Thomas Maribo

Postural balance in low back pain patients: criterion-related validity of centre of pressure assessed on a portable force platform.

IntroductionAltered postural control has been observed in low back pain (LBP) patients. They seem to be more dependent on vision when standing. The objective of the study was to determine concurrent and predictive validity of measures of postural stability in LBP patients.Materials and methodsCentre of Pressure (CoP) measurements were tested against pain, fear of pain, and physical function. Velocity, anterior–posterior displacement, and the Romberg Ratio obtained on a portable force platform were used as measures of postural stability.ResultsBaseline and 12-week follow-up results of 97 LBP patients were evaluated. The correlations between CoP measurements and pain, fear of pain, and physical function were poor. There were no significant differences in CoP measurements between patients with no change or deterioration and patients with improvement in pain and back-specific function.ConclusionThis first study of concurrent and predictive validity of postural balance in LBP patients revealed no association between CoP measures and pain, fear of pain, and physical function.

Wearing an active spinal orthosis improves back extensor strength in women with osteoporotic vertebral fractures

Background: Vertebral fractures are the most common clinical manifestations of osteoporosis. Vertebral fractures and reduced back extensor strength can result in hyperkyphosis. Hyperkyphosis is associated with diminished daily functioning and an increased risk of falling. Improvements in back extensor strength can result in decreased kyphosis and thus a decreased risk of falls and fractures. Objectives: The aim was to examine the effects of an active spinal orthosis – Spinomed III – on back extensor strength, back pain and physical functioning in women with osteoporotic vertebral fractures. Study design: Experimental follow-up. Methods: The women used the active spinal orthosis for 3 months. Outcomes were changes in isometric back extensor strength, changes in back pain and changes in physical functioning. Results: A total of 13 women were included in the trial. Wearing the orthosis during a 3-month period was associated with an increase in back extensor strength of 50% (p = 0.01). The study demonstrated a 33% reduction in back pain and a 6.5-point improvement in physical functioning. The differences in pain and physical functioning were borderline significant. Conclusion: The women demonstrated a clinically relevant improvement in the back extensor strength. The differences in pain and physical functioning were clinically relevant and borderline significant. Clinical relevance The results imply that Spinomed III could be recommended for women with vertebral fractures as a supplement to traditional back strengthening exercises. It is essential that the orthosis is adjusted correctly and that there is an individual programme concerning the amount of time the orthosis has to be worn every day.

Systematic Literature Review on ICF From 2001 to 2013 in the Nordic Countries Focusing on Clinical and Rehabilitation Context.

We present a systematic review on International Classification of Functioning, Disability and Health (ICF) used in the Nordic countries from 2001 through 2013, describing and quantifying the development in utilization of ICF, and describe the extent to which the different components of the ICF have been used. A search was conducted in EMBASE, MEDLINE and PsycInfo. Papers from Nordic countries were included if ICF was mentioned in title or abstract. Papers were assigned to one of eight categories covering the wide rehabilitation area; furthermore, area of focus was assigned. Use of ICF components and intervention were coded in papers categorized as “clinical and/or rehabilitation contexts” or “non-clinical contexts”. One hundred seventy papers were included, of these 99 papers were from the categories “clinical and/or rehabilitation contexts” or “non-clinical contexts”. Forty-two percent of the 170 included papers were published in the period 2011 - 2013. There was an increase in ICF-relevant papers from 2001 to 2013, especially in the categories “clinical and/or rehabilitation contexts” and “non-clinical contexts”. The most represented focus areas were neurology, musculoskeletal, and work-related areas. All five or at least four ICF components were mentioned in the results or discussions in most papers, and activity was most frequently mentioned.

