Jan D. Reinhardt

The effect of whole body vibration on balance, gait performance and mobility in people with stroke: a systematic review and meta-analysis

Objective: To examine the effect of whole body vibration on balance, gait performance and mobility among people with stroke. Method: A systematic review was conducted by two independent reviewers who completed the article search and selection. We included randomized controlled trials published in English examining effects of whole body vibration on balance, gait, mobility, muscle strength and muscle tone in adults with a clinical diagnosis of stroke. Articles were excluded if they were research studies on people with other primary diagnosis, abstracts published in the conferences or books. The Cochrane risk of bias tool was used to assess the methodological quality of the selected studies. Data source: Sources included Cochrane Central Register of Controlled Trials, Pubmed, MEDLINE, CINAHL, EMBASE, PEDro, PsycINFO, Science Citation Index, ClinicalTrials.gov, Current Controlled Trials, Stroke Trials Registry, and reference lists of all relevant articles. Result: Eight randomized controlled trials (nine articles) involving 271 participants were included in this meta-analysis. No significant improvement was found regarding Berg balance scale (SMD=-0.08, 95%CI=-1.35 to 1.19, P=0.91), mobility (SMD=0.45, 95%CI=-0.46 to 1.37, P=0.33), maximal isometric contracion of knee extension strength (SMD=0.23, 95%CI=-0.27 to 0.74, P=0.36), and maximal isometric contracion of knee extension strength (SMD=0.09, 95%CI=-0.38 to 0.56, P=0.71). Conclusion: There was no evidence for effects of whole body vibration on balance in people with stroke. Effects of whole body vibration on mobility and gait performance remain inconclusive. More large and high-quality trials are required.

Effects of whole-body vibration training with quadriceps strengthening exercise on functioning and gait parameters in patients with medial compartment knee osteoarthritis: a randomised controlled preliminary study

OBJECTIVEnTo compare the effects of whole-body vibration training (WBVT) with quadriceps strengthening exercise (QSE) with QSE alone on functioning and gait parameters in patients with medial compartment knee osteoarthritis.nnnDESIGNnRandomised controlled preliminary study.nnnSETTINGnDepartment of Rehabilitation Medicine, West China Hospital, Chengdu, Sichuan, Peoples Republic of China.nnnSUBJECTSnThirty-nine patients with medial compartment knee osteoarthritis.nnnINTERVENTIONSnParticipants were assigned at random to one of two groups.nnnMAIN MEASURESnVisual analogue scale (VAS) for pain, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), timed up and go test (TUG), 6-minute walk distance test (6MWD), and three-dimensional gait analysis during level walking at baseline, 12 weeks and 16 weeks (follow-up).nnnRESULTSnCompared with baseline, significant improvements in VAS, all WOMAC scales, TUG, 6MWD and all spatiotemporal parameters were seen in both the WBVT+QSE group and the QSE alone group at 12 and 16 weeks. However, the WBVT+QSE group showed greater improvements than the QSE alone group in WOMAC scales (physical function), TUG, 6MWD and cadence at 12 weeks. No differences were found between the WBVT+QSE and QSE alone groups in VAS, WOMAC scales (pain, stiffness), kinematic and kinetic gait parameters, and other spatiotemporal parameters at 12 weeks and 16 weeks.nnnCONCLUSIONnOver a 3-month period, WBVT in combination with QSE improved symptoms, physical function and spatiotemporal parameters in patients with medial compartment knee osteoarthritis, and led to greater improvement than QSE alone in WOMAC scales (physical function), TUG, 6MWD and cadence.

