Background Multiple sclerosis (MS) is one of the world’s most common neurologic disorders leading... more Background Multiple sclerosis (MS) is one of the world’s most common neurologic disorders leading to severe disability in young adults. MS-related fatigue directly impacts on the quality of life and activity levels of people with MS. Self-management strategies are used to support them in the care of their health. Mobile health (mHealth) solutions can offer tools to help symptom management. Following a user-centered design and evidence-based process, an mHealth solution called More Stamina was created to help persons with MS manage their fatigue. Objective The overall study aims are to explore the feasibility, acceptability, and usability of More Stamina, a mobile app for fatigue self-management for persons with MS. Methods A mixed-methods, multicenter study will be used to assess the feasibility, acceptability, and usability of More Stamina. The study will take place during the third and fourth quarters of 2020 (Q3-Q4 2020) in 3 locations: Argentina, Spain, and Switzerland. A longit...
PURPOSE To evaluate discriminative validity, relative reliability and absolute reliability of fou... more PURPOSE To evaluate discriminative validity, relative reliability and absolute reliability of four tablet-based tests for the evaluation of upper limb motor function in healthy persons and patients with neurological disorders. METHODS Cross-sectional study in 54 participants: 29 patients with upper limb movement impairment due to a neurological condition recruited from an inpatient rehabilitation centre and 25 healthy persons. Accuracy, speed and path length were analysed for four tablet-based tests: "Spiral drawings," "Tapping," "Follow the dot" and "Trace a star." The area under the receiver operating characteristic curve (AUC) was used to evaluate discriminative validity. Relative reliability was analysed with the intra-class correlation coefficient (ICC), and absolute reliability by limits of agreement (LoA) and minimal detectable difference (MDD). RESULTS All four tests showed excellent discriminative validity for the parameter accuracy (AUC 0.93-0.98). Tapping was the best test for discriminating patients from healthy persons. Test-retest reliability was good for accuracy in all tests (ICC = 0.76-0.88), but poor to moderate for speed and path length (ICC = 0.20-0.69). The MDD varied between 14% and 38%. Performance on the four tablet-based tests was stable between sessions, indicating that there was no learning effect. CONCLUSION The parameter accuracy showed excellent discriminative validity and reliability in all four tablet-based tests. Discriminative validity was excellent for all three parameters in the Tapping test. In the other tasks speed showed good to poor reliability, while the reliability of path-length was poor in all tasks. Results were comparable for the dominant and non-dominant hand. Tablet-based tests have the advantage that patients can use them for self-monitoring of upper limb motor function. Implications for rehabilitation Four tablet-based tests for the assessment of upper limb motor function in patients with upper limb neurological dysfunction were evaluated: "Spiral drawings", "Tapping", "Follow the dot" and "Trace a star". The parameter accuracy in these four tests had excellent discriminative validity and good reliability. Patients can perform the tests independently at home for self-monitoring of progress. This may increase patients' motivation to exercise at home. The results can be sent to physicians, enabling the earlier detection of deterioration, which may require medical attention.
BACKGROUND Multiple sclerosis (MS) is one of the world’s most common neurologic disorders of the ... more BACKGROUND Multiple sclerosis (MS) is one of the world’s most common neurologic disorders of the young adults leading to severe disability. MS Fatigue impacts directly on the quality of life and activity levels of people with MS. Self-management strategies are used to support them in the care of their health. Mobile health (mHealth) solutions can offer tools to help symptom management. Following a user-centered design and evidence-based process, a mHealth solution called More Stamina was created to help persons with MS manage their fatigue OBJECTIVE The overall study aims are to explore the feasibility, acceptability, and usability of More Stamina, a mobile app for fatigue self-management for persons with MS. METHODS A mixed methods multicenter study will be used to assess the feasibility, acceptability, and usability of More Stamina. The study will take place during the first and second quarters of 2020 (Q1-Q2 2020) in three locations: Argentina, Spain and Switzerland. A longitudin...
Objective: Fatigue experienced by people with multiple sclerosis (pwMS) is multidimensional, cons... more Objective: Fatigue experienced by people with multiple sclerosis (pwMS) is multidimensional, consisting of different components, such as perceived, physical and cognitive fatigue and performance fatigability. At present, there is no gold standard to assess performance fatigability in pwMS; therefore, we aimed to determine whether, during a fatiguing task, average rectified value (ARV), mean frequency of the power spectrum (MNF), muscle fiber conduction velocity (CV) and fractal dimension (FD) of surface electromyography (sEMG) may be used as indirect indices of performance fatigability. Moreover, we analyzed whether a three-week rehabilitation program impacts on performance fatigability in pwMS, and whether a relationship between sEMG parameters and trait levels of perceived fatigability, before and after rehabilitation, does exist. Approach: Twenty-one pwMS performed a 20% maximal voluntary contraction (MVC) of 1 min, and afterwards a 60% MVC held until exhaustion. sEMG signals wer...
