Effects of an outpatient physical exercise program on hematopoietic stem-cell transplantation recipients: a randomized clinical trial.

Patients who undergo hematopoietic SCT (HSCT) often experience physical and psychological problems, even long after treatment has been completed. This study was performed to evaluate the effects of a 12-week outpatient physical exercise (PE) program, incorporating aerobic and strength exercises, as compared with a usual care control condition on patients' physical performance and psychosocial well-being. Patients who had completed HSCT up to 6 months earlier were randomly assigned to a supervised PE program (n=64) or a usual care control group (n=67). Primary outcomes were quantified physical performance and self-reported physical functioning. Secondary outcomes were body composition measurement, quantified walking activity and patient-reported outcomes (physical activity, fatigue and health-related quality of life). Assessments were at baseline, immediately after program completion and at 3-month follow-up. Significant intervention effects were observed at both posttreatment and follow-up on physical performance measures. No other outcomes yielded statistically significant group differences. PE should be considered in the management of HSCT recipients to improve physical performance after discharge from the hospital. Further research is needed to determine how the program can be enhanced so that improved physical performance also translates into improved physical and psychosocial functioning in daily life.

The effect of physical exercise on cancer-related fatigue during cancer treatment: a meta-analysis of randomised controlled trials.

The aim of this meta-analysis was to evaluate the effects of different exercise prescription parameters during cancer treatment on cancer-related fatigue (CRF). We also aimed to gain insight into the safety and feasibility of exercise during adjuvant cancer treatment. A systematic search of CINAHL, Cochrane Library, Embase, Medline, Scopus and PEDro was carried out. Randomised controlled trials studying the effects of exercise during cancer treatment on CRF were included. In total, 18 studies (12 in breast, four in prostate and two in other cancer patients) met all the inclusion criteria. During breast cancer treatment, home-based exercise lead to a small, non-significant reduction (standardised mean difference 0.10, 95% confidence interval -0.25 to 0.45), whereas supervised aerobic exercise showed a medium, significant reduction in CRF (standardised mean difference 0.30, 95% confidence interval 0.09 to 0.51) compared with no exercise. A subgroup analysis of home-based (n=65) and supervised aerobic (n=98) and resistance exercise programmes (n=208) in prostate cancer patients showed no significant reduction in CRF in favour of the exercise group. Adherence ranged from 39% of the patients who visited at least 70% of the supervised exercise sessions to 100% completion of a home-based walking programme. In more than half the studies (12 of 18; 67%) adverse events were reported. Eight events in total (0.72%) occurred in these studies.

Physical activity and enhanced fitness to improve cognitive function in older people without known cognitive impairment.

