Intervention effects maintenance: 6-month randomized controlled trial follow-up of standard and reflexive pelvic floor muscle training.

BACKGROUND: To date, the focus of pelvic floor muscle training for women suffering from stress urinary incontinence has been on voluntary contractions although involuntary pelvic floor muscle contractions are crucial to guarantee continence in high-impact situations typically triggering this condition. The authors developed 2 pelvic floor muscle home training programs, one including standard voluntary pelvic floor muscle training and one including involuntary reflexive pelvic floor muscle training. OBJECTIVE: This study aimed to test 2 pelvic floor muscle home training programs regarding maintenance of effects of a previous 16-week intervention in terms of stress urinary incontinence symptoms (International Consultation on Incontinence Modular Questionnaire-Urinary Incontinence short form, modified 20-minute pad test), impact on quality of life (Lower Urinary Tract Symptoms Quality of Life module), and digitally assessed pelvic floor muscle strength. STUDY DESIGN: This trial was a continuation of a previously published triple-blind prospective randomized controlled trial with a 6-month evaluation endpoint with 2 intervention groups (experimental group with involuntary reflexive home pelvic floor muscle training and control group with standard voluntary home pelvic floor muscle training). RESULTS: From the originally included 96 randomized and allocated participants (experimental group=46, control group=46), 33 control and 27 experimental participants completed the 6-month follow-up. From post-16-week physiotherapy intervention to 6-month follow-up (home pelvic floor muscle training), there were statistically significant improvements in pelvic floor muscle strength (control and experimental group), and no difference in the International Consultation on Incontinence Modular Questionnaire-Urinary Incontinence short form and pad test, or the Lower Urinary Tract Symptoms Quality of Life module Part B (control and experimental group) and Part A (control group). However, there was a statistically significant improvement in the Lower Urinary Tract Symptoms Quality of Life module Part A (experimental group). At no point in time (pre, post, follow-up) was there any statistically significant difference between the groups. CONCLUSION: Both groups could maintain their intervention training effects. This trial investigated involuntary reflexive pelvic floor muscle training alone, which proved to be an effective alternative to standard voluntary pelvic floor muscle training for maintenance of training effects among women suffering from stress urinary incontinence.

Evaluation of short-term effects of three passive aquatic interventions on chronic non-specific low back pain: Study protocol for a randomized cross-over clinical trial.

BACKGROUND: Low back pain (LBP) is among the most common physical ailments and its chronic manifestation is a leading cause for disability worldwide. LBP is not attributable to a known diagnosis in 85% of the cases and therefore called chronic non-specific LBP (cnLBP). Passive immersion in warm water is commonly claimed to reduce muscular tension and pain, but not yet sufficiently investigated with regard to cnLBP. The current study compares three passive aquatic interventions regarding their effects on cnLBP: floating (resting in a supine immersed position on flotation devices), WATSU (a passive hands-on treatment, in which a practitioner stands in warm water, gently moving and massaging the client), and a Spa session. METHODS: In this randomized cross-over clinical trial, all 24 adult participants with cnLBP will undergo the three interventions in balanced order with a washout-period of at least two weeks in between. Assessments will take place at baseline and follow-up of study and immediately before and after each intervention. Assessments cover the primary outcome self-reported current pain (Visual Analog Scale, range: 0-100 mm), other self-report questionnaires (addressing, e.g., personality traits or -states), and physiological parameters (e.g., measurement of spinal range of motion). DISCUSSION: The study adds estimates of intervention-specific effect-sizes of widespread passive aquatic interventions to cnLBP. The study also points to potential underlying pain-reducing mechanisms. TRIAL REGISTRATION: The protocol was approved by the Ethics Committee of the Canton Bern (ProjectID: 2018-00461). Trial registration is intended at ClinicalTrials.gov.

Application areas and effects of aquatic therapy WATSU - A survey among practitioners.

