Allied Health Professions Accreditation Standards for Work Integrated Learning: A Document Analysis.

A key role of allied health (AH) professional regulatory and professional bodies is to ensure that AH education programs provide work-integrated learning (WIL) opportunities for students. The requirements are outlined via the respective profession's educational accreditation standards. Although a significant component of the AH professional degrees, researchers have not explored how standards specific to WIL are developed, nor how WIL might be conceptualised through the standards. This study explored how WIL is conceptualised through comparing the WIL education standards across Australian AH professions. Using a non-experimental explanatory mixed-methods research design, a document analysis of Australian education program accreditation standards (and associated documents) for 15 AH professions was undertaken. Data analysis included inductive textual and thematic analyses to compare AH professionals' conceptualisation of WIL. This study found a high degree of variation in how AH professions describe WIL. While there was a common requirement for students to demonstrate competency in WIL, requirements for WIL quantity, assessment and supervision varied. Four key themes were identified regarding the contribution of WIL to curriculum and student learning: (1) the relationship between WIL and the program curriculum; (2) WIL as a learning process; (3) learning from diverse WIL contexts; and (4) developing competence through WIL. Overall, the diversity in the standards reflected differing understandings of what WIL is. Thus, in the absence of frameworks for designing accreditation standards, the risk is that some AH professions will continue to perpetuate the myth that the primary purpose of WIL is to provide a bridge between theory and practice.

Identification of factors important to study quality in exercise performance studies.

OBJECTIVES: This study aimed to identify factors important to quality in exercise performance studies, specifically in the domains of aerobic, anaerobic and strength exercise. Factors related to diet and body composition were also targeted as these often influence or change with exercise. DESIGN: Cross-sectional study employing focus groups and a modified Delphi method. METHODS: Academic staff and research students within the discipline of exercise science in a research-intensive university participated in focus groups to generate discipline-specific factors important to study quality. These factors were subsequently presented in a modified Delphi survey to a panel of international researchers with expertise in at least one of the domains. Item consensus was defined as >70% agreement on importance. The initial round contained all items generated from the focus groups. Subsequent rounds only presented items where consensus was not achieved, and additional items suggested by participants. RESULTS: The academic staff (n = 10) and research students (n = 9) generated 22 items generic to all exercise performance studies and 71 domain-specific items. Over two Delphi survey rounds involving 18 international researchers, consensus on importance was achieved for 19 generic items. Identified factors addressed exercise testing and prescription protocols, equipment and compliance to interventions. Consensus on 66 specific items was achieved but was limited by small domain-specific participant numbers (4-8). CONCLUSIONS: Numerous discipline-specific factors were identified as important to study quality. These factors can subsequently be used to inform the development of a tool to evaluate study quality in exercise performance research or inform best clinical practice.

Feasibility of the PHYZ X 2U program: a mobile and cloud-based outreach service to improve chronic disease outcomes in underserviced rural communities.

Chronic disease is prevalent in rural communities, but access to health care is limited. Allied health intervention, incorporating behaviour change and exercise, may improve health outcomes. PHYZ X 2U is a new service delivery model incorporating face-to-face consultations via a mobile clinic and remote health coaching, delivered by physiotherapy and exercise physiology clinicians and university students on clinical placement, to provide exercise programs to people living with chronic disease in rural New South Wales, Australia. This pilot study evaluated the feasibility and acceptability of PHYZ X 2U by evaluating participants' goal attainment, exercise, quality of life and behaviour change following participation in the 12-week program, and amount of health coaching received. Sixty-two participants with one or more chronic diseases set a total of 123 goals. Thirty-nine (63%) participants completed the program, with 59% of these achieving their goals and 43% progressing in their attitudes and behaviour towards exercise. Weekly exercise increased by 1h following program participation (P=0.02), but quality of life remained unchanged (P=0.24). Participants who completed the program received more health coaching than those lost to follow up. PHYZ X 2U can increase access to allied health for people with chronic disease living in rural and remote areas. Refining the service to maximise program adherence and optimally manage a broad range of chronic diseases is required.

Predictors of recurrent sprains after an index lateral ankle sprain: a longitudinal study.