BACKGROUND: Physical activity is beneficial for healthy ageing. It may also help maintain good cognitive function in older age. Aerobic activity improves cardiovascular fitness, but it is not known whether this sort of fitness is necessary for improved cognitive function. Studies in which activity, fitness and cognition are reported in the same individuals could help to resolve this question. OBJECTIVES: To assess the effectiveness of physical activity, aimed at improving cardiorespiratory fitness, on cognitive function in older people without known cognitive impairment. SEARCH STRATEGY: We searched MEDLINE, EMBASE, PEDro, SPORTDiscus, PsycINFO, CINAHL, Cochrane Controlled Trials Register (CENTRAL), Dissertation abstracts international and ongoing trials registers on 15 December 2005 with no language restrictions. SELECTION CRITERIA: All published randomised controlled trials comparing aerobic physical activity programmes with any other intervention or no intervention with participants older than 55 years of age were eligible for inclusion. DATA COLLECTION AND ANALYSIS: Eleven RCTs fulfilling the inclusion criteria are included in this review. Two reviewers independently extracted the data from these included studies. MAIN RESULTS: Eight out of 11 studies reported that aerobic exercise interventions resulted in increased cardiorespiratory fitness of the intervention group (an improvement on the maximum oxygen uptake test which is considered to be the single best indicator of the cardiorespiratory system) of approximately 14% and this improvement coincided with improvements in cognitive capacity. The largest effects on cognitive function were found on motor function, auditory attention and delayed memory functions (effect sizes of 1.17, 0.52 and 0.50 respectively). However, the results for delayed memory functions should be interpreted with care since they are based on a single study. Moderate effects were observed for cognitive speed (speed at which information is processed; effect size 0.26) and visual attention (effect size 0.26). AUTHORS' CONCLUSIONS: There is evidence that aerobic physical activities which improve cardiorespiratory fitness are beneficial for cognitive function in healthy older adults, with effects observed for motor function, cognitive speed, delayed memory functions and auditory and visual attention. However, the majority of comparisons yielded no significant results. The data are insufficient to show that the improvements in cognitive function which can be attributed to physical exercise are due to improvements in cardiovascular fitness, although the temporal association suggests that this might be the case. Larger studies are still required to confirm whether the aerobic training component is necessary, or whether the same can be achieved with any type of physical exercise. At the same time, it would be informative to understand why some cognitive functions seem to improve with (aerobic) physical exercise while other functions seem to be insensitive to physical exercise. Clinicians and scientists in the field of neuropsychology should seek mutual agreement on a smaller battery of cognitive tests to use, in order to render research on cognition clinically relevant and transparent and heighten the reproducibility of results for future research.

Contracture preventive positioning of the hemiplegic arm in subacute stroke patients: a pilot randomized controlled trial.

OBJECTIVE: To investigate the effectiveness of a contracture preventive positioning procedure for the hemiplegic arm in subacute stroke patients in addition to conventional physio- and occupational therapy. DESIGN: A single-blind pilot randomized controlled trial. SETTING: Inpatient neurological units from three rehabilitation centres in the Netherlands. SUBJECTS: Nineteen subacute stroke patients (minus two drop-outs) with a severe motor deficit of the arm. INTERVENTIONS: All subjects underwent conventional rehabilitation care. Nine subjects additionally received a positioning procedure for two 30-min sessions a day, five days a week, for five weeks. MAIN MEASURES: Passive range of motion of five arm movements using a hydrogoniometer and resistance to passive movement at the elbow using the Ashworth Scale. Secondary outcome measures were pain at the end range of passive motions, the arm section of the Fugl-Meyer Assessment and Barthel Index scores for ADL-independence. Outcome measures were taken after five weeks and additional measurements after 10 weeks by two assessors blinded to group allocation. RESULTS: Comparison of the experimental (n = 9) with the control subjects (n = 8) after five weeks showed that additional positioning significantly slowed down development of shoulder abduction contracture (P = 0.042, -5.3 degrees versus -23 degrees). No other differences were found between the groups. CONCLUSIONS: Applying a contracture preventive positioning procedure for the hemiplegic arm slowed down the development of shoulder abduction contracture. Positioning did not show significant additional value on other outcome measures. Since the sample size was small, results of this study need future verification.

Orthotic devices for treating patellofemoral pain syndrome.

