Norelee Kennedy

Do patients with chronic low back pain have an altered level and/or pattern of physical activity compared to healthy individuals? A systematic review of the literature.

BACKGROUND It is commonly assumed that patients with chronic low back pain are less active than healthy individuals. There has been a recent increase in the number of studies published comparing the physical activity levels of patients with chronic low back pain and healthy individuals. OBJECTIVES The aim of this systematic review was to determine, based on the current body of evidence, if patients with chronic low back pain have a lower level and/or altered pattern of physical activity compared with asymptomatic, healthy individuals. DATA SOURCES The electronic databases Embase, Medline, ISI Web of Knowledge, Cinahl, Sport Discus and Nursing and Allied Health were searched from the beginning of each database until the end of December 2009. REVIEW METHODS Studies which compared the level and/or pattern of physical activity of patients with chronic low back pain and healthy controls were included. The quality of the included studies was assessed using an assessment tool based on the Newcastle-Ottawa Scale. The scale was modified for the purposes of this study. RESULTS Seven studies were included in the final review. Four studies recruited adult patients (18-65 years), two studies examined older adults (≥65 years) and one study recruited adolescents (<18 years). Pooled data revealed no significant difference in the overall activity level of adults or adolescents with CLBP, however there is evidence that older adults with chronic low back pain are less active than controls. The results suggest that patients exhibit an altered pattern of physical activity over the course of a day compared to controls. Major methodological limitations were identified and are discussed. CONCLUSION There is no conclusive evidence that patients with chronic low back pain are less active than healthy individuals. Based on a limited number of studies, there is some evidence that the distribution of activities over the course of a day is different between patients with chronic low back pain and controls.

The effect of low-dye taping on rearfoot motion and plantar pressure during the stance phase of gait

BackgroundLow-dye (LD) taping is commonly used to reduce rearfoot pronation. No studies have previously investigated the effectiveness of LD taping using both plantar pressure distribution (F-Scan) and 3-D (CODA) analysis of rearfoot motion.Methods20 healthy subjects with a navicular drop test exceeding 10 mm participated in the study. T tests were used to determine whether significant (p < 0.05) differences in plantar pressure and rearfoot motion occurred with LD taping.ResultsLD taping resulted in statistically significant increases in peak plantar pressure in the lateral midfoot (p = 0.000), along with significant decreases in pressure in the medial forefoot (p = 0.014), and the medial (p = 0.000) and lateral hindfoot (p = 0.007). No significant changes occurred in the medial midfoot (p = 0.794) or lateral forefoot (p = 0.654). When assessed using motion analysis, taping resulted in a statistically significant decrease in rearfoot pronation (p = 0.006), supination (p = 0.025) and total rearfoot range of motion (p = 0.000). The mean rearfoot position during stance was not significantly different however (p = 0.188).ConclusionLD taping is associated with alterations in peak plantar pressure in the midfoot and forefoot that indicate reduced pronation with LD taping. However, LD taping appears to reduce both pronation and supination in the rearfoot, rather than simply reducing pronation, when assessed using 3D motion analysis. Therefore, it would appear that LD taping does indeed reduce pronation, by restricting rearfoot motion in general, rather than pronation specifically. The degree of change observed with LD taping was however very small, and further research is needed to clarify the clinical significance of these initial findings.

Study to Determine the Criterion Validity of the SenseWear Armband as a Measure of Physical Activity in People With Rheumatoid Arthritis

Measuring physical activity in people with rheumatoid arthritis (RA) is of great importance in light of the increased mortality in this population due to cardiovascular disease. Validation of activity monitors in specific populations is recommended to ensure the accuracy of physical activity measurement. Thus, the purpose of this study was to determine the validity of the SenseWear Pro3 Armband (SWA) as a measure of physical activity during activities of daily living (ADL) in people with RA.

