The effect of a holistic self-management plan on asthma control.

The holistic self-management plan includes lifelong actions that enable patients to cope with their disease. The present study was designed to evaluate the effect of a holistic self-management plan on asthma control. A 12-month controlled study was conducted. Adult patients with mild-to-moderate asthma (n = 24) who attended the emergency asthma department were randomized to two groups: One group followed four educational sessions and three personal home sessions (n = 12), while a second group received a short manual with asthma information (n = 12). The main measure was the asthma control test (ACT), while secondary outcomes were self-efficacy (general self-efficacy scale, GSE), end-tidal carbon dioxide (ETCO2), respiratory rate (RR), breathing hold time (BHT), the Nijmegen Questionnaire (NQ), and spirometry (FEV1% predicted (forced expiratory volume in 1 second % predicted)) scores. The 2 × 4 ANOVA showed a significant interaction effect between intervention and time in ACT (p = 0.001), GSE (p < 0.001), ETCO2 (p < 0.001), RR (p < 0.001), BHT (p < 0.001), NQ (p = 0.05), and FEV1% predicted (p < 0.001). Predictors of asthma control were self-efficacy and ETCO2. In conclusion, this exploratory study provided support for the effectiveness of holistic self-management in asthma control. Behavioral changes, as indicated by the development of self-efficacy and the reduction of hyperventilation, contributed to the effectiveness of the intervention.

The scope of physiotherapy services provided in public ICUs in Greece: A pilot study.

The aim of the present study was to determine the scope of physiotherapy services provided in Greek ICUs in Athens. A cross-sectional study was conducted with two postal questionnaires administered separately, one for ICU directors and one for ICU physiotherapists. Responses were received from 19 ICU directors and 103 physiotherapists employed in all the adult public mixed medical and surgical ICUs across Athens. The response rate for the survey completion was 100% for ICU directors and 68.7% for physiotherapists. The results showed a 1:50 to 1:12 range in the ratio of physiotherapists to ICU beds. Among the 19 ICUs, 15 (78.9%) employed physiotherapists on a rotational basis, while four (21.0%) retained them exclusively. On weekdays, all surveyed ICUs were covered by physiotherapists in the morning and 10/19 (52.6%) during the afternoon. On weekends, 12/19 (63.2%) of the surveyed ICUs reported physiotherapy care during the morning and 4/19 (21.0%) during both morning and afternoon. All 103 physiotherapists conducted airway clearance techniques and progressive mobilization, 92/103 (89.3%) were involved in extubating patients, 102/103 (99.0%) in passive and active range of motion exercises, and 61/103 (59.2%) in walking. In conclusion, all Greek ICUs in Athens surveyed had physiotherapy cover. The physiotherapists working in these ICUs in Athens were involved in respiratory care and mobilization.

Validity and reliability evidence of the TOCA-C in a sample of Greek students.

Validity and reliability evidence of the Teacher Observation of Classroom Adaptation-Checklist (TOCA-C) was examined in 186 Greek students through exploratory factor analysis, divergent and concurrent validity, internal consistency, and test-retest reliability. The TOCA-C showed a high internal consistency for the three factors of Concentration Problems, Disruptive/Aggressive Behaviour, and Prosocial Behaviour (αs = .89-.96), and acceptable two-week test-retest reliability. The three-factor solution explained 74.50% of the total variance. Regarding divergent validity, a significant Sex × Disability interaction was evident for Disruptive Behaviour, with women scoring higher in 'special' and lower in 'general' schools compared to men. Main effects were significant across disability, but not across sex. Correlations with the Strengths and Difficulties Questionnaire suggested convergent and divergent validity evidence. The TOCA-C should be useful in testing Greek students with and without disabilities.

Hyperventilation in asthma: a validation study of the Nijmegen Questionnaire--NQ.

