Association of scoliosis with lower extremity alignments, muscle strengths, and foot characteristics and their alterations in adolescent idiopathic scoliosis.

BACKGROUND: The association between changes occurring in the spine and lower body parts is not well understood in adolescent idiopathic scoliosis (AIS). OBJECTIVES: The first aim of the study was to investigate the association of scoliosis with lower extremity (LE) alignments, foot characteristics, and muscle strengths in adolescents. Secondly, comparisons of the data among AIS with single and double curves and control groups were determined. METHODS: Thirty-one participants were recruited and classified into 3 groups; AIS with a single curve (n= 7), AIS with double curves (n= 14), and controls (n= 10). Association of the presence of scoliosis with LE alignments (Q and TC angles), LE muscle strengths (hip, knee, and ankle), and foot characteristics (arch indexes) were examined using the point biserial correlation, and the data among three groups were compared using the ANOVA. RESULTS: Scoliosis was associated with Q angle, arch indexes, and all LE muscle strengths except for hip extensors and ankle plantar flexors strengths. Comparisons among the three groups showed significant increases in LE alignments and foot characteristics in AIS. Almost all LE muscle strengths decreased in AIS, especially for the single curve group. CONCLUSIONS: Apart from spinal deformity, the AIS has changed in LE alignments, muscle strengths, and foot characteristics. Therapists should consider these associations and alterations for designing proper management.

Electromyography of paraspinal muscles during self-corrective positions in adolescent idiopathic scoliosis.

BACKGROUND: Self-corrective exercise is commonly used in the training protocol of patients with adolescent idiopathic scoliosis (AIS). The muscle activation pattern during symmetrical and overcorrection exercises is then explored to guide the treatment. OBJECTIVE: To compare the paraspinal muscle activity during three self-corrective positions and the habitual standing in AIS. METHODS: Thirty-three adolescents with double curved scoliosis were examined. The curve type and Cobb's angle were determined from their whole spine X-ray. They adopted habitual standing, symmetrical correction and two overcorrected positions (O1 and O2). The surface electromyography (EMG) was monitored on both sides of paraspinal muscles at the apex areas of scoliotic curves. The EMG ratio between sides was inferred as the corrective effect. RESULTS: All three self-correction positions produced greater EMG ratios compared with the habitual standing. The greatest EMG ratios were observed during the O1 position at the thoracic curve and the habitual standing at the lumbar curve. Participants with different subtypes of curves exhibited similar patterns of EMG ratios. CONCLUSION: From the biomechanical viewpoint, all three self-corrective positions possibly provided therapeutic effects for the scoliotic body regardless of the subtype of scoliosis curves. The O1 position seemed to be most effective for the adjusting activation of thoracic paraspinal muscles. The symmetrical corrective position is otherwise recommended for adjusting the lumbar muscle activation.

The clinical and biomechanical effects of customized foot orthoses in individuals with plantar heel pain: A pre-post intervention study.

BACKGROUND: Customized foot orthoses (CFOs) are often recommended for the management of plantar heel pain. However, there is a lack of information regarding lower limb and multi-segment foot motion during gait. RESEARCH QUESTION: This study aimed to determine the effects of heat moulded CFOs on foot and lower limb kinematics when compared with prefabricated foot orthoses (PFOs) and wearing no orthoses (shod condition), and to determine the short-term effects of CFOs on pain intensity and foot function. METHODS: The immediate effects of CFOs on the lower limb and multi-segment foot motion were assessed. Participants were then asked to use the CFOs for one month and foot pain, function, and temporal-spatial parameters were assessed at baseline and at one month follow up. RESULTS: Thirty-five participants (22 females), aged 40.1 (10.5) years, with a mean duration of symptoms of 12.59 months were recruited. The symptomatic limbs showed a higher forefoot varus angle and greater rearfoot and forefoot corrections were required compared to the non-symptomatic limbs. When compared with PFOs and shod conditions, CFOs provided the least forefoot and knee motion in the transverse plane during contact phase (P < 0.05, d=0.844-1.720), least rearfoot motion in the coronal plane during midstance (P < 0.05, d=0.652), and least forefoot motion in the frontal plane, knee motion in the transverse plane, and hallux motion during the propulsive phase (P < 0.05, d=0.921-1.513). Significant improvements were seen for foot pain and function (P < 0.05, d=1.390-2.231) with significant increases in cadence and walking velocity after one month of CFO use (P < 0.05, d=0.315-0.353), and those most likely to respond had greater pain and less ankle eversion (P < 0.05, d=0.855-1.115). SIGNIFICANCE: CFOs appear to improve pathological biomechanics associated with plantar heel pain. After one month follow up, the CFOs decreased pain intensity and increased foot function, and showed significant improvements in temporal and spatial parameters of gait.

