In the lower leg, landing after a jump induces reflexes, the role of which is not well understood. This is even more so for reflexes following landing on inverting surfaces. The latter condition is of special interest since ankle inversion traumata are one of the most common injuries during sport. Most studies have investigated ankle inversions during a static standing condition. However, ankle injuries occur during more dynamic activities such as jumping. Therefore, the present study aimed at reproducing these situations but in a completely safe setting. EMG responses were recorded after landing on an inverting surface, which caused a mild ankle inversion of 25 deg of rotation (in a range sufficient to elicit reflexes but safe enough to exclude sprains). The results are compared with data from landing on a non‐inverting surface to understand the effect of the inversion. In general, landing on the platform resulted in short and long latency responses (SLR and LLR) in triceps surae (soleus, gastrocnemius medialis and lateralis) and peroneal muscles (long and short peroneal) but not in the tibialis anterior muscle. Landing on the inverting platform caused significant LLRs in the peroneal muscles (which underwent the largest stretch) but not in the triceps muscles. Conversely, landing on a non‐inverting platform induced larger SLRs in triceps than in the peroneal muscles. Although the peroneal LLRs thus appeared to be selectively recruited in an inverting perturbation, their role during such perturbations should be limited since the latency of these responses was about 90 ms while the inversion lasts only 42 ms. The SLRs, if present, had an onset latency of around 44 ms. In the period following the inversion, however, the responses may be important in preventing further stretch of these muscles.

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BackgroundThe use of measurement instruments in physiotherapy has been recommended in clinical practice guidelines to improve evidence-based practice. The aims of the study were (a) to describe the current use of measurement instruments by physiotherapists working in Germany and (b) to investigate the facilitators and barriers to use measurement instruments.MethodsThis cross-sectional study used a nationwide online survey, which was accessible to all physiotherapists working in Germany.ResultsIn total, 522 adult physiotherapists working in Germany completed the questionnaire. The mean age of the respondents was 38 years, 63% were female, and 53% had >10 years of work experience.Thirty-one percent of the respondents used measurement instruments in ≥80% of their patients, and 26% used measurement instruments in ≤20%. Measurement instruments were used for diagnostic and prognostic purposes by 69% and 22% of respondents, respectively. The three most frequently reported measurement instruments were “goniometer” (n = 254), some kind of a “visual/numeric analogue scale” (n = 139), and the “manual examination of muscle-strength” (n = 54). Seven of the 13 most stated measurement instruments measure activities or participation.The most important facilitator was physiotherapists’ positive attitudes towards measurement instruments. Two out of three respondents reported having sufficient knowledge and skills to apply measurement instruments in clinical practice. The most pronounced barriers were insufficient additional financial compensations and requiring extra time to document test scores. Seventy-eight percent of the respondents could imagine using an electronic device for a user-friendly patient health record system in clinical practice.ConclusionsThe limited use of measurement instruments reported by physiotherapists working in Germany appears to be due to organisational issues, in combination with a lack of knowledge and skills needed to apply the measurement instruments, rather than due to individual or managerial reasons. To support the use of measurement instruments, sufficient time resources and adequate financial compensation are required. Educational approaches should focus on imparting patient-centred and patient-reported outcomes to quantify activities and participation. Electronic patient health record systems have potential to facilitate the application of standardised measurement instruments if the barriers identified in this survey are addressed properly.Electronic supplementary materialThe online version of this article (10.1186/s12913-018-3563-2) contains supplementary material, which is available to authorized users.

BackgroundMobility is a key outcome in geriatric rehabilitation. The de Morton Mobility Index (DEMMI) is an internationally well-established, unidimensional measure of mobility with good psychometric properties. The aim of this study was to examine the reliability and construct validity of the German translation of the DEMMI in geriatric inpatients.MethodsThis cross-sectional study included patients admitted to a sub-acute inpatient geriatric rehabilitation hospital (reliability sample: N = 33; validity sample: N = 107). Reliability, validity, and unidimensionality were investigated.ResultsInter-rater reliability between two graduate physiotherapists was excellent, with intra-class correlation coefficient of 0.94 (95% confidence interval: 0.88-0.97). The minimal detectable change with 90% confidence was 9 points. Construct validity for the DEMMI was evidenced by significant moderate to strong correlations with other measures of mobility and related constructs (Performance Oriented Mobility Assessment: rho = 0.89; Functional Ambulation Categories: rho = 0.70; six-minute walk test: rho = 0.73; gait speed: rho = 0.67; Falls Efficacy Scale International: rho = −0.68). Known-groups validity was indicated by significant DEMMI mean group differences between independent versus dependent walkers and walking aid users versus non-users. Unidimensionality of the German DEMMI translation was confirmed by Rasch analysis.ConclusionsThe German translation of the DEMMI is a unidimensional instrument producing valid and reproducible measurement of mobility in an inpatient geriatric rehabilitation setting.

We have investigated whether control of balance is improved during stance and gait and sit-to-stand tasks after unilateral total hip replacement undertaken for osteoarthritis of the hip. We examined 25 patients with a mean age of 67 years (sd 6.2) before and at four and 12 months after surgery and compared the findings with those of 50 healthy age-matched control subjects. For all tasks, balance was quantified using angular measurements of movement of the trunk. Before surgery, control of balance during gait and sit-to-stand tasks was abnormal in patients with severe osteoarthritis of the hip, while balance during stance was similar to that of the healthy control group. After total hip replacement, there was a progressive improvement at four and 12 months for most gait and sit-to-stand tasks and in the time needed to complete them. By 12 months, the values approached those of the control group. However, trunk pitch (forwards-backwards) and roll (side-to-side) velocities were less stable (greater than the control) when walking over barriers as was roll for the sit-to-stand task, indicative of a residual deficit of balance. Our data suggest that patients with symptomatic osteoarthritis of the hip have marked deficits of balance in gait tasks, which may explain the increased risk of falling which has been reported in some epidemiological studies. However, total hip replacement may help these patients to regain almost normal control of balance for some gait tasks, as we found in this study. Despite the improvement in most components of balance, however, the deficit in the control of trunk velocity during gait suggests that a cautious follow-up is required after total hip replacement regarding the risk of a fall, especially in the elderly.