INTRODUCTION: WATSU (WaterShiatsu) is a treatment administered in warm water. The present study investigated if and how frequently scientifically studied application areas and effects of WATSU occur in practice, whether similar effectiveness of WATSU is observed in trials and practice, and whether practitioners can contribute additional application areas and effects of WATSU. METHODS: Application areas and effects of WATSU reported in a recent systematic review were extracted verbatim to be assessed in a worldwide multilingual cross section online survey, generating quantitative and qualitative data. A pre-test and retest were conducted to ensure quality and evaluate the questionnaire's psychometric properties. RESULTS: Answers of 191 respondents were processed. All proposed 26 application areas and 20 effects were confirmed, each with relatively high ratings of observed effectiveness of WATSU. WATSU was frequently applied in healthy individuals (including during pregnancy), and individuals in various pain- (e.g., low back pain, neck pain, myofascial pain, fibromyalgia) and stress-related (e.g., stress, depression, sleep disorders, fatigue, anxiety disorders) conditions. Frequently confirmed effects were physical relaxation, relief of physical tension, pain relief, increased mobility and flexibility, improved quality of life, spiritual experiences, and increased psychological health. Respondents contributed 73 additional application areas and effects (both, mental and physical) of WATSU. CONCLUSIONS: Application areas and effects of WATSU are consistently employed practically and scientifically. Respondents' ratings of effectiveness of WATSU match tentative research efforts. WATSU is cautiously recommended for the use in pain- and stress-related conditions. Short- and long-term effectiveness of WATSU need to be evaluated in high level intervention studies.

Involuntary reflexive pelvic floor muscle training in addition to standard training versus standard training alone for women with stress urinary incontinence: a randomized controlled trial.

INTRODUCTION AND HYPOTHESIS: Although involuntary reflexive pelvic floor muscle contractions seem crucial during stress urinary incontinence-provoking situations, hitherto existing guidelines feature voluntary pelvic floor muscle training only. Two pelvic floor muscle protocols were compared regarding their effect on stress urinary incontinence in women: one focusing on standard physiotherapy with voluntary pelvic floor muscle training, the other additionally including involuntary reflexive pelvic floor muscle training. METHODS: This study was designed as a triple-blind prospective randomized controlled trial with women suffering from stress urinary incontinence with two physiotherapy intervention groups (control group: standard physiotherapy, n = 48, experimental group: standard physiotherapy plus involuntary reflexive pelvic floor muscle training triggered by whole-body movements such as jumps n = 48). Both interventions lasted 16 weeks (9 personal physiotherapy consultations and 78 home training sessions). Group differences and development over time were analyzed concerning the primary outcome International Consultation on Incontinence Modular Questionnaire Urinary Incontinence short form (ICIQ-UIsf) by mixed effect regression models. RESULTS: The ICIQ-UIsf score decreased significantly over time for both groups by about 3 points from about 10 to about 7 points with no group differences at any point in time. DISCUSSION: This trial did not find any additional benefit for stress urinary incontinence by adding involuntary reflexive pelvic floor muscle training to standard training. Both training protocols showed similar clinically relevant improvements; however, there was still moderate incontinence after interventions. Future studies should test and apply pelvic floor muscle function-oriented training methods for pelvic floor muscle hypertrophy, intramuscular coordination, and power, which are more in line with conventional skeletal muscle training, i.e., performed with higher intensities and workout.

Activation patterns of pelvic floor muscles in women with incontinence while running: a randomized controlled trial.