OBJECTIVE: To explore and identify the predictors of ankle sprain after an index (first) lateral ankle sprain. DESIGN: Prospective cohort study, Level of evidence II. SETTING: Musculoskeletal research laboratory at the University of Sydney. PARTICIPANTS: A sample of convenience (70 controls, 30 with an index sprain) was recruited. METHODS: Potential predictors of ankle sprain were measured including: demographic measures, perceived ankle instability, ankle joint ligamentous laxity, passive range of ankle motion, balance, proprioception, motor planning and control, and inversion/eversion peak power. Participants were followed up monthly and the number of ankle sprains was recorded over 12 months. RESULTS: Ninety-six participants completed the study; 10 participants sustained an ankle sprain. A combination of 10 predictors including: a recent index sprain, younger age, greater height and weight, perceived instability, increased laxity, impaired balance, and greater inversion/eversion peak power explained 27 to 56% of the variance in occurrence of ankle sprain (χ211,95=30.67, p=0.001). The regression model correctly classified 90% of cases. The strongest independent predictors were history of an index sprain (odds ratio (OR)=8.23, 95% confidence interval (CI)=1.66 to 40.72) and younger age (OR=8.41, 95%CI=1.48 to 47.96). CONCLUSION: A recent index ankle sprain and younger age were the only independent predictors of ankle sprain. The combination of greater height or weight, feeling of instability, peak power and impaired balance predicted the occurrence of ankle sprain in almost 90% of participants. These findings could form the basis for intervention targeted at reducing recurrence of sprain after an index sprain.

Gait patterns of children and adolescents with Charcot-Marie-Tooth disease.

Gait abnormalities reported in childhood Charcot-Marie-Tooth disease (CMT) include foot-drop, reduced ankle power at push-off and increased knee and hip flexion for swing clearance ('steppage-gait'). The purpose of this study was to describe the gait patterns of 60 children aged 6-17 years with CMT (CMTall) and distinguish differences based on functional weakness using the CMT Pediatric Scale (CMTPedS). Data were captured using Vicon Nexus system and compared to 50 healthy norms. Data were subdivided into three groups denoting increasing severity of dorsiflexion and plantarflexion weakness from the CMTPedS: no difficulty heel or toe walking (CMTND), difficulty heel walking (CMTDH), difficulty toe and heel walking (CMTDTH). Compared to healthy norms, CMTall demonstrated significantly worse gait profile score, reduced ankle dorsiflexion during swing (foot-drop), reduced ankle dorsiflexor moment in loading response and reduced external thigh-foot angle. Contrary to previous studies there were no signs of reduced ankle power or compensation through 'steppage gait' in this mild-moderately affected population. Instead, CMTall demonstrated reduced internal hip rotation and reduced hip abductor moment. When data were sub-grouped and compared to healthy norms, three different gait patterns at the ankle emerged: CMTND had a near-normal gait pattern, CMTDH presented with foot-drop, and CMTDTH had increased peak dorsiflexion and reduced ankle power generation. Several distinct and abnormal gait patterns were identified in children with CMT, with increasing gait abnormalities in more functionally severe cases. Classifying gait patterns based on disease severity might be a valuable tool in clinical decision making, assessing disease progression and phenotype-genotype correlation studies.

The effect of ankle taping on functional performance in participants with functional ankle instability.

OBJECTIVE: To investigate the effect of rigid ankle tape on functional performance, self-efficacy and perceived stability, confidence and reassurance during functional tasks in participants with functional ankle instability. DESIGN: Clinical measurement, crossover design. METHODS: Participants (n = 25) with functional ankle instability (Cumberland Ankle Instability Score < 25) were recruited from university students and sporting clubs. Participants performed five functional tests with and without the ankle taped. The tests were: figure-8 hopping test, hopping obstacle course, star excursion balance test (SEBT), single-leg stance and stair descent test. Secondary outcome measures were self-efficacy and perception measures. RESULTS: Rigid tape significantly decreased the stair descent time by 4% (p = 0.014), but had no effect on performance in the other tests. Self-efficacy increased significantly (p < 0.001). Perceived stability, confidence and reassurance also increased with the ankle taped (p < 0.05) during the stair and two hopping tasks, but not during the SEBT or single-leg stance test. CONCLUSION: Although taping the ankle did not affect performance, except to improve stair descent, it increased self-efficacy and perceived confidence in dynamic tasks. These findings suggest that taping may reduce apprehension without affecting functional performance in those with functional ankle instability and permit continued physical activity or sport participation.