Prevalence of scapular dyskinesis in office workers with neck and scapular pain.

Objectives. This study aimed to investigate the presence of scapular dyskinesis (SD) in office workers with neck and scapular complaints. The postural malalignment and related muscle adaptations were also explored. Methods. SD and its subtypes were determined. Postural deviations and the length of commonly reported muscle tightness were evaluated. Results. Among 99 participants, 90% of them had SD. Considering both sides or 198 scapula, 90.4% were identified as having painful scapula and 19% as having painless scapula. There was a difference in the proportion of SD on painful (93%) and painless (69%) sides. Postural deviations including rounded shoulder (100%), forward head (43.3%) and thoracic hyperkyphosis (54.5%) were prevalent. Persons with type III SD had a higher percentage of forward head than other types. There was also tightness of the pectoralis minor (100%), levator scapulae (93.0%) and upper trapezius (98.3%) muscles without different proportions among types of SD. The greatest proportion of persons with SD had tightness of the levator scapulae. Conclusions. There was a high prevalence of SD among office workers with neck and scapular complaints. SD was also associated with abnormal posture and muscle tightness. The proper management of SD and working posture is warranted.

Can orthotic wedges change the lower-extremity and multi-segment foot kinematics during gait in people with plantar fasciitis?

BACKGROUND: Orthotic wedges with medial posting of the forefoot and rearfoot have been shown to be effective in controlling excessive foot pronation in people with plantar fasciitis (PF), however the best prescription remains unclear. RESEARCH QUESTION: The aim of this study was to determine the biomechanical effects of two designs of orthotic wedges within a shoe on the hip, knee, rearfoot, and forefoot kinematics in individuals with PF. METHODS: Thirty-five participants with PF were recruited. They were asked to walk under three randomized conditions; shod, shod with orthotic wedges with foot assessment technique 1 (W1), and shod with orthotic wedges from a new assessment technique (W2). Biomechanical outcomes included lower limb and multi-segment foot kinematics in each subphase of the stance gait, including contact phase, midstance phase, and propulsive phase. RESULTS: Compared with shod, the W1 significantly increased rearfoot dorsiflexion, decreased peak forefoot dorsiflexion, and peak rearfoot eversion during the contact phase. In addition, W1 increased rearfoot inversion, decreased hallux dorsiflexion, and peak hallux dorsiflexion during the propulsive phase. For W2, the wedge significantly decreased peak knee internal rotation, decreased forefoot abduction, peak forefoot dorsiflexion, and peak rearfoot eversion during the contact phase. In addition, W2 increased rearfoot inversion, decreased hallux dorsiflexion, and decreased peak hallux dorsiflexion during the propulsive phase. When comparing W1 and W2, W1 showed greater rearfoot dorsiflexion during the contact phase. SIGNIFICANCE: These findings suggest that the use of forefoot varus wedges, and the combination of forefoot and rearfoot varus wedges, can change the lower limb kinematics, the multi-segment foot kinematics estimated using markers fixed to the shoe, and the relative length of the plantar fascia which can be associated with a reduction in pain and symptoms during walking.

The Adaptation of Participation Scale Short Simplified Questionnaire into Indonesian Language and the Psychometric Properties in Individuals with Type 2 Diabetes Mellitus with Vestibular Dysfunction.

