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Background and Purpose. Measurements of walking speeds are commonly used as an objective measure of functional performance in patients with knee osteoarthritis (OA) and are easily performed in a clinical setting. However, the choice in which the walking speed evaluation should be performed is controversial. The aim of this study was to identify the most discriminating walking speed after surgical interventions in patients with knee osteoarthritis, and to compare the responsiveness of the different gait speeds. Method. A prospective clinical one-year follow-up study involving 54 patients with knee osteoarthritis (63 (±5) years of age) who were operated with either a unicompartmental knee arthroplasty or a high tibial osteotomy was undertaken. Thirty-nine patients had unilateral knee OA and 15 patients had bilateral knee OA or other symptoms from the lower extremities that could influence walking. The patients were examined at a gait laboratory before surgery, and one year after surgery. The patients were instructed to walk at slow, normal and fast walking speed. Results. All patients (n = 54) walked faster one year after the surgical intervention compared to before surgery (p = 0.001) at slow (+15%), normal (+8%) and fast (+7%) walking speed. This increase was similar for the three walking speeds (p = 0.171). Patients with unilateral knee OA (n = 39) reached an average change of +0.12 m/s, which was considered clinically important, while patients with bilateral knee OA (n = 15) did not increase their walking speed > 0.12 m/s. Effect size was moderate for slow walking speed and small for normal and fast walking speeds, respectively. Conclusions. The different walking speeds were equally good in detecting changes one year after surgical interventions. In this study, responsiveness favoured slow walking speed, however, the advantages of normal walking speed are discussed. Copyright © 2007 John Wiley & Sons, Ltd. (Source: Physiotherapy Research International)

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Background and Purpose. One must understand the potentials and limitations of all tests used to evaluate interventions. The aim of the present study was to clarify the reproducibility, smallest percentage difference needed to be able to detect a genuine change and correlation regarding the 10-m and 30-m timed walks (10TW, 30TW) and the ‘timed up and go’ (TUG) test in people with moderate multiple sclerosis (MS). Method. A repeated-measures design was used, with randomization into two groups and different time intervals used for testing. The 10TW and 30TW were performed three times and TUG twice at each testing. Self-selected speed was used for 10TW and forced speed (quickly but safely) for 30TW and TUG. Forty-three people were tested on three occasions within one week. Each person was tested at approximately the same time of the day and by the same physiotherapist on each occasion. Results. The reproducibility was very high. For a single testing occasion, the intraclass correlation was 0.97 for the 10TW and 0.98 for the 30TW and TUG. The smallest percentage difference needed to be able to detect a genuine change in the entire study group was approximately -23% or +31% for either the 10TW or TUG. It was evident from the 30TW testing results that lower values applied to those with less (-14% to +17%) rather than more (-38% or +60%) disability. The correlation between all tests for the entire study group was 0.85 (0.76-0.91). Conclusion. It is sufficient to use only one attempt and to choose only one of the tests when evaluating people with moderate MS. In the case of the 30TW, greater attention must be paid to the degree of disability when determining the smallest percentage difference needed to establish a genuine change, than with either the 10TW or TUG. Copyright © 2007 John Wiley & Sons. Ltd. (Source: Physiotherapy Research International)

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Background and Purpose. Physiotherapy is considered an essential component of the management of patients after thoracotomy, yet the type of interventions utilized, and evidence for their efficacy, has not been established. The aim of the present study was to ascertain the current physiotherapy management of patients undergoing thoracotomy and the factors influencing practice among different providers. Method. A purpose-designed postal questionnaire was distributed to senior physiotherapists in all thoracic surgical units throughout Australia and New Zealand (n = 57). Results. A response rate of 81% was obtained (n = 46). Pre-operatively, 16 respondents (35%) reported assessing all thoracotomy patients. The majority of respondents (n = 44; 96%) indicated that all patients were seen by physiotherapists after surgery, with 29 respondents (63%) performing prophylactic physiotherapy interventions to prevent post-operative pulmonary complications. Respondents reported that physiotherapy treatment was usually commenced on day one post-operatively (n = 37; 80%) with the most commonly used treatment interventions being deep breathing exercises, the active cycle of breathing techniques, cough, forced expiration techniques and sustained maximal inspirations. Most respondents reported that patients first sat out of bed (n = 41; 89%), commenced shoulder range of movement (n = 23; 50%) and walking (n = 32; 70%) on day one post-operatively. The majority of respondents reported that they offered no post-operative pulmonary rehabilitation (n = 25; 54%), outpatient follow-up (n = 43; 94%) or post-thoracotomy pain management (n = 40; 87%). Respondents indicated that personal experience, literature recommendations and established practice were the factors which most influenced physiotherapy practice. Conclusion. Most patients after thoracotomy receive physiotherapy assessment and/or treatment in the immediate post-operative period, but only one-third were routinely seen pre-operatively and relatively few were reviewed following discharge from hospital. Further studies are required to guide physiotherapists in determining the efficacy of their practices for patients undergoing thoracotomy. Copyright © 2007 John Wiley & Sons, Ltd. (Source: Physiotherapy Research International)