Safety and efficacy of progressive resistance exercise for Charcot-Marie-Tooth disease in children: a randomised, double-blind, sham-controlled trial.

BACKGROUND: Exercise is potentially therapeutic for neuromuscular disorders, but a risk of harm exists due to overwork weakness. We aimed to assess the safety and efficacy of progressive resistance exercise for foot dorsiflexion weakness in children with Charcot-Marie-Tooth disease. METHODS: We did this randomised, double-blind, sham-controlled trial across the Sydney Children's Hospitals Network (NSW, Australia). Children aged 6-17 years with Charcot-Marie-Tooth disease were eligible if they had foot dorsiflexion weakness (negative Z score based on age-matched and sex-matched normative reference values). We randomly allocated (1:1) children, with random block sizes of 4, 6, and 8 and stratification by age, to receive 6 months (three times per week on non-consecutive days; 72 sessions in total) of progressive resistance training (from 50% to 70% of the most recent one repetition maximum) or sham training (negligible non-progressed intensity), using an adjustable exercise cuff to exercise the dorsiflexors of each foot. The primary efficacy outcome was the between-group difference in dorsiflexion strength assessed by hand-held dynamometry (expressed as a Z score) from baseline to months 6, 12, and 24. The primary safety outcome was the between-group difference in muscle and intramuscular fat volume of the anterior compartment of the lower leg assessed by MRI (expressed as a scaled volume) from baseline to 6 months and 24 months. Participants, parents, outcome evaluators, and investigators other than the treatment team were masked to treatment assignment. Analysis was by intention to treat. The trial is registered with the Australian New Zealand Clinical Trials Registry, number ACTRN12613000552785. FINDINGS: From Sept 2, 2013, to Dec 11, 2014, we randomly assigned 60 children to receive progressive resistance exercise (n=30) or sham training (n=30), and 55 (92%) children completed the trial. ANCOVA-adjusted Z score differences in dorsiflexion strength between groups were 0 (95% CI -0·37 to 0·42; p=0·91) at 6 months, 0·3 (-0·23 to 0·81; p=0·27) at 12 months, and 0·6 (95% CI 0·03 to 1·12; p=0·041) at 24 months. Scaled muscle and fat volume was comparable between groups at 6 months (ANCOVA-adjusted muscle volume difference 0, 95% CI -0·03 to 0·10, p=0·24; and fat volume difference 0, 95% CI -0·01 to 0·05, p=0·25) and 24 months (0, -0·08 to 0·12, p=0·67; and 0, -0·05 to 0·03, p=0·58). No serious adverse events were reported. INTERPRETATION: 6 months of targeted progressive resistance exercise attenuated long-term progression of dorsiflexion weakness without detrimental effect on muscle morphology or other signs of overwork weakness in paediatric patients with Charcot-Marie-Tooth disease. FUNDING: Muscular Dystrophy Association and Australian National Health and Medical Research Council.

Using Balance Tests to Discriminate Between Participants With a Recent Index Lateral Ankle Sprain and Healthy Control Participants: A Cross-Sectional Study.

