Anne Therese Tveter

Health-Related Physical Fitness Measures: Reference Values and Reference Equations for Use in Clinical Practice

OBJECTIVE To provide reference values and reference equations for frequently used clinical field tests of health-related physical fitness for use in clinical practice. DESIGN Cross-sectional design. SETTING General community. PARTICIPANTS Convenience sample of volunteers (N=370) between 18 and 90 years of age were recruited from a wide range of settings (ie, work sites, schools, community centers for older adults) and different geographic locations (ie, urban, suburban, rural) in southeastern Norway. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES The participants conducted 5 clinical field tests (6-minute walk test, stair test, 30-second sit-to-stand test, handgrip test, fingertip-to-floor test). RESULTS The results of the field tests showed that performance remained unchanged until approximately 50 years of age; after that, performance deteriorated with increasing age. Grip strength (79%), meters walked in 6 minutes (60%), and seconds used on the stair test (59%) could be well predicted by age, sex, height, and weight in participants ≥50 years of age, whereas the performance on all tests was less well predicted in participants <50 years of age. CONCLUSIONS The reference values and reference equations provided in this study may increase the applicability and interpretability of the 6-minute walk test, stair test, 30-second sit-to-stand test, handgrip test, and fingertip-to-floor test in clinical practice.

A normative sample of gait and hopping on one leg parameters in children 7–12 years of age

BACKGROUND Accomplishment of a series of successive hops is an advanced motor skill and requires adequate timing and coordination. Hopping on one leg performance might therefore be a more sensitive test with higher discriminatory power than ordinary gait in evaluating motor competence both in healthy and diseased children. OBJECTIVE The purpose of the study was to develop a normative sample on walking at a normalized speed of 1.5 m/s and hopping on one leg parameters in children 7-12 years of age, and to evaluate the influence of age and gender on the different parameters. METHOD 360 girls and boys between 7 and 12 years participated in the study. All data were collected using the GAITRite system. The children were instructed to walk at four different speeds and to hop on either leg with as long serial jumps as possible across the whole walkway. RESULTS There was an increase in absolute step length of 15% from 7 to 12 years of age. However, for normalized step length there was no increase. The total increase in absolute and normalized hop length from 7 to 12 years was 64% and 36%, respectively. Multiple regression analysis displayed a significant increase for absolute and normalized hopping length with age. CONCLUSION While step length only showed a small increase from 7 to 12 years of age, hop length showed significant increase both in absolute and normalized values. The variability, however, was large, indicating that a normative sample of hop length measurements includes a wide range of values for each age group.

Influence of thigh muscle strength and balance on hop length in one-legged hopping in children aged 7–12 years

BACKGROUND Lower extremity muscular strength and balance are essential components in many motor performance skills. One-legged hopping is considered to be the most advanced jumping skill, because it requires greater muscle strength and better balance than other jumping skills. To what degree muscle strength and balance have significant influence on hop length in children is, however, unknown. OBJECTIVE The purpose of the present study was to identify predictive factors for hop length in one-legged hopping. The main hypothesis was that both muscle strength of the thigh (quadriceps and hamstrings) and balance would be significant predictors in healthy children 7-12 years of age. METHOD 341 girls and boys were included in the study. Hopping data was collected using the GAITRite system, muscle strength was tested isokinetically by a Cybex 6000 and one leg static balance was measured by the KAT 2000 system. RESULTS Hop length and thigh muscle strength showed increased values from one age group to the next from 7 to 12 years of age, while static balance only showed minor fluctuation. Multiple regression analysis showed that thigh strength, static balance, age and gender all together explained 53.4% of the variance in hop length. Age, quadriceps strength and hamstrings strength made the largest contributions with Beta 0.32, p<0.001, Beta 0.26, p=0.001 and Beta 0.18, p=0.003, respectively. Static balance and gender did not contribute significantly. CONCLUSION Of the measurements investigated in this study, age and thigh muscle strength are the strongest predictors for hop length in one-legged hopping skills in children.

Does outpatient physical therapy with the aim of improving health-related physical fitness influence the level of physical activity in patients with long-term musculoskeletal conditions?