COPD: Journal of Chronic Obstructive Pulmonary Disease
Abstract Exercise can improve walking capacity in persons with chronic obstructive pulmonary dise... more Abstract Exercise can improve walking capacity in persons with chronic obstructive pulmonary disease (COPD). However, most endurance training programs use cycle ergometers. The objectives of this study were: (i) to evaluate the feasibility of a randomized controlled trial (RCT) comparing outdoor walking training (OWT) to cycle ergometer training (CT) during inpatient rehabilitation in persons with severe COPD; (ii) to estimate the effect of OWT and CT on health-related quality of life, physical capacity and physical activity; and (iii) to estimate the required sample size for a RCT. A single-blind randomized controlled feasibility trial was conducted with three months' follow-up in the rehabilitation center in Walenstadtberg, Switzerland. Sixteen patients were included in the study, which had a recruitment rate of 33% (16/48). Patients were allocated to an OWT (n = 8) or CT (n = 8) group. Participants completed 75% of scheduled training and the follow-up rate was 75%. All participants in the OWT group were satisfied with the training. The OWT group had better health-related quality of life after three weeks' training compared to the CT group (p = 0.042, 95% confidence interval (95% CI) 1.06–49.94, effect size (d)=1.19). No exacerbations occurred in the OWT group, but three occurred in the CT group after three months’ follow-up. There was no significant difference in the other outcomes. In conclusion, the study design and the OWT are feasible. Health-related quality of life improved in the OWT group compared to the CT group after three weeks' inpatient rehabilitation. A minimum of 46 participants is needed for a RCT. Trial registration: www.who.int/trialsearch DRKS00010977
Purpose: Determine the association of different social factors with Functional Capacity Evaluatio... more Purpose: Determine the association of different social factors with Functional Capacity Evaluation (FCE) performance in adults. Materials and methods: A systematic literature search was performed in MEDLINE, CINAHL, and PsycINFO electronic databases. Studies were eligible if they studied social factor's association with the performance of adults undergoing FCE. Studies were assessed on methodological quality and quality of evidence. The review was performed using best-evidence synthesis methods. Results: Thirteen studies were eligible and 11 social factors were studied. Considerable heterogeneity regarding measurements, populations, and methods existed among the studies. High quality of evidence was found for the association of FCE performance with the country of FCE and examiner's fear behavior; moderate quality of evidence with previous job salary; and low or very low quality of evidence with compensation status, litigation status, type of instruction, time of day (workday), primary or mother language, and ethnicity. Other social factors were not studied. Conclusions: Evidence for associations of various social factors with FCE performance was found, but robust conclusions about the strength of the associations cannot be made. Quality of evidence ranged from high to very low. Further research on social factors, also within a biopsychosocial context, is necessary to provide a better understanding of FCE performance. ä IMPLICATIONS FOR REHABILITATION Research on Functional Capacity Evaluation (FCE) performance and its association with biopsychosocial factors have scarcely addressed the impact of social factors, limiting full understanding of FCE results. The social factors, healthcare (examiner's fear behavior and type of instruction), personal or cultural systems (country of FCE, primary or mother language, and ethnicity), workplace system (previous job salary, time of day (workday)), and legislative and insurance system (compensation and litigation status), have a bearing in FCE performance. Better understanding of factors associating with functional capacity provide insights in FCE, allowing clinicians to improve the evaluations and interpretations of the assessment and better design the rehabilitation program. Better understanding of factors that influence FCE performance, and of unstudied factors, will allow researchers guidance to further investigate the construct of functional capacity.
Disturbances in Tryptophan metabolism play a crucial role in multiple sclerosis (MS). Exercise is... more Disturbances in Tryptophan metabolism play a crucial role in multiple sclerosis (MS). Exercise is suspected to counteract the progress of MS and its side effects. Current research suggests alterations of Tryptophan metabolism in healthy individuals in response to exercise. We investigated the influence of acute aerobic exercise and training on Tryptophan metabolism in 57 inpatients with relapsing remitting ((RRMS) n=33) and secondary progressive ((SPMS) n=24) MS. Serotonin increased after training, whereas the kynurenine pathway was only activated in persons with RRMS. Further research is warranted to investigate whether these changes are associated with clinical measures (e.g. depressions and immune function).