Background: Type 2 diabetes mellitus (T2DM) has been reported to affect the vestibular system resulting in dizziness and vertigo complaints. This complication is known to disable the social participation. The Participation Scale Short Simplified (PSSS) has been developed to quantify the severity of social participation restrictions. The aim of this study was to translate and cross-culturally adapt the PSSS into Indonesian Bahasa (PSSS-Ina). The measurement properties of the translated version and the factors contributing to the severe participation restriction were determined. Methods: The participants comprised 55 T2DM with vestibular dysfunction (VD) in the community center for diabetes mellitus in Central Java, Indonesia. The signs of VD were confirmed by head impulse test, Dix Hallpike Test, and supine roll test. The PSSS-Ina was administered twice with a four-week interval. The physical examination was also performed to identify the contributing factors. Results: The test-retest reliability of the PSSS Indonesian Bahasa version (PSSS-Ina) between two measurement sessions was excellent (ICC of 0.93, p < 0.001, and 95% CI: 0.88-0.95). The correlation coefficient between two administrations was high (r = 0.88). Based on the demonstrated content validity, the values of the corrected item and total correlation were greater than 0.3. No floor and ceiling effects were observed. The good internal consistency was confirmed with Cronbach's alpha of 0.84. The factor analysis produced three factors of activity participation, social engagement, and work-related participation. The multiple logistic regression revealed that the balance performance of mCTSIB was the main factor contributing to the severe participation restriction reflected by the PSSS-Ina score. Conclusion: The Indonesian version of the PSSS-Ina demonstrated excellent comprehensibility and reliability in individuals suffering T2DM with VD. This tool is therefore helpful in identifying the participation limitation in individuals with VD.

Effects of physical-cognitive training on physical and psychological functions among older adults with type 2 diabetes and balance impairment: a randomized controlled trial.

Risks of falls among older adults are multifactorial in nature. A combined training program might be beneficial on fall-related outcomes. This study aimed to explore the effects of group-based physical-cognitive trainings on physical and psychological outcomes among older adults with type 2 diabetes mellitus (T2DM) and balance impairment. Fall incidence were also determined. Thirty-seven older adults with T2DM and balance impairment were randomly assigned to control and intervention groups. The intervention program comprised of 24 training sessions of 45-60 min exercise for 8 weeks. The exercise consisted of warm-up, aerobic exercise by nine square stepping, resistance exercise combined with cognitive training and cool down. All participants were assessed at baseline, 4 and 8 weeks after intervention, and 1-year follow-up. Both groups reported similar rates of falls. Global cognition, depressive symptoms, and fear of falling did not differ between groups at any time. The Timed Up & Go (TUG) test, alternate stepping test (AST), knee extensors, ankle plantarflexors, and dorsiflexors strength differed at 4 weeks. TUG, AST, hip abductors, knee flexors, ankle plantarflexors, and dorsiflexors strength differed at 8 weeks. The activity of daily living (ADL), TUG test (P=0.002) and AST, hip extensors and abductors, knee extensors and flexors, ankle plantarflexors and dorsiflexors were different at 1-year follow-up. The group-based physical-cognitive training could benefit older adults with T2DM in terms of maintaining ADL. The intervention could reduce fall risk factors by improving balance and lower limb muscle strength among older adults with T2DM and balance impairment.

Immediate effects of muscle energy technique and stabilization exercise in patients with chronic low back pain with suspected facet joint origin: A pilot study.