BACKGROUND: Patellofemoral pain syndrome is a frequently reported condition in active adults. A wide variety of conservative treatment strategies have been described. As yet, no optimal strategy has been identified. Application of orthotic devices e.g. knee braces, knee straps, forms of taping of the knee, active training devices, knee sleeves and in-shoe orthotics to support the foot have been advocated to treat this condition. OBJECTIVES: To assess the effectiveness of foot and knee orthotics for treatment of patellofemoral pain syndrome. SEARCH STRATEGY: We searched the Cochrane Musculoskeletal Injuries Group specialised register (December 2001), the Cochrane Controlled Trials register (Issue 2, 2000), MEDLINE (January 1966 to March 2000; EMBASE (January 1988 to March 2000); CINAHL (January 1982 to March 2000) and PEDro (up to March 2000). Relevant orthotic companies were contacted. SELECTION CRITERIA: All randomised and quasi-randomised trials comparing the effectiveness of knee or foot orthotics for treatment of patellofemoral pain syndrome were selected. Trials describing the use of orthotic devices in conjunction with operative treatment were excluded. DATA COLLECTION AND ANALYSIS: Three reviewers independently assessed methodological quality of the identified trials by use of a modified version of the Cochrane Musculoskeletal Injuries Group assessment tool, consisting 11 items. Two reviewers extracted data without blinding. Trialists were contacted to obtain missing data. MAIN RESULTS: Five trials involving 362 participants were included in this review. Five other trials await possible inclusion if further information can be obtained and one awaits further assessment. Due to clinical heterogeneity, we refrained from statistical pooling and conducted analysis by grading the strength of scientific evidence. The level of obtained research-based evidence was graded as limited as all trials were of low methodological quality. This limited research-based evidence showed the Protonics orthosis at six week follow-up was significantly more effective for decrease in pain (weighted mean difference (WMD) between groups 3.2; 95% confidence interval (CI) 2.8 to 3.6), functional improvement on the Kujala score (WMD 45.6; 95% CI 43.4 to 47.7) and change in patellofemoral congruence angle (WMD 17.2; 95% CI 14.1 to 20.3) when compared to no treatment. A comprehensive programme including tape application was significantly superior to a monitored exercise programme without tape application for decrease in worst pain (WMD 1.6; 95% CI 0.4 to 2.8) and usual pain (WMD 1.2; 95% CI 0.2 to 2.1), and clinical change and functional improvement questionnaire scores (WMD 10, 95% CI 2.07 to 17.93) at four weeks follow-up. The trials reported statistically significant differences in patient satisfaction after applied therapy (WMD 3.3; 95% CI 0.5 to 6.1) in favour of the McConnell regimen compared with the Coumans bandage at six weeks follow-up. REVIEWER'S CONCLUSIONS: The evidence from randomised controlled trials is currently too limited to draw definitive conclusions about the use of knee and foot orthotics for the treatment of patellofemoral pain. Future high quality trials in this field are warranted.

Effect of a physical therapeutic intervention for balance problems in the elderly: a single-blind, randomized, controlled multicentre trial.

OBJECTIVE: To establish the effect of a short, individualized exercise programme on balance dysfunction in the elderly. DESIGN: A single-blind, randomized, controlled, multicentre trial. SETTING: Physical and recreational therapy departments from two rehabilitation centres. PARTICIPANTS: Ninety-four subjects of >75 years with functional balance problems living independently or in a residential care facility. Seventy-seven subjects completed the intervention period and four-week follow-up. At a one-year follow-up 49 subjects were evaluated on balance functioning. INTERVENTIONS: Twelve sessions of an individualized balance training programme (experimental group) or 12 sessions of an individualized extra attention programme (control group) given in 4-6 weeks. MAIN OUTCOME MEASURES: Berg Balance Scale and the Dynamic Gait Index to establish balance functioning, a visual analogue scale to establish fear of falling in daily life and the Hospital Anxiety Depression Scale to verify feelings of anxiety and depression. RESULTS: Subjects in the experimental group improved significantly more on the Berg Balance Scale and the Dynamic Gait Index than those in the control group (p f 0.001, p f 0.001, respectively). However the effect disappeared at a one-year follow-up on the Berg Balance Scale. No prognostic factors could be identified to determine who would benefit most from the individualized exercise programme. Results on the other response variables revealed no effect of the intervention. CONCLUSION: A short individualized exercise programme can improve functional balance in people aged 75 years and older. This improvement was maintained at least for one month but had worn off by one year.

The QA pressure measurement system: an accuracy and reliability study.