Effects of whole body vibration on pain, stiffness and physical functions in patients with knee osteoarthritis: a systematic review and meta-analysis

Objective: To assess the effects of whole body vibration for pain, stiffness and physical functions in patients with knee osteoarthritis. Data sources: We searched the Cochrane Central Register of Controlled Trials, MEDLINE, Physiotherapy Evidence Database (PEDro) and EMBASE (up to October 2014) to identify relevant randomized controlled trials. The outcome measures were pain, stiffness and physical functions. Review methods: Two investigators identified eligible studies and extracted data independently. The PEDro score was used to evaluate the methodological quality of the selected studies. Standard mean differences (SMDs) and 95% confidence intervals (CIs) were calculated, and heterogeneity was assessed using the I2 test. Results: A total of five randomized controlled trials involving 170 patients with knee osteoarthritis met the inclusion criteria. Only four studies involving 144 patients were deemed to be good quality trials (PEDro scoreu2009=u20096–7). Meta-analysis revealed that whole body vibration has a significant treatment effect in Western Ontario and McMaster Universities index physical function score (SMDu2009=u2009−0.72 points, 95% CIu2009=u2009−1.14 to −0.30, Pu2009=u20090.0008), 12u2009weeks whole body vibration improved the 6-minute walk test (SMD 1.15u2009m, 95% CI 0.50 to 1.80, Pu2009=u20090.0006) and balance (SMDu2009=u2009−0.78 points, 95% CI −1.40 to −0.16, Pu2009=u20090.01). Whole body vibration was not associated with a significant reduction in Western Ontario and McMaster Universities index pain and stiffness score. Conclusion: Eight-week and 12-week whole body vibration is beneficial for improving physical functions in patients with knee osteoarthritis and could be included in rehabilitation programs.

Psychometric properties of the Nottwil Environmental Factors Inventory Short Form

OBJECTIVESnTo examine the psychometric properties of the Nottwil Environmental Factors Inventory Short Form using Rasch analysis; to determine its construct validity and internal consistency; and to develop a metric for scoring.nnnDESIGNnCross-sectional psychometric study. Construct validity of the Nottwil Environmental Factors Inventory Short Form, including model fit, person and item fit, local item dependence, dimensionality, and differential item functioning (DIF), was investigated with Rasch analysis. Internal consistency was assessed with Cronbach alpha and item-total correlations.nnnSETTINGnCommunity.nnnPARTICIPANTSnSwiss residents aged >16 years and living with traumatic or nontraumatic spinal cord injury (SCI) (N=1549).nnnINTERVENTIONSnNot applicable.nnnMAIN OUTCOME MEASUREnThe Nottwil Environmental Factors Inventory Short Form, a 14-item questionnaire developed to assess perceived impact of environmental barriers on participation.nnnRESULTSnLocal dependencies between items addressing a similar content could be solved by creating a testlet. With 1 testlet there was strong evidence for unidimensionality of the Nottwil Environmental Factors Inventory Short Form. Although person-item targeting revealed a floor effect, indicating few perceived environmental barriers to participation in the Swiss SCI population, the item fit was good. Only a few items presented DIF. The Nottwil Environmental Factors Inventory Short Form showed good internal consistency (α=.82).nnnCONCLUSIONSnThis psychometric analysis supports the use of the Nottwil Environmental Factors Inventory Short Form to evaluate perceived environmental barriers to participation in persons with SCI living in the community.

Effects of Whole Body Vibration Exercise associated with Quadriceps Resistance Exercise on functioning and quality of life in patients with knee osteoarthritis: a randomized controlled trial:

Objective: To determine effects of Whole Body Vibration Exercise (WBVE) associated with quadriceps resistance exercises (QRE) versus QRE only on pain, physical function, biomarkers in serum and urine, activities of daily living (ADL), and quality of life in patients with knee osteoarthitis (OA). Design: Randomized-controlled trial . Setting: Rehabilitation medicine outpatient department of West China Hospital, Chengdu, Sichuan, People’s Republic of China. Subjects: Forty-nine patients were assigned to WBVE+QRE and 50 to QRE . Main outcome measures: Primary outcomes included pain assessed with visual analogue scale (VAS), Timed up & go test (TUG), 6-min walk distance test (6MWD), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Secondary outcomes comprised range of motion, muscular strength, serum COMP and urinary CTX-II, Lequesne Index (LI), and SF-36. All outcomes were analyzed with mixed effects regression. Results: Compared with QRE, WBVE+QRE showed significantly greater improvement in VAS at 4weeks (p=0.03), in VAS (p<0.01), 6MWD (p=0.01), WOMAC pain (p=0.01), and WOMAC physical function (p=0.02) at 16 weeks, and in all primary outcomes at 24 weeks (all p<0.01). Conclusion: Over a six months period, WBVE in combination with QRE was superior to QRE in most outcomes.