INTRODUCTION AND HYPOTHESIS: Running is known to cause urinary leakage in women with stress urinary incontinence (SUI). Task-specific fiber-type recruitment while running can be estimated using wavelets. The aim of this study was to compare the effect of a new physiotherapy program including involuntary, reflexive training with a standard physiotherapy program on pelvic floor muscle (PFM) activation patterns and fiber-type recruitment behavior while running. METHODS: In this triple-blinded randomized controlled trial, women with SUI were randomly allocated to the control group (CON), which performed a standard physiotherapy program, or the experimental group (EXP), which received additional involuntary, reflexive training. PFM electromyography (EMG) was recorded during 10 s at three running speeds and analyzed using Morse wavelets. The relative distribution of power (%) over the frequencies from 20 to 200 Hz was extracted and analyzed within six-time intervals of 30 ms. Statistical nonparametric mapping was performed to identify power spectra differences. RESULTS: Thirty-nine (CON) and 38 (EXP) women were included. The power spectra showed no statistically significant group differences. The time intervals from 30 ms before to 30 ms after initial contact showed significantly lower intensities than the intervals from 30 to 150 ms after initial contact in the lowest and higher intensities in the highest frequencies for all running speeds and both groups. CONCLUSIONS: Power spectra shifts toward higher frequency bands in the pre-initial contact phase could indicate a feed-forward anticipation and a muscle tuning for the expected impact of initial contact event in order to maintain continence.

Health status, comorbidities and cost-of-illness in females with stress urinary incontinence living in the Canton of Bern.

INTRODUCTION: Two thirds of women suffering from stress urinary incontinence (SUI) reported a negative impact on quality of life (QoL). SUI can also lead to less physical activity and more comorbidities. SUI may result in a substantial economic burden on health care services but numbers are not clear. Therefore, the aim of this study was to estimate the health status, the comorbidities and the health costs of women with SUI living in the Canton of Bern (Switzerland). METHODS: This cost-of-illness (COI) study was embedded in an RCT (n=96) exploring the effect of two pelvic floor muscle training protocols in women with SUI. A prevalence-based COI study with a societal perspective and a bottom-up approach was applied. Baseline demographics, comorbidities and cost data were collected prospectively during 16 weeks. Descriptive statistics, a frequency and a one-way sensitivity analysis were performed. RESULTS: Thirty-seven participants volunteered in this COI study. About 95 % had at least one comorbidity. The most commonly reported problem was back pain (47.6 %). Fifty-one percent consulted a medical doctor, the prevalence of drug consumption was 70 %, 11 % reported less efficiency whilst working and 30 % less physical activity. Mental stress was mentioned by 59.5 % of the participants. The average health costs were CHF 2256. DISCUSSION: This COI study provided data on health status, comorbidities, QoL, health care use, productivity losses and costs of SUI. The high prevalence of comorbidities observed in this study was comparable to obese females of a similar age group. The high economic burden of SUI requires cost-effective preventive actions and clinical treatment concepts.

Applications, indications, and effects of passive hydrotherapy WATSU (WaterShiatsu)-A systematic review and meta-analysis.

BACKGROUND: WATSU (portmanteau word: water and shiatsu) is a form of passive hydrotherapy in chest-deep thermoneutral water (35°C = 95°F = 308.15 K). It combines elements of myofascial stretching, joint mobilization, massage, and shiatsu and is reported to be used to address physical and mental issues. The objective of this systematic review (PROSPERO Registration No. CRD42016029347) and the meta-analyses was to assess the applications, indications, and the effects of WATSU to form a basis for further studies. METHODS: A search for "WATSU OR watershiatsu OR (water AND shiatsu)" was conducted without any restrictions in 32 databases. Peer reviewed original articles addressing WATSU as a stand-alone hydrotherapy were assessed for risk of bias. Quantitative data of effects on pain, physical function, and mental issues were processed in random model meta-analyses with subgroup analyses by study design. Effect sizes were expressed as Hedges's g (± 95% confidence intervals). RESULTS: Of 1,906 unique citations, 27 articles regardless of study design were assessed for risk of bias. WATSU has been applied to individuals of all ages. Indications covered acute (e.g. pregnancy related low back pain) and chronic conditions (e.g. cerebral palsy) with beneficial effects of WATSU regarding e.g. relaxation or sleep quality. Meta-analyses suggest beneficial effect sizes of WATSU on pain (overall Hedges's g = -0.71, 95% CI = -0.91 to -0.51), physical function (overall Hedges's g = -0.76, 95% CI = -1.08 to -0.44), and mental issues (overall Hedges's g = -0.68, 95% CI = -1.02 to -0.35). CONCLUSION: Various applications, indications and beneficial effects of WATSU were identified. The grade of this evidence is estimated to be low to moderate at the best. To strengthen the findings of this study, high-quality RCTs are needed.