INTRODUCTION: The Nijmegen questionnaire (NQ) has previously been used for screening the hyperventilation syndrome (HVS) in asthmatics. However, no validity study has been reported so far. OBJECTIVE: To examine the validity and reliability of the NQ in asthma patients and identify the prevalence of HVS. METHODS: The NQ (n = 162) was examined for translation, construct, cross-sectional and discriminant validity as well as for internal consistency and test-retest reliability. RESULTS: Principal component analysis and exploratory factor analysis revealed a single factor solution with 11 items and 58.6% of explained variability. These 11 NQ items showed high internal consistency (Cronbach's alpha = 0.92) and test-retest reliability (IR = 0.98). Higher NQ scores were found in the following subgroups: women versus men (p < 0.01); participants with moderate versus mild asthma (p < 0.001) or uncontrolled versus controlled asthma (p < 0.001), and participants with breath-hold time (BHT) < 30 versus ≥ 30 s (p < 0.01) or end-tidal CO2 (ETCO2) ≤ 35 versus >35 mmHg (p < 0.001). A cut-off score of >17 discriminated the participants with regard to the presence of HVS. The NQ showed 92.73% sensitivity and 91.59% specificity. The total NQ score was found significantly correlated with ETCO2 (r = -0.68), RR (r = 0.66) and BHT (r = -0.65). The prevalence of HVS was found 34%. CONCLUSION: The NQ is a valid and reliable questionnaire for screening HVS in patients with stable mild-to-moderate asthma.

Effects of static and dynamic stretching on sprint and jump performance in boys and girls.

The aim of this study was to investigate the acute effects of static (SS) and dynamic stretching (DS) on explosive power, flexibility, and sprinting ability of adolescent boys and girls and to report possible gender interactions. Forty-seven active adolescent boys and girls were randomly tested after SS and DS of 40 seconds on quadriceps, hamstrings, hip extensors, and plantar flexors; no stretching was performed at the control condition. Pretreatment and posttreatment tests examined the effects of stretching on 20-m sprint run (20 m), countermovement jump (CMJ) height, and sit and reach flexibility test. In terms of performance, SS hindered 20 m and CMJ in boys and girls by 2.5 and 6.3%, respectively. Dynamic stretching had no effect on 20 m in boys and girls but impaired CMJ by 2.2%. In terms of flexibility, both SS and DS improved performance with SS being more beneficial (12.1%) compared with DS (6.5%). No gender interaction was found. It can therefore be concluded that SS significantly negates sprinting performance and explosive power in adolescent boys and girls, whereas DS deteriorates explosive power and has no effect on sprinting performance. This diversity of effects denotes that the mode of stretching used in adolescent boys and girls should be task specific.

Validity and clinical utility of functional assessments in children with cerebral palsy.

OBJECTIVE: To examine the validity and clinical utility of functional assessments (1-minute walk test, 10-meter walk test, Timed Up & Go [TUG] test, Timed Up and Down Stairs [TUDS] test, sit-to-stand [STS] test, and lateral step-up [LSU] test). DESIGN: Cross-sectional study. SETTING: Four special schools for adolescents with physical disabilities. PARTICIPANTS: Adolescents with spastic tetraplegia and diplegia (at levels I-III) were selected through convenience sampling (N=35; mean age, 14.97±2.03y). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: GMFM-88 (dimensions D and E), 1-minute walk, 10-meter walk, TUG, TUDS, STS, and LSU tests. Data were analyzed using Pearson intercorrelations, multiple regression analysis, and multivariate analysis of variance (MANOVA). RESULTS: Significant moderate to high intercorrelations were found. Three significant positive predictors emerged (1-minute walk, 10-meter walk, and LSU) with the following regression equation: YGMFM-88 (dimensions D and E) = 5.708 + .402 × X1-minute walk + .920 × XLSU + .404 × X10-meter walk The MANOVA was significant (Λ=.163, F=14.732, P<.001, η(2)=.596), and post hoc comparisons revealed significant differences across Gross Motor Function Classification System Expanded and Revised levels in all paired comparisons for the 1-minute walk and LSU tests. For the 10-meter walk test, significant differences were evident in the level I versus level III and level II versus level III comparisons. No significant differences were found in the 10-meter walk test between levels I and II. CONCLUSIONS: These functional assessments (1-minute walk, LSU, and 10-meter walk tests) are simple to administer, quick, low cost, and user-friendly. Although these assessments are not a substitute for the criterion standard (GMFM-88), they may be used for a quick assessment in adolescents with cerebral palsy (levels I-III) either at school or during rehabilitation, especially when time is limited.

Validity and reliability of the FSS in Greek MS patients.