The Danish Version of the Modified Constant-Murley Shoulder Score: Reliability, Agreement, and Construct Validity

STUDY DESIGN Test-retest study. Objectives To assess the reliability, agreement, and validity of the Danish version of the modified Constant-Murley score (CMS). BACKGROUND Modified CMS guidelines were published in 2008. These modifications have recently been translated and cross-culturally adapted into a Danish version. However, the reliability and the validity of this version have yet to be established. METHODS A total of 45 patients with shoulder impingement syndrome were examined by 2 raters using the modified version of the CMS and a questionnaire that included the Oxford shoulder score. Both raters had a minimum of experience using the CMS. Intrarater and interrater agreement and reliability were examined and compared. Construct validity was assessed by the correlation between the scores of the CMS and the Oxford shoulder score. RESULTS The minimal detectable change was estimated to be 13 and 11 points for raters A and B, respectively. The intraclass correlation coefficient was 0.93 for rater A and 0.95 for rater B. Interrater comparison demonstrated a minimal detectable change of 12 points and an intraclass correlation coefficient of 0.94. The correlation coefficient between the CMS and the Oxford shoulder score was 0.76. CONCLUSION The intrarater and interrater reliability and agreement of the Danish version of the modified CMS were found to be acceptable, and construct validity was confirmed.

Predictors of vocational prognosis after herniated lumbar disc: a two-year follow-up study of 2039 patients diagnosed at hospital.

Study Design. A register study with 2 years of follow up. Objective. To identify predictors of an unfavorable vocational prognosis after hospital contact for herniated lumbar disc (HLD). Summary of Background Data. There is sparse information about vocational prognosis among HLD patients diagnosed at hospital. Methods. We followed all in- and outpatients diagnosed with HLD at a Danish University Hospital 2001 to 2005 eligible for the labor market in the Danish National Register on Public Transfer Payments (n = 2039). Clinical data were obtained from the Danish National Patient Register. The outcome measure was unfavorable vocational prognosis defined as less than 40 weeks of employment within the second year after hospital contact. Cox proportional hazards models were used. Results. Altogether 41.8% had an unfavorable vocational prognosis. The outcome was associated with unskilled work Hazard Ratio (HR) 2.1 (95% confidence interval [CI] = 1.5–2.8), skilled work HR 1.9 (CI = 1.3–2.7), and semi academic work HR 1.5 (CI = 1.1–2.0) as compared with academic work and less than 40 weeks of employment within year two before hospital contact HR 2.1 (CI = 1.9–2.5). Further negative prognostic factors were lumbar fusion alone HR 1.4 (CI = 1.1–1.8) and in combination with discectomy HR 1.6 (CI = 1.2–2.2) as compared with nonsurgical treatment, ethnicity other than Danish HR 1.55 (CI = 1.2–1.8), and female gender HR 1.2 (CI = 1.1–1.4). Discectomy, age, and year of inclusion were not associated with the outcome. Conclusion. The risk of an unfavorable vocational prognosis after hospital contact for HLD was substantial. Nonacademic work and less than 40 weeks of employment within year two before hospital contact were the strongest prognostic factors, but also lumbar fusion alone and in combination with discectomy, ethnicity, and gender had a negative influence. There seems to be a need for actions addressing these patient categories to avoid long-term sick leave and premature withdrawal from the labor market.

Efficacy of Preoperative Progressive Resistance Training on Postoperative Outcomes in Patients Undergoing Total Knee Arthroplasty.

To investigate the efficacy of 4 weeks of preoperative and 4 weeks of postoperative progressive resistance training (PRT), compared to 4 weeks of postoperative PRT only on functional performance, muscle strength, and patient‐reported outcomes in patients undergoing total knee arthroplasty (TKA).

Efficacy of pre‐operative progressive resistance training on post‐operative outcomes in patients undergoing total knee arthroplasty

To investigate the efficacy of 4 weeks of preoperative and 4 weeks of postoperative progressive resistance training (PRT), compared to 4 weeks of postoperative PRT only on functional performance, muscle strength, and patient‐reported outcomes in patients undergoing total knee arthroplasty (TKA).

The Fugl–Meyer assessment of the upper extremity: reliability, responsiveness and validity of the Danish version