Electromyography of pelvic floor muscles with true differential versus faux differential electrode configuration.

INTRODUCTION AND HYPOTHESIS: In pelvic floor muscle (PFM) electromyography (EMG) two different bipolar configurations are applied: "true differential" configuration (TD) measures neuromuscular activity with two ipsilateral electrodes, whereas "faux differential" configuration (FD) has two electrodes placed on each side of the PFMs. The aim of the study was to determine possible differences and the relationship between both configurations. METHODS: A secondary data analysis of 28 continent (CON) and 22 stress urinary incontinent (SUI) women was performed. Surface EMG was measured using a vaginal probe during maximal voluntary (MVC) and fast voluntary (FVC) contractions. TD and FD were explored with amplitude- and time-related EMG parameters, cross-correlation coefficients (R(0)) and statistical parametric mapping (SPM). RESULTS: Of a total of 62 comparisons of EMG parameters of MVC and FVC, only one comparison showed significant differences between the two configurations (CON group, FVC4peak TD versus FD, p = 0.015). R(0) were high in both groups for all MVC and FVC variables (R(0) ≥ 0.989). SPM detected 3 out of 28 comparisons with short (0.124-0.404 s) significant supra-threshold clusters (p < 0.025). CONCLUSIONS: The findings suggest that TD and FD might measure neuromuscular activity almost the same. Very high cross-correlation coefficients and a very limited number of significant results from EMG parameters, as well as SPM, suggest that in the measured sample the choice of TD or FD might remain practically irrelevant. To gain further insight into the scientific and clinical relevance of choosing either of the electrode configurations, the comparisons should be re-evaluated on a sample with more severe incontinence symptoms.

Pelvic floor muscle activity patterns in women with and without stress urinary incontinence while running.

BACKGROUND: High-impact activities are often related to urine leakage in women, so deeper insight into continence mechanisms of pelvic floor muscles (PFMs) while running is needed. Therefore, simultaneous information about the intensity of PFM muscle activity and fibre recruitment behavior at each time point of the gait cycle can help in understanding PFM activity patterns. OBJECTIVE: We aimed to analyse spectral changes of the pre- and post-initial contact phase during running at 3 different speeds and to compare women with stress urinary continence (SUI) to those without SUI by using a wavelet approach. METHODS: PFM electromyography (EMG) was recorded during 7, 11 and 15km/h treadmill running and analysed with Morse wavelets. The relative distribution of power was extracted during 6 time intervals of 30ms, from 30ms before to 150ms after initial contact. RESULTS: We included 28 women without SUI (mean [SD] age 38.9 [10.3] years) and 21 with SUI (mean age 46.1 [9.9] years). The groups did not differ in power spectra for each time interval. However, we found significantly less EMG intensity in the lower frequency bands but more intensity in the higher frequency bands in the pre-initial contact phase than at post-initial contact. CONCLUSION: Morse wavelets could be used to extract differences between pre- and post-initial contact activation behavior of PFMs during different running speeds as well as spectral changes toward high or low frequencies. This information sheds light on specific differences in involuntary reflexive activation patterns while running. Muscular preparation and adaptation a few milliseconds before initial contact could be helpful.

Pelvic floor muscle displacement during jumps in continent and incontinent women: An exploratory study.