OBJECTIVES: The study provided validity and reliability evidence of the Fatigue Severity Scale (FSS) in Greek patients with multiple sclerosis (MS). MATERIALS AND METHODS: The FSS was administered to 72 MS patients, without co morbid fatigue and 75 matched paired controls with respect to gender and age. Both groups responded to the FSS, SF-36v2, BDI-II and a demographic questionnaire on two time points separated by a 1-week interval. Exploratory and confirmatory factor analysis was performed to test construct validity, concurrent and divergent validity, internal and test-retest reliability were also examined. RESULTS: Exploratory and confirmatory factor analysis, intercorrelations with BDI-II (r = 0.552, p < 0.01) and SF-36v2 vitality (r = -0.715, p < 0.01) and physical functioning (r = -0.673, p < 0.01) subscales, and differences between patients and non patients (t (145) = 6.007, p < 0.001), revealed sufficient construct, concurrent and divergent validity evidence. The factor analysis demonstrated a unidimensional structure Cronbach alpha (0.953) and ICC (0.889) was high, indicating that the responses of our sample were internally consistent and stable across time. CONCLUSION: The Greek version of FSS is valid and reliable and may be used by clinicians and researchers to assess fatigue of Greek MS patients.

Validity evidence of the Lateral Step Up (LSU) test for adolescents with spastic cerebral palsy.

PURPOSE: The present study examined the concurrent and construct validity of the Lateral Step Up (LSU) test, for adolescents with CP. METHOD: A total of 35 adolescents, classified as GMFCS Levels I, II and III, were examined using LSU, GMFM - 88 (D & E), other functional mobility measures (TUG, STS, TUDS), body structures and functions (strength, ROM and spasticity). RESULTS: LSU inter-correlations with: (i) GMFM - 88 (D & E) (r = 0.656), (ii) functional mobility measures (r = -0.567 to 0.721) and (iii) body structures and functions (r = 0.155 to 0.563) were at the appropriate range. The LSU differentiated adolescents with CP (F = 16.185, p = 0.000, η(2) = 0.503), according to their GMFCS (I > II, II > III, I > III). Finally, 50.27% of the LSU variability was explained by GMFCS differences, with 65.7% of adolescents classified correctly across the three levels. CONCLUSIONS: The LSU may be perceived as a valid instrument for assessing the functional mobility of adolescents with CP. IMPLICATIONS FOR REHABILITATION: • LSU is valid for assessing functional mobility and strength in CP adolescents. • LSU may be used in accordance with other functional mobility measures in the school environment. • The LSU may be used from physical therapists to predict the functional mobility of CP adolescents at GMFCS Levels I­III.

The effect of treadmill training on gross motor function and walking speed in ambulatory adolescents with cerebral palsy: a randomized controlled trial.

OBJECTIVE: The aim of this study was to evaluate the effect of a treadmill program on gross motor function, walking speed, and spasticity of ambulatory adolescents with spastic cerebral palsy (diplegia and tetraplegia). DESIGN: In this randomized controlled trial, 22 adolescents (13-19 yrs old) from a special school for children with physical disabilities were randomly allocated to the experimental and control training groups. The experimental training group underwent a treadmill program without body weight support at a comfortable speed. The control group received treatment with conventional physiotherapy, which consisted of three sets of exercises with mat activities, balance, gait training, and functional gross motor activities. The program lasted 12 wks with a frequency of three times per week for both groups. Pretest and posttest measurements of self-selected walking speed, gross motor function, and spasticity were conducted. RESULTS: The analysis of covariance findings examining posttest differences between groups were significant with respect to self-selected walking speed (F = 8.545, P = 0.000) and gross motor function (F = 9.088, P = 0.007), whereas no significance was found for spasticity. CONCLUSIONS: Treadmill training may improve the walking speed and gross motor function of adolescents with spastic cerebral palsy, without adverse effects on spasticity.

Postural profile and falls of osteoporotic women.

OBJECTIVES: 1. To compare postural alignment in erect standing between osteoporotic fallers, osteoporotic non-fallers and healthy women. 2. To compare BMI, number of fractures and intensity of pain between osteoporotic fallers and non-fallers. METHODS: Thirty-six osteoporotic women with vertebral fractures and 40 healthy women participated in the study. Spinal curvatures were assessed with a digital inclinometer. Photographic measurements of knee, hip, shoulder and head were carried out in sagittal plane. RESULTS: Significant differences were found between osteoporotic fallers and healthy women in the head (p=0.040), and thoracic angles (p=0.001). Significant differences were found between fallers and non-fallers in BMI (p=0.000), number of fractures (p=0.033) and pain (p=0.005), with fallers being heavier, with less fractures and pain than non-fallers. CONCLUSIONS: Osteoporotic fallers probably differ from osteoporotic non-fallers and healthy women. Researchers and clinicians may consider, in the future, the above differences when planning research and clinical intervention in this field. Replication studies are necessary to confirm the present findings.