OBJECTIVE: The main purpose of this study was to determine the accuracy and reliability of the Queen Alexandra Pressure Measurement System (QA PMS). Furthermore, we examined whether there were significant differences in measured pressures of the buttock area during sitting between normal subjects and spinal cord injured (SCI) patients. DESIGN: Accuracy (calibration) and reliability (test-retest) study. SETTING: The spinal cord unit of Tertiary Care Centre 'De Hoogstraat' in Utrecht, The Netherlands. PATIENTS: A convenience sample of 16 SCI patients and 15 normal subjects. MAIN OUTCOME MEASURES: The accuracy was determined by using the Standard Error of the Mean (SEM, in mmHg). The Technical Error of Measurement (TEM, in mmHg) was calculated as measure for differences between two paired measurements. The reliability was determined by using an Intraclass Correlation Coefficient (ICC). Significant differences in measured pressures between both groups (P<0.05) were determined by using an unpaired (two sample) t-test. RESULTS: Accuracy (calibration): mean SEM=0.30 (+/-0.1) mmHg, indicating a high level of accuracy. Differences between two paired measurements: mean TEM calibration= 1.87 (+/-0.76) mmHg; mean TEM normal subjects=4.76 (+/-1.78) mmHg; mean TEM SCI patients=6.34 (+/-2.19) mmHg. Reliability: mean ICC(3,1) calibration=0.85 (95% CI=0.74 0.95); mean ICC(2.1) normal subjects=0.92 (95% CI=0.90 0.94); mean ICC(2.1) SCI patients=0.90 (95% CI=0.88 0.92). The normal subjects had significantly higher mean pressures (P=0.028) than the SCI patients (mean pressures 31.0 vs 28.5 mmHg), whilst the SCI patients had significantly higher peak-pressures (P=0.0000) than the normal subjects (mean peak-pressures: 134.1 vs 75.7 mmHg). CONCLUSIONS: The QA Pressure Measurement System has sufficient accuracy and good reliability as a measurement procedure. There are significant differences between the measured pressures of both groups: the significantly higher peak pressures of the SCI patients seem to be the most important.

Intraexaminer and interexaminer reliability of the Gillet test.

OBJECTIVES: The purpose of this study was to determine the intraexaminer and interexaminer reliability of the Gillet test. STUDY DESIGN: In a test-retest study the incidence of asymmetric or symmetric sacroiliac joint motion was investigated with the Gillet test. METHODS: Forty-one male subjects volunteered for this study (mean age, 23 +/- 2.24 years). Thirty-eight subjects were examined in the first test procedure, and at least 4 days later 37 subjects were examined again. The subjects were subdivided into symptomatic and asymptomatic groups on the basis of certain criteria. RESULTS: To obtain the intraexaminer and interexaminer reliability values, Cohen's kappa, the percentage agreement, bias-adjusted kappa, and prevalence-adjusted bias-adjusted kappa were used. The mean Cohen's kappa did not exceed the value of 0.081. Only the percentage agreement of the symptomatic group did exceed the minimum level of 80%. When kappa was positive, the prevalence-adjusted bias-adjusted kappa was markedly higher than kappa; when kappa was negative, the prevalence-adjusted bias-adjusted kappa was only slightly higher than kappa. Only small differences were found between kappa and bias-adjusted kappa. CONCLUSION: The Gillet test, as performed in this study, does not appear to be reliable.

Reliability of manual skinfold tests in a healthy male population.

OBJECTIVE: To assess the intra- and interexaminer agreement of a manual skinfold thickness test and a manual skinfold compliance test. The relation between the weekly routine of the examiners and the intraexaminer reliability was also assessed for both tests. DESIGN: This is a reliability study of a common palpatory procedure to assess skinfold thickness and skinfold compliance. Twelve healthy subjects were palpated twice in two sessions by 12 examiners. SETTING: The study was conducted at the Polytechnic of Utrecht (the Netherlands), Faculty of Health Care, Department of Physiotherapy. SUBJECTS: Healthy male subjects recruited from students of the Polytechnic of Utrecht (the Netherlands), Department of Physiotherapy. RESULTS: The intraexaminer agreement Intraclass Correlation Coefficient [ICC(3.1)] was .25 for skinfold thickness and .28 for skinfold compliance. The interexaminer agreement [ICC(2,1)] ranged from .01 to .24. The Pearson correlation coefficient between the examiners age and routine vs. intraexaminer agreement ranged from -.41 to .23 (nonsignificant). CONCLUSIONS: The intra- and interexaminer agreement of the manual skinfold test produced poor-to-fair reliability. The correlation between the examiners' weekly routine and the intraexaminer reliability ranged from low negative to little (if any). This study shows a lack of reliability of palpatory tests for skinfold thickness and skinfold compliance. This outcome agrees with results of previous studies found in the literature.

