Better balance: a randomised controlled trial of oculomotor and gaze stability exercises to reduce risk of falling after stroke.

OBJECTIVE: To assess the effect of a domiciliary program of oculomotor and gaze stability exercises on the incidence of falls and risk of fall in stroke survivors. DESIGN: Two-arm, non-blinded parallel randomized controlled trial. SUBJECTS: Stroke survivors older than 60 years, with positive Romberg test and autonomous gait after the stroke. SETTING: Physiotherapy outpatient clinic of a tertiary care hospital. INTERVENTIONS: Every participant accomplished the current rehabilitation program; the intervention group was randomly allocated into an additional three weeks intervention with a domiciliary program of oculomotor and gaze stability exercises. MAIN MEASURES: Primary outcome was the incidence of falls through the three weeks after the intervention started; in addition, the variation of the estimated risk for falling assessed by both Berg Balance Scale (four points) and Timed Up and Go Test (four seconds) was the secondary outcome. RESULTS: 79 patients were recruited and 68 completed the protocol (control group 35; intervention group 33). During the follow up, falls were registered in 4/35 participants in the control group and no event occurred in the intervention group (P = 0.064). The estimated risk for falling decreased in 11/35 control group participants and in 28/33 intervention group participants (RR 0.37; 95%CI 0.22-0.62; P < 0.001). CONCLUSION: After three weeks of a domiciliary program of oculomotor and gaze stability exercises, the estimated risk of falling significantly diminished and no falls occurred among the intervention group. These findings encourage further exploration of this promising intervention. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02280980.

Is a combined programme of manual therapy and exercise more effective than usual care in patients with non-specific chronic neck pain? A randomized controlled trial.

OBJECTIVE: The aim of this study was to compare the effectiveness of a combined intervention of manual therapy and exercise (MET) versus usual care (UC), on disability, pain intensity and global perceived recovery, in patients with non-specific chronic neck pain (CNP). DESIGN: Randomized controlled trial. SETTING: Outpatient care units. SUBJECTS: Sixty-four non-specific CNP patients were randomly allocated to MET (n = 32) or UC (n = 32) groups. INTERVENTIONS: Participants in the MET group received 12 sessions of mobilization and exercise, whereas the UC group received 15 sessions of usual care in physiotherapy. MAIN MEASURES: The primary outcome was disability (Neck Disability Index). The secondary outcomes were pain intensity (Numeric Pain Rating Scale) and global perceived recovery (Patient Global Impression Change). Patients were assessed at baseline, three weeks, six weeks (end of treatment) and at a three-month follow-up. RESULTS: Fifty-eight participants completed the study. No significant between-group difference was observed on disability and pain intensity at baseline. A significant between-group difference was observed on disability at three-week, six-week and three-month follow-up (median (P25-P75): 6 (3.25-9.81) vs. 15.5 (11.28-20.75); P < 0.001), favouring the MET group. Regarding pain intensity, a significant between-group difference was observed at six-week and three-month follow-up (median (P25-P75): 2 (1-2.51) vs. 5 (3.33-6); P < 0.001), with superiority of effect in MET group. Concerning the global perceived recovery, a significant between-group difference was observed only at the three-month follow-up (P = 0.001), favouring the MET group. CONCLUSION: This study's findings suggest that a combination of manual therapy and exercise is more effective than usual care on disability, pain intensity and global perceived recovery.

Assessing the risk for falls among Portuguese community-dwelling stroke survivors. Are we using the better tools? Observational study.