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Background and Purpose. Fear-avoidance beliefs are important determinants for disability in patients with non-specific low-back pain (LBP). The association with self-reported level of physical activity is less known. The aim of the present study was to describe the level of physical activity in patients with chronic non-specific LBP and its relation to fear-avoidance beliefs and pain catastrophizing. Method. A cross-sectional study on 64 patients with chronic non-specific LBP in primary healthcare. The variables measured and the questionnaires used were: level of physical activity (six-graded scale); activity limitations (Roland Morris Disability Questionnare (RDQ)); fear-avoidance beliefs (Tampa Scale of Kinesiophobia (TSK) 13-item and sub-scales ‘activity avoidance’ and ’somatic focus’); and pain catastrophizing (Pain Catastrophizing Scale (PCS)). The level of physical activity was dichotomised into low and high physical activity. Individual median scores on the TSK and PCS scales were used to group the patients into different levels of fear-avoidance beliefs and pain catastrophizing. Univariate logistic regressions were used to calculate odds ratios for having low physical activity. Results. Patients with low physical activity had significantly higher scores in fear-avoidance beliefs and pain catastrophizing (p < 0.05). Odds ratios for low level of physical activity were between 4 and 8 (p < 0.05) for patients with high fear-avoidance beliefs or medium/high pain catastrophizing. Conclusions. This study indicates that it seems important for physiotherapists in primary care to measure levels of fear-avoidance beliefs or pain catastrophizing. In particular, the two subscales of the TSK could be of real value for clinicians when making treatment decisions concerning physical exercise therapy for patients with chronic LBP. Copyright © 2007 John Wiley & Sons, Ltd. (Source: Physiotherapy Research International)

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Background and Purpose. Physiotherapists develop clinical reasoning theories and applied manual therapy skills through a variety of educational exposures. No studies have assessed the importance of selected theories such as the convex-concave rule, capsular pattern and scapulohumeral rhythm during clinical decision-making by physiotherapists. The present study investigated which variables physiotherapists considered were associated with the importance of these theories during practice and investigated physiotherapists’ perception of translational motion biomechanics of the glenohumeral (GH) joint. Method. Six hundred and sixty physiotherapists in the USA volunteered to participate in this study. Using ologit regression analyses, the identifier themes and clinical background characteristics were associated with importance of peripheral biomechanics in manual therapy application and reliability/validity of the scapulohumeral rhythm theory in predicting pathological sequences of the shoulder complex. An intraclass correlation coefficient (ICC) was used to determine agreement regarding necessary translation of the GH joint for normal movement. Results. The majority of physiotherapists indicated that all theories were important or very important during treatment decision-making and reported frequent utilization. Regression models identified that the importance placed on peripheral biomechanics was negatively influenced by academic qualification (bachelors and masters degrees) and gender (men were less likely to report that scapulohumeral rhythm was a reliable/valid predictor of shoulder pathology). ICC values identified excellent agreement among clinicians regarding translational motion. Conclusions. The importance of biomechanics of the periphery for use, validation and frequency was based heavily on adoption of selected theories of glenohumeral movements despite evidence that suggests the theories lack validity. Copyright © 2007 John Wiley & Sons, Ltd. (Source: Physiotherapy Research International)

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Background and Purpose. Several years after the acute polio illness, patients may develop new post-polio symptoms. The purpose of the present study was to evaluate patients with post-polio symptoms with regard to perceived fatigue, functional ability, muscle strength, pain and with regard to measured physical fitness and isometric muscle strength. In addition, the relationship between the results of these subjective and objective measurements was investigated. Method. This was a prospective cross-sectional study in which 32 patients with post-polio symptoms were included. Main outcome measures were the Fatigue Severity Scale (FSS), the Disability Rating Index (DRI), pain intensity, pain distribution, self-reported and measured muscle strength and oxygen uptake. Results. A marked reduction in isometric muscle strength compared to normal data, high scores in fatigue, widespread pain, low oxygen uptake and difficulties in performing some daily activities were found. Self-reported general muscle strength, pain intensity and pain distribution correlated significantly with patients’ perceived fatigue and function at the activity level. There was no significant correlation between self-reported and measured results except for that found between isometric muscle strength in the legs and patients’ perceived general muscle strength and oxygen uptake. Conclusions. Evaluation of pain intensity, pain distribution, perceived muscle strength, fatigue and ability to perform daily tasks reveals important aspects of health status in patients with post-polio symptoms. Reduction in isometric muscle strength was not reflected in those tests or in reported symptoms, and should be monitored independently using a sensitive assessment tool. Accurate screening of isometric muscle strength in isolated muscle groups contributes to therapeutic management in making a functional diagnosis at the level of body function and structure when designing specific training programmes and in motivating patients. An evaluation combining self-reports with sensitive muscle strength measures provide supplementary information and is appropriate for evaluating these patients in physiotherapy practice. Copyright © 2007 John Wiley & Sons, Ltd. (Source: Physiotherapy Research International)

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Background and Purpose. The recovery of sitting balance after a stroke is assumed to be essential to obtain independence in other vital functions. The purpose of the present study was to investigate weight distribution while sitting and standing still, and weight transfer during seated reaching tasks performed by stroke subjects and healthy subjects. Method. The study was cross-sectional. Twenty-one stroke subjects and 21 healthy subjects, matched by age and gender, participated. Main measures were weight distribution while standing and sitting still, and displacements of centre of pressure (COP) during seated reaching tasks. Data were collected using a balance performance monitor (BPM), including software. Results. Stroke subjects had less symmetrical weight distribution in standing than that of healthy subjects (p < 0.001). No significant differences between the groups were found while sitting still, and no associations between asymmetries in standing still and sitting positions within individual stroke subjects were found. Neither did the degree of weight distribution in sitting correspond to COP displacements in seated reaching tasks. However, COP displacement patterns in reaching tasks in the seated position were different in stroke subjects from those of healthy subjects. Stroke subjects showed more lateral displacement when reaching forwards (p < 0.001), and less lateral displacement when reaching sideways to the unaffected side (p = 0.01). Conclusion. COP displacement patterns in stroke subjects deviate more than those of healthy subjects in seated reaching tasks. The deviating COP displacement patterns are discussed as a possible dysfunction in the ability to make postural adjustments and learn an efficient movement pattern. Copyright © 2007 John Wiley & Sons, Ltd. (Source: Physiotherapy Research International)

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