INTRODUCTION: The prevalence of stress urinary incontinence during high-impact activities is high. Enhanced comprehension of pelvic floor muscle (PFM) displacement and activity is clinically relevant for the development of specific approaches in rehabilitation. The aim of the study is to investigate and to compare PFM displacement between the continent and incontinent women during jumps. METHODS: A cross-sectional, exploratory design was applied to investigate PFM displacement during drop jumps (DJ) and countermovement jumps (CMJ). PFM displacement was assessed in craniocaudal translation and forward-backward rotation with an electromagnetic tracking system. RESULTS: Twenty-eight continent and 22 incontinent women were included. During the first landing of DJ, a primary caudal, during the second landing of DJ/CMJ a primary cranial translation and during all jump a primary backward rotation was observed. No significant difference between the groups was found. DISCUSSION: PFM displacement during running demonstrated caudal translation/forward rotation before and cranial translation/backward rotation after heel strike. During the second landing of DJ/CMJ a cranial translation/backward rotation and during the first landing of DJ a caudal translation/backward rotation has been observed after ground contact. This may be due to the longer lasting bodyweight force in the first landing of DJ. No eccentric-concentric stretch-shortening cycle could be seen. CONCLUSION: This study indicates that during jumps two opposite reactions of involuntary PFM displacement happen, but no stretch-shortening cycle with an eccentric-concentric contraction could be found. Jumping stimuli inducing involuntary PFM displacement should be used for future investigations to consider a beneficial effect concerning continence.

Development of an ICF-based questionnaire for urinary and/or fecal incontinence (ICF-IAF): The female patients' perspective using focus groups (subproject).

AIMS: The aim of this study was to identify the problems and resources of women with urinary or fecal incontinence based on the International Classification of Function and Health (ICF) framework and detecting the impact on the personal environment and quality of life. This study forms part of a project with an overall goal to enable standardized planning and evaluation of interventions in multi-professional settings. METHODS: To answer the study question a mixed-method sequential design with a priority to the quantitative approach was considered appropriate. Regarding methods, focus groups were chosen to collect data. Transcripts were analyzed with content analysis and identified concepts linked to the corresponding ICF categories by two different raters. Cohen's kappa was calculated for interrater reliability. RESULTS: Thirteen women with a mean age of 69.9 years were recruited. Four focus groups were conducted, whereas saturation was reached after two focus groups. Overall transcripts 99 defined ICF categories at second level could be linked (body functions = 31, body structures = 5, activities and participation = 33, and environmental factors = 30) whereas 4 categories were not sufficiently covered by the ICF (3 = personal factors, 1 = not covered). CONCLUSIONS: This study has determined 103 resources and problems based on the ICF model of women with urinary and/or fecal incontinence. In spite of these results, it was shown that four concepts are not fully covered by the ICF framework. The current data highlight the importance of an extension of the ICF model, especially towards the personal factors of patients.

Development of an ICF-based questionnaire for urinary and/or fecal incontinence (ICF-IAF): The male patients' perspective using focus groups.

AIMS: This study seeks to explore barriers faced by and resources available to male patients with urinary (UI) and/or fecal incontinence (FI) based on the ICF framework. As a result, this study contributes to the development of the ICF-Incontinence Assessment Form (ICF-IAF), which is designed to be a standardized planning and evaluation tool for interventions in a multidisciplinary setting. METHODS: A mixed-method sequential design that places emphasis on the quantitative approach was considered appropriate for this study. Focus group interviews (FG) were chosen to collect data. Data were analysed with deductive content analysis and themes identified during FG were linked to the most corresponding ICF categories by two raters. Cohen's κ was calculated to determine interrater reliability. RESULTS: Four FG were conducted with a total of 13 male participants. The mean age of the participants was 74.7 years. A total of 73 barriers and resources on the second ICF level (body functions 26, body structures five, activities and participation 26 and environmental factors 16), whereby four categories were not sufficiently covered by the ICF, could be identified. The κ score for the two raters was 0.82. CONCLUSIONS: While barriers are fundamental factors affecting patients, this study found that resources are as important and should not be overlooked in the conventional treatment in both UI and FI-specific assessments.

Reliability and validity of pelvic floor muscle displacement measurements during voluntary contractions.