OBJECTIVE To evaluate any change in self-reported level of physical activity in patients receiving a general physical exercise programme in addition to disease-specific physiotherapy treatment. DESIGN Pre-post-intervention study. SETTING Outpatient physiotherapy clinics. PARTICIPANTS One hundred and ninety patients with long-term musculoskeletal conditions attending outpatient physiotherapy were recruited from seven physiotherapy clinics. INTERVENTIONS Physiotherapy including disease-specific modalities and a general individually tailored exercise programme. Patients were evaluated at baseline and at the end of the programme. MAIN OUTCOME MEASURES International Physical Activity Questionnaire short form (IPAQ-sf) and COOP WONCA functional assessment charts. RESULTS Forty-two patients were excluded from the analysis because they did not complete the IPAQ-sf correctly or dropped out during the treatment period. There was a significant increase in the number of metabolic equivalent task (MET)-min/week for vigorous and moderate-intensity activities, walking and total physical activity. The number of exercise sessions per week increased from 1.8 [standard deviation (SD) 0.9] to 2.2 (SD 1.2) (P=0.001). The proportion of patients with a low level of physical activity decreased by 12%, and the proportion of the participants who did not/could not exercise decreased from 26% to 8%. The COOP WONCA charts showed significant improvements in the physical fitness, feelings, daily activities and social activities items. CONCLUSION A significant increase was found in the number of MET-min/week for all activity levels. Therefore, a general physical exercise programme initiated by a physiotherapist led to a positive change in level of physical activity.

Patients with musculoskeletal conditions do less vigorous physical activity and have poorer physical fitness than population controls: a cross-sectional study

OBJECTIVES To compare physical activity and physical fitness in patients with various musculoskeletal conditions receiving physiotherapy in primary care with population controls. DESIGN Cross-sectional. PARTICIPANTS One hundred and sixty-seven patients with musculoskeletal conditions receiving physiotherapy in primary care and 313 population controls from various settings and geographical areas. MAIN OUTCOME MEASURES Physical activity was measured with the International Physical Activity Questionnaire short-form (IPAQ-sf) and reported in metabolic equivalents (METs). The 6-minute walk test and 30-second sit-to-stand test reflected cardiorespiratory endurance and muscular strength, respectively. RESULTS Differences in physical activity between the groups were explored using the Mann-Whitney U-test. The patient group reported significantly less vigorous activity compared with the control group {median 0 [interquartile range (IQR) 0 to 960] vs median 240 [IQR 0 to 1440] MET minutes/week, respectively)} (P=0.001). A similar proportion of patients (68%) and controls (75%) reached the recommended level of health-enhancing physical activity (P=0.11). Linear regression analyses adjusted for age, body mass index and gender showed significantly poorer fitness in the patient group compared with the control group, reflected by the 6-minute walk test and the 30-second sit-to-stand test {mean difference 69m [95% confidence interval (CI) 52 to 85; P≤0.001] and six repetitions [95% CI 5 to 7; P≤0.001], respectively}. CONCLUSIONS Patients with various long-term musculoskeletal conditions receiving physiotherapy in primary care had significantly poorer physical fitness and reported less vigorous physical activity compared with population controls.

Impaired motor competence in children with transplanted liver.

Objectives: Although reduced cognitive function has been demonstrated after liver transplantation in children, few data are available concerning motor competence. Methods: Thirty-five children ages 4 to 12 years were tested using Movement Assessment Battery for Children (M-ABC) test at a median of 5.1 (3.9–6.9) years after liver transplantation and compared with reference material of healthy children. Results: Children with transplantation had worse M-ABC score 8.0 (interquartile range 5.0–11.5), compared with healthy children 3.5 (1.0–6.0) (P < 0.0001). All of the subscores (manual dexterity [P < 0.0001], ball skills [P = 0.0037], and balance [P = 0.0032]) were significantly worse in the children with liver transplantation compared with the healthy reference group. Twenty-nine percent of the children with liver transplantation had impaired motor competence, compared with 9% of a healthy reference group. Seventeen of the patients with transplantation were retested 1 year later, and 11 were tested 4 years later with no changes in total M-ABC score. Ball skill competence was worse 4 years after first assessment (P = 0.013). For children with transplantation and cholestatic liver disease (n = 26), renal function was a significant predictor for total M-ABC score (P = 0.018). Conclusions: Children with liver transplantation had impaired motor competence compared with healthy children. Ball skills developed adversely several years after liver transplantation, and motor competence did not improve with time after transplantation. Renal function was a significant predictor for motor competence in children with liver transplantation and cholestatic liver disease.

