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Background: Aberrant movement in chronic low back pain (CLBP) is associated with a deficit in the lumbar multifidus (LM) and changes in cortical topography. Anodal transcranial direct current stimulation (a