INTRODUCTION AND HYPOTHESIS: Understanding the functioning of pelvic floor muscles (PFM) is crucial in female PFM rehabilitation. The aim of this study was to determine the intra-session retest reliability and validity to evaluate the quantity of PFM displacement. METHODS: This cross-sectional observational study examined the PFM displacement of 17 young healthy nulliparous women in the midsagittal plane. Three maximal voluntary contractions (MVCs) and five fast voluntary contractions (FVCs) were simultaneously examined with an electromagnetic tracking system (ETS) and transabdominal ultrasound (TAUS) and expressed in millimeters (mean, SD). To evaluate reliability and validity, the analysis of variance, intraclass coefficient (2,1), standard error of measurement (SEM), and minimal detectable difference (MDD) were calculated. RESULTS: Maximal voluntary contractions and FVCs in supine position measured by an ETS (TAUS) showed a displacement of MVC: 3.5 ± 1.9 mm (7.8 ± 4.5 mm), FVC: 3.5 ± 2.4 mm (7.6 ± 5.3 mm), and during standing of MVC: 5.2 ± 1.6 mm (9.4 ± 3.8 mm) and FVC: 4.8 ± 2.5 mm (9.7 ± 4.1 mm). Intraclass correlation for the ETS (TAUS) measurement varied between 0.79 and 0.89 (0.61 and 0.74), SEM 0.52 and 1.03 mm (1.54 and 3.2 mm), and MDD 1.54 and 3.2 mm (6.64 and 7.53 mm). The correlation between an ETS and TAUS varied between 0.53 and 0.67. CONCLUSIONS: For MVC and FVC, ETS measurements are highly reliable and TAUS measurements are moderately reliable for both contraction types. The correlation between the TAUS and ETS measurements is moderate. An ETS seems to be a reliable and valid measurement tool for evaluating PFM displacement during voluntary contractions. In future studies, the reproducibility and validity of ETS measurements need to be investigated in impact activities.

Development and validation of the ICF-Incontinence Assessment Form (ICF-IAF) to identify problems and resources for planning and evaluation of interventions using the Classification of Functioning, Disability and Health of the World Health Organization: Preliminary study.

AIMS: Current level-A recommended questionnaires that provide a valid assessment of urinary incontinence (UI) and/or faecal incontinence (FI), but do not cover all aspects of the burden of the disease in the sense of the bio-psycho-social model of the World Health Organization's International Classification of Functioning, Disability and Health (ICF). Therefore, an ICF oriented questionnaire for patients with UI and/or FI to assess treatment barriers (problems) as well as positive influencing factors (resources), the "ICF-Incontinence Assessment Form" will be developed. The aim of this preliminary study was (a) to identify problems and resources of UI and/or FI in current level-A recommended questionnaires and (b) to evaluate problems and resources of patients with UI and/or FI from the perspective of experienced physiotherapists. METHODS: (a) Current level-A recommended questionnaires for UI and/or FI were analyzed. Questions were linked to the ICF categories. (b) A 3-round Delphi technique survey among 262 physiotherapists from five German-speaking countries was used to evaluate patients' problems and resources relevant to physiotherapy. RESULTS: (a) A total of 27 identified questionnaires were linked to 110 ICF categories. No positive influencing factors could be identified. (b) After Delphi-round 3, 110 categories of problems and 71 resources were identified. CONCLUSION: Since there is a lack of resource items in the present validated questionnaires, there is a need for a short, practical questionnaire to assess and monitor both, problems and resources of patients with UI and/or FI.

Pelvic floor muscle activity during fast voluntary contractions in continent and incontinent women.