BACKGROUND: Facet joint is a potential structure to be the source of chronic low back pain (LBP) affecting lumbar motion, pain, and disability. Other than the recommended treatment of lumbar stabilization exercise (LSE), several manual procedures including muscle energy technique (MET) are commonly used in physical therapy clinic. However, little evidences of the effects of MET have been reported. OBJECTIVE: This study aimed to compare the immediate effects of MET and LSE in patients with chronic LBP with suspected facet joint origin. METHODS: Twenty-one patients with low back pain were recruited and randomly assigned to receive treatment either MET or LSE. The outcomes were kinematic changes, pain intensity, and disability level. Lumbar active range of motion (ROM) of flexion, extension, left and right lateral flexion, and left and right rotation were evaluated using the three-dimension motion analysis system at baseline and immediately after treatment. Pain intensity was evaluated using visual analogue scale (VAS) at baseline, immediately after, and two days after treatment. Thai version of the modified Oswestry disability questionnaire (ODQ) was utilized at baseline and two days after treatment. The mixed model analysis of variance was used to analyze all outcomes. RESULTS: The results showed that all outcomes were not different between groups after treatments. Although there were statistically significant improvements after the treatments when collapsing the groups, the minimal clinically important change was found only for pain but not for lumbar movements and disabilities scores. CONCLUSION: The effect of MET and LSE alone in single session might not be intensive enough to improve movements and decrease disability in patients with chronic LBP with suspected facet joint origin.

Intertester reliability of a movement impairment-based classification system for individuals with shoulder pain.

BACKGROUND: Other than pathoanatomical diagnosis, physical therapy managements need the diagnosis of movement-related impairments for guiding treatment interventions. The classification system of the Movement System Impairment (MSI) has been adopted to label the musculoskeletal disorders in physical therapy practice. However, reliability study of this classification system in individuals with shoulder pain has not been reported in the literature. OBJECTIVE: This paper investigated the intertester reliability of the diagnosis based on the MSI classification system in individuals with shoulder pain. METHODS: The patients with shoulder pain, between the ages 18-60 years, were recruited if he or she had pain between 30 and 70 on the 100 mm visual analog scale for at least three months. The examiners who were two physical therapists with different clinical experiences received a standardized training program. They independently examined 45 patients in random order. Each patient was examined by both therapists on the same day. The standardized examination scheme based on the MSI approach was used. Patients were identified to subgroup syndromes according to scapular and humeral syndromes and also determining their subcategory syndromes. Six scapular subcategory syndromes included downward rotated, depressed, abducted, wing, internal rotated/anterior tilted, and elevated. Three humeral subcategory syndromes were anterior glide, superior glide, and medial rotated. More than one subgroup and subcategory of syndromes could be identified in each patient. The test results of each session were blinded to another therapist. The percentages of agreement and kappa statistic were determined. RESULTS: The results showed that agreement levels in identifying subgroup syndromes was fair (71.11% agreement, kappa coefficient = 0.34) and classifying subcategories syndromes were poor to substantial (73.33-91.11% agreement, kappa coefficient = 0.20 - 0.66). The overall agreement and kappa value of the MSI classification of subcategory syndromes was poor (kappa coefficient = 0.11; 95% CI 0.05-0.18). The agreement level of subcategories for scapular depression and humeral superior glide syndromes was substantial. The scapular winging, depression, and downward rotation were the three syndromes that were most frequently identified by both the examiners. CONCLUSION: The intertester reliability between therapists with different experience according to the MSI approach for shoulder pain classification was generally acceptable to poor due to the nature of the classification system. The standardized procedure and intensive training can be used for inculcating novice therapists with adequate level of intertester reliability of examination.

Fear of Falling, Lower Extremity Strength, and Physical and Balance Performance in Older Adults with Diabetes Mellitus.

Fear of falling (FoF) is known to affect the physical activities and quality of life of older adults with type 2 diabetes mellitus (DM). Many complications of DM, especially ones distressing lower extremity (LE), could lead to increased fall risk and FoF. This study aimed to explore the relationship between FoF, LE muscle strength, and physical performance in older adults without diabetes mellitus (ONDM) and with DM (ODM) with varying degrees of balance impairment. The participants comprised 20 ONDM and 110 ODM. The ODM was grouped by the number of failed performances of the modified clinical test of sensory interaction and balance (mCTSIB). The scores of FoF, balance performance of mCTSIB, physical performance of TUG, and LE muscle strength were compared between groups. The results showed that FoF was present in 30% and 60% of the ONDM and ODM, respectively. Forty percent of the ODM failed one condition of the mCTSIB, while 18% and 16% failed two and three conditions, respectively. As the number of failed performances on the mCTSIB increased, the proportions of participants with FoF significantly increased. The psychosocial domain of FoF, LE muscle strength, and TUG score was significantly different between groups and more affected in the ODM with a greater number of failed performances on the mCTSIB. In conclusion, the mCTSIB can differentiate the varying degrees of balance impairment among ODM. FoF, LE muscle strength, and physical performance are more affected as the degree of balance impairment increases. Comprehensive management related to balance and falls in the ODM should include a regular evaluation and monitoring of standing balance, LE muscle strength, physical performance, and FoF.