CONTEXT: The first step to identifying factors that increase the risk of recurrent ankle sprains is to identify impairments after a first sprain and compare performance with individuals who have never sustained a sprain. Few researchers have restricted recruitment to a homogeneous group of patients with first sprains, thereby introducing the potential for confounding. OBJECTIVE: To identify impairments that differ in participants with a recent index lateral ankle sprain versus participants with no history of ankle sprain. DESIGN: Cross-sectional study. PATIENTS OR OTHER PARTICIPANTS: We recruited a sample of convenience from May 2010 to April 2013 that included 70 volunteers (age = 27.4 ± 8.3 years, height = 168.7 ± 9.5 cm, mass = 65.0 ± 12.5 kg) serving as controls and 30 volunteers (age = 31.1 ± 13.3 years, height = 168.3 ± 9.1 cm, mass = 67.3 ± 13.7 kg) with index ankle sprains. MAIN OUTCOME MEASURE(S): We collected demographic and physical performance variables, including ankle-joint range of motion, balance (time to balance after perturbation, Star Excursion Balance Test, foot lifts during single-legged stance, demi-pointe balance test), proprioception, motor planning, inversion-eversion peak power, and timed stair tests. Discriminant analysis was conducted to determine the relationship between explanatory variables and sprain status. Sequential discriminant analysis was performed to identify the most relevant variables that explained the greatest variance. RESULTS: The average time since the sprain was 3.5 ± 1.5 months. The model, including all variables, correctly predicted a sprain status of 77% (n = 23) of the sprain group and 80% (n = 56) of the control group and explained 40% of the variance between groups ([Formula: see text] = 42.16, P = .03). Backward stepwise discriminant analysis revealed associations between sprain status and only 2 tests: Star Excursion Balance Test in the anterior direction and foot lifts during single-legged stance ([Formula: see text] = 15.2, P = .001). These 2 tests explained 15% of the between-groups variance and correctly predicted group membership of 63% (n = 19) of the sprain group and 69% (n = 48) of the control group. CONCLUSIONS: Balance impairments were associated with a recent first ankle sprain, but proprioception, motor control, power, and function were not.

1000 Norms Project: protocol of a cross-sectional study cataloging human variation.

BACKGROUND: Clinical decision-making regarding diagnosis and management largely depends on comparison with healthy or 'normal' values. Physiotherapists and researchers therefore need access to robust patient-centred outcome measures and appropriate reference values. However there is a lack of high-quality reference data for many clinical measures. The aim of the 1000 Norms Project is to generate a freely accessible database of musculoskeletal and neurological reference values representative of the healthy population across the lifespan. METHODS/DESIGN: In 2012 the 1000 Norms Project Consortium defined the concept of 'normal', established a sampling strategy and selected measures based on clinical significance, psychometric properties and the need for reference data. Musculoskeletal and neurological items tapping the constructs of dexterity, balance, ambulation, joint range of motion, strength and power, endurance and motor planning will be collected in this cross-sectional study. Standardised questionnaires will evaluate quality of life, physical activity, and musculoskeletal health. Saliva DNA will be analysed for the ACTN3 genotype ('gene for speed'). A volunteer cohort of 1000 participants aged 3 to 100 years will be recruited according to a set of self-reported health criteria. Descriptive statistics will be generated, creating tables of mean values and standard deviations stratified for age and gender. Quantile regression equations will be used to generate age charts and age-specific centile values. DISCUSSION: This project will be a powerful resource to assist physiotherapists and clinicians across all areas of healthcare to diagnose pathology, track disease progression and evaluate treatment response. This reference dataset will also contribute to the development of robust patient-centred clinical trial outcome measures.

Correlates of functional ankle instability in children and adolescents with Charcot-Marie-Tooth disease.

BACKGROUND: Functional ankle instability (FAI) is commonly reported by children and adolescents with Charcot-Marie-Tooth disease (CMT), however,, the specific variables associated with FAI remain unknown. An improved understanding of these variables may suggest interventions to improve ankle stability and possibly prevent the long-term complications associated with ankle instability in this population. The aim of this study was to therefore investigate the relationship between FAI and other functional, structural, anthropometric and demographic characteristics in a cross sectional sample of children and adolescents with CMT. METHODS: Thirty children and adolescents with CMT aged 7-18 years were recruited from the Peripheral Neuropathy Clinics of a large tertiary paediatric hospital. Measures of FAI were obtained using the Cumberland Ankle Instability Tool (CAIT). Demographic and anthropometric data was also collected. Other variables collected included foot structure (Foot Posture Index), ankle range of motion (weight bearing lunge) and functional parameters (balance, timed motor function and falls). Descriptive statistics were calculated to characterise the participants. Pearson's correlation coefficients were calculated to investigate the correlates of right and left FAI and demographic (age), anthropometric (height, weight, BMI), foot/ankle (foot structure and ankle flexibility) and functional parameters (balance task, timed motor function and falls frequency). Point biserial correlation was employed to correlate gender with right and left FAI. RESULTS: All but one study participant (n = 29) reported moderate to severe bilateral FAI with females reporting significantly greater ankle instability than males. FAI was significantly associated with cavus foot structure (r = .69, P < .001), female gender (r = -.47, P < .001) and impaired balance (r = .50, P < .001). CONCLUSIONS: This study confirms FAI is common in children and adolescents with CMT. An examination of the correlates of FAI suggests interventions, which target balance, and normalise foot structure should be explored to evaluate whether they might help to improve ankle stability in this population.

