Trevor Russell

Effect of Neck Exercise on Sitting Posture in Patients With Chronic Neck Pain

Background and Purpose Poor sitting posture has been implicated in the development and perpetuation of neck pain symptoms. This study had 2 purposes: (1) to compare change in cervical and thoracic posture during a distracting task between subjects with chronic neck pain and control subjects and (2) to compare the effects of 2 different neck exercise regimens on the ability of people with neck pain to maintain an upright cervical and thoracic posture during this task. Subjects Fifty-eight subjects with chronic, nonsevere neck pain and 10 control subjects participated in the study. Method Change in cervical and thoracic posture from an upright posture was measured every 2 minutes during a 10-minute computer task. Following baseline measurements, the subjects with neck pain were randomized into one of two 6-week exercise intervention groups: a group that received training of the craniocervical flexor muscles or a group that received endurance-strength training of the cervical flexor muscles. The primary outcomes following intervention were changes in the angle of cervical and thoracic posture during the computer task. Results Subjects with neck pain demonstrated a change in cervical angle across the duration of the task (mean=4.4°; 95% confidence interval [CI]=3.3–5.4), consistent with a more forward head posture. No significant difference was observed for the change in cervical angle across the duration of the task for the control group subjects (mean=2.2°; 95% CI=1.0–3.4). Following intervention, the craniocervical flexor training group demonstrated a significant reduction in the change of cervical angle across the duration of the computer task. Discussion and Conclusion This study showed that people with chronic neck pain demonstrate a reduced ability to maintain an upright posture when distracted. Following intervention with an exercise program targeted at training the craniocervical flexor muscles, subjects with neck pain demonstrated an improved ability to maintain a neutral cervical posture during prolonged sitting.

Internet-based Outpatient Telerehabilitation for Patients Following Total Knee Arthroplasty: A Randomized Controlled Trial

BACKGROUND total knee arthroplasty is an effective means for relieving the symptoms associated with degenerative arthritis of the knee. Rehabilitation is a necessary adjunct to surgery and is important in regaining optimum function. Access to high-quality rehabilitation services is not always possible, especially for those who live in rural or remote areas. The aim of this study was to evaluate the equivalence of an Internet-based telerehabilitation program compared with conventional outpatient physical therapy for patients who have had a total knee arthroplasty. METHODS this investigation was a single-blinded, prospective, randomized, controlled noninferiority trial. Sixty-five participants were randomized to receive a six-week program of outpatient physical therapy either in the conventional manner or by means of an Internet-based telerehabilitation program. The primary outcome measure was the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) measured at baseline and six weeks by a blinded independent assessor. Secondary outcomes included the Patient-Specific Functional Scale, the timed up-and-go test, pain intensity, knee flexion and extension, quadriceps muscle strength, limb girth measurements, and an assessment of gait. Noninferiority was assessed through the comparison of group differences with a noninferiority margin and with linear mixed model statistics. RESULTS baseline characteristics between groups were similar, and all participants had significant improvement on all outcome measures with the intervention (p < 0.01 for all). After the six-week intervention, participants in the telerehabilitation group achieved outcomes comparable to those of the conventional rehabilitation group with regard to flexion and extension range of motion, muscle strength, limb girth, pain, timed up-and-go test, quality of life, and clinical gait and WOMAC scores. Better outcomes for the Patient-Specific Functional Scale and the stiffness subscale of the WOMAC were found in the telerehabilitation group (p < 0.05). The telerehabilitation intervention was well received by participants, who reported a high level of satisfaction with this novel technology. CONCLUSIONS the outcomes achieved via telerehabilitation at six weeks following total knee arthroplasty were comparable with those after conventional rehabilitation. LEVEL OF EVIDENCE therapeutic Level I. See Instructions to Authors for a complete description of levels of evidence.

Physical rehabilitation using telemedicine

Telerehabilitation is the provision at a distance of rehabilitation services such as physiotherapy, speech pathology or occupational therapy. The primary aim is to provide equitable access to rehabilitation services. Broadly speaking, the technologies used for telemedicine-based physical rehabilitation can be classified as: (1) image-based telerehabilitation; (2) sensor-based telerehabilitation; and (3) virtual environments and virtual reality telerehabilitation. To date, much of the research has been technology focused, and has consisted of single case or small sample research designs. The next step is to demonstrate viable telerehabilitation services in real world environments using well controlled research methodologies with large patient cohorts. In addition, the broader issues of cost-benefit and cost-effectiveness require investigation. If this can be done, then the undoubted potential benefits of telerehabilitation, for both the patient and health-care systems, can be realized.

Treating disordered speech and voice in Parkinson's disease online: a randomized controlled non-inferiority trial.

