Henri Kiers

A Systematic Review of the Relationship between Physical Activities in Sports or Daily Life and Postural Sway in Upright Stance

BackgroundIn many sports, maintaining balance is necessary to compete at a high level. Also, in many health problems, balance is impaired. Postural sway (PS) is often used as an indicator of upright balance control, and physical activity (PA) might enhance balance control. However, the relationship between PS and PA has never been systematically reviewed.ObjectiveOur objective was to summarize the evidence regarding the relationship between PS in upright bipedal and unipedal standing and PA.MethodsWe conducted a literature search in MEDLINE, EmBase, CINAHL, the Cochrane Database, and PEDro, up to March 2012, with no limit on the starting date. Characteristics and methodological aspects of each article were extracted by two reviewers. We used centre of pressure (CoP) velocity, and variables related to the CoP area, to compare studies.ResultsA total of 39 articles were reviewed from an initial yield of 2,058. Of these 39 studies, 37 used a comparative design, one was a cohort study, and one was a randomized controlled trial.ConclusionThe main conclusion was that in general, sport practitioners sway less than controls, and high-level athletes sway less than low-level athletes. Additionally, we identified specific effects dependent on the use of vision, sport-specific postures, and frequency and duration of the (sports) activity. PS in unperturbed bipedal stance appears to have limited sensitivity to detect subtle differences between groups of healthy people.

Physical fitness, rather than self-reported physical activities, is more strongly associated with low back pain: evidence from a working population

IntroductionPhysical activity is suggested to be important for low back pain (LBP) but a major problem is the limited validity of the measurement of physical activities, which is usually based on questionnaires. Physical fitness can be viewed as a more objective measurement and our question was how physical activity based on self-reports and objective measured levels of physical fitness were associated with LBP.Materials and methodsWe analyzed cross-sectional data of 1,723 police employees. Physical activity was assessed by questionnaire (SQUASH) measuring type of activity, intensity, and time spent on these activities. Physical fitness was based on muscular dynamic endurance capacity and peak oxygen uptake (VO2 peak). Severe LBP, interfering with functioning, was defined by pain ratings ≥4 on a scale of 0–10.ResultsHigher levels of physical fitness, both muscular and aerobic, were associated with less LBP (OR: 0.54; 95% CI: 0.34–0.86, respectively, 0.59: 95%CI: 0.35–0.99). For self-reported physical activity, both a low and a high level of the total physical activity pattern were associated with an increase of LBP (OR: 1.52; 95%CI: 1.00–2.31, respectively, 1.60; 95%CI: 1.05–2.44).ConclusionThese findings suggest that physical activity of an intensity that improves physical fitness may be important in the prevention of LBP.

Effectiveness of Peer Assessment for Implementing a Dutch Physical Therapy Low Back Pain Guideline: Cluster Randomized Controlled Trial

Background Clinical practice guidelines are considered important instruments to improve quality of care. However, success is dependent on adherence, which may be improved using peer assessment, a strategy in which professionals assess performance of their peers in a simulated setting. Objective The aim of this study was to determine whether peer assessment is more effective than case-based discussions to improve knowledge and guideline-consistent clinical reasoning in the Dutch physical therapy guideline for low back pain (LBP). Design A cluster randomized controlled trial was conducted. Setting and Participants Ten communities of practice (CoPs) of physical therapists were cluster randomized (N=90): 6 CoPs in the peer-assessment group (n=49) and 4 CoPs in the case-based discussion group (control group) (n=41). Intervention Both groups participated in 4 educational sessions and used clinical patient cases. The peer-assessment group reflected on performed LBP management in different roles. The control group used structured discussions. Measurements Outcomes were assessed at baseline and at 6 months. The primary outcome measure was knowledge and guideline-consistent reasoning, measured with 12 performance indicators using 4 vignettes with specific guideline-related patient profiles. For each participant, the total score was calculated by adding up the percentage scores (0–100) per vignette, divided by 4. The secondary outcome measure was reflective practice, as measured by the Self-Reflection and Insight Scale (20–100). Results Vignettes were completed by 78 participants (87%). Multilevel analysis showed an increase in guideline-consistent clinical reasoning of 8.4% in the peer-assessment group, whereas the control group showed a decline of 0.1% (estimated group difference=8.7%, 95% confidence interval=3.9 to 13.4). No group differences were found on self-reflection. Limitations The small sample size, a short-term follow-up, and the use of vignettes as a proxy for behavior were limitations of the study. Conclusions Peer assessment leads to an increase in knowledge and guideline-consistent clinical reasoning.