Energy expenditure in individuals with spinal cord injury quantified by doubly labeled water and a multi-sensor armband.

BACKGROUND: The objective of this study was to determine whether doubly labeled water (DLW) and a multi-sensor armband (SWA) could detect the variation in energy expenditure incurred by a period of increased exercise (EXE) versus a period of high sedentary activity (SED), in individuals with spinal cord injury (SCI). METHODS: Eight participants with SCI were submitted to 2 testing periods of energy expenditure assessment: 1) a 14-day phase during which sedentary living conditions were imposed and 2) a 14-day phase during which an exercise training intervention was employed. For each phase, total daily energy expenditure (TDEE) and physical activity energy expenditure (PAEE) were measured by DLW and SWA. RESULTS: Mean TDEE assessed by DLW, was significantly higher during EXE versus SED (11,605 ± 2151 kJ·day⁻¹ and 10,069 ± 2310 kJ·day⁻¹). PAEE predicted by DLW was also significantly higher during EXE versus SED (5422 ± 2240 kJ·day⁻¹ and 3855 ± 2496 kJ·day⁻¹). SWA-predicted PAEE significantly underestimated PAEE measured by the DLW during SED and EXE. CONCLUSION: DLW is sensitive to detect variation in within-individual energy expenditure during voluntary increase in physical activity in individuals with SCI. SWA failed to detect statistically significant variations in energy expenditure between periods of high versus low activity in SCI.

Randomised controlled trial protocol of foot and ankle exercise for children with Charcot-Marie-Tooth disease.

INTRODUCTION: Charcot-Marie-Tooth disease (CMT) is one of the most commonly inherited neuromuscular diseases--there is no effective treatment. Foot and ankle weakness is a major problem for children with CMT, thus interventions that focus on maintaining and increasing strength may provide a solution. RESEARCH QUESTION: Is progressive resistance strength training an effective and safe intervention to improve strength, disability, gait and quality of life of children with CMT? PARTICIPANTS AND SETTING: Sixty children (6 to 17 years) with confirmed CMT who reside in Sydney, Australia will be recruited via referral from a paediatric neurologist, advertisements or the Australasian Paediatric CMT Registry. INTERVENTION: Participants will be randomised to undergo a 24-week, thrice weekly, high-intensity progressive resistance foot and ankle exercise programme (HIGH) or low-intensity foot and ankle exercise control programme (LOW). MEASUREMENTS: Out-come measures will be conducted at baseline, 6, 12 and 24 months.The primary outcome is isometric dorsiflexion strength measured by hand-held dynamometry. Secondary outcomes include disability, gait, quality of life, functional ankle instability and muscle volume and fatty infiltration of the anterior compartment of the lower leg (determined by MRI). PROCEDURE: Randomisation and allocation will be by a computer-generated algorithm, maintained and assigned by an external phone-based system, concealed to the investigators. Participants, parents and the outcome assessors will be blinded to group assignment. ANALYSIS: Treatment effect between groups is by intention-to-treat with a linear regression approach to analysis of covariance using 95% CI and p < 0.05. DISCUSSION: This study is the first randomised controlled trial to evaluate the risks and benefits of strengthening the affected muscles in children with CMT. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry. REGISTRATION NUMBER: ACTRN12613000552785.

Predictors of chronic ankle instability after an index lateral ankle sprain: a systematic review.