Sensibility testing in patients with a lumbosacral radicular syndrome.

OBJECTIVE: To examine whether there is a significant difference in gnostic sensibility between affected and unaffected legs of patients suffering from lumbosacral radicular syndrome (LRS) resulting from a disc herniation and to determine the validity of the sensibility test for detecting a disc herniation. DESIGN: Observer blind study of sensibility testing. SETTING: Four general hospitals (neurology department) and one practice of physical and manual therapy. SUBJECTS: Fifty-one patients with radicular pain in the lumbosacral nerve roots for at least 4 wk and/or neurological deficits. METHODS: The gnostic sensibility of 51 patients with a unilateral LRS was tested using Semmes-Weinstein monofilaments for the L4, L5 and S1 dermatomes. RESULTS: Gnostic hypoesthetic impairments in the L4, L5 and S1 dermatomes were found in 84.6% of the 43 patients in which the presence of disc herniation was confirmed by CT. There was significant difference in gnostic sensibility between the affected and unaffected legs in the L4, L5, and S1 dermatomes for disc herniation at the L4-L5 level and for the L5 and S1 dermatomes for a disc herniation at the L5-S1 level. There was no significant difference in gnostic sensibility in the L4 dermatome for a disc herniation at the L5-S1 level. CONCLUSION: The gnostic sensibility of the affected leg is hypoesthetic compared with the unaffected leg. The specificity of the sensibility test using monofilaments is acceptable, but the sensitivity is not. The monofilament test is a useful and practical tool for excluding the presence of a disc herniation at dermatomes L4, L5 and S1 and disc herniations at the L4-L5, L5-S1 level.

Assessing anterior cruciate ligament injuries: the association and differential value of questionnaires, clinical tests, and functional tests.

It is important to examine the package of questionnaires and clinical and functional tests as used in anterior cruciate ligament (ACL)-injured patients in order to gain insight on the patient's present status. Nine measuring systems in three categories were examined: four questionnaires, three clinical tests, and two functional tests. Differences between sports activity rating system, factor occupational rating system scale, and Tegner scores pre- and post-injury and the differences between the affected and unaffected knee in the clinical and functional tests were calculated using the Wilcoxon test for paired observations. These differences proved to be significant (p < 0.05). The association between the various tests was also examined. None of the associations satisfied the preset standards. Based on these low levels of association, it does not seem possible to reduce the package of tests to one questionnaire, one clinical test, and one functional test as all questionnaires and tests seem to be related to different aspects of the injured ACL. Based upon these results, the total package should be used to gain insight in both impairment and disability level in patients with an injured ACL.

Negative affect, pain and disability in osteoarthritis patients: the mediating role of muscle weakness.

Negative affect has been shown to be associated with high levels of pain and disability in osteoarthritis (OA) patients. As an explanation of this association, it was hypothesized that muscle weakness is a mediating factor between negative affect, pain and disability. Accordingly, negative affect enhances the patient's tendency to avoid pain-related activities; a low activity level induces muscle weakness, instability of joints and thus pain and disability. This theory leads to the prediction that the association between negative affect, pain and disability is most pronounced in patients with weak muscles. The prediction was tested in a study on patients with OA of the hip and/or knee. Regarding disability (but not pain), the prediction was confirmed. This study indicates that muscle weakness is a mediating factor between negative affect and disability in OA-patients.