Effects of low-dye taping on plantar pressure pre and post exercise: an exploratory study

BackgroundLow-Dye taping is used for excessive pronation at the subtalar joint of the foot. Previous research has focused on the tapes immediate effect on plantar pressure. Its effectiveness following exercise has not been investigated. Peak plantar pressure distribution provides an indirect representation of subtalar joint kinematics. The objectives of the study were 1) To determine the effects of Low-Dye taping on peak plantar pressure immediately post-application. 2) To determine whether any initial effects are maintained following exercise.Methods12 asymptomatic subjects participated; each being screened for excessive pronation (navicular drop > 10 mm). Plantar pressure data was recorded, using the F-scan, at four intervals during the testing session: un-taped, baseline-taped, post-exercise session 1, and post-exercise session 2. Each exercise session consisted of a 10-minute walk at a normal pace. The foot was divided into 6 regions during data analysis. Repeated-measures analysis of variance (ANOVA) was used to assess regional pressure variations across the four testing conditions.ResultsReduced lateral forefoot peak plantar pressure was the only significant difference immediately post tape application (p = 0.039). This effect was lost after 10 minutes of exercise (p = 0.036). Each exercise session resulted in significantly higher medial forefoot peak pressure compared to un-taped; (p = 0.015) and (p = 0.014) respectively, and baseline-taped; (p = 0.036) and (p = 0.015) respectively. Medial and lateral rearfoot values had also increased after the second session (p = 0.004), following their non-significant reduction at baseline-taped. A trend towards a medial-to-lateral shift in pressure present in the midfoot immediately following tape application was still present after 20 minutes of exercise.ConclusionLow-Dye tapes initial effect of reduced lateral forefoot peak plantar pressure was lost after a 10-minute walk. However, the tape continued to have an effect on the medial forefoot after 20 minutes of exercise. Further studies with larger sample sizes are required to examine the important finding of the anti-pronatory trend present in the midfoot.

Correlates of Physical Activity in Adults With Rheumatoid Arthritis: A Systematic Review

BACKGROUND Physical activity (PA) is an important component in the management of Rheumatoid Arthritis (RA). To date the correlates of PA have not been thoroughly investigated in the RA population. The aim of this systematic review was to determine the correlates of PA in the adult RA population. METHODS A search of Medline, EMBASE, AMED, CINAHL plus, Pubmed, Web of Science, and the Cochrane Library was conducted. A manual search of reference lists was conducted to compliment the electronic search. Ten studies fulfilled the inclusion criteria and were assessed for methodological quality. RESULTS Results determined correlates in 4 categories: sociodemographic, physical, psychological and social variables. The variables varied greatly and were inconsistently studied. Changes were noted from a previous review in 2005 in relation to the association between certain variables and PA, including age, gender, disease duration, pain, exercise beliefs and social support. CONCLUSIONS Positive associations with PA were found for motivation, self-efficacy, health perception, and previous PA levels. Negative associations were found for fatigue, a coerced regulation style and certain physiological variables. In addition differences between correlates of PA in the adult RA population and other chronic disease and healthy adult populations have been demonstrated.

Behaviour change interventions to promote physical activity in rheumatoid arthritis: a systematic review

Research has shown that people who have rheumatoid arthritis (RA) do not usually participate in enough physical activity to obtain the benefits of optimal physical activity levels, including quality of life, aerobic fitness and disease-related characteristics. Behaviour change theory underpins the promotion of physical activity. The aim of this systematic review was to explore behaviour change interventions which targeted physical activity behaviour in people who have RA, focusing on the theory underpinning the interventions and the behaviour change techniques utilised using specific behaviour change taxonomy. An electronic database search was conducted via EBSCOhost, PubMed, Cochrane Central Register of Controlled Trials and Web of Science databases in August 2014, using Medical Subject Headings and keywords. A manual search of reference lists was also conducted. Randomised control trials which used behaviour change techniques and targeted physical activity behaviour in adults who have RA were included. Two reviewers independently screened studies for inclusion. Methodological quality was assessed using the Cochrane risk of bias tool. Five studies with 784 participants were included in the review. Methodological quality of the studies was mixed. The studies consisted of behaviour change interventions or combined practical physical activity and behaviour change interventions and utilised a large variety of behaviour change techniques. Four studies reported increased physical activity behaviour. All studies used subjective methods of assessing physical activity with only one study utilising an objective measure. There has been varied success of behaviour change interventions in promoting physical activity behaviour in people who have RA. Further studies are required to develop and implement the optimal behaviour change intervention in this population.

Activity level classification algorithm using SHIMMER™ wearable sensors for individuals with rheumatoid arthritis

In rheumatoid arthritis (RA) it is believed that symptoms associated with the progression of the disease result in a reduction in the physical activity level of the patient. One of the key flaws of the research surrounding this hypothesis to date is the use of non-validated physical activity outcomes measures. In this study, an algorithm to estimate physical activity levels in patients as they perform a simulated protocol of typical activities of daily living using SHIMMER kinematic sensors, incorporating tri-axial gyroscopes and accelerometers, is proposed. The results are validated against simultaneously recorded energy expenditure data and the defined activity protocol and demonstrate that SHIMMER can be used to accurately estimate physical activity levels in RA populations.