OBJECTIVES: To identify the predictors of chronic ankle instability after an index lateral ankle sprain. DESIGN: Systematic review. METHODS: The databases of MEDLINE, CINAHL, AMED, Scopus, SPORTDiscus, Embase, Web of Science, PubMed, PEDro, and Cochrane Register of Clinical Trials were searched from the earliest record until May 2013. Prospective studies investigating any potential intrinsic predictors of chronic ankle instability after an index ankle sprain were included. Eligible studies had a prospective design (follow-up of at least three months), participants of any age with an index ankle sprain, and had assessed ongoing impairments associated with chronic ankle instability. Eligible studies were screened and data extracted by two independent reviewers. RESULTS: Four studies were included. Three potential predictors of chronic ankle instability, i.e., postural control, perceived instability, and severity of the index sprain, were investigated. Decreased postural control measured by number of foot lifts during single-leg stance with eyes closed and perceived instability measured by Cumberland Ankle Instability Tool were not predictors of chronic ankle instability. While the results of one study showed that the severity of the initial sprain was a predictor of re-sprain, another study did not. CONCLUSIONS: Of the three investigated potential predictors of chronic ankle instability after an index ankle sprain, only severity of initial sprain (grade II) predicted re-sprain. However, concerns about validity of the grading system suggest that these findings should be interpreted with caution.

Exercise, energy expenditure, and body composition in people with spinal cord injury.

BACKGROUND: The objective of this study was to verify the long-term effects of exercise on energy expenditure and body composition in individuals with spinal cord injury (SCI), as very little information is available on this population under free-living conditions. METHODS: Free-living energy expenditure and body composition using doubly labeled water (DLW) was measured in 13 individuals with SCI, subdivided in 2 groups: (1) sedentary (SED; N = 7) and (2) regularly engaged in any exercise program, for at least 150 min·wk(-1) (EXE; N = 6). RESULTS: The total daily energy expenditure (TDEE) was significantly higher in the EXE group (33 ± 4.5 kcal·kg(-1)·day(-1)) if compared with SED group (27 ± 4.3 kcal·kg(-1)·day(-1)). The percentage of body fat was significantly higher in SED group than in EXE group (38 ± 6% and 28 ± 9%). CONCLUSION: Our findings revealed that, despite the severity of SCI, the actual ACSM's guidelines for weight management for healthy adults exercise could significantly increase TDEE and BMR and improve body composition in individuals who regularly perform exercise. However, the EXE group still showed a high percentage of body fat, suggesting that a more specific approach might be considered (ie, increased intensity or volume, or combining with a diet program).

High-intensity progressive resistance training improves flat-ground walking in older adults with symptomatic peripheral arterial disease.

OBJECTIVES: To assess the efficacy of whole-body progressive resistance training (PRT) as a treatment for the symptoms of peripheral arterial disease (PAD) in older adults. DESIGN: Randomized controlled pilot trial. SETTING: University clinical weight training facility in Sydney, Australia. PARTICIPANTS: Twenty-two older adults with symptomatic PAD. INTERVENTIONS: The efficacy of supervised whole-body high-intensity PRT (H-PRT) with low-intensity nonprogressive resistance training (L-RT) and a usual care control group that performed unsupervised walking for 6 months was compared. MEASUREMENTS: Pilot outcome measures included 6-minute walk (6 MW) outcomes, body composition, dynamic muscle strength and endurance, and performance-based tests of function. RESULTS: Mean age was 71.1 ± 7.2. Mean ankle brachial index was 0.55 ± 0.13. Exercise adherence was similar in all groups (P = .29). H-PRT (n = 8) improved total 6MW distance (mean difference (MD) 62.6 ± 58.0 m, P = .02) significantly more than L-RT (n = 7; MD=-48.2 ± 67.6 m) and controls (n = 7; MD=-9.9 ± 52.9 m). Change in 6MW onset of claudication was significantly and independently related to change in bilateral calf endurance (correlation coefficient (r) = 0.65, P = .03), and change in 6MW distance was significantly and independently related to change in bilateral hip extensor endurance (r = 0.71, P = .02) in all groups. CONCLUSION: H-PRT significantly improved 6MW ability in older adults with intermittent claudication from PAD, whereas L-RT and unsupervised walking did not. Improvement in walking ability was significantly related to improvements in bilateral calf and hip extensor endurance, supporting further investigations targeted at musculoskeletal impairment in this cohort.

The effect of exercise on fitness and performance-based tests of function in intermittent claudication: a systematic review.