Impact of remote physiological ischemic training on vascular endothelial growth factor, endothelial progenitor cells and coronary angiogenesis after myocardial ischemia.

OBJECTIVEnThis experimental study investigates the potential role of physiological ischemic training (PIT) of remote limbs on vascular endothelial growth factor (VEGF), endothelial progenitor cells (EPCs) and myocardial angiogenesis after myocardial ischemia.nnnMETHODSnForty-two rabbits were assigned into six groups at random: sham-operated (SO), training only (TO), myocardial ischemia (MI), PIT, EPC promoter (PIT+), and EPC inhibitor (PIT-). MI was experimentally induced by implanting a constrictor around the left ventricular branch. The PIT procedure included three 3-min cycles of cuff inflations on the hind limbs followed by a 5 min reperfusion. VEGF mRNA, protein and EPC numbers were measured in plasma and myocardium. Capillary density (CD), coronary blood flow (CBF) and coronary collateral blood flow (CCBF) were also determined.nnnRESULTSnGroups were compared using non-parametric statistics and associations between agents were explored with fractional polynomial regression. VEGF-mRNA and -protein levels were highest in PIT+ and PIT. PIT differed significantly from SO, TO, MI, and PIT- regarding VEGF-mRNA and -protein in plasma and VEGF-protein in myocardium. EPCs were highest in PIT+ followed by PIT. PIT differed significantly from SO, TO, MI, and PIT- regarding plasma EPCs. CD, CCBF and CCBF/CBF were significantly increased in PIT+ and PIT as compared to controls. PIT- did not differ significantly from SO and TO. VEGF explained up to 43% of variance in EPCs. EPCs explained up to 87% of variance in CD. CD explained up to 97% of variance in CCBF and CCBF/CBF.nnnCONCLUSIONnPIT stimulates VEGF-mediated mobilization of EPCs as well as angiogenesis and might be proven as a new treatment strategy for patients with coronary heart disease.

Age-related variation in mobility independence among wheelchair users with spinal cord injury: A cross-sectional study

Objective: To evaluate age-related variation in mobility independence among community-living wheelchair users with spinal cord injury (SCI). Design: Community Survey (2011–2013) as part of the Swiss Spinal Cord Injury Cohort Study. Setting: Community. Participants: Individuals aged 16 years or older with traumatic or non-traumatic SCI permanently residing in Switzerland and using a wheelchair for moving around moderate distances (10–100u2005m). Interventions: Not applicable. Outcome Measures: Mobility-related items of the Spinal Cord Independence Measure-Self Report were matched to the three principal domains “changing basic body position,” “transferring oneself” and “moving around.” Binary outcomes (“independence” vs. “no independence”) were created for every domain and analyzed using multivariable logistic regression (adjusted for sex, socioeconomic factors, SCI characteristics, and health conditions). Results: Regression analyses (Nu2009=u2009949; 27% women; median age 51, interquartile range 41–61) showed a decline in the odds of independence (odds ratio; 95% confidence interval) with increasing age for “changing basic body position” (age 16–30 (reference), 31–45 (0.99; 0.53–1.83), 46–60 (0.64; 0.33–1.21), 61–75 (0.45; 0.22–0.92), 76+ (0.18; 0.07–0.44); Pu2009<u20090.001), “transferring oneself” (age 16–30 (reference), 31–45 (0.77; 0.37–1.61), 46–60 (0.39; 0.18–0.84), 61+ (0.05; 0.02–0.14); Pu2009<u20090.001), and “moving around” (age 16–30 (reference), 31–45 (0.79; 0.42–1.48), 46–60 (0.49; 0.26–0.94), 61–75 (0.49; 0.24–1.01), 75+ (0.11; 0.04–0.30); Pu2009<u20090.001). Conclusions: Mobility independence was negatively associated with age in wheelchair users with SCI. Future longitudinal analyses are required to gain further insights into the causal factors for the age-related decline.