Mit Schmerzprovokationstests am Iliosakralgelenk können Physiotherapeuten klinisch untersuchen, o... more Mit Schmerzprovokationstests am Iliosakralgelenk können Physiotherapeuten klinisch untersuchen, ob das Gelenk für Beschwerden an Rücken und Gesäß verantwortlich ist. Um auszuschließen, dass nicht doch eine benachbarte Struktur die Symptome auslöst, sollten Therapeuten drei bis sechs Tests in Kombination verwenden.
Background: Aerobic exercise can improve cognitive performance in healthy elderly people. Objecti... more Background: Aerobic exercise can improve cognitive performance in healthy elderly people. Objective: The aim of this study was to investigate the influence of a 3-week high-intensity aerobic exercise programme (high-intensity training group (HIT)) on cognitive performance in persons with multiple sclerosis (MS) compared with a standard exercise programme (control training (CT)). Methods: A total of 60 persons with MS (Expanded Disability Status Scale (EDSS): 1.0–6.5) were randomized to a HIT group (3×/week for 20 minutes, including five 3-minute exercise intervals at 80% of peak oxygen uptake (VO2-peak)) or a CT group (continuously 5×/week for 30 minutes/session at 65% of VO2-peak). Cognitive performance was assessed using the Brief International Cognitive Assessment for MS at entry ( t0) and discharge ( t1). Furthermore, VO2-peak, brain-derived neurotrophic factor, serotonin and matrix metalloproteinases (MMP)-2 and -9 were measured. Results: Compared to CT, HIT significantly impro...
Improving mobility in elderly persons is a primary goal in geriatric rehabilitation. Self-regulat... more Improving mobility in elderly persons is a primary goal in geriatric rehabilitation. Self-regulated exercises with instruction leaflets are used to increase training volume but adherence is often low. Exergames may improve adherence. This study therefore compared exergames with self-regulated exercise using instruction leaflets. The primary outcome was adherence. Secondary outcomes were enjoyment, motivation and balance during walking. Design: single center parallel group non-blinded randomized controlled trial with central stratified randomization. center for geriatric inpatient rehabilitation. Included were patients over 65 with mobility restrictions who were able to perform self-regulated exercise. Patients were assigned to self-regulated exercise using a) exergames on Windows Kinect® (exergame group EG) or b) instruction leaflets (conventional group CG). During two 30 min sessions physical therapists instructed self-regulated exercise to be conducted twice daily during thirty mi...
Journal of back and musculoskeletal rehabilitation, Jan 23, 2016
Lateral gliding cervical spine mobilisation is shown to improve shoulder pain, disability and fun... more Lateral gliding cervical spine mobilisation is shown to improve shoulder pain, disability and function. However, despite common clinical-use, no study reports the effect of unilateral anterior-posterior (A-P) cervical mobilisation on shoulder pain and function, and particularly in patients after arthroscopic shoulder surgery. Examine the immediate effect of single-level Grade III cervical unilateral A-P mobilisation on shoulder pain, flexion and abduction range of motion (ROM) and external rotator strength compared to placebo cervical unilateral A-P light touch pressure. Single session intervention with a crossover design in 32 (15 women) postoperative arthroscopic shoulder patients. Immediate and superior treatment effects were shown for A-P cervical mobilisation in improving flexion ROM, isometric strength of external rotation, and pain intensity during flexion (all p< 0.05) when compared to the placebo. However, effects may not be considered clinically meaningful. Unilateral A...
Weare pleased to have the opportunity to respond to the letter to the editor from Prof. Dr. S. Sa... more Weare pleased to have the opportunity to respond to the letter to the editor from Prof. Dr. S. Sabour regarding our recent publication (Bauer et al., 2016). We will attempt to address the issues raised in this letter. Our study assessed the reliability of interval-scaled outcome measures of eleven different movement dysfunction tests (Bauer et al., 2016). As stated by Prof. S. Sabour, the reproducibility of such outcome measures is generally quantified by intraclass correlation (ICC) coefficients. However, these coefficients are based on statistical models incorporating only two sources of error (for example rater or occasion, and residual error). We used the generalizability theory (G-theory) and subsequent D-studies to estimate reliability (F-coefficients). The advantage of this method is the possibility to incorporate multiple sources of error and their interaction (Streiner and Geoffrey, 2008). Besides residual error, we investigated two additional sources of error: trial (repeated measures on the same day) and day (repeated measures on two different days). Thus, using ICC to assess reproducibility was not appropriate for our study design. Furthermore, ICC's are just special cases of F-Coefficients when G-theory is applied to a study designwhich incorporates only one source of error besides residual error (Brennan, 2001). Themain concern stated by Prof. Dr. S. Sabour was that we investigated the reliability of averagemeasures instead of singlemeasurements and thus drew a misleading conclusion. We may not have been concise about our methodology. F-coefficients, as calculated by the formula in chapter 2.4 and listed in Table 2, express the reliability of a single measurement without averaging the results of repeated measures (number of repetitions nt 1⁄4 1 and number of days nd 1⁄4 1). Our statement “On average, ROM tests were more reliable compared to MCI and RE test” did not refer to the reliability of average measures, but the averaged reliability of single measures. Based on the preceding arguments, we are still certain about the appropriate use of statistical methods for our study design and the validity of our conclusion. Further, we fully agree with Prof. Dr. S. Sabour that appropriate tests should be usedwith careful interpretation to avoidmisleading messages due to inappropriate use of statistical tests.