Resistance training in addition to multidisciplinary rehabilitation for patients with chronic pain in the low back: Study protocol

Introduction Chronic low back pain (LBP) is a major health problem worldwide. Multidisciplinary rehabilitation and exercise is recommended for the management of chronic LBP. However, there is a need to investigate effective exercise interventions that is available in clinics and as home-based training on a large scale. This article presents the design and rationale of the first randomized clinical trial investigating the effects of progressive resistance training with elastic bands in addition to multidisciplinary rehabilitation for patients with moderate to severe chronic LBP. Methods and analysis We aim to enroll 100 patients with chronic LBP referred to a specialized outpatient hospital clinic in Norway. Participants will be randomized equally to either; a) 3 tion including whole-body progressive resistance training using elastic bands – followed by home-based progressive resistance training for 9 weeks, or b) 3 weeks of multidisciplinary rehabilitation including general physical exercise – followed by home-based general physical exercise for 9 weeks. Questionnaires and strength tests will be collected at baseline, weeks 3 and 12, and at 6 and 12 months. The primary outcome is between-group changes in pain-related disability at week 12 assessed by the Oswestry disability index. Secondary outcomes include pain, work ability, work status, mental health, health-related quality of life, global rating of change, general health, and muscular strength and pain-related disability up to 12 months of follow-up. Discussion This study will provide valuable information for clinicians working with patients with chronic LBP. Trial registration ClinicalTrials.gov, number NCT02420236.

Osteoarthritis-related walking disability and arterial stiffness-results from a cross-sectional study

To compare the 6‐minute walking distance (6MWD) in a population‐based cohort of patients with osteoarthritis (OA) with that in matched peers from the general population, and to explore the associations between walking ability and risk of cardiovascular disease (CVD) in the OA cohort.

FRI0649-HPR Innovation in Health Care – Laboratory Validity and Reliability of A New Sensor Developed To Measure Cervical Rotation

Background For patients with axial spondyloarthritis (axSpA) it is recommended to monitor spinal mobility regularly. Cervical rotation (CR) is usually measured with goniometer or myrinometer, but might give imprecise results. Technological innovation provides opportunities to develop and improve measurement methods for use in clinical practice. Objectives To evaluate validity and reliability of a sensor developed to measure rotation around the vertical axis in a laboratory setting. Methods A sensor was developed by engineers in close collaboration with health professionals and patients with axSpA. It was tested in a laboratory setting and the data collected was compared with Cybex 6000 simulation data as gold standard. The sensor was mounted to the cybex with a bracket in six different positions, 1) straight up 2) straight down 3) up, tilted 30°around the frontal axis 4) down, tilted 30°around the frontal axis 5) up, tilted 30°around the frontal axis, 20° around the sagittal axis 6) down, tilted 30°around the frontal axis, 20° around the sagittal axis. Reference angles were set at approximately 10, 30, 60, 90 and 120 degrees. From a centre position the sensor was moved from left to right (one cycle) by manual force at the speed allowed (60°/second) until stop brackets were reached. Criterion validity and reliability for single measures and for the mean of three trials (left, right or cycle) was evaluated with two ways mixed interclass correlation coefficientagreement (ICC). Limits of agreement (LoA) (Bland and Altman method), and smallest detectable changeagreement (SDC95%) with 95%CI were calculated to evaluate the measurement error of the sensor. Results A total number of 261 cycles were performed. The ICC values were excellent for all measurement (ICC: 1.0; 95% CI 1.0, 1.0). One cycle of movement showed lower measure error (LoA) compared to single measures (left or right) (table 1). The measurement error was further improved by using the mean of 3 cycles (figure 1). The SDC95 was 0.87 for one cycle and 0.80 for the mean of three cycles.Table 1. Results from the reliability evaluation of a new sensor Mean diff (SD) LoA SDC95% Single Left, ° −0.06 (0.93) −1.88–1.76 1.82 Right, ° 0.28 (1.35) −2.36–2.93 2.65 Cycle, ° 0.11 (0.44) −0.78–0.98 0.87 Mean of three Left, ° −0.02 (0.82) −1.59–1.61 1.61 Right, ° 0.30 (1.25) −2.15–2.75 2.44 Cycle, ° 0.14 (0.40) −0.65–0.93 0.80Figure 1 Conclusions The sensor showed excellent criterion validity and reliability for rotation around the vertical axis in the range of motion from 10 to 120 degrees, especially for cycles and mean of 3 cycles. When assessing a single cycle or the average of three cycles, a change of 1 degree is needed for real change beyond measurement error. Our findings justify proceeding with further evaluations of the sensor in patients with axSpA. Disclosure of Interest None declared