BACKGROUND AND OBJECTIVE: Exercise is a widely accepted treatment known to improve walking ability in persons with peripheral arterial disease (PAD); however, it has not been confirmed as to whether exercise improves fitness and performance-based function and, consequently, performance of activities of daily living (ADL). This systematic review aims to identify whether any mode of structured exercise improves physical fitness or performance-based tests of function and whether improvement in walking ability is related to an improvement in these outcomes. DATA SOURCES AND STUDY SELECTION: Eligible studies included randomized controlled trials (RCTs) using an exercise intervention for the treatment of intermittent claudication with fitness (including the 6-min walk (6MW), aerobic capacity, shuttle and muscle strength) tests and performance-based tests of function as the outcomes. STUDY APPRAISAL AND METHODS: Assessment of study quality was performed using a modified version of the Physiotherapy Evidence Database Scale (PEDro). Relative effect sizes, mean differences (MDs) and 95 % confidence intervals were calculated and adjusted via Hedges' bias-corrected for small sample sizes. Regression analyses were performed to establish relationships between walking ability and fitness outcomes. RESULTS: Twenty-four RCTs met the inclusion criteria: 19 aerobic training interventions and 5 progressive resistance training (PRT). In total 924 participants (71 % male) were studied; with few participants over 75 years of age and the mean ankle brachial index was mean ± standard deviation (SD) 0.66 ± 0.06. The most common outcome measured was aerobic capacity (52 % of trials), which improved by 8.3 % ± 8.7 % on average. Although there were no significant relationships, up to 16 % of the variance in walking distances can be explained by changes in walking economy. Muscle strength was measured in only five trials, improving by 42 % ± 74 % on average. There was a strong significant relationship between change in plantar flexor muscle strength and change in initial claudication time (r = 0.99; p = 0.001) and absolute claudication time (r = 0.75; p = 0.05) measured on a treadmill across trials measuring this muscle group. The 6MW distance was measured in only 14 % of trials. Walking and PRT significantly improved 6MW initial claudication distance (MD range 52-129 m) and total walking distance (MD range 36-108 m) in studies that measured this outcome. Only one trial assessed performance-based tests of function, and they did not improve significantly. CONCLUSION: Although data are limited, there is a strong significant relationship between plantar flexor muscle strength and treadmill walking ability. More research is needed to assess improvements in walking economy at specific timepoints and whether this translates to improvements in claudication outcomes and measurements pertaining to muscle strength. Future trials should focus on interventions that improve lower limb muscle strength and assess muscle strength, power and endurance across a variety of lower extremity muscle groups in order to understand these relationships further. The 6MW, muscle strength and performance-based tests of function such as chair stand, balance scale, stair climb and gait speed are understudied in PAD. Future trials should examine the effects of exercise on performance-based tests of function, which may predict actual ADL performance and incident disability.

Preliminary evidence that low ankle-brachial index is associated with reduced bilateral hip extensor strength and functional mobility in peripheral arterial disease.

OBJECTIVE: Peripheral arterial disease (PAD) has been associated with skeletal muscle pathology, including atrophy of the affected muscles. In addition, oxidative metabolism is impaired, muscle function is reduced, and gait and mobility are restricted. We hypothesized that greater severity of symptomatic PAD would be associated with lower levels of muscle mass, strength, and endurance, and that these musculoskeletal abnormalities in turn would impair functional performance and walking ability in patients with PAD. METHODS: We assessed 22 persons with intermittent claudication from PAD in this cross-sectional pilot study. Outcome assessments included initial claudication distance and absolute claudication distance via treadmill protocols and outcomes from the 6-minute walk (6MW). Secondary outcomes included one repetition maximum strength/endurance testing of hip extensors, hip abductors, quadriceps, hamstrings, plantar flexors, pectoral, and upper back muscle groups, as well as performance-based tests of function. Univariate and stepwise multiple regression models were constructed to evaluate relationships and are presented. RESULTS: Twenty-two participants (63.6% male; mean [standard deviation] age, 73.6 [8.2] years; range, 55-85 years) were studied. Mean (standard deviation) resting ankle-brachial index (ABI) was 0.54 ([0.13]; range, 0.28-0.82), and participants ranged from having mild claudication to rest pain. Lower resting ABI was significantly associated with reduced bilateral hip extensor strength (r = 0.54; P = .007) and reduced whole body strength (r = 0.32; P = .05). In addition, lower ABI was associated with a shorter distance to first stop during the 6MW (r = 0.38; P = .05) and poorer single leg balance (r = 0.44; P = .03). Reduced bilateral hip extensor strength was also significantly associated with functional outcomes, including reduced 6MW distance to first stop (r = 0.74; P = .001), reduced 6MW distance (r = 0.75; P < .001), and reduced total short physical performance battery score (worse function; r = 0.75; P = .003). CONCLUSIONS: Our results suggest the existence of a causal pathway from a reduction in ABI to muscle atrophy and weakness, to whole body disability represented by claudication outcomes and performance-based tests of functional mobility in an older cohort with symptomatic PAD. Longitudinal outcomes from this study and future trials are required to investigate the effects of an anabolic intervention targeting the muscles involved in mobility and activities of daily living and whether an increase in muscle strength will improve symptoms of claudication and lead to improvements in other functional outcomes in patients with PAD.

