Darja Rugelj

Low back pain and other work-related musculoskeletal problems among physiotherapists

This technical note reports the findings of a self-administered questionnaire regarding low back pain (LBP) and other musculoskeletal problems completed by 113 physiotherapists (15% of the active physiotherapists in the Republic of Slovenia). The study revealed that the overall incidence among the sample population of physiotherapists is 73.7% and the most prominent factor appears to be the age of the respondents. The only triggering factor for LBP within the physiotherapy profession appears to be handling of dependent patients.

The effect of functional balance training in frail nursing home residents

The purpose of this study was to design and evaluate the specifically targeted functional balance training for a group of frail nursing home residents. Fifty residents of two nursing homes were assigned to an exercise and control group. Thirty-three participants (age 75.7 + or - 6.7 years) in the balance training group finished 12 weeks of training protocol that consisted of 14 activities that challenged different balance subsystems. The results showed that the participants in the training group reached higher score on Berg Balance Scale (BBS) (p < 0.001), were able to stand longer on a compliant surface with eyes opened and closed (p < 0.01 and p < 0.02, respectively), and were faster at both, the four square and ten meter walk tests (p < 0.001), whereas there were no changes for the control group during the same time period. Anyhow, functional improvement of balance did not reflect in the parameters of postural sway. In conclusion our results suggest that the specifically targeted functional balance training is effective as far as functional activities are concerned while this kind of training does not reflect as a change in the steadiness of the center of pressure (CoP).

The effect of load mass and its placement on postural sway.

The purpose of this study was to investigate the effects of increasing load on postural sway in two different carrying positions: backpack and waist jacket. Potential differences between males and females were additionally evaluated. 60 young college students participated in this study, and were assigned to backpack and waist jacket groups. The loads in both groups were 12, 21 and 30 kg. Stabilometry was used to assess the amount of postural sway. The medio-lateral and antero-posterior mean sway, mean velocity, medio-lateral and antero-posterior path length and sway area of the centre of pressure position were calculated. In the backpack group all analyzed sway parameters linearly increased with additional load, the differences were significant at p < 0.001. However no significant change of the analyzed parameters was found when the subjects carried additional load in the waist jacket. Our results indicate that postural sway depends on the amount of the load carried in a backpack. Additionally, the position of the load is of significant importance. Carrying weight in a backpack increases postural sway with increasing weight whereas carrying weight in a waist jacket does not influence the amount of postural sway. There are no significant differences in the response to the amount and configuration of the load between male and female subjects.

Inter-rater reliability of the GNRB® knee arthrometer

BACKGROUND In clinical settings, where arthrometers are mainly used by different clinicians, knowing the inter-rater reliability of the instrument is crucial in order for the results from different examiners to be accurately interpreted and limitations fully understood. The aim of this study was to evaluate the inter-rater reliability of the GNRB® knee arthrometer. METHODS Knee anterior laxity in both knees was tested in a group of young, uninjured subjects (N=27, 13 females) by two examiners. Knee anterior laxity was calculated at test forces of 134 N and 250 N with values presented for the unstandardised and standardised conditions (relative to patellar stabilisation force). RESULTS The ICCs ranged from 0.220 to 0.424. CONCLUSIONS The inter-rater reliability of the GNRB® knee arthrometer is low.

Robotic knee laxity testing: Reliability and normative data

PURPOSE To evaluate the reliability of the GeNouRoB knee arthrometer and present normative values of knee anterior laxity using this device on young females. METHODS Anterior laxity in both knees was tested in two groups of young, uninjured females using the hamstrings electromyography biofeedback feature of the device. There were 13 participants in the group tested for reliability and 23 for the normative study. Laxity (mm of movement of the proximal tibia in the anterior direction relative to the femur) was calculated at test forces of 134 N and 250 N with values presented for the unstandardised and standardised (relative to stabilisation force) conditions. RESULTS The relative reliability (95% limits of agreement) of the device for laxity at a test force of 134 N was 2 to 3mm. Left knee anterior laxity was almost 1mm greater than the right. CONCLUSIONS The relative reliability of the GeNouRoB arthrometer is comparable to the KT device. In agreement with previous work on the nonrobotic KT arthrometer, the knee anterior laxity values found with the GeNouRoB are greater in the left as compared to the right knee.

The influence of very low illumination on the postural sway of young and elderly adults.