Identification of knee osteoarthritis disability phenotypes regarding activity limitation: a cluster analysis.

BACKGROUND: Studies have reported the subtypes of individuals with knee osteoarthritis (OA) attempting to cluster this heterogonous condition. Activity limitations are commonly used to set goals in knee OA management and better identify subgroups based on level of disability in this patient population. Therefore, the objective of this study was to identify those activity limitations which could classify the disability phenotypes of knee OA. The phenotypes were also validated by comparing impairments and participation restrictions. METHODS: Participants comprised individuals with symptomatic knee OA. They were interviewed and undertook physical examination according to a standard evaluation forms based on the International Classification of Functioning, Disability and Health (ICF) model. Cluster analysis was used to determine those activity limitations which could best classify the phenotypes of knee OA. To validate the clustered variables, comparisons and regression analysis were performed for the impairments consisting of pain intensity, passive range of motion and muscle strength, and the participation restrictions included the difficulty level of acquiring goods and services and community life. RESULTS: In all, 250 participants with symptomatic knee OA were enrolled in the study. Three activity limitations identified from data distribution and literature were used as the cluster variables, included the difficulty level of maintaining a standing position, timed stair climbing and 40-m self-paced walk test. The analysis showed four phenotypes of individuals with knee OA according to the levels of disability from no to severe level of disability. All parameters of impairment and participation restrictions significantly differed among phenotypes. Subgroups with greater disability experienced worse pain intensity, limited range of motion (ROM), muscle power and participation restriction levels. The variance accounted for of the subgroups were also greater than overall participants. CONCLUSION: The results of this study emphasized the heterogeneous natures of knee OA. Three activity limitations identified could classify the individuals with symptomatic knee OA to homogeneous subgroups from no to severe level of disability. The management plan, based on these homogeneous subgroups of knee OA, could be designated by considering the levels of impairments and participation restrictions.

Effect of Sensory Impairment on Balance Performance and Lower Limb Muscle Strength in Older Adults With Type 2 Diabetes.

OBJECTIVE: To compare balance performance and lower limb muscle strength between older adults with type 2 diabetes mellitus (DM), with and without sensory impairments and non-DM groups. Influence of a number of sensory impairments, and muscle strength on balance performance were explored. METHODS: Ninety-two older adults with and without type 2 DM, were examined relative to visual function with the Snellen chart, Melbourne Edge test, and Howard-Dolman test, vestibular function with the modified Romberg test, proprioception of the big toe, and diabetic peripheral neuropathy with the Michigan Neuropathy Screening Instrument. Balance performances were evaluated with the Romberg test, Functional Reach Test (FRT), and Timed Up and Go test (TUG). Strength of knee and ankle muscles was measured. RESULTS: FRT of type 2 DM groups with at least two sensory impairments, was lower than the non-DM group (p<0.05). TUG of all DM groups, was worse than the non-DM group (p<0.01). Lower limb muscle strength of type 2 DM groups with two and three sensory impairments, was weaker than non-DM group (p<0.05). Regression analysis showed that type 2 DM with three sensory impairments, ankle dorsiflexors strength, and age were influential predictors of TUG. CONCLUSION: There were significant differences, of muscle strength and balance performance among groups. Poorer balance and reduced lower limb strength were marked in older adults with type 2 DM, even ones without sensory impairment. Muscle weakness seemed to progress, from the distal part of lower limbs. A greater number of sensory impairments, weaker dorsiflexors, and advanced age influenced balance performance.