Prevalence and impact of chronic musculoskeletal ankle disorders in the community.

OBJECTIVE: To determine the point prevalence of chronic musculoskeletal ankle disorders in the community. DESIGN: Cross-sectional stratified (metropolitan vs regional) random sample. SETTING: General community. PARTICIPANTS: Population-based computer-aided telephone survey of people (N=2078) aged 18 to 65 years in New South Wales, Australia. Of those contacted, 751 participants provided data. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Point prevalence for no history of ankle injury or chronic ankle problems (no ankle problems), history of ankle injury without residual problems, and chronic ankle disorders. Chronic musculoskeletal ankle disorders due to ankle sprain, fracture, arthritis, or other disorder compared by chi-square test for the presence of pain, weakness, giving way, swelling and instability, activity limitation, and health care use in the past year. RESULTS: There were 231 (30.8%) participants with no ankle problems, 342 (45.5%) with a history of ankle injury but no chronic problems, and 178 (23.7%) with chronic ankle disorders. The major component of chronic ankle disorders was musculoskeletal disorders (n=147, 19.6% of the total sample), most of which were due to ankle injury (n=117, 15.6% of the total). There was no difference among the arthritis, fracture, sprain, and other groups in the prevalence of the specific complaints, or health care use. Significantly more participants with arthritis had to limit activity than in the sprain group (Chi-square test, P=.035). CONCLUSIONS: Chronic musculoskeletal ankle disorders affected almost 20% of the Australian community. The majority were due to a previous ankle injury, and most people had to limit or change their physical activity because of the ankle disorder.

The effect of ankle taping or bracing on proprioception in functional ankle instability: a systematic review and meta-analysis.

OBJECTIVES: To determine if wearing an ankle brace or taping the ankle, compared to no brace or tape, improves proprioceptive acuity in people with a history of ankle sprain or functional ankle instability. DESIGN: Systematic review and meta-analysis. METHODS: Studies using controlled, cross-over designs whereby participants who had sprained their ankle at least once or had functional ankle instability, underwent some form of proprioceptive sensation testing with and without ankle brace or tape, were included. Proprioceptive acuity was reported for the ankle tape/brace condition and the condition where no tape or brace was worn. Meta-analysis was employed to compare proprioceptive acuity with and without ankle tape/brace. RESULTS: Eight studies were included in the review. Studies measured either sense of movement or sense of joint position. The mean differences in 19 of 32 comparisons were not significant. Of the remaining mean differences, 10 were positive, indicating better proprioceptive acuity in the taped/braced condition and 3 were negative, indicating poorer proprioceptive acuity. Overall, there was no significant effect with ankle tape/brace compared to the no tape/brace condition (mean difference: 0.08°, 95% CI: -0.39 to 0.55). This finding was consistent when the two aspects of proprioception (sense of movement or joint position) were considered separately. CONCLUSIONS: The pooled evidence suggests that using an ankle brace or ankle tape has no effect on proprioceptive acuity in participants with recurrent ankle sprain or who have functional ankle instability.