The aim of this study was to determine and verify the optimal location of the motion axis (MA) fo... more The aim of this study was to determine and verify the optimal location of the motion axis (MA) for the seat of a dynamic office chair. A dynamic seat that supports pelvic motion may improve physical well-being and decrease the risk of sitting-associated disorders. However, office work requires an undisturbed view on the work task, which means a stable position of the upper trunk and head. Current dynamic office chairs do not fulfill this need. Consequently, a dynamic seat was adapted to the physiological kinematics of the human spine. Three-dimensional motion tracking in free sitting helped determine the physiological MA of the spine in the frontal plane. Three dynamic seats with physiological, lower, and higher MA were compared in stable upper body posture (thorax inclination) and seat support of pelvic motion (dynamic fitting accuracy). Spinal kinematics during sitting and walking were compared. The physiological MA was at the level of the 11th thoracic vertebra, causing minimal t...
Background: To determine whether there is a difference between patients with low back pain and he... more Background: To determine whether there is a difference between patients with low back pain and healthy controls in a test battery score for movement control of the lumbar spine. Methods: This was a case control study, carried out in five outpatient physiotherapy practices in the German-speaking part of Switzerland. Twelve physiotherapists tested the ability of 210 subjects (108 patients with non-specific low back pain and 102 control subjects without back pain) to control their movements in the lumbar spine using a set of six tests. We observed the number of positive tests out of six (mean, standard deviation and 95% confidence interval of the mean). The significance of the differences between the groups was calculated with Mann-Whitney U test and p was set on <0.05. The effect size (d) between the groups was calculated and d>0.8 was considered a large difference. Results: On average, patients with low back pain had 2.21(95%CI 1.94-2.48) positive tests and the healthy controls 0.75 (95%CI 0.55-0.95). The effect size was d = 1.18 (p < 0.001). There was a significant difference between acute and chronic (p < 0.01), as well as between subacute and chronic patient groups (p < 0.03), but not between acute and subacute patient groups (p > 0.7). Conclusion: This is the first study demonstrating a significant difference between patients with low back pain and subjects without back pain regarding their ability to actively control the movements of the low back. The effect size between patients with low back pain and healthy controls in movement control is large.
Method Ten office workers laterally flexed their spine in self-selected comfortable range during ... more Method Ten office workers laterally flexed their spine in self-selected comfortable range during a standardized reading task. Maximum spine-flexion and thorax-inclination and-translation were measured with infrared cameras during dynamic sitting for five minutes. Muscular activity of back muscles (left and right longissimus (L-/R-LONG), left iliocostalis (L-ILIO), right multifidus (R-MULT)) and thigh muscles (right vastus medialis (R-VASTM) and lateralis (R-VASTL)) were recorded by surface EMG while dynamic and static sitting and expressed as % of maximum EMG activity during gait.
Motion capture of the trunk using three-dimensional optoelectronic systems and skin markers place... more Motion capture of the trunk using three-dimensional optoelectronic systems and skin markers placed on anatomical landmarks is prone to error due to marker placement, thus decreasing between-day reliability. The influence of these errors on angular output might be reduced by using an overdetermined number of markers and optimization algorithms, or by defining the neutral position using a reference trial. The purpose of this study was to quantify and compare the between-day reliability of trunk kinematics, when using these methods. In each of two sessions, 20 subjects performed four movement tasks. Trunk kinematics were established through the plug-in-gait protocol, the point cloud optimization algorithm, and by defining upright standing as neutral position. Between-day reliability was analyzed using generalizability theory and quantified by indexes of dependability. Across all movement tasks, none of the methods was superior in terms of between-day reliability. The point cloud algorithm did not improve between-day reliability, but did result in 24.3% greater axial rotation angles. The definition of neutral position by means of a reference trial revealed 5.8% higher indexes of dependability for lateral bending and axial rotation angles, but 13.7% smaller indexes of dependability for flexion angles. Further, using a reference trial resulted in 8.3° greater trunk flexion angles. Therefore, the selection of appropriate marker placement and the corresponding calculation of angular output are dependent on the movement task and the underlying research question.