This study assesses the estimation of the risk for falls among community-dwelling stroke survivors referred for ambulatory physiotherapy and explores factors that affect the risk. Methods: Observational, cross-sectional with nested case-control study, of individuals, referred to physiotherapy less than 12 months after stroke and able to walk independently. Berg Balance Scale, Timed Up and Go Test, and the Motor Assessment Scale were applied. Berg Balance Scale ≤45 or Timed Up and Go Test > 14 were used to estimate the risk for falls. The discrimination ability of the estimation was assessed. Alternative models were explored by logistic regression analysis. Results: One hundred sixty-seven patients fulfilled the inclusion criteria. Patients were 21 to 87years old (median 66), 98 men (58.7%), and in 133 (79.6%) the stroke occurred in the last 6 months. Falls were reported by 78 (46.7%) of the patients but 139 (83.2% [95%CI 76.84-88.14]) were estimated as having risk for falls. The discrimination ability of the estimation of the actual occurrence of falls by Berg Balance Scale ≤45 or Timed Up and Go Test >14 was 55% (95%CI 47.5-62.4). The actual occurrence of falls was associated only with Motor Assessment Scale, as a protective factor. The discrimination ability of the estimation of the actual occurrence of falls by Motor Assessment Scale alone was area under the curve 0.69 (95%CI 0.60-0.77). Conclusions: Different tools with better performance are needed to identify the risk for falls after stroke.

Empirical Investigation of Work-Related Social Media Usage and Social-Related Social Media Usage on Employees' Work Performance.

The trend of using social media in the workplace is now becoming ubiquitous. Along witbenefits, social media also has negative consequences. Employees use social media for both work and social purposes. Therefore, using a quantitative approach, this study explores the impact of work-related social media usage and social-related social media usage on employees' work performance. This study also investigates the mediating effect of extra-role behaviors on social media usage (professional and personal purpose) and work performance relationships. We examined survey data of 241 employees working in different organizations with the help of the partial least square (PLS) 3.0 version. Convenience sampling has been used to reach respondents. The outcomes of this study demonstrate that both professional and personal-related social media usage have a positive and significant impact on employees' work performance. This study also highlighted that extra-role behavior positively and significantly mediates the relationship between social media usage (work and personal) and employees' work performance. This study provides practical insights to managers, such as that, instead of banning social media usage in companies, there must be some limits and regulations for using social media that would facilitate firms to increase employees' engagement and productivity.

Assessing the Impact of Green Hiring on Sustainable Performance: Mediating Role of Green Performance Management and Compensation.

The global need to preserve ecology has propelled the green movement across the globe. An emerging managerial challenge for all organizations is to protect natural resources by reducing their negative impact on the environment and increase sustainable performance. Greening is the need of the age to conserve natural resources. This study investigates the impact of green human resource management practice-i.e., green hiring-on the sustainable performance of public and private healthcare organizations. A quantitative research approach was used for data collection. Scale survey of 160 responses was gathered from public and private healthcare organizations. Partial least square-structural equation modeling was used for data analysis. The study results suggest that green recruitment has a positive and significant impact on environmental performance, economic performance, and social performance. Path coefficients test also revealed that green performance management and compensation significantly mediate the relationship between green hiring and sustainable performance of public and private healthcare organizations. This study is helpful for organizations in adapting GHRM practices that will benefit the organizations in all ways. This study also provides a better understanding to policymakers on how to promote GHRM practices and increase sustainability in organizations.

Gait profile score identifies changes in gait kinematics in nonfaller, faller and recurrent faller older adults women.

