ABSTRACT
Purpose: We identified evidence evaluating the effect of exercise on functional mobility in adults (aged 18 y or older) with cerebral palsy (CP). Method: An exhaustive search was conducted using the electronic databases PubMed, MEDLINE, CINAHL, PsycINFO, SPORTDiscus, and Cochrane Database of Systematic Reviews from the earliest available evidence (1975) to the present (January 2016) for studies whose participants were ambulatory adults with CP receiving conservative treatment to address functional mobility limitations. Two independent reviewers agreed on the eligibility, inclusion, and level of evidence of each study. The Maastricht-Amsterdam List (MAL) was used to assess evidence quality. Results: Five of the six studies included were randomized controlled trials, and one was a pre-post case series. Interventions included whole-body vibration, treadmill training without body-weight support, rhythmic auditory stimulation, dynamic balance and gait activities, progressive resistance training, and interactive serious gaming for balance. All studies were considered high quality, as indicated by their MAL scores. Four studies showed no statistical difference and trivial effect sizes between the intervention and the control group. Rhythmic auditory stimulation and interactive serious gaming were found to be statistically significant in benefiting adults with CP. Conclusions: Evidence of the effect of exercise on functional mobility for ambulatory adults with CP is lacking. A need exists for quality research to determine the best interventions for adults with CP to maximize functional mobility.
Objectif : recenser les données probantes sur l'efficacité de l'exercice sur la mobilité fonctionnelle des adultes (18 ans et plus) atteints de paralysie cérébrale (PC). Méthode : une recherche exhaustive a été menée dans les bases de données électroniques PubMed, MEDLINE, CINAHL, PsycInfo, SPORTDiscus et Cochrane Database of Systematic Reviews à partir des données les plus anciennes (1975) jusqu'à aujourd'hui (janvier 2016) sur des études menées auprès d'adultes ambulatoires atteints de PC recevant un traitement conservateur pour leur mobilité fonctionnelle réduite. Deux examinateurs indépendants ont convenu de l'admissibilité, de l'inclusion et du niveau de données probantes de chaque étude. La liste de critères Maastricht-Amsterdam (MA) a été utilisée pour évaluer la qualité des preuves. Résultats : cinq des six études incluses étaient des essais randomisés et l'autre était une série de cas avant/après. Les interventions incluaient des vibrations transmises à l'ensemble du corps, un entraînement sur tapis roulant sans support du poids corporel, une stimulation auditive rythmique, des activités d'équilibre dynamique et de démarche, des exercices progressifs de musculation et des jeux interactifs d'équilibre. Toutes les études étaient de grande qualité, comme l'indique leur score de la liste de critères MA. Quatre études n'ont montré aucune différence statistique et ont montré une ampleur de l'effet négligeable entre l'intervention et le groupe témoin. La stimulation auditive rythmique et les jeux interactifs ont montré des bienfaits significatifs d'un point de vue statistique chez les adultes atteints de PC. Conclusions : il n'y a pas suffisamment de données probantes sur l'effet de l'exercice sur la mobilité fonctionnelle des adultes ambulatoires atteints de PC. Des recherches de qualité sont nécessaires pour déterminer les interventions les plus efficaces pour améliorer la mobilité fonctionnelle des adultes atteints de PC.
ABSTRACT
This study was aimed at determining the effect of an integrated group balance class for community-dwelling older adults within entry-level physical therapist coursework on student perceptions of geriatric physical therapy and geriatric physical therapy education. Twenty-nine Doctor of Physical Therapy (DPT) students, 21-33 years old, in their second year of coursework in 2012, participated in an integrated clinical experience with exposure to geriatric patients at an outpatient facility at the Louis Stokes Cleveland Department of Veterans Affairs Medical Center in Akron, Ohio, USA. Student perceptions were collected before and after participation in the 8-week balance class. The Wilcoxon sign-ranked test was used to identify differences in perceptions after participation in the group balance class. Cohen's d values were calculated to measure the size of the pre-participation to post-participation effect for each measure. At the conclusion of the group class, the DPT students demonstrated an increase in positive perceptions of geriatric physical therapy in 8 measures, with small effect sizes (d=0.15-0.30). Two perceptions of geriatric physical therapy demonstrated a significant positive increase (P<.05) with moderate effect sizes (d=0.47 and d=0.50). The students' perceptions of geriatric education in the curriculum demonstrated a large positive effect for quality (d=1.68) and enjoyment (d=1.96). Positive changes were found in most of the perceptions of geriatrics and geriatric education after participation, suggesting that integrated clinical experiences with geriatric patients are an effective way to positively influence perceptions of physical therapist practice with older adults.
