36-82) and 63 controls with asymptomatic and clinically normal knees (45 women, 18 men; mean age 63 years, range 46-85) underwent assessment of static postural sway. 108 subjects (59 patients, 49 controls) also underwent assessment of knee proprioceptive activity and MVC (including calculation of quadriceps activation). In patients with knee OA knee pain, stiffness, and functional disability were assessed using the WOMAC Index. The height (m) and weight (kg) of all subjects was assessed. RESULTS: Compared with controls, patients with knee OA were heavier (mean difference 15.3 kg, p<0.001), had increased postural lateral sway (controls: median 2.3, interquartile (IQ) range 1.8-2.9; patients: median 4.7, IQ range 1.9-4.7, p<0.001), reduced proprioceptive acuity (controls: mean 7.9, 95% CI 6.9 to 8.9; patients: mean 12.0, 95% CI 10.5 to 13.6, p<0.001), weaker quadriceps strength (controls: mean 22.5, 95% CI 19.9 to 24.6; patients: mean 14.7, 95% CI 12.5 to 16.9, p<0.001), and less percentage activation of quadriceps (controls: mean 87.4, 95% CI 80.7 to 94.2; patients: mean 66.0, 95% CI 58.8 to 73.2, p<0.001). The significant predictors of postural sway were knee pain and the ratio of MVC/body weight. CONCLUSIONS: Compared with age and sex matched controls, subjects with symptomatic knee OA have quadriceps weakness, reduced knee proprioception, and increased postural sway. Pain and muscle strength may particularly influence postural sway. The interaction between physiological, structural, and functional abnormalities in knee OA deserves further study.

Inter-rater reliability of the Nottingham method of stereognosis assessment.

OBJECTIVE: To investigate the inter-rater reliability of stereognosis assessment in stroke patients, as measured by the Nottingham Sensory Assessment (NSA). SUBJECTS: Twenty stroke patients consented to participate in the study. The subjects were aged between 40 and 93 years, and were no more than three months post stroke. DESIGN: The stereognostic ability of the subjects was assessed by two of three examiners within a 24-hour period. The method laid out by the NSA was followed throughout the study. ANALYSIS: Point to point agreement of scores and therefore reliability levels were assessed between examiners using the kappa coefficient of agreement. RESULTS: The majority of subjects (n = 13) were found to have impaired stereognosis on their affected side. A good level of reliability was found for the majority of items (n = 32), with kappa values being rated as substantial or higher for most of the objects tested. In eight cases the reliability was fair or moderate. These cases included the glass, biro and 10p coin when the affected side was assessed by examiners 1 and 2, and the pencil when the same side was assessed by examiners 1 and 3. These levels of reliability were acceptable, but were not as high as the researchers had hoped. CONCLUSION: It is concluded that the Nottingham method of stereognosis assessment is a reliable assessment tool between raters.

Physical activity and body composition: what do the national surveys reveal?

Measures of height, body weight, waist and hip girths are available from the Allied Dunbar National Fitness Survey and have been used to explore differences between respondents reporting differing levels of habitual physical activity. Body mass index (BMI), waist-to-hip ratio (WHR) and waist-to-height ratio were derived. Physical activity was estimated from a structured interview. The questionnaire permitted a separate estimate of levels of participation in vigorous and moderate intensity activity, as well as total energy expenditure. Each index of body composition was regressed against the measures of physical activity and other lifestyle factors. Relationships between activity and body composition measures were weak with different patterns emerging for men and women. These data suggest that it is doubtful whether changes in body composition brought about by interventions to increase population levels of physical activity will be revealed by measuring BMI. However WHR and waist-to-height ratio indices reflecting the bulk of the intra-abdominal fat stores may prove more informative.

Lack of variation in muscle strength with menstrual status in healthy women aged 45-54 years: data from a national survey.

Isometric handgrip, quadriceps muscle strength and leg extensor power were assessed as part of a large representative survey of adult men and women in England. The gender ratios for these muscle strength measurements did not differ across age groups, which ranged from 25 to 65 years. Data from a subsample of women who were aged between 45 and 54 years and free of major health problems or current gynaecological problems (n = 299) and were analysed to see if there were differences in the muscle measurements according to reported menstrual status. Analysis of variance was used to compare four subgroups of women as follows: those who were still menstruating regularly (n = 89), those who had stopped altogether (n = 92), those who were irregular (n = 33) and those on hormone replacement therapy (n = 15). No significant differences were found between these subgroups in any of the three muscle measurements, body mass, fat-free mass (derived from four skinfolds), body mass index, or customary activity levels. There was a significant age difference of 2 years between two subgroups. After having controlled for this, using analysis of covariance, the outcome was not changed. These women were also compared with men in the same age range; the women had about 60% of the strength of the men and a highly significant difference remained after controlling for fat-free mass in all subgroups. No evidence was found for an ergogenic effect of the high oestrogen status conferred by natural menstruation or hormone replacement therapy.