Happiness: A Review of Evidence Relevant to Occupational Science

Occupational scientists must synthesise and apply knowledge generated within related disciplines to ensure the continued development of the discipline. This paper reviews the evidence available to occupational scientists on human happiness. This body of knowledge can be utilised by occupational scientists to better understand the subjective experience of occupational engagement. Two key philosophical traditions in happiness studies, hedonism and eudaimonia, are presented and theories of human happiness, including set-point theory, are described. A number of thematic areas of research on human happiness are reviewed. The relationships between happiness and health, living situation, personal goals, work, volunteering, flow, religiosity and relationships are reviewed. The reviewed studies underscore the centrality of occupation to current understandings of human happiness.

Physical function in hospice patients and physiotherapy interventions: a profile of hospice physiotherapy.

OBJECTIVE There is a dearth of international research on hospice physiotherapy. This study aims to profile hospice physiotherapy in an Irish setting in order to inform practice internationally. DESIGN The study design consisted of a retrospective chart audit over 6 months. SETTING The study took place at a specialist palliative care inpatient unit (hospice) in Limerick, Ireland. PARTICIPANTS All patients were discharged (through death or discharge onwards) from January to June 2010. OUTCOME MEASURE The Edmonton Functional Assessment Tool (EFAT-2) was used as an outcome measure. RESULTS Sixty-five percent were referred for physiotherapy; 58% (n=144) were assessed and treated. A wide range of patients was referred (mean functional score 11, range 1-23, SD 5). Rehabilitation activities were widespread: 48% with more than one functional score recorded made improvements; 53% of physiotherapy patients were eventually discharged home; 47% of physiotherapy patients died, of whom 52% received physiotherapy in the last week of life. The median physiotherapy program lasted 11 days (range 1-186, SD 22) whereas the median number of treatments was four (range 1-99, SD 10). The most common interventions were gait re-education (67%), transfer training (58%), and exercises (53%). One third of treatment attempts were unsuccessful because of the unavailability/unsuitability of patients. Challenges for physiotherapists included frequent suspension of treatment and large functional fluctuations in patients. CONCLUSION There was a high referral rate to physiotherapy in this hospice. Functional changes in hospice patients were mapped, showing that physiotherapy involved both rehabilitative and quality of life/supportive measures. The most common treatments were physical activity interventions.

Individualised cognitive functional therapy compared with a combined exercise and pain education class for patients with non-specific chronic low back pain: study protocol for a multicentre randomised controlled trial

Introduction Non-specific chronic low back pain (NSCLBP) is a very common and costly musculoskeletal disorder associated with a complex interplay of biopsychosocial factors. Cognitive functional therapy (CFT) represents a novel, patient-centred intervention which directly challenges pain-related behaviours in a cognitively integrated, functionally specific and graduated manner. CFT aims to target all biopsychosocial factors that are deemed to be barriers to recovery for an individual patient with NSCLBP. A recent randomised controlled trial (RCT) demonstrated the superiority of individualised CFT for NSCLBP compared to manual therapy combined with exercise. However, several previous RCTs have suggested that class-based interventions are as effective as individualised interventions. Therefore, it is important to examine whether an individualised intervention, such as CFT, demonstrates clinical effectiveness compared to a relatively cheaper exercise and education class. The current study will compare the clinical effectiveness of individualised CFT with a combined exercise and pain education class in people with NSCLBP. Methods and analysis This study is a multicentre RCT. 214 participants, aged 18–75 years, with NSCLBP for at least 6 months will be randomised to one of two interventions across three sites. The experimental group will receive individualised CFT and the length of the intervention will be varied in a pragmatic manner based on the clinical progression of participants. The control group will attend six classes which will be provided over a period of 6–8 weeks. Participants will be assessed preintervention, postintervention and after 6 and12 months. The primary outcomes will be functional disability and pain intensity. Non-specific predictors, moderators and mediators of outcome will also be analysed. Ethics and dissemination Ethical approval has been obtained from the Mayo General Hospital Research Ethics Committee (MGH-14-UL). Outcomes will be disseminated through publication according to the SPIRIT statement and will be presented at scientific conferences. Trial registration number (ClinicalTrials.gov NCT02145728).