AB0833-HPR Health-related physical fitness testing in physiotherapy practice – reliability and feasibility

Background People with musculoskeletal conditions (MSCs) tend to be less physically active1 and more deconditioned than healthy controls2;3. Thus, physiotherapists seeing patients with MSCs should include an individually tailored exercise program in the treatment plan. According to current recommendations, these exercise programs should focus on health-related physical fitness4. For measuring patients’ physical fitness, reliable and feasible instruments are needed. Objectives To examine reliability and feasibility of frequently used patient-reported and performance-based instruments for measuring health-related physical fitness in patients with a variety of MSCs. Methods In a test-retest study, 81 patients were tested twice one week apart. Patients conducted five performance-based tests (the 6 min walk test (6MWT), the stair test (ST), the handgrip test, the 30 sec sit-to-stand test (30sSTS) and the modified fingertip-to-floor test (FTF)) and answered two questionnaires (the Self-assessed physical fitness questionnaire and the COOP/WONCA Charts). Reliability and measurement error was calculated with ICC2.1 or weighted kappa and Standard Error of Measurement (SEM) and Smallest Detectable Change (SDC). ICC2.1 and weighted kappa values of <0.70 were considered acceptable. Results All performance-based tests and the Self-assessed physical fitness questionnaire and three of six charts in the COOP/WONCA Charts showed acceptable reliability. SDC90% was calculated to 49 meters, 8 sec and 4 kg for the 6MWT, the ST and the handgrip test, respectively. Correspondingly, 4 sit-to-stands and 9 cm fingertip-to-floor distance was shown for the 30sSTS and the FTF test. Changes of two points were needed to detect changes beyond measurement error in the Self-assessed physical fitness questionnaire. The 6MWT was the most time consuming, with all other instruments each taking less than 3 min to complete. About 40% needed assistance in answering the COOP/WONCA Charts, while the corresponding value for the Physical Fitness Quetionnaire was about 20%. Conclusions All instruments seem feasible for use in patients with MSCs. The 6MWT, the ST, the handgrip test and the Self-assessed physical fitness questionnaire can be recommended as reliable instruments with acceptable measurement error, while the 30sSTS test and the modified FTF test showed high variability for use in assessing change in health-related physical fitness. The COOP/WONCA Chart might be more suitable for screening purposes. References Farr et al. Physical activity levels in patients with early knee osteoarthritis measured by accelerometry. Arthritis Rheum 2008; 59(9):1229-1236. Ryan et al. Individuals with chronic low back pain have a lower level, and an altered pattern, of physical activity compared with matched controls: an observational study. Aust J Physiother 2009; 55(1):53-58. Hodselmans et al. Nonspecific chronic low back pain patients are deconditioned and have an increased body fat percentage. Int J Rehabil Res 2010; 33(3):268-270. Nelson et al. Physical activity and public health in older adults: recommendation from the American College of Sports Medicine and the American Heart Association. Med Sci Sports Exerc 2007; 39(8):1435-1445. Disclosure of Interest None Declared