Development of an extensive assessment list for knee osteoarthritis based on the International Classification of Functioning, Disability and Health: a Delphi study.

The objective of this study was to develop an extensive assessment list for individuals with knee osteoarthritis based on the International Classification of Functioning, Disability and Health (ICF) osteoarthritis comprehensive Core Set. Ten experienced physical therapists including five lecturers and five clinicians were purposively nominated to form an expert panel. Consensus among the experts was obtained through a four-iteration Delphi technique. A list of ICF categories and their third- and fourth-level categories were selected and matched with outcome measures associated with knee osteoarthritis. The expert panel agreed that 26 out of 38 second-level categories of the comprehensive ICF core set for osteoarthritis were relevant to identify problems related to knee osteoarthritis. The information relevant to the specific categories for knee osteoarthritis was obtained from self-reported, subjective observation and physical examination. The extensive assessment list for knee osteoarthritis based on the comprehensive ICF core set for osteoarthritis was assembled. This assessment tool can be used to expansively identify the multidimensional disabilities of impairment, activity limitation and participation restriction in individuals with knee osteoarthritis.

Predictors of Community Participation Among Individuals With First Stroke: A Thailand Study.

OBJECTIVE: To describe perceived participation among persons with first stroke and to identify the predictors based on the International Classification of Functioning, Disability and Health (ICF) concept of participation after stroke. METHODS: A total of 121 participants completed 4 questionnaires: the Impact on Participation and Autonomy (IPA), Personal Resource Questionnaire (PRQ2000), Hospital Anxiety and Depression Scale (HADS), and personal history. They were evaluated for their balance, motor function, functional and walking ability. RESULTS: The majority of participants perceived participation restriction in family role as poor to very poor. The best predictors of participation included social support, walking and balance, functional ability, number of secondary health problems and affected side, account for 66.6% of the variances in participation. CONCLUSION: The study highlights the importance of social support, walking and balance performance, functional ability in daily living, and number of secondary health problems after stroke. These factors that facilitate participation after stroke should be addressed by health personnel during rehabilitation.

Effects of physical, virtual reality-based, and brain exercise on physical, cognition, and preference in older persons: a randomized controlled trial.

BACKGROUND: Physical exercise (PE), virtual reality-based exercise (VRE), and brain exercise (BE) can influence physical and cognitive conditions in older persons. However, it is not known which of the three types of exercises provide the best effects on physical and cognitive status, and which exercise is preferred by older persons. This study compared the effects of PE, VRE, and BE on balance, muscle strength, cognition, and fall concern. In addition, exercise effort perception and contentment in older persons was evaluated. METHODS: Eighty-four older persons (n = 84) were randomly selected for PE, VRE, BE, and control groups. The exercise groups received 8-week training, whereas the control group did not. Balance was assessed by Berg Balance Scale (BBS) and Timed Up and Go test (TUG), muscle strength by 5 Times Sit to Stand (5TSTS) and left and right hand grip strength (HGS), cognition by Montreal Cognitive Assessment (MoCA) and Timed Up and Go test Cognition (TUG-cog), fall concern by Fall Efficacy Scale International (FES-I), exercise effort perception by Borg category ratio scale (Borg CR-10), and exercise contentment by a questionnaire. RESULTS: After exercise, PE significantly enhanced TUG and 5TSTS to a greater extent than VRE (TUG; p = 0.004, 5TSTS; p = 0.027) and BE (TUG; p = 0,012, 5TSTS; p < 0.001). VRE significantly improved MoCA (p < 0.001) and FES-I (p = 0.036) compared to PE, and 5TSTS (p < 0.001) and FES-I (p = 0.011) were improved relative to BE. MoCA was significantly enhanced by BE compared to PE (p < 0.001) and both MoCA and TUG-cog were improved compared to VRE (p = 0.04). PE and VRE significantly (p < 0.001) increased Borg CR-10 in all exercise sessions, whereas BE showed a significant improvement (p < 0.001) in the first 4 sessions. Participants had a significantly greater satisfaction with BE than controls (p = 0.006), and enjoyed VRE and BE more than PE (p < 0.001). Subjects in all exercise groups exhibited benefits compared to the control group (p < 0.001). CONCLUSIONS: PE provided the best results in physical tests, VRE produced measurable improvements in physical and cognition scores, while BE enhanced cognition ability in older persons. Older persons preferred VRE and BE compared to PE. Both exercises are suggested to older persons to improve physical and cognitive conditions.

