The effect of a home exercise intervention on persons with lower limb amputations: a randomized controlled trial.

OBJECTIVE: To establish if a home-based exercise and education programme is more effective than usual treatment in improving function, mobility and quality of life in people with lower limb amputation due to peripheral vascular disease. METHOD: A blocked randomized single-blinded controlled trial (RCT) with 154 participants (54 female; mean age 58) compared a home-based exercise and education programme (n = 77) with usual care (control) (n = 77). Participants were measured at baseline, immediately post intervention at three months, and after a further three months without any intervention. The outcome measures were the Barthel Index, Participation Scale, EuroQuol 5D, Modified Locomotor Capability Index and Timed Up and Go Test. Changes over time were established using generalized estimating equations and analysis of covariance, (P < 0.05). RESULTS: The Participation Scale (18.73 ± 14.91 against 26.67 ± 19.14; P = 0.011), the EuroQuol5D visual analogue scale (69.10 ± 20.31 against 55.37 ± 27.67; P = 0.003), EuroQuol5D utility index (0.672 ± 0.300 against 0.532 ± 0.358; P = 0.25) and the Modified Capability Index (21.03 ± 15.79 against 15.91 ± 13.67; P = 0.034) improved in the intervention group compared with the control group at three months. At six months, there was no difference between the groups in any of the measures except for the EuroQuol5D visual analogue scale (74.52 ± 16.14 against 66.34 ± 22.91; P = 0.033). Although there were no differences between the Timed Up and Go test at 3 (35.39 ± 32.48 against 45.08 ± 41.52; P = 0.192) and six months (28.22 ± 20.96 against 36.08 ± 36.19; P = 0.189) between the groups the intervention group was more mobile. CONCLUSION: This intervention improved function, mobility and quality of life in persons following lower limb amputation in the first three months post amputation.

Intra-rater and inter-rater reliability of six musculoskeletal preparticipatory screening tests.

BACKGROUND: High injury prevalence rates call for effective sports injury prevention strategies, which include the development and application of practical and reliable pre-participatory screening tools. OBJECTIVES: The aim of this study was to investigate the intra-rater and inter-rater reliability of the one-legged hyperextension test (1LHET), the empty can (EC) and full can (FC) tests, the standing stork test (SST), the bridge-hold test (BHT) and the 747 balance test (747BT). METHOD: Thirty-five healthy, injury-free male athletes (cricket and soccer players), aged 16-24 years, were evaluated by two physiotherapists. For each of the tests, the participants were evaluated twice (on two consecutive days) by each physiotherapist. Both the intra- and inter-rater reliability were determined. Cohen's kappa (k) was calculated for the 1LHET, the EC and FC tests and the SST. The intraclass correlation coefficient (ICC) was used for the BHT and the 747BT. A confidence level of 95% (p ≤ 0.05) was applied as the criterion for determining the statistical significance of the results. RESULTS: The SST presented with the lowest level of intra-rater agreement (ICC = -0.20 to 0.10). On the other hand, the EC test was the only test where one rater achieved an excellent intersessional agreement (k = 0.80; 95% confidence interval [CI] 0.40-1.20). Substantial to excellent results for the inter-rater agreement for both sessions were recorded for the 1LHET (k = 0.70-0.90) and the BHT (ICC = 0.70-0.90). CONCLUSION: Reliability values need to be considered when making clinical decisions based on screening tests. A more refined description of the testing procedures and criteria for interpretation might be necessary before including the six screening tests investigated in this study in formal screening protocols. CLINICAL IMPLICATION: Confirmed reliability of screening tests would enable sports professionals to make informed decisions when designing preparticipatory musculoskeletal screening tools and when dealing with the management of injury risks in athletes. KEYWORDS: musculoskeletal screening; injury risk management; intra-rater reliability; inter-rater reliability; soccer; cricket.

Functional outcomes after flexor tendon repair of the hand.

OBJECTIVES: This study aims to evaluate the hand function after flexor tendon repair (FTR) and to investigate factors associated with functional outcomes. PATIENTS AND METHODS: Between January 2013 and September 2015, a total of 126 patients (84 males, 42 females; mean age 31 years; range, 15 to 62 years) who underwent FTR due to flexor tendon injuries (FTIs) were included. The hand function was assessed using the Jebsen Hand Function Test (JHFT) and Quick Disabilities of the Arm, Shoulder and Hand (Quick DASH) at three and six months following FTR. RESULTS: Of the patients, 94 (75%) and 72 (56%) completed the three-month and six-month assessment visits, respectively. A total of 65 patients (51.1%) had both three and six-month follow-up data. The patients regained a fair amount of power grip strength and more than half of their pinch grip strength compared to the unaffected hand. The results of assessment of hand function at activity and participation levels (JHFT and Quick DASH) showed slightly higher levels of disability. Of 41 patients who were employed prior to injury, 29 (71%) returned to work at six months after surgery. Zone IV injury and language barrier were associated with poor functional outcomes at six months. CONCLUSION: Our study results showed that the JHFT and Quick DASH scores of the patients were less than the established norms, although functional outcomes improved over time. Based on these results, we suggest that the presence of zone IV FTI and language barrier are associated with poor functional outcomes.