Abstract Objective: To translate the Fugl-Meyer Assessment of the Upper Extremity (FMA-UE) into Danish and to establish the inter-tester reliability, responsiveness, Minimal Clinically Important Difference (MCID) and concurrent validity of the FMA-UE in a population of stroke patients. Method: The translation was conducted in accordance with the principles outlined by the ISPOR Task Force for Translation and Cultural Adaption. Inter-rater reliability was assessed at baseline. Each patient was tested by two examiners and inter class correlation (ICC) was calculated. Responsiveness was assessed using receiver operating characteristic (ROC) curve statistics. The FMA-UE change score was used to assess sensitivity and specificity and to correctly determine which patients had improved. The MCID and the area under the curve (AUC) were established using the ROC. The FMA-UE’s concurrent validity with the Motor Assessment Scale was determined using Spearman’s rank correlation. Setting: The study took place at Skive Neurorehabilition, Denmark from May 2014 to February 2015. Participants: Inpatients, who were in the acute to sub-acute stage of stroke and aged > 18 years. Interventions: Not applicable. Main outcome measure: The FMA-UE. Results: In 50 inpatients the ICC was 0.95, AUC was 0.87, with a sensitivity of 77%, a specificity of 89% and an MCID ≥ 4. Concurrent validity was high, with r = 0.94–0.95. Conclusion: The FMA-UE was successfully translated into Danish. An MCID ≥ 4 was found. This study provides evidence that the FMA-UE is a reliable, responsive and valid instrument for measuring upper limb impairment after stroke. Implications for rehabilitation One of the most widely recognized measures of upper extremity motor impairment post-stroke is the Fugl-Meyer Assessment of the Upper Extremity (FMA-UE). The psychometric properties of a measurement depends on the population and setting in which it is used. In this study, the FMA-UE is translated into Danish and the psychometric properties of FMA-UE is determined in a Danish population of patients with stroke. The FMA-UE is now available to use for clinicians in Denmark.

FUNCTIONAL PERFORMANCE IS ASSOCIATED WITH BOTH KNEE EXTENSOR AND FLEXOR MUSCLE STRENGTH IN PATIENTS SCHEDULED FOR TOTAL KNEE ARTHROPLASTY: A CROSS-SECTIONAL STUDY

OBJECTIVE To determine whether muscle strength in patients scheduled for total knee arthroplasty is: (i) strongly associated with both measured functional performance and patient-reported measures; (ii) more closely associated with functional performance when measured during concentric than during isometric contractions; and (iii) more strongly related to the 30-s chair stand test than to the timed-up-and-go and walking measures. DESIGN Cross-sectional-study. PATIENTS Fifty-nine patients (36 women, 23 men), mean age 70.4 years. METHODS Associations between muscle strength, measured functional performance, and patient-reported measures were calculated. RESULTS Both knee extensor and knee flexor strength were associated with performance-based measures. In general, concentric knee flexor muscle strength was more strongly associated with functional performance than was isometric knee flexor strength. Concentric and isometric knee extensor strength were of equal importance. The 30-s chair stand test was better than the timed-up-and-go and the walking tests at determining muscle strength. CONCLUSION Future rehabilitation programmes should include both the knee extensor muscles and the knee flexor muscles in order to improve functional performance. The 30-s chair stand test is a valid and clinical relevant proxy measure of knee extensor and knee flexor muscle strength.

The effect on physical performance of a functional assessment and immediate rehabilitation of acutely admitted elderly patients with reduced functional performance: the design of a randomised clinical trial

Introduction Illness and hospitalisation, even of short duration, pose separate risks for permanently reduced functional performance in elderly medical patients. Functional assessment in the acute pathway will ensure early detection of declining performance and form the basis for mobilisation during hospitalisation and subsequent rehabilitation. For optimal results rehabilitation should begin immediately after discharge.The aim of this study is to investigate the effect of a systematic functional assessment in the emergency department (ED) of elderly medical patients with reduced functional performance when combined with immediate postdischarge rehabilitation. Method and analysis The study is a two-way factorial randomised clinical trial. Participants will be recruited among patients admitted to the ED who are above 65 years of age with reduced functional performance. Patients will be randomly assigned to one of four groups: (1) functional assessment and immediate rehabilitation; (2) functional assessment and rehabilitation as usual; (3) assessment as usual and immediate rehabilitation; (4) assessment and rehabilitation as usual. Primary outcome 30 s chair-stand test administered at admission and 3 weeks after discharge. Ethics and dissemination The study has been approved by the Regional Scientific Ethical Committees of Southern Denmark in February 2014. The study findings will be published in peer-reviewed journals and presented at national and international conferences. Trial registration number: ClinicalTrials.gov Identifier: NCT02062541.