The rehabilitation research matrix: producing knowledge at micro, meso, and macro levels

Abstract Purpose: EU policy documents and health scholars point out that in order to understand the complexity of modern health systems, as well as to devise appropriate policy responses, considering micro, meso, and macro levels is indispensable. This article aims to develop an analytical framework for how rehabilitation as an interdisciplinary field can be framed in such a three-level framework. Methods: This is a conceptual paper based on recent contributions to the development of a theory of rehabilitation. The paper applies sociological theory to build an analytical framework for a holistic understanding of rehabilitation. Results: Three groups of agents in the field of rehabilitation are identified: individuals with disabilities, professionals, and governmental authorities. The paper systematizes how these agents are positioned and act at micro, meso, and macro levels. In the intersection between the three levels of society and the three groups of actors, a nine-cell table emerges. In the cells of the table, key examples of important social processes to study in the field of disability and rehabilitation are identified. At the micro level, individuals experience a daily life relevant to rehabilitation, professionals ask what works in therapy, and policy authorities promote a strong work ethic. At the meso level, individuals with disabilities act as service user groups, professionals develop organizational designs and the policy authorities ask for cost-effective services. At the macro level, organizations representing people with disabilities lobby, professionals negotiate authorization issues, and the policymaking authorities must identify what can count as just distribution of services. The nine cells of the table are elaborated on by presenting relevant current studies exemplifying each cell. Conclusion: To systematize societal levels and agents involved is to enhance the understanding of rehabilitation as an interdisciplinary field of research. Implications for rehabilitation Rehabilitation practice and research must relate to different levels of society and identify different social agents. Service users are not only individuals receiving therapy, but also organized agents influencing the organization of rehabilitation services as well as priorities made at the level of policy development. Both the results produced by health professionals doing a clinical trial and political scientists studying rehabilitation policy disputes will improve when placed in a wide frame of knowledge production.

Natural Disasters: Health-Related Aspects

Natural disasters are sudden ecological disruptions or threats exceeding the adjustment capacity of affected communities. Natural disasters impact on public health directly by causing death and traumatic injuries and indirectly through compromise of public infrastructure, disruption of health care delivery, and displacement of affected populations. Health consequences of natural disasters include fatalities, traumatic injuries, communicable disease, psychological disorders and distress, and long-term disability. Public health in disaster-affected regions can be managed with a cycle encompassing response, recovery, mitigation, and preparedness phase.

Remote physiological ischemic training promotes coronary angiogenesis via molecular and cellular mobilization after myocardial ischemia

AIMnThis study was designed to explore the mechanism of physiological ischemic training (PIT) on remote limbs, with a special focus on the potential role of endothelial progenitor cells (EPCs), vascular endothelial growth factor (VEGF), and nitric oxide (NO) in local ischemic myocardium.nnnMETHODnMyocardial ischemia (MI) rabbit models were randomly assigned to sham-operated group (SO), training-only group (TO), MI group, PIT group, VEGF inhibitor group (VEGF-), NO inhibitor group (NO-), VEGF and NO inhibitor group (VEGF-/NO-), and EPC inhibitor group (EPC-). A constrictor was implanted around the left ventricular branch to induce controlled MI. The PIT procedure consisted of three cycles of a 3-minutes cuff inflation on the hindlimbs with a reperfusion of 5xa0minutes. Plasma and myocardial EPC numbers, VEGF level, and NO concentration, as well as capillary density (CD), coronary blood flow (CBF), and coronary collateral blood flow (CCBF) in myocardium, were measured.nnnRESULTSnNonparametric statistical techniques were applied to identify the differences between groups, and regression models were used to detect correlations between agents. VEGF levels, NO concentrations, and also EPC counts in both plasma and myocardium were highest in the PIT group. Capillary density, CCBF, and CCBF/CBF were also statistically elevated in the PIT group. VEGF explained 74% of variance in NO. NO explained 65% of variance in EPCs. EPCs explained 68% of variance in capillary density. Capillary density explained 78% of variance in CCBF and CCBF/CBF.nnnCONCLUSIONnPIT mobilized EPCs and promoted revascularization through upregulating VEGF and NO level.