Joan McMeeken

Body image and psychological well-being in pregnancy. A comparison of exercisers and non-exercisers

Summary: This study compared the perceptions of body image and psychological well‐being between exercising and non‐exercising pregnant women. A prospective longitudinal study was conducted with 65 nulliparous women (mean age years = 30.3, range = 23–39) who were allocated to 2 groups based on level of recreational exercise participation; 25 exercisers were compared with 18 non‐exercisers. A self‐report exercise history questionnaire and a 10 item Body Cathexis Scale were completed on two occasions during the pregnancy, at approximately 17 weeks and 30 weeks of gestation. The General Health Questionnaire (GHQ‐28) was administered in late pregnancy. There was a significant difference between the exercise group and the non‐exercise group in late pregnancy for some items on the Body Cathexis Scale. The exercise group had a lower level of probable caseness on the GHQ‐28 with reduced frequency of somatic symptoms, anxiety and insomnia, and a higher level of psychological well‐being.

Can simulation replace part of clinical time? Two parallel randomised controlled trials

Medical Education 2012

Conservative management of lumbar disc herniation with associated radiculopathy: a systematic review

Study Design. A systematic review of randomized controlled trials. Objective. To determine the efficacy and adverse effects of conservative treatments for people who have lumbar disc herniation with associated radiculopathy (LDHR). Summary of Background Data. Although conservative management is commonly used for people who have LDHR, the efficacy and adverse effects of conservative treatments for this condition are unclear. Methods. We searched 10 computer databases for trials published in English between 1971 and 2008. Trials focusing on people with referred leg symptoms and radiologic confirmation of a lumbar disc herniation were included if at least 1 group received a conservative and noninjection treatment. Results. Eighteen trials involving 1671 participants were included. Seven (39%) trials were considered of high quality. Meta-analysis on 2 high-quality trials revealed that advice is less effective than microdiscectomy surgery at short-term follow-up, but equally effective at long-term follow-up. Individual high-quality trials provided moderate evidence that stabilization exercises are more effective than no treatment, that manipulation is more effective than sham manipulation for people with acute symptoms and an intact anulus, and that no difference exists among traction, laser, and ultrasound. One trial showed some additional benefit from adding mechanical traction to medication and electrotherapy methods. Adverse events were associated with traction (pain, anxiety, lower limb weakness, and fainting) and ibuprofen (gastrointestinal events). Conclusion. Advice is less effective than microdiscectomy in the short term but equally effective in the long term for people who have LDHR. Moderate evidence favors stabilization exercises over no treatment, manipulation over sham manipulation, and the addition of mechanical traction to medication and electrotherapy. There was no difference among traction, laser, and ultrasound. Adverse events were associated with traction and ibuprofen. Additional high-quality trials would allow firmer conclusions regarding adverse effects and efficacy.

Age-related differences in the time course of capsaicin-induced hyperalgesia

Abstract The effect of age on hyperalgesia, one of the most common signs of injury, has not been previously examined in humans. A psychophysical study was conducted in 10 young (26.9±4.6 years) and 10 older (79.0±5.7 years) healthy volunteers to investigate the effect of age on the development of hyperalgesia induced by topical application of capsaicin (0.1 ml, 5 mg/ml). The capsaicin patch (diameter 2 cm) was applied for 1 h. The intensity of capsaicin‐induced spontaneous sensation, mechanical pain threshold, area of flare, heat and punctate hyperalgesia were measured hourly for 3 h after the application. Older adults took a longer period to report first pain. There was no age effect on the magnitude of spontaneous sensation, flare size and area of heat hyperalgesia. The area of heat hyperalgesia rapidly decreased over time in both age groups. In marked contrast, the area of punctate hyperalgesia and associated reduction in the mechanical pain threshold were maintained in older adults over the entire 3 h test period, but resolved rapidly in young adults. We conclude that, given the same intensity of noxious stimulation, older adults display a similar magnitude of hyperalgesia as younger persons. However, once initiated, punctate hyperalgesia appears to resolve more slowly in older people. This finding may indicate age differences in the plasticity of spinal cord neurons following an acute injury.