BACKGROUND Telerehabilitation may be a feasible solution to the current problems faced by people with Parkinsons disease in accessing speech pathology services. AIM To investigate the validity and reliability of online delivery of the Lee Silverman Voice Treatment (LSVT®) for the speech and voice disorder associated with Parkinsons disease. METHOD & PROCEDURES Thirty-four participants with Parkinsons disease and mild-to-moderate hypokinetic dysarthria took part in the randomized controlled non-inferiority laboratory trial and received the LSVT® in either the online or the face-to-face environment. Online sessions were conducted via two personal computer-based videoconferencing systems with real-time and store-and-forward capabilities operating on a 128 kbit/s Internet connection. Participants were assessed pre- and post-treatment on acoustic measures of mean vocal sound pressure level, phonation time, maximum fundamental frequency range, and perceptual measures of voice, articulatory precision and speech intelligibility. OUTCOMES & RESULTS Non-inferiority of the online LSVT® modality was confirmed for the primary outcome measure of mean change in sound pressure level on a monologue task. Additionally, non-significant main effects for the LSVT® environment, dysarthria severity, and interaction effects were obtained for all outcomes measures. Significant improvements following the LSVT® were also noted on the majority of measures. The LSVT® was successfully delivered online, although some networking difficulties were encountered on a few occasions. High participant satisfaction was reported overall. CONCLUSIONS & IMPLICATIONS Online treatment for hypokinetic dysarthria associated with Parkinsons disease appears to be clinically valid and reliable. Suggestions for future research are outlined.

Health-Related Quality of Life After Anterior Cruciate Ligament Reconstruction A Systematic Review

Background: Anterior cruciate ligament reconstructions (ACLRs) are frequently performed on young, active patients and can result in persistent knee symptoms and activity limitations that may affect health-related quality of life (HRQoL). To date, there has been no systematic review of HRQoL outcomes after ACLR. Purpose: The objectives of this study were to report HRQoL ≥5 years after ACLR, compare HRQoL outcomes with available population norms, and describe factors that may affect HRQoL in this population. Study Design: Systematic review. Methods: All studies reporting HRQoL ≥5 years after ACLR with hamstring or patellar tendon autografts were eligible for review. Common HRQoL outcomes were pooled using a random-effects meta-analysis and compared with published population norms. The Spearman rank correlation coefficient (ρ) was used to identify variables associated with HRQoL outcomes. Where insufficient data were available, outcomes were reported descriptively. Results: Fourteen studies were eligible for review, and HRQoL was reported for 2493 patients at a mean of 9 years (range, 5-16 years) after ACLR. Pooling of knee-related quality of life outcomes (Knee injury and Osteoarthritis Outcome Score [KOOS]–QOL) found impairments after ACLR when compared with population norms. In comparison, studies using the Short Form–36 (SF-36) reported similar or better HRQoL compared with normative data. The KOOS-QOL subscores correlated strongly with KOOS-sport/recreation (ρ = .70, P = .04) and KOOS-pain (ρ = .85, P = .003) subscores. Severe radiographic osteoarthritis, meniscal injuries sustained after surgery, and revision ACLR were associated with poorer HRQoL outcomes at a minimum 5-year follow-up. The negative influence of concomitant meniscal surgery on HRQoL became apparent more than 10 years after ACLR. Conclusion: This review found that patients assessed using a knee-specific measure (KOOS-QOL) were more likely to report poorer HRQoL values, compared with population norms, than those assessed using a generic HRQoL measure (SF-36). Revision surgeries, meniscal injuries, and severe radiographic osteoarthritis were associated with poorer HRQoL outcomes after ACLR. However, these relationships should be interpreted with caution, as they were only investigated in a small number of studies. Clinical Relevance: These results can be used by clinicians to educate patients about potential long-term outcomes after ACLR and to develop strategies for optimizing postoperative HRQoL.

Assessing disordered speech and voice in Parkinson's disease: a telerehabilitation application

BACKGROUND Patients with Parkinsons disease face numerous access barriers to speech pathology services for appropriate assessment and treatment. Telerehabilitation is a possible solution to this problem, whereby rehabilitation services may be delivered to the patient at a distance, via telecommunication and information technologies. A number of studies have demonstrated the capacity of telerehabilitation to provide reliable and valid assessments of speech, voice and language. However, no studies have specifically focused on assessing patients with Parkinsons disease. AIMS To investigate the validity and reliability of a telerehabilitation application for assessing the speech and voice disorder associated with Parkinsons disease. METHODS & PROCEDURES Sixty-one participants with Parkinsons disease and hypokinetic dysarthria were simultaneously assessed in an online and face-to-face environment by two speech-language pathologists. The assessment protocol included perceptual measures of voice and oromotor function, articulatory precision, speech intelligibility, and acoustic measures of vocal sound pressure level, phonation time and pitch range. Online assessments were conducted via a personal computer-based videoconferencing system with store-and-forward capabilities, operating on a 128 kbit/s Internet connection. The level of agreement between the online and face-to-face ratings was determined using several different analyses, depending on the parameter. These included per cent close agreement, quadratic weighted Kappa, and the Bland and Altman limits of agreement. OUTCOMES & RESULTS Per cent close agreement between the two environments was within a predetermined clinical criterion of 80% agreement for all voice and oromotor parameters, articulatory precision and speech intelligibility in conversation. Levels of agreement between the environments, based on quadratic weighted Kappa, ranged from poor to good for vocal parameters and from fair to very good for oromotor parameters. Bland and Altman limits of agreement analyses revealed comparability between online and face-to-face environments for vocal sound pressure level, phonation time, pitch range, sentence intelligibility and communication efficiency in reading. Intra- and inter-rater reliability scores for all tasks were comparable between the online and face-to-face environments. CONCLUSIONS & IMPLICATIONS For the majority of parameters, comparable levels of agreement were achieved between the two environments. Online assessment of disordered speech and voice in Parkinsons disease appears to be valid and reliable. The telerehabilitation application described in this study provides evidence for the delivery of online assessment for the dysarthric speech disorder associated with Parkinsons disease.