Agreement of clinical examination for low back pain with facet joint origin.

BACKGROUND: Low back pain (LBP) with facet joint origin is a common diagnosis of patients referred to physical therapy clinic. An expert consensus of diagnostic criteria has been proposed. However, the reliability of the assessment has not been proved. OBJECTIVE: To test the degrees of agreement between two physical therapists for nine physical examination items and the diagnosis of facet joint origin. METHODS: The examination according to diagnostic criteria was performed independently by two physical therapists in 45 patients with chronic LBP. The percent agreements and Kappa coefficients of each examination item and diagnostic conclusion were calculated. RESULTS: The percent agreements of nine examined items ranged from 73.3-91.1%. The Kappa coefficients, widely ranged from 0.250-0.690 ( p = 0 . 48 to < 0 . 001 ), showed statistically significant agreements for all examination items. The low level of agreements was partly due to improper distributions of test results. The agreement of conclusion was 86.7% and Kappa coefficient was 0.492 ( p = 0 . 001 ) which reflected good agreement of facet diagnosis. CONCLUSION: There were adequate agreements for clinical examination of LBP with facet joint origin. The low level of agreement suggested the clinicians to have operational definition and rigorous training sessions although the examinations seemed to be routinely performed.

Predictors of the Functional Abilities in Individuals with Stroke after Home Physical Therapy Program.

Background: Community stroke rehabilitation has been reported to be beneficial. Evidences of factors influencing the functional outcomes of home based treatment were limited. Objective: To identify the predictors of the activities of daily living (ADL) function of individuals with stroke after obtaining treatment program at home. Material and Method: Three hundred sixty five individuals with stroke that participated in the home rehabilitation program were included in the present study. The patients received six months of physical therapy treatment program at home according to the results of evaluations. Personal characteristics and clinical outcomes including Gasglow coma, Barthel index (BI), Postural Assessment Scale for Stroke Patients (PASS), and Stroke Rehabilitation Assessment of Movement (STREAM) were recorded. Results: At discharge, five variables were identified as the predictors of Barthel index scores and explained 90.5% of variances. The PASS maintaining position was the strongest predictors contributing 86.0%. The STREAM, PASS changing position, Gasglow coma score and age then added 4.5% of variances explanation of the BI score. Conclusion: The ability to perform ADL in stroke patients was greatly explained by the ability to maintain positions at the time of discharging from the rehabilitation program at home. Other outcomes contributed in the different manners compared to the time of starting rehabilitation program.

Capacity of Physiotherapy Workforce Production in Thailand: Public-Private Mix, Secular Trend and Geographic Distribution.

BACKGROUND AND PURPOSE: In Thailand, the shortage of physiotherapists has been an increasing concern because of increased health burden from demographic and epidemiologic changes. This study aims to analyse the current situation of the physiotherapy workforce production system, secular trend, geographical distribution and comparison of public and private physiotherapy training institutes. METHODS: Longitudinal data related to production capacity of the physiotherapy institutes were applied. Data from 2008 to 2012 were obtained from all 16 physiotherapy institutes in Thailand. Data during 2000-2007 were also retrieved from annual reports from the Ministry of Education. Descriptive statistics were initially used. Comparison was made between public and private physiotherapy institutes in terms of the number of students admitted and graduated, number of teachers, annual tuition fee, student-teacher ratio and dropout rate within 1 year. Predictive factors for graduation within 4 years were determined using logistic regression. RESULTS: In Thailand, there was an average of 800 physiotherapy graduates per year. New private institutes have been recently established and have steadily increased student admission rates. However, this has resulted in a high student-teacher ratio (median 7.1, inter-quartile range (IQR) 5.9-10.0). The first-year dropout rate in 2012 was 29.1%. Geographically, the majority of the institutes are clustered in the central region. Multivariate analysis revealed significantly lower probability of graduation within 4 years among students admitted to the private institutes and those in non-north-east region. CONCLUSION: The production capacity of the physiotherapy workforce is below an estimated need. Private physiotherapy institutes need more support to improve the situation of staff shortages and student graduation rates. The non-central regions should be encouraged to produce more physiotherapists. Copyright © 2015 John Wiley & Sons, Ltd.