Postural sway and integration of proprioceptive signals in subjects with LBP

Patients with non-specific low back pain (LBP) may use postural control strategies that differ from healthy subjects. To study these possible differences, we measured the amount and structure of postural sway, and the response to muscle vibration in a working cohort of 215 subjects. Subjects were standing on a force plate in bipedal stance. In the first trial the eyes were open, no perturbation applied. In the following 6 trials, vision was occluded and subjects stood under various conditions of vibration/no vibration of the lumbar spine or m. Triceps Surae (TSM) on firm surface and on foam surface. We performed a factor analysis to reduce the large amount of variables that are available to quantify all effects. Subjects with LBP showed the same amount of sway as subjects without LBP, but the structure of their sway pattern was less regular with higher frequency content. Subjects with LBP also showed a smaller response to TSM vibration, and a slower balance recovery after cessation of vibration when standing on a solid surface. There was a weak but significant association between smaller responses to TSM vibration and an irregular, high frequency sway pattern, independent from LBP. A model for control of postural sway is proposed. This model suggests that subjects with LBP use more co-contraction and less cognitive control, to maintain a standing balance when compared to subjects without LBP. In addition, a reduced weighting of proprioceptive signals in subjects with LBP is suggested as an explanation for the findings in this study.

Test-retest reliability of muscle vibration effects on postural sway

The effect of alterations in the processing of proprioceptive signals, on postural control, has been studied using muscle vibration effects. However, reliability and agreement of muscle vibration have still to be addressed. This study aimed to assess intra- and interday reliability and agreement of vibration effects of lumbar paraspinal and triceps surae muscles in a non-selected sample of 20 subjects, standing on solid surface and on foam. We used mean position and velocity of Centre of Pressure (CoP), during and after vibration to quantify the effect of muscle vibration. We also calculated the ratio of vibration effects on the lumbar paraspinal and triceps surae muscles (proprioceptive weighting). Displacement of the CoP during vibration showed good reliability (ICCs>0.6), and proprioceptive weighting of displacement fair to good reliability (0.52-0.73). Agreement measures were poor, with most CVs ranging between 18% and 36%. Change in CoP velocity appeared not to be reliable. Balance recovery, when based on CoP position and calculated a short period after cessation of vibration, showed good reliability. According to this study, displacement during vibration, proprioceptive weighting and selected recovery variables are the most reliable indicators of the response to muscle vibration.

Randomised controlled study comparing comfort-related outcomes between two rigid gas permeable (RGP) lenses with different sessile drop contact angles

Citation information: Fortuin MF, Schilperoort J, Evans BJW, Edgar DF, Tello Manon HM & Kiers H. Randomised controlled study comparing comfort‐related outcomes between two rigid gas permeable (RGP) lenses with different sessile drop contact angles. Ophthalmic Physiol Opt 2011, 31, 190–199. doi: 10.1111/j.1475‐1313.2010.00812.x

Randomised controlled trial of the effects of two rigid gas permeable (RGP) contact lens materials and two surface cleaners on straylight values

Purpose:  In a double‐masked randomized controlled crossover study we investigated both the retinal responses to straylight, and the effects of lens cleaners on straylight values, in two different RGP contact lens materials.