The purpose of the present study was to evaluate the influence of very low ambient illumination and complete darkness on the postural sway of young and elderly adults. Eighteen healthy young participants aged 23.8±1.5 years and 26 community-dwelling elderly aged 69.8±5.6 years were studied. Each participant performed four tests while standing on a force platform in the following conditions: in normal light (215 lx) with open eyes and with closed eyes, in very low illumination (0.25 lx) with open eyes, and in complete darkness with open eyes. The sequences of the tests in the altered visual conditions were determined by random blocs. Postural sway was assessed by means of the force platform measurements. The centre of pressure variables: the medio-lateral and antero-posterior path lengths, mean velocities, sway areas, and fractal dimensions were analysed. Very low illumination resulted in a statistically significant increase in postural sway in both the young and elderly groups compared to normal light, although the increase was significantly smaller than those observed in the eyes closed and complete darkness condition, and no significant effects of illumination on fractal dimensions were detected. The gains of the sways in the very low or no illumination conditions relative to the normal light condition were significantly larger in the group of young participants than in the group of elderly participants (up to 50% and 25%, respectively). However, the response patterns to changes in illumination were similar in the young and elderly participants, with the exception of the short-range fractal dimension of the medio-lateral sway. In conclusion, very low illumination resulted in increased postural sway compared to normal illumination; however, in the closed eye and complete darkness conditions, postural sway was significantly higher than in the very low illumination condition regardless of the age of the participants.

Do fallers and nonfallers equally benefit from balance specific exercise program? A pilot study.

The purpose of the study was to determine the sample size that would allow broad generalizability of the results. To investigate the differences in the responsiveness of fallers and nonfallers to a multicomponent functional balance specific program, 23 participating subjects (70.1 ± 6.6 years) were divided into nonfallers group (13) and fallers group (10). The components of the balance specific program were (1) changing of the center of gravity (CoG) in the vertical direction, (2) shifting of the CoG to the border of stability, (3) rotation of the head and body about the vertical axis, (4) standing and walking on soft surface, and (5) walking over obstacles or on a narrow path. At the end of eight months of the training program, there was no significant difference between the two groups regarding postural sway. The total center of pressure path length was used as the principal outcome measure for the sample size calculation. Based on these results the a priori sample size calculation yielded the estimate of 110 subjects required to be enrolled in order to get 20 subjects in fallers and 30 subjects in nonfallers group for the 80% power to detect the results as significant.

Effect of repeated passive anterior loading on human knee anterior laxity

BACKGROUND Increased knee anterior laxity results when the anterior cruciate ligament is injured. This increased laxity can cause knee dysfunction. Until recently this laxity was believed to be only diminished through surgery. But recent findings indicate that knee anterior laxity may be decreased with repeated loading of the knee. OBJECTIVE The purpose of this study was to test the hypothesis that regular passive anterior loading of the uninjured human knee would enhance its stiffness. STUDY DESIGN Randomized controlled trial. METHODS Knee anterior laxity was tested using an arthrometer in 22 young, uninjured females before, during and after a 3 month period during which passive anterior loading was applied by a trained physiotherapist over 5 sessions per week to a randomly assigned knee. RESULTS Knee anterior laxity was not affected by the passive anterior loading of the knee. CONCLUSIONS Given that in this study repeated passive loading of the knee did not change knee anterior laxity, it would be easy to conclude that this training is ineffective and no further research is required. We caution against this given the relatively short duration and possibly insufficient intensity of the training and the population studied; individuals with normal joint laxity. We recommend that future research be performed that consists of individuals with lax joints who receive training for prolonged periods.

The influence of light hypothenar contact during a reaching movement on the centre of pressure (COP) forward displacement.

The purpose of this study was to evaluate the effect of additional light hand contact (F<1 N) in the region of the hypothenar eminence on forward movement of the center of pressure (COP) and dominant hand. Subjects sled their hypothenar eminence on a vertically-oriented pressure sensitive board while reaching forward beyond their arm length. In the two separate experiments forty nine healthy, college-aged volunteers participated in the study. Thirty subjects (mean age of 22.2±2.4 years, 6 male and 24 female) participated in the experiment on level ground and nineteen subjects (22±2.6 years, 5 male and 14 female) in the experiment on an elevated surface. The forward displacement of the COP was significantly larger (p = 0.002) when subjects were allowed to slide with the hand as compared to no contact when the activity occurred on level ground (84±10 mm and 79±11 mm, respectively), and on a one meter elevated surface (71±17 mm and 65±21 mm, respectively). The maximal forward reach of the dominant hand was significantly greater when subjects were allowed to slide with the hypothenar eminence as compared to the no contact condition on the level ground (336±35 mm and 344±38 mm, respectively, p<0.02), and on the one meter elevated surface (298±58 mm and 307±58 mm, respectively, p<0.01). This data indicate that subjects were able to use additional haptic information from the hypothenar region to bring their COP and dominant hand further forward while standing on level ground as well as on a one m elevated surface.