The purpose of this study was to determine the effects of a 12-week standing program on ankle mobility and femur bone mineral density in patients with lower limb paralysis following recent spinal cord injury. An assessor-blinded within-subject randomised controlled trial was undertaken. Twenty patients with lower limb paralysis following a recent spinal cord injury were recruited. Subjects stood weight-bearing through one leg on a tilt-table for 30 minutes, three times each week for 12 weeks. By standing on one leg a large dorsiflexion stretch was applied to the ankle and an axial load was applied to the bones of the weight-bearing leg. Ankle mobility and femur bone mineral density of both legs were measured at the beginning and end of the study. Ankle mobility (range of motion) was measured with the application of a 17 Nm dorsiflexion torque. Femur bone mineral density was measured using dual energy X-ray absorptiometry (DEXA). The effect of standing was estimated from the difference between legs in mean change of ankle mobility and femur bone mineral density. The results indicated a mean treatment effect on ankle mobility of 4 degrees (95% CI 2 to 6 degrees) and on femur bone mineral density of 0.005 g/cm(2) (95% CI -0.015 to 0.025 g/cm(2)). Tilt-table standing for 30 minutes, three times per week for 12 weeks has a small effect on ankle mobility, and little or no effect on femur bone mineral density. It is unclear whether clinicians and patients would consider such effects to be clinically worthwhile.
Study design: A cross-sectional descriptive study was undertaken. Objectives: The overall objective was to explore the potential usefulness of clinicians' and patients' impressions of change in motor performance for clinical trials. Specifically, the aim was to compare clinicians' and patients' impressions of change in motor performance with standardized outcome measures in people with spinal cord injury (SCI). Setting: Spinal injury units, Sydney, Australia. Methods: Thirty people undergoing rehabilitation after recent SCI were recruited. They were assessed on two occasions separated by between 1 and 5 months. On both occasions, patients were assessed sitting unsupported (n ¼ 25), transferring (n ¼ 23) and walking (n ¼ 12) using standardized outcome measures. On the second occasion, patients rated their impressions of change in each of the three motor tasks since their initial assessment. A 15-point scale was used. In addition, patients were videoed performing the three motor tasks on the two occasions. Two clinicians with SCI experience independently viewed the pairs of videos and rated their impressions of change using the same 15-point scale. Clinicians' and patients' impressions of change were compared with each other and to the standardized objective measures. Results: Clinicians' and patients' impressions of change were greater than change measured with standardized objective measures for all three motor tasks (Po0.01). In addition, patients' impressions of change were greater than clinicians' impressions of change for transferring, but comparable for unsupported sitting and walking. Conclusion: Clinicians' and patients' impressions of change in motor performance may have potential for evaluating treatment effectiveness in clinical trials.
Study design A multi-centred, single-blinded randomised controlled trial. Objectives To determine the effect of 10,000 voluntary contractions over 8 weeks on the strength of very weak muscles in people with spinal cord injury (SCI). Settings Seven hospitals in Australia and Asia. Methods One hundred and twenty people with recent SCI undergoing inpatient rehabilitation were randomised to either a Treatment or Control Group. One major muscle group from an upper or lower limb was selected if the muscle had grade 1 or grade 2 strength on a standard six-point manual muscle test. Participants allocated to the Treatment Group performed 10,000 isolated contractions of the selected muscle group, as well as usual care in 48 sessions over 8 weeks. Participants allocated to the Control Group received usual care alone. Participants were assessed at baseline and 8 weeks by a blinded assessor. The primary outcome was voluntary muscle strength on a 13-point manual muscle test. There were three secondary outcomes capturing therapists' and participants' perceptions of strength and function. Results The mean between-group difference of voluntary strength at 8 weeks was 0.4/13 points (95% confidence interval −0.5 to 1.4) in favour of the Treatment Group. There were no notable between-group differences on any secondary outcome. Conclusion Ten thousand isolated contractions of very weak muscles in people with SCI over 8 weeks has either no or a very small effect on voluntary strength.
Study design: A within-participant, double-blind, cross-over, randomised control trial. Objectives: To determine the short-term effects of bronchodilator therapy on respiratory function in people with recently acquired motor complete tetraplegia. Setting: Hospital, Australia. Methods: A total of 12 people with recently acquired tetraplegia were randomised to receive either a one-off dose of a bronchodilator followed by an equivalent dose of a placebo propellant between 1 day and 1 week later or visa versa. The three outcomes were forced expiratory volume in 1 s (FEV1), peak expiratory flow rate (PEF) and forced vital capacity (FVC). These were measured while supine by a blinded assessor 10 and 30 min after treatment. Data were analysed on 11 participants and reported as percentage of predicted. Results: The FEV1, FVC and PEF mean between-group differences (95% confidence interval) at 10 min post treatment were 7.3% (2.7-11.9%; P ¼ 0.003), 5.5% (1.6-9.4%; P ¼ 0.008) and 20.1% (1.1-40.4%; P ¼ 0.039). Similar effects were observed at 30 min for FVC and FEV1 but not for PEF. Conclusion: Bronchodilator therapy has a beneficial effect on FEV1, FVC and PEF in participants with recently acquired tetraplegia.
Study design: Clinometrics study. Objective: To devise a way of capturing the unbiased perspectives of people living with a spinal cord injury (SCI) in assessments of mobility. Setting: SCI unit and community. Methods: Three groups of raters used the Global Impression of Change Scale (GICS) to rate change in mobility of a cohort of patients with a recent SCI. The three groups of raters were as follows: 10 people with a recent SCI, 10 people with an established SCI and 10 physiotherapists. The ratings were done after viewing 51 pairs of videos depicting one of three motor tasks: sitting unsupported, transferring and walking. Each pair of videos showed the same person performing the same motor task on two occasions. The videos were taken between 1 h and 5 months apart and presented side by side, randomly left or right, on the screen. Raters were asked to score the amount of change in performance between the two videos on a 7-point Global Impression of Change Scale (GICS). Intra-rater reliability for the three motor tasks and three groups of raters was determined using intra-class correlation coefficients. Results: People with an SCI were reliable at rating change in patients' abilities to transfer and walk with ICC's ranging from 0.66 to 0.81 (95% Confidence interval bounds ranging from 0.51 to 0.94). Physiotherapists were consistently but only marginally more reliable at rating than people with an SCI. Conclusions: Videos and the GICS may provide a way of using the unbiased perspectives of people living with spinal cord injury in assessments of mobility.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.