BACKGROUND: Quantification of differences in gait kinematics between young and older adults provides insight on age-related gait changes and can contribute to the investigation of risk of falls. Gait Profile Score (GPS) is an index that indicates gait quality, using kinematic gait data, but so far it has not been used in an elderly population without neurological conditions. RESEARCH QUESTION: Is the Gait Profile Score (GPS) an index that shows reliability for use in old adults? Does this index detect changes in gait quality observed by kinematic data between nonfaller, faller and recurrent faller older adults? METHODS: Forty-nine women (mean age 72,43 ± 6,44; 27 faller and 22 nonfaller) were included in the study. Intra-session reliability was obtained from the intraclass correlation coefficient (ICC) between the five strides of each session. RESULTS: Overall value of GPS shows no difference between nonfaller (6.65 ± 1.59º), faller (6.67 ± 2.05º) and recurrent faller (6.62 ± 0.86º) older adult. In all groups larger values of Gait Variable Scores (GVS) were observed in the hip and knee joints. Intra-session ICC values the GVS and GPS presented high stability, ranging from 0.80 to 0.99. MDC lower values in GPS were observed in the faller (0.39; ICC - 0.97) and recurrent faller (0.69; ICC - 0.90). SIGNIFICANCE: Due to the high reliability, GPS has proven to be a valid method to analyze the gait quality of faller and nonfaller older woman. The most sensitive indexes (GPS and GVS) are the gear changes in fallers and recurrent fallers.

Effects of oculomotor and gaze stability exercises on balance after stroke: Clinical trial protocol.

HIGHLIGHTS: Balance problems after stroke are an important risk factor for falling.The inability to maintain balance decreased potential for recovery.This trial assesses the effect of oculomotor and gaze stability training on balance. BACKGROUND: The inability to maintain balance after stroke is an important risk factor for falling and relates to decreased potential for recovery. The vestibular system and gaze stability contribute respectively to postural stability and to maintain balance. Rehabilitation may be more effective with domiciliary training. OBJECTIVE: This trial aims to verify if balance impairment after stroke improves with a domiciliary oculomotor and gaze stability training program. METHODS: Individuals older than 60 years, discharged after suffering brain stroke with referral to the physiotherapy department, will be assessed for orthostatic balance. Patients with stroke diagnosis 3-15 months before recruitment, positive Romberg test and able to walk 3 m alone are invited to participate in this randomized controlled trial. Participants will be allocated in two intervention groups through block randomization, either the current rehabilitation program or to a supplemental intervention focused on oculomotor and gaze stability exercises to be applied at home twice a day for three weeks. Primary outcome measures are the Motor Assessment Scale, Berg Balance Scale and Timed Up and Go Test. Trial registration: ClinicalTrials.gov (NCT02280980). RESULTS: A minimum difference of four seconds in the TUG and a minimum difference of four points in BBS will be considered positive outcomes. CONCLUSIONS: Oculomotor and gaze stability exercises may be a promising complement to conventional physiotherapy intervention after brain stroke, improving the balance impairment.

Dominance of pressure natriuresis in acute depressor responses to increased renal artery pressure in rabbits and rats.

Increasing renal artery pressure (RAP) activates pressure diuresis/natriuresis and inhibits renal renin release. There is also evidence that increasing RAP stimulates release of a putative depressor hormone from the renal medulla, although this hypothesis remains controversial. We examined the relative roles of these antihypertensive mechanisms in the acute depressor responses to increased RAP in anaesthetized rabbits and rats. In rabbits, an extracorporeal circuit was established which allows RAP to be set and controlled without direct effects on systemic haemodynamics. When RAP was maintained at approximately 65 mmHg, cardiac output (CO) and mean arterial pressure (MAP) did not change significantly. In contrast, when RAP was increased to approximately 160 mmHg, CO and MAP fell 20 +/- 5 % and 36 +/- 5 %, respectively, over 30 min. Urine flow also increased more than 28-fold when RAP was increased. When compound sodium lactate was infused intravenously at a rate equal to urine flow, neither CO nor MAP fell significantly in response to increased RAP. In 1 kidney-1 clip hypertensive rats, MAP fell by 54 +/- 10 mmHg over a 2 h period after unclipping. In rats in which isotonic NaCl was administered intravenously at a rate equal to urine flow, MAP did not change significantly after unclipping (-14 +/- 9 mmHg). Our results suggest that the depressor responses to increasing RAP in these experimental models are chiefly attributable to hypovolaemia secondary to pressure diuresis/natruresis. These models therefore appear not to be bioassays for release of a putative renal medullary depressor hormone.