Evidence of splinting in low back pain? : A systematic review of perturbation studies

PurposeThe purpose of this systematic review was to assess whether LBP patients demonstrate signs of splinting by evaluating the reactions to unexpected mechanical perturbations in terms of (1) trunk muscle activity, (2) kinetic and (3) kinematic trunk responses and (4) estimated mechanical properties of the trunk.MethodsThe literature was systematically reviewed to identify studies that compared responses to mechanical trunk perturbations between LBP patients and healthy controls in terms of muscle activation, kinematics, kinetics, and/or mechanical properties. If more than four studies reported an outcome, the results of these studies were pooled.ResultsNineteen studies were included, of which sixteen reported muscle activation, five kinematic responses, two kinetic responses, and two estimated mechanical trunk properties. We found evidence of a longer response time of muscle activation, which would be in line with splinting behaviour in LBP. No signs of splinting behaviour were found in any of the other outcome measures.ConclusionsWe conclude that there is currently no convincing evidence for the presence of splinting behaviour in LBP patients, because we found no indications for splinting in terms of kinetic and kinematic responses to perturbation and derived mechanical properties of the trunk. Consistent evidence on delayed onsets of muscle activation in response to perturbations was found, but this may have other causes than splinting behaviour.

Serious gaming voor het vergroten van de adherentie van fysiotherapeuten en manueel therapeuten aan de richtlijn lage rugpijn : Een gerandomiseerde gecontroleerde studie

SamenvattingFysiotherapie en/of manuele therapie spelen een belangrijke rol in de zorg voor mensen met lage rugpijn. Om de kwaliteit van deze zorg te verbeteren is een richtlijn ontwikkeld die vervolgens geïmplementeerd dient te worden. Technologische innovaties zoals serious games kunnen een rol spelen bij de implementatie van deze richtlijn. In een gerandomiseerde gecontroleerde studie is onderzocht in hoeverre een serious game de implementatie van een richtlijn lage rugpijn bevorderd. Achtenveertig fysiotherapeuten/manueel therapeuten zijn at random toegewezen aan een serious game groep of een groep die voorlichting kreeg over de richtlijn. Uitkomstmaten in deze studie zijn de mate van adherentie aan de richtlijn (vignettentoets), ervaren knelpunten van implementatie, de mening van de deelnemer over de wijze van implementeren, en de mate waarin de richtlijn is gelezen en wordt toegepast in de praktijk naar eigen inschatting van de deelnemer. Na zes weken follow-up is er geen significant effect gevonden van de serious game op de mate van adherentie aan de richtlijn (0,4 punten op 100 puntsschaal; 95% betrouwbaarheidsinterval -4,0 tot 4,8) ten opzichte van de voorlichtingsgroep. Ook voor de andere uitkomsten werden geen statistisch significante effecten gevonden. Het introduceren van een serious game had derhalve geen groter effect op de mate van adherentie aan de richtlijn lage rugpijn dan voorlichting.AbstractSerious gaming to improve guideline adherence of physiotherapists in low back pain care: a randomized controlled trial Physiotherapy and manual therapy are important treatment options for low back pain. To improve quality of care a clinical guideline has been developed which needs to be implemented in clinical practice. Technological innovations such as serious games may be helpful to increase the implementation of the guideline. We studied in a randomized controlled trial the effects of a serious game on guideline adherence of physiotherapists and manual therapists. Forty-eight physiotherapists/manual therapists were randomly allocated to a serious game group or a group which received education about the guideline. Outcomes in this study were guideline adherence (scored with patient vignettes), perceived barriers for guideline use, opinion regarding the implementation method used, and the degree to which the guideline has been read and used in clinical practice. After 6 weeks no significant effects were found for guideline adherence (0,4 points on 0-100 points scale; 95% confidence interval -4.0 to 4.8) and the other outcomes. The serious game therefore had no beneficial effect on guideline adherence when compared to education about the guideline. Keywords: low back pain, physiotherapy, manual therapy, guideline, implementation, serious game