AIMS: Stress urinary incontinence (SUI) has also been attributed to a lower speed of contraction of the pelvic floor muscles (PFM). Therefore, PFM assessment and training implement fast voluntary contractions (FVC). The purpose of the study was to explore FVC regarding feasibility, on-/offset and rate of activity determination, as well as differences between continent (CON) and stress urinary incontinent (SUI) women. METHODS: Fifty women were included and examined by means of PFM EMG during rest, maximum voluntary contractions (MVC), and five FVC. MVC-peak activity was used to normalize EMG-data. On-/offset of muscle activity was determined as mean of rectified rest activity plus 1 standard deviation. Linear regression was calculated for rate of activity from onset to peak, peak to offset, and within 200 ms after both onset and peak. Peak activity and time variables related to onset, peak, and offset were calculated. RESULTS: On-/offsets were evaluable for 234/222 of 250 FVC by a computer-based algorithm, 16/28 on-/offsets had to be determined manually. There was no significant difference between groups (CON/SUI) regarding FVC peak (92.1/99.3 %MVC), time to peak (514.2/525.6 ms), and increase of activity (182.8/182.1 %MVC/s). The SUI group showed a significantly slower activity decrease (-120.7/-74.4 %MVC/s). CONCLUSIONS: FVC analyses were shown to be feasible. The significant difference observed between the groups did not refer to activity increase but instead to a prolonged relaxation phase in the SUI group. This prompts to reconsider the interpretation of FVC in PFM testing and training.

Wavelet analyses of electromyographic signals derived from lower extremity muscles while walking or running: A systematic review.

Surface electromyography is often used to assess muscle activity and muscle function. A wavelet approach provides information about the intensity of muscle activity and motor unit recruitment strategies at every time point of the gait cycle. The aim was to review papers that employed wavelet analyses to investigate electromyograms of lower extremity muscles during walking and running. Eleven databases were searched up until June 1st 2017. The composition was based on the PICO model and the PRISMA checklist. First author, year, subject characteristics, intervention, outcome measures & variables, results and wavelet specification were extracted. Eighteen studies included the use of wavelets to investigate electromyograms of lower extremity muscles. Three main topics were discussed: 1.) The capability of the method to correctly assign participants to a specific group (recognition rate) varied between 68.4%-100%. 2.) Patients with ankle osteoarthritis or total knee arthroplasty presented a delayed muscle activation in the early stance phase but a prolonged activation in mid stance. 3.) Atrophic muscles did not contain type II muscle fiber components but more energy in their lower frequencies. The simultaneous information of time, frequency and intensity is of high clinical relevance because it offers valuable information about pre-and reflex activation behavior on different walking and running speeds as well as spectral changes towards high or low frequencies at every time point of the gait cycle.

Intra- and interday reliability of the dynamic navicular rise, a new measure for dynamic foot function: A descriptive, cross-sectional laboratory study.

BACKGROUND: The lack of reliable parameters to evaluate dynamic foot function, emphasizes the need for a deeper insight in foot biomechanics. The aims were to investigate the reliability of a new parameter (dynamic navicular rise dNR), and its relationship with the dynamic navicular drop (dND). METHODS: Twenty healthy participants (mean age 30.2±8.1years) had to walk on even ground and downstairs. Data of ten trials per task on two measurement days were recorded. The dNR was defined as the difference in millimetres (mm) between the minimum navicular height (NH) during stance and the NH at toe off. To test intra- and interday reliability, Intraclass Correlation Coefficients (ICC2.1) and repeatability were calculated. To obtain the absolute repeatability (RP) in mm, the equation RP=1.96×SDdifferences was used. Furthermore, the relationship between the dNR and the dND was examined by calculating Pearson (r) or Spearman (rs) correlation coefficients. RESULTS: Included participants showed a mean dNR of (12.2±3.7) mm for level walking and (14.8±3.4) mm for stair descent. The ICC2.1 for the dNR were 0.98 (intraday), 0.91 (interday) for level walking and 0.97 (intraday), 0.94 (interday) for stair descent. The interday repeatability was 3.2mm (level walking), 2.7mm (stair descent) respectively. For level walking, r was 0.31 (p=0.049), and rs=0.88 (p<0.001) for stair descent. CONCLUSIONS: The dNR seems to be highly reliable (ICCs), however, repeatability is unacceptable. For level walking, the dNR might be an independent measure, but not for stair climbing.

Time Pressure, Time Autonomy, and Sickness Absenteeism in Hospital Employees: A Longitudinal Study on Organizational Absenteeism Records.