Acceleration of Fresh Fracture Repair Using the Sonic Accelerated Fracture Healing System (SAFHS): A Review

Abstract. The Sonic Accelerated Fracture Healing System (SAFHS) is a relatively new fracture management tool which incorporates the application of a specifically modified diagnostic ultrasound unit to healing fractures with the intention of accelerating repair. In an animal fracture model, this device has been shown to accelerate the rate of biomechanical healing by a factor of 1.4–1.6. In two randomized, controlled trials in humans, the same unit has been shown to reduce the time frame of clinical and radiographic healing by 38%. In the two fracture regions investigated, tibial diaphysis and distal radius, this represented a 58 day and 37 day reduction in healing time, respectively. Despite its effect on the entire process of fresh fracture repair, the effect of the SAFHS on the individual stages and processes involved has not been established. This paper reviews these stages and processes, and discusses the clinical and practical implications of the effect of the SAFHS on fracture repair and the need for further research into this modality.

When is a change a genuine change?: A clinically meaningful interpretation of grip strength measurements in healthy and disabled women

The aim of this study was twofold: 1) to use estimates of random and systematic error to ascertain the test-retest reliability of grip strength measurements obtained with the Jamar hand dynamometer in healthy and disabled women, and 2) to determine the size of the change required to detect a genuine change in grip strength for accurate and meaningful clinical interpretation. Previous research has shown grip strength measurements obtained with a Jamar hand dynamometer from healthy and disabled subjects on different occasions to be reliable. However, the test-retest reliability has been based on correlation coefficients rather than on the actual size of the test-retest differences required to detect a genuine change in grip. The test-retest reliability of maximum grip strength measurements in 32 healthy women and painfree grip in 10 disabled women with nonspecific regional pain (NSRP) was determined. Reliability, based on estimates of systematic and random error, was high in both subject groups. There was no statistically significant systematic error between tests. Test-retest measurement error was +/-5.7 kg (12.5 lb) and +/-5.9 kg (13.0 lb) in healthy and disabled subjects, respectively, 95% of the time. In this population of healthy women and women with NSRP, any change in grip of less than 6 kg (13.2 lb) could have occurred by chance. The results of our study suggest that a change of more than 6 kg (13.2 lb) is necessary to detect a genuine change in grip strength 95% of the time.

A Targeted Home- and Center-Based Exercise Program for People After Total Hip Replacement: A Randomized Clinical Trial

OBJECTIVE To examine the physical function, gait, and quality of life of patients after total hip replacement (THR) randomly assigned to either a targeted home- or center-based exercise program. DESIGN Randomized controlled trial. SETTING Rehabilitation research center in Australia. PARTICIPANTS Twenty-three patients with unilateral THR were randomly assigned to a supervised center-based exercise group (n=11) or an unsupervised home-based exercise group (n=12). INTERVENTION The center-based group completed an 8-week targeted exercise program while under the direct supervision of a physiotherapist. After initial instruction, the home-based group completed the 8-week targeted exercise program at home without further supervision. MAIN OUTCOME MEASURES Quality of life, physical function, and spatiotemporal measures of gait. RESULTS No significant interaction (group by time) or main effects of grouping were found. Within each group, quality of life, and stair climbing improved significantly (P<.05) as did Timed Up & Go test and 6-minute walk test performances (P<.05). Walking speed increased by 16 cm/s (P<.01), cadence by 8 steps/min (P<.05), step length by 4.7 cm (P<.05), and double-support time reduced by a factor of 16%. Step length symmetry showed significant improvement (P<.05) over time. Step length differential between the affected and unaffected limbs reduced from 4.0 to 2.7 cm. CONCLUSIONS The targeted strengthening program was effective for both the home- and center-based groups. No group differences were found in the majority of the outcome measures. This finding is important because it shows that THR patients can achieve significant improvements through a targeted strengthening program delivered at a center or at home.