Assessing Acquired Language Disorders in Adults via the Internet

Aphasia, a language disturbance, frequently occurs following acquired brain impairment in adults. Because management of aphasia is often long-term, provision of ongoing and equitable access to treatment creates a significant challenge to speech-language pathologists (SLPs). This study aimed to determine the validity and reliability of assessing aphasia using standardized language assessments via an Internet-based videoconferencing system using a bandwidth of 128 kbits/sec. Thirty-two participants with aphasia due to stroke or traumatic brain injury were assessed simultaneously in either a face-to-face or online-led environment by two SLPs. Short forms of the Boston Diagnostic Aphasia Examination (BDAE-3) and the Boston Naming Test (BNT, 2nd edition) were administered. An eight-item participant satisfaction questionnaire was completed by 15 participants assigned to the online-led assessment. Results failed to identify any significant differences between the 24 subtest scores of the BDAE-3 and the BNT scores obtained in the online and face-to-face test environments (p > 0.01). Weighted kappa statistics indicated moderate to very good agreement (0.59-1.00) between the two assessors for the 24 subtests and eight rating scales of the BDAE-3, the BNT, and for aphasia diagnosis. Good to very good inter- and intra-rater reliability for the online assessment was found across the majority of assessment tasks. Participants reported high overall satisfaction, comfort level, and audio and visual quality in the online environment. This study supports the validity and reliability of delivering standardized assessments of aphasia online and provides a basis for ongoing development of telerehabilitation as an alternate mode of service delivery to persons with aphasia.

Treating the speech disorder in Parkinson's disease online:

The Lee Silverman Voice Treatment (LSVT) has been shown to be highly effective in treating the speech disorder in Parkinsons Disease (PD). However, patient access to this treatment remains limited in Australia, due to availability of speech pathologists, patient mobility and distance issues. We have investigated the feasibility and effectiveness of an Internet-based telerehabilitation application (eREHAB) for the delivery of the LSVT to persons with PD and disordered speech. Ten participants with PD and dysarthria were treated online with the LSVT for a total of 16 sessions. There were significant improvements in sound pressure levels for vowel prolongation, reading and conversational monologue (P<0.01), pitch range (P<0.05) and in perceptual features of pitch and loudness variability, loudness level (P<0.01) and breathiness (P<0.05). A participant satisfaction questionnaire indicated that 70% of participants expressed overall satisfaction with the online treatment. Telerehabilitation was feasible and effective in delivering the LSVT to people with PD.

Can the Internet be used as a medium to evaluate knee angle

Telemedicine promises to revolutionize medical care delivery in rural and remote areas. The ability to accurately evaluate physical impairment via the Internet is important to the possible future provision of Internet-based physiotherapy. This study evaluated the reliability and validity of assessing knee range of motion via the Internet. Two therapists evaluated knee angle on a single subject via two methods of assessment: the Internet and the traditional method (face-to-face). Nine random positions of the knee were chosen with the principal examiner performing 20 face-to-face and two sets of 20 Internet measures in each position (n=540). The secondary therapist performed Internet assessments only. The Internet connection was established at a readily available speed of 17 kbit/s. The Internet-based goniometer was found to be a valid tool for measuring both knee flexion and extension angles. It was shown to possess both high intra and inter-rater reliability. Difference average plots of the scores verified the consistency of measurement between both modes of assessment. The successful evaluation of the physical outcome measure of knee range of motion via the Internet assists the further development of Internet-based physiotherapy applications.

High-flexion total knee arthroplasty: a systematic review

This study is a systematic literature review of outcomes following total knee arthroplasty with implants specifically designed to enable increased knee flexion. English language comparative studies without date restriction were identified through a computerised literature search and bibliography review. Nine studies met the inclusion criteria representing a total of 399 high-flexion knee arthroplasties in 370 patients. Five studies reported greater flexion or range of motion; however, the methodological rigour was questionable with inadequate blinding, flawed participant selection, short follow-up periods and functional outcomes which lacked sensitivity. There was insufficient evidence of improved range of motion or functional performance after high-flexion knee arthroplasty.