BACKGROUND: Although work absenteeism is in the focus of occupational health, longitudinal studies on organizational absenteeism records in hospital work are lacking. This longitudinal study tests time pressure and lack of time autonomy to be related to higher sickness absenteeism. METHODS: Data was collected for 180 employees (45% nurses) of a Swiss hospital at baseline and at follow-up after 1 year. Absent times (hours per month) were received from the human resources department of the hospital. One-year follow-up of organizational absenteeism records were regressed on self-reported job satisfaction, time pressure, and time autonomy (i.e., control) at baseline. RESULTS: A multivariate regression showed significant prediction of absenteeism by time pressure at baseline and time autonomy, indicating that a stress process is involved in some sickness absenteeism behavior. Job satisfaction and the interaction of time pressure and time autonomy did not predict sickness absenteeism. CONCLUSION: Results confirmed time pressure and time autonomy as limiting factors in healthcare and a key target in work redesign.

Acute effects of partial-body vibration in sitting position.

AIM: To investigate the acute effects of sinusoidal and stochastic resonance partial-body vibration in sitting position, including muscle activity, heart rate variability, balance and flexibility. METHODS: Fifty healthy participants were assigned randomly to two training conditions: A sinusoidal partial-body vibration (SIN, 8 Hz) or a stochastic resonance partial-body vibration (STOCH, 8 ± 2 Hz). For baseline assessment participants sat on the vibration platform without vibration. Both training conditions consisted of five series of a one-minute vibration training and a one-minute break between them. In this experimental study surface electromyography (EMG) of the erector spinae (ES), one of the back muscles, and heart rate variability (HRV) was measured at baseline and during training. Balance and flexibility were assessed at baseline and immediately after training. Balance was measured with the modified star excursion balance test (mSEBT) and flexibility was assessed through the modified fingertip-to-floor method (mFTF). RESULTS: Paired sample t-test showed a significant increase in balance that was restricted to STOCH (t = -2.22, P = 0.018; SIN: t = -0.09, P = 0.466). An increase in flexibility was also restricted to STOCH (t = 2.65, P = 0.007; SIN: t = 1.41, P = 0.086). There was no significant change of muscle activity in the ES-EMG in STOCH or SIN conditions. In both training conditions, HRV decreased significantly, but remained in a low-load range (STOCH: t = 2.89, P = 0.004; SIN: t = 2.55, P = 0.009). CONCLUSION: In sitting position, stochastic resonance partial-body vibration can improve balance and flexibility while cardiovascular load is low. STOCH can be a valuable training option to people who are unable to stand (e.g., people, who are temporarily wheelchair-bound).

Effects of Stochastic Resonance Whole-Body Vibration in Individuals with Unilateral Brain Lesion: A Single-Blind Randomized Controlled Trial: Whole-Body Vibration and Neuromuscular Function.

INTRODUCTION: Stochastic resonance whole-body vibration (SR-WBV) devices are promising sensorimotor interventions to address muscle weakness and to improve balance and mobility particularly in the elderly. However, it remains inconclusive whether individuals with stroke or traumatic brain injury (TBI) can profit from this method. The aim of this prospective single-blind randomized controlled trial was to investigate the effects of SR-WBV on muscle strength as well as gait and balance performance in this population. METHODS: Forty-eight individuals with stroke or TBI were randomly allocated to an experimental and a sham group. Participants were exposed daily to 5 consecutives 1-minute SR-WBV sessions, whereas the experimental group trained in a standing position with 5 Hz and the sham group in a seated position with 1 Hz. Isometric muscle strength properties of the paretic knee extensor muscles as well as balance and gait performance were measured at baseline, after the first session and after two weeks of SR-WBV. RESULTS: Both groups showed short- and long-term effects in gait performance. However, no between-group effects could be found at the three measurement points. DISCUSSION: Complementary SR-WBV showed no beneficial effects immediately after the intervention and after two weeks of conventional rehabilitation therapy. Future research is needed to identify the potential efficacy of SR-WBV in individuals with stroke and TBI using shorter and less exhausting test procedures and a generally prolonged intervention time.