Ultrasound usage and dosage in sports physiotherapy

Ultrasound (US) therapy is the most widely available and frequently used electrophysical agent in physiotherapy. Despite this, there is minimal scientific evidence supporting its use. This raises the question of how is US being used in clinical practice? With a questionnaire, this study investigated US usage and dosage in sports physiotherapy. The results confirm the wide availability and frequent use of US. Applications were found to cover a wide range of clinical scenarios, during which therapists use a range of dosages. Two trends in dosage were evident and relate to the treatment of either acute or chronic conditions. Although rationale exists for these dosages, clinical evidence is currently lacking. Reasons for this lack of evidence are discussed. The results of this study provide a profile of US usage and dosage in sports physiotherapy and highlight the need for further research into its effects.

Hip and Ankle Range of Motion in Elite Classical Ballet Dancers and Controls

ObjectiveTo report range of motion at the hip and ankle in male and female ballet dancers compared with controls. DesignCross-sectional cohort study with convenience control sample. SettingNational classical ballet school in Australia. ParticipantsThirty-three female and 30 male fulltime ballet students of mean (SD) age 16.9 (0.8) and 18.0 (1.4) years, respectively. Controls were 31 female and 16 male nondancing, normally active university students of average ages 18.8 ± 0.6 and 18.8 ± 0.9 years, respectively. Main Outcome MeasuresDegrees of range of motion of left and right sides for the following four movements: standing plié in parallel–passive ankle dorsiflexion (DF), standing turnout in the balletic first position – lower limb external rotation (LLER), supine hip external rotation (ER), supine hip internal rotation (IR). Two additional ranges of motion were calculated. External rotation below the hip joint (BHER) was derived by subtracting hip ER from LLER, and total supine hip rotation (Hip IR + ER) was derived by summing hip ER and hip IR. Main ResultsOn both left and right sides, dancers had greater LLER (p < 0.0001) and hip ER (p < 0.0001) but lesser hip IR than the controls (p < 0.0001). Female but not male dancers had greater total supine hip rotation (hip ER + IR) than controls (p < 0.05). There was no difference in either BHER or ankle DF between dancers and controls. Within dancers, females had greater range in both left and right hip IR, LLER, and hip IR + ER. There was no difference in hip ER. Regression analysis revealed that LLER related to hip ER in both males and females. ConclusionsElite classical dance students had greater hip external rotation (both ER and LLER) and less hip internal rotation than controls but similar BHER and ankle DF. Since ER below the hip joint and ankle DF do not differ between dancers and controls, despite repeated training of these movements in ballet, there may be anatomical (bony/ligamentous) limitations to these movements.

Quantitative ultrasound assessment of acute bone loss following spinal cord injury: a longitudinal pilot study.

Abstract: Spinal cord injury (SCI) results in substantial and rapid osteoporosis. Given its rapid onset, assessment of bone changes in the early stages (first 6 months) following SCI is important. This is particularly pertinent if intervention is to be implemented. Quantitative ultrasound (QUS) represents a potential assessment tool for the evaluation of skeletal changes in the early stages following SCI. This longitudinal pilot study assessed changes in QUS measures of calcaneal broadband ultrasound attenuation (BUA) and speed of sound (SOS) in 15 male subjects (age 23.9 ± 7.3 years) over a 6-week period. Their mean time since SCI was 110.3 ± 34.5 days. Also assessed were bone mineral density of the calcaneus (BMDc) and proximal tibia (BMDt) using dual-energy X-ray absorptiometry (DXA). Confirming the rapid onset of bone loss following SCI, BMDc and BMDt decreased by 7.5 ± 3.0% (p<0.001) and 5.3 ± 4.2% (p<0.001), respectively. QUS was sensitive to these changes. BUA decreased by 8.5 ± 6.9% (p<0.001), whilst SOS decreased by 1.5 ± 1.3% (p<0.001). Suggesting an influence of the material properties of bone on BUA, BUA was correlated with BMDc at both the initial (r= 0.68, p<0.01) and final (r = 0.62, p<0.01) assessments. There were no significant correlations in the magnitude of change over the 6-week assessment period between any of the skeletal measures (all p>0.05). This suggests that skeletal qualities other than material properties also influence QUS measures. Overall, this study confirmed the rapid onset of bone loss following SCI and showed QUS to be a useful portable measure of acute bone changes. This may allow assessment of bone loss and the efficacy of intervention on this loss in the early stages following injury, a period where traditional axial DXA assessment is limited by practical constraints.