Background Multiple sclerosis (MS) is one of the world’s most common neurologic disorders leading... more Background Multiple sclerosis (MS) is one of the world’s most common neurologic disorders leading to severe disability in young adults. MS-related fatigue directly impacts on the quality of life and activity levels of people with MS. Self-management strategies are used to support them in the care of their health. Mobile health (mHealth) solutions can offer tools to help symptom management. Following a user-centered design and evidence-based process, an mHealth solution called More Stamina was created to help persons with MS manage their fatigue. Objective The overall study aims are to explore the feasibility, acceptability, and usability of More Stamina, a mobile app for fatigue self-management for persons with MS. Methods A mixed-methods, multicenter study will be used to assess the feasibility, acceptability, and usability of More Stamina. The study will take place during the third and fourth quarters of 2020 (Q3-Q4 2020) in 3 locations: Argentina, Spain, and Switzerland. A longit...
PURPOSE To evaluate discriminative validity, relative reliability and absolute reliability of fou... more PURPOSE To evaluate discriminative validity, relative reliability and absolute reliability of four tablet-based tests for the evaluation of upper limb motor function in healthy persons and patients with neurological disorders. METHODS Cross-sectional study in 54 participants: 29 patients with upper limb movement impairment due to a neurological condition recruited from an inpatient rehabilitation centre and 25 healthy persons. Accuracy, speed and path length were analysed for four tablet-based tests: "Spiral drawings," "Tapping," "Follow the dot" and "Trace a star." The area under the receiver operating characteristic curve (AUC) was used to evaluate discriminative validity. Relative reliability was analysed with the intra-class correlation coefficient (ICC), and absolute reliability by limits of agreement (LoA) and minimal detectable difference (MDD). RESULTS All four tests showed excellent discriminative validity for the parameter accuracy (AUC 0.93-0.98). Tapping was the best test for discriminating patients from healthy persons. Test-retest reliability was good for accuracy in all tests (ICC = 0.76-0.88), but poor to moderate for speed and path length (ICC = 0.20-0.69). The MDD varied between 14% and 38%. Performance on the four tablet-based tests was stable between sessions, indicating that there was no learning effect. CONCLUSION The parameter accuracy showed excellent discriminative validity and reliability in all four tablet-based tests. Discriminative validity was excellent for all three parameters in the Tapping test. In the other tasks speed showed good to poor reliability, while the reliability of path-length was poor in all tasks. Results were comparable for the dominant and non-dominant hand. Tablet-based tests have the advantage that patients can use them for self-monitoring of upper limb motor function. Implications for rehabilitation Four tablet-based tests for the assessment of upper limb motor function in patients with upper limb neurological dysfunction were evaluated: "Spiral drawings", "Tapping", "Follow the dot" and "Trace a star". The parameter accuracy in these four tests had excellent discriminative validity and good reliability. Patients can perform the tests independently at home for self-monitoring of progress. This may increase patients' motivation to exercise at home. The results can be sent to physicians, enabling the earlier detection of deterioration, which may require medical attention.
BACKGROUND Multiple sclerosis (MS) is one of the world’s most common neurologic disorders of the ... more BACKGROUND Multiple sclerosis (MS) is one of the world’s most common neurologic disorders of the young adults leading to severe disability. MS Fatigue impacts directly on the quality of life and activity levels of people with MS. Self-management strategies are used to support them in the care of their health. Mobile health (mHealth) solutions can offer tools to help symptom management. Following a user-centered design and evidence-based process, a mHealth solution called More Stamina was created to help persons with MS manage their fatigue OBJECTIVE The overall study aims are to explore the feasibility, acceptability, and usability of More Stamina, a mobile app for fatigue self-management for persons with MS. METHODS A mixed methods multicenter study will be used to assess the feasibility, acceptability, and usability of More Stamina. The study will take place during the first and second quarters of 2020 (Q1-Q2 2020) in three locations: Argentina, Spain and Switzerland. A longitudin...
Objective: Fatigue experienced by people with multiple sclerosis (pwMS) is multidimensional, cons... more Objective: Fatigue experienced by people with multiple sclerosis (pwMS) is multidimensional, consisting of different components, such as perceived, physical and cognitive fatigue and performance fatigability. At present, there is no gold standard to assess performance fatigability in pwMS; therefore, we aimed to determine whether, during a fatiguing task, average rectified value (ARV), mean frequency of the power spectrum (MNF), muscle fiber conduction velocity (CV) and fractal dimension (FD) of surface electromyography (sEMG) may be used as indirect indices of performance fatigability. Moreover, we analyzed whether a three-week rehabilitation program impacts on performance fatigability in pwMS, and whether a relationship between sEMG parameters and trait levels of perceived fatigability, before and after rehabilitation, does exist. Approach: Twenty-one pwMS performed a 20% maximal voluntary contraction (MVC) of 1 min, and afterwards a 60% MVC held until exhaustion. sEMG signals wer...