Plantar Pressure Distribution Pattern during Mid-Stance Phase of the Gait in Patients with Chronic Non-Specific Low Back Pain.

OBJECTIVE: To examine the characteristics of the plantar pressure distribution patterns during mid-stance phase of the gait cycle in subjects with chronic non-specific low back pain and asymptomatic subjects. MATERIAL AND METHOD: Twenty-three males and 17 females with chronic non-specific low back pain and age- and gender-matched asymptomatic subjects walked barefoot along a gait mat at comfortable speedfor three trials. The left and right plantar pressure distributions were recorded during mid-stance phase and divided into 12 areas. Descriptive statistics including mean and standard deviation of demographic data and plantar pressure were calculated, and plantar pressure distribution patterns were described. RESULTS: Mean and standard deviation of numeric pain rating scale of chronic non-specific low back pain group were 4.04±1.58. The average mean peak pressure of both chronic non-specific low back pain and asymptomatic subjects located at the fifth area (lateral aspect offorefoot) in both feet. However the modes of the peak pressure of subjects with chronic non-specific low back pain were in the different areas in the left and right feet. The distribution patterns of the average mean peak pressure were not the same in chronic non-specific low back pain and asymptomatic subjects. This altered foot contact in the subjects with chronic non-specific low back pain may be used to avoid pain or to compensate for limited mobility of the lower limbs at pre-swing phase. CONCLUSION: At mid-stance phase of walking, the pressures on the plantar surface were unequally distributed in subjects with chronic non-specific low back pain.

The Adaptive Patterns of Pelvic Alignment in Individuals with Adolescent Idiopathic Scoliosis.

OBJECTIVE: To investigate the adaptive pattern of pelvic alignment and to determine the correlations between pelvic alignment and Angle of Trunk Rotation (ATR) of each curve type in individuals with Adolescent Idiopathic Scoliosis (AIS). MATERIAL AND METHOD: This cross-sectional study of 31 AIS subjects was divided according to single or double curve patterns. Demographic data and A TR were collected. Five-view photos were shot before using Scion Image Software to calculate pelvic alignment. Independent t-test was used to compare pelvic alignment between groups. Pearson's correlation coefficient was used to identify the correlation between pelvic alignment and ATR. RESULTS: The subjects with single and double curves, showed significant difference in the right sagittal and transverse planes (p = 0.021). The double-curve group showed significant negative correlation of anterior-pelvic-obliquity and ATR (p = 0.037), significant positive correlations of left-pelvic-tilt and ATR (p = 0.021), and right-pelvic-tilt and ATR (p = 0.005). The major-curve group showed significant negative correlation of anterior-pelvic-obliquity and ATR (p = 0.014), significant positive correlation of right-pelvic-tilt and ATR (p = 0.021), and top-pelvic-rotation and ATR (P = 0.032). The near-pelvis-curve group showed only significant negative correlation ofanterior-pelvic-obliquity and ATR (p = 0.032). CONCLUSION: Both AIS groups showed different pelvic tilt and rotation. ATR showed the correlation with pelvic tilt and obliquity in double-curve group only. A larger curve influenced the pelvic-spinal rotation relationship more than the near-pelvic-curve. Thus, awareness ofpelvic alignment in AIS assessment and treatment is recommended.