Competitive state anxiety and performance in young female rhythmic gymnasts.

The study was designed to examine the competitive state anxiety and self-confidence of rhythmic gymnasts participating in the Greek national competition. 86 participants, ages 11 and 12 years, completed the Competitive State Anxiety Inventory-2, 1 hr. before competition. The athletes, classified by performance (high and low performance) and participation in the finals (finalists and nonfinalists), responded to the three subscales: Cognitive Anxiety, Somatic Anxiety, and Self-confidence. Analyses indicated differences in Self-confidence between high versus low performance groups and finalists versus nonfinalists. No significant differences were found on Cognitive and Somatic Anxiety. In a regression analysis, Self-confidence was the only significant predictor of performance for this sample. Implications refer to the development of strategies to enhance self-confidence in order to improve the gymnast's performance during competition.

The effect of physiotherapy-based breathing retraining on asthma control.

BACKGROUND: The mechanism of the breathing retraining effect on asthma control is not adequately based on evidence. OBJECTIVE: The present study was designed to evaluate the effect of physiotherapy-based breathing retraining on asthma control and on asthma physiological indices across time. STUDY DESIGN: A 6-month controlled study was conducted. Adult patients with stable, mild to moderate asthma (n = 40), under the same specialist's care, were randomized either to be trained as one group receiving 12 individual breathing retraining sessions (n = 20), or to have usual asthma care (n = 20). The main outcome was the Asthma Control Test score, with secondary outcomes the end-tidal carbon dioxide, respiratory rate, spirometry, and the scores of Nijmegen Hyperventilation Questionnaire, Medical Research Council scale, and SF-36v2 quality-of-life questionnaire. RESULTS: The 2 × 4 ANOVA showed significant interaction between intervention and time in asthma control (F = 9.03, p < .001, η(2) = 0.19), end-tidal carbon dioxide (p < .001), respiratory rate (p < .001), symptoms of hypocapnia (p = .001), FEV1% predicted (p = .022), and breathlessness disability (p = .023). The 2 × 4 MANOVA showed significant interaction between intervention and time, with respect to the two components of the SF-36v2 (p < .001). CONCLUSION: Breathing retraining resulted in improvement not only in asthma control but in physiological indices across time as well. Further studies are needed to confirm the benefits of this training in order to help patients with stable asthma achieve the control of their disease.

Validity of St. George's Respiratory Questionnaire for Greek patients with chronic obstructive pulmonary disease.

The purpose of the present study was to examine the validity of St. George's Respiratory Questionnaire (SGRQ), a disease-specific survey of health-related quality of life, in adult Greek patients with chronic obstructive pulmonary disease (COPD). Questionnaire scores, dyspnea scores, spirometry values, and demographic data were collected from 72 patients with a diagnosis of COPD exacerbation. Follow-up visits were performed at 1-mo. intervals for the first 3 mo. after discharge and a final visit was performed 6 mo. after discharge. 27 (37.5%) patients were readmitted during the follow-up period. Recovery after exacerbation was prolonged and questionnaire scores were sensitive to the patients' health-status changes across time. The SGRQ discriminated COPD patients according to disease stage, and the SGRQ scores during the recovery course were related to readmission. Correlations between the SGRQ and % FEV1 were not significant during exacerbation but a significant negative correlation was observed during the stable phase of the disease. The SGRQ appeared to have acceptable discriminant and concurrent validities in Greek COPD patients who differed according to their exacerbation stage.

Kinesthetic ability in children with spastic hemiplegia.

The purpose was to examine the differences in kinesthetic ability, at the elbow joint, between children with (n = 15) and without (n= 15) spastic hemiplegia. The Kin Com 125 AP isokinetic dynamometer Configuration Chattanooga was used. Results revealed significant (p < .05) interaction between participant groups and side which was a repeated measures factor (nonaffected side for CP group and dominant side for nonCP group vs. affected side for CP and nondominant side for nonCP group) with respect to the passive reproduction of movement (PRM) and detection of passive movement (DPM). The interaction was attributed to the kinesthetic deficits of the hemiplegic participants compared to the control group. A significant relationship was found between the level of spasticity and PRM scores.