COPD: Journal of Chronic Obstructive Pulmonary Disease
Abstract Exercise can improve walking capacity in persons with chronic obstructive pulmonary dise... more Abstract Exercise can improve walking capacity in persons with chronic obstructive pulmonary disease (COPD). However, most endurance training programs use cycle ergometers. The objectives of this study were: (i) to evaluate the feasibility of a randomized controlled trial (RCT) comparing outdoor walking training (OWT) to cycle ergometer training (CT) during inpatient rehabilitation in persons with severe COPD; (ii) to estimate the effect of OWT and CT on health-related quality of life, physical capacity and physical activity; and (iii) to estimate the required sample size for a RCT. A single-blind randomized controlled feasibility trial was conducted with three months' follow-up in the rehabilitation center in Walenstadtberg, Switzerland. Sixteen patients were included in the study, which had a recruitment rate of 33% (16/48). Patients were allocated to an OWT (n = 8) or CT (n = 8) group. Participants completed 75% of scheduled training and the follow-up rate was 75%. All participants in the OWT group were satisfied with the training. The OWT group had better health-related quality of life after three weeks' training compared to the CT group (p = 0.042, 95% confidence interval (95% CI) 1.06–49.94, effect size (d)=1.19). No exacerbations occurred in the OWT group, but three occurred in the CT group after three months’ follow-up. There was no significant difference in the other outcomes. In conclusion, the study design and the OWT are feasible. Health-related quality of life improved in the OWT group compared to the CT group after three weeks' inpatient rehabilitation. A minimum of 46 participants is needed for a RCT. Trial registration: www.who.int/trialsearch DRKS00010977
Purpose: Determine the association of different social factors with Functional Capacity Evaluatio... more Purpose: Determine the association of different social factors with Functional Capacity Evaluation (FCE) performance in adults. Materials and methods: A systematic literature search was performed in MEDLINE, CINAHL, and PsycINFO electronic databases. Studies were eligible if they studied social factor's association with the performance of adults undergoing FCE. Studies were assessed on methodological quality and quality of evidence. The review was performed using best-evidence synthesis methods. Results: Thirteen studies were eligible and 11 social factors were studied. Considerable heterogeneity regarding measurements, populations, and methods existed among the studies. High quality of evidence was found for the association of FCE performance with the country of FCE and examiner's fear behavior; moderate quality of evidence with previous job salary; and low or very low quality of evidence with compensation status, litigation status, type of instruction, time of day (workday), primary or mother language, and ethnicity. Other social factors were not studied. Conclusions: Evidence for associations of various social factors with FCE performance was found, but robust conclusions about the strength of the associations cannot be made. Quality of evidence ranged from high to very low. Further research on social factors, also within a biopsychosocial context, is necessary to provide a better understanding of FCE performance. ä IMPLICATIONS FOR REHABILITATION Research on Functional Capacity Evaluation (FCE) performance and its association with biopsychosocial factors have scarcely addressed the impact of social factors, limiting full understanding of FCE results. The social factors, healthcare (examiner's fear behavior and type of instruction), personal or cultural systems (country of FCE, primary or mother language, and ethnicity), workplace system (previous job salary, time of day (workday)), and legislative and insurance system (compensation and litigation status), have a bearing in FCE performance. Better understanding of factors associating with functional capacity provide insights in FCE, allowing clinicians to improve the evaluations and interpretations of the assessment and better design the rehabilitation program. Better understanding of factors that influence FCE performance, and of unstudied factors, will allow researchers guidance to further investigate the construct of functional capacity.
Disturbances in Tryptophan metabolism play a crucial role in multiple sclerosis (MS). Exercise is... more Disturbances in Tryptophan metabolism play a crucial role in multiple sclerosis (MS). Exercise is suspected to counteract the progress of MS and its side effects. Current research suggests alterations of Tryptophan metabolism in healthy individuals in response to exercise. We investigated the influence of acute aerobic exercise and training on Tryptophan metabolism in 57 inpatients with relapsing remitting ((RRMS) n=33) and secondary progressive ((SPMS) n=24) MS. Serotonin increased after training, whereas the kynurenine pathway was only activated in persons with RRMS. Further research is warranted to investigate whether these changes are associated with clinical measures (e.g. depressions and immune function).
Mit Schmerzprovokationstests am Iliosakralgelenk können Physiotherapeuten klinisch untersuchen, o... more Mit Schmerzprovokationstests am Iliosakralgelenk können Physiotherapeuten klinisch untersuchen, ob das Gelenk für Beschwerden an Rücken und Gesäß verantwortlich ist. Um auszuschließen, dass nicht doch eine benachbarte Struktur die Symptome auslöst, sollten Therapeuten drei bis sechs Tests in Kombination verwenden.
Background: Aerobic exercise can improve cognitive performance in healthy elderly people. Objecti... more Background: Aerobic exercise can improve cognitive performance in healthy elderly people. Objective: The aim of this study was to investigate the influence of a 3-week high-intensity aerobic exercise programme (high-intensity training group (HIT)) on cognitive performance in persons with multiple sclerosis (MS) compared with a standard exercise programme (control training (CT)). Methods: A total of 60 persons with MS (Expanded Disability Status Scale (EDSS): 1.0–6.5) were randomized to a HIT group (3×/week for 20 minutes, including five 3-minute exercise intervals at 80% of peak oxygen uptake (VO2-peak)) or a CT group (continuously 5×/week for 30 minutes/session at 65% of VO2-peak). Cognitive performance was assessed using the Brief International Cognitive Assessment for MS at entry ( t0) and discharge ( t1). Furthermore, VO2-peak, brain-derived neurotrophic factor, serotonin and matrix metalloproteinases (MMP)-2 and -9 were measured. Results: Compared to CT, HIT significantly impro...
Improving mobility in elderly persons is a primary goal in geriatric rehabilitation. Self-regulat... more Improving mobility in elderly persons is a primary goal in geriatric rehabilitation. Self-regulated exercises with instruction leaflets are used to increase training volume but adherence is often low. Exergames may improve adherence. This study therefore compared exergames with self-regulated exercise using instruction leaflets. The primary outcome was adherence. Secondary outcomes were enjoyment, motivation and balance during walking. Design: single center parallel group non-blinded randomized controlled trial with central stratified randomization. center for geriatric inpatient rehabilitation. Included were patients over 65 with mobility restrictions who were able to perform self-regulated exercise. Patients were assigned to self-regulated exercise using a) exergames on Windows Kinect® (exergame group EG) or b) instruction leaflets (conventional group CG). During two 30 min sessions physical therapists instructed self-regulated exercise to be conducted twice daily during thirty mi...
Journal of back and musculoskeletal rehabilitation, Jan 23, 2016
Lateral gliding cervical spine mobilisation is shown to improve shoulder pain, disability and fun... more Lateral gliding cervical spine mobilisation is shown to improve shoulder pain, disability and function. However, despite common clinical-use, no study reports the effect of unilateral anterior-posterior (A-P) cervical mobilisation on shoulder pain and function, and particularly in patients after arthroscopic shoulder surgery. Examine the immediate effect of single-level Grade III cervical unilateral A-P mobilisation on shoulder pain, flexion and abduction range of motion (ROM) and external rotator strength compared to placebo cervical unilateral A-P light touch pressure. Single session intervention with a crossover design in 32 (15 women) postoperative arthroscopic shoulder patients. Immediate and superior treatment effects were shown for A-P cervical mobilisation in improving flexion ROM, isometric strength of external rotation, and pain intensity during flexion (all p< 0.05) when compared to the placebo. However, effects may not be considered clinically meaningful. Unilateral A...
Weare pleased to have the opportunity to respond to the letter to the editor from Prof. Dr. S. Sa... more Weare pleased to have the opportunity to respond to the letter to the editor from Prof. Dr. S. Sabour regarding our recent publication (Bauer et al., 2016). We will attempt to address the issues raised in this letter. Our study assessed the reliability of interval-scaled outcome measures of eleven different movement dysfunction tests (Bauer et al., 2016). As stated by Prof. S. Sabour, the reproducibility of such outcome measures is generally quantified by intraclass correlation (ICC) coefficients. However, these coefficients are based on statistical models incorporating only two sources of error (for example rater or occasion, and residual error). We used the generalizability theory (G-theory) and subsequent D-studies to estimate reliability (F-coefficients). The advantage of this method is the possibility to incorporate multiple sources of error and their interaction (Streiner and Geoffrey, 2008). Besides residual error, we investigated two additional sources of error: trial (repeated measures on the same day) and day (repeated measures on two different days). Thus, using ICC to assess reproducibility was not appropriate for our study design. Furthermore, ICC's are just special cases of F-Coefficients when G-theory is applied to a study designwhich incorporates only one source of error besides residual error (Brennan, 2001). Themain concern stated by Prof. Dr. S. Sabour was that we investigated the reliability of averagemeasures instead of singlemeasurements and thus drew a misleading conclusion. We may not have been concise about our methodology. F-coefficients, as calculated by the formula in chapter 2.4 and listed in Table 2, express the reliability of a single measurement without averaging the results of repeated measures (number of repetitions nt 1⁄4 1 and number of days nd 1⁄4 1). Our statement “On average, ROM tests were more reliable compared to MCI and RE test” did not refer to the reliability of average measures, but the averaged reliability of single measures. Based on the preceding arguments, we are still certain about the appropriate use of statistical methods for our study design and the validity of our conclusion. Further, we fully agree with Prof. Dr. S. Sabour that appropriate tests should be usedwith careful interpretation to avoidmisleading messages due to inappropriate use of statistical tests.
The aim of this study was to determine and verify the optimal location of the motion axis (MA) fo... more The aim of this study was to determine and verify the optimal location of the motion axis (MA) for the seat of a dynamic office chair. A dynamic seat that supports pelvic motion may improve physical well-being and decrease the risk of sitting-associated disorders. However, office work requires an undisturbed view on the work task, which means a stable position of the upper trunk and head. Current dynamic office chairs do not fulfill this need. Consequently, a dynamic seat was adapted to the physiological kinematics of the human spine. Three-dimensional motion tracking in free sitting helped determine the physiological MA of the spine in the frontal plane. Three dynamic seats with physiological, lower, and higher MA were compared in stable upper body posture (thorax inclination) and seat support of pelvic motion (dynamic fitting accuracy). Spinal kinematics during sitting and walking were compared. The physiological MA was at the level of the 11th thoracic vertebra, causing minimal t...
Background: To determine whether there is a difference between patients with low back pain and he... more Background: To determine whether there is a difference between patients with low back pain and healthy controls in a test battery score for movement control of the lumbar spine. Methods: This was a case control study, carried out in five outpatient physiotherapy practices in the German-speaking part of Switzerland. Twelve physiotherapists tested the ability of 210 subjects (108 patients with non-specific low back pain and 102 control subjects without back pain) to control their movements in the lumbar spine using a set of six tests. We observed the number of positive tests out of six (mean, standard deviation and 95% confidence interval of the mean). The significance of the differences between the groups was calculated with Mann-Whitney U test and p was set on <0.05. The effect size (d) between the groups was calculated and d>0.8 was considered a large difference. Results: On average, patients with low back pain had 2.21(95%CI 1.94-2.48) positive tests and the healthy controls 0.75 (95%CI 0.55-0.95). The effect size was d = 1.18 (p < 0.001). There was a significant difference between acute and chronic (p < 0.01), as well as between subacute and chronic patient groups (p < 0.03), but not between acute and subacute patient groups (p > 0.7). Conclusion: This is the first study demonstrating a significant difference between patients with low back pain and subjects without back pain regarding their ability to actively control the movements of the low back. The effect size between patients with low back pain and healthy controls in movement control is large.
Method Ten office workers laterally flexed their spine in self-selected comfortable range during ... more Method Ten office workers laterally flexed their spine in self-selected comfortable range during a standardized reading task. Maximum spine-flexion and thorax-inclination and-translation were measured with infrared cameras during dynamic sitting for five minutes. Muscular activity of back muscles (left and right longissimus (L-/R-LONG), left iliocostalis (L-ILIO), right multifidus (R-MULT)) and thigh muscles (right vastus medialis (R-VASTM) and lateralis (R-VASTL)) were recorded by surface EMG while dynamic and static sitting and expressed as % of maximum EMG activity during gait.
Motion capture of the trunk using three-dimensional optoelectronic systems and skin markers place... more Motion capture of the trunk using three-dimensional optoelectronic systems and skin markers placed on anatomical landmarks is prone to error due to marker placement, thus decreasing between-day reliability. The influence of these errors on angular output might be reduced by using an overdetermined number of markers and optimization algorithms, or by defining the neutral position using a reference trial. The purpose of this study was to quantify and compare the between-day reliability of trunk kinematics, when using these methods. In each of two sessions, 20 subjects performed four movement tasks. Trunk kinematics were established through the plug-in-gait protocol, the point cloud optimization algorithm, and by defining upright standing as neutral position. Between-day reliability was analyzed using generalizability theory and quantified by indexes of dependability. Across all movement tasks, none of the methods was superior in terms of between-day reliability. The point cloud algorithm did not improve between-day reliability, but did result in 24.3% greater axial rotation angles. The definition of neutral position by means of a reference trial revealed 5.8% higher indexes of dependability for lateral bending and axial rotation angles, but 13.7% smaller indexes of dependability for flexion angles. Further, using a reference trial resulted in 8.3° greater trunk flexion angles. Therefore, the selection of appropriate marker placement and the corresponding calculation of angular output are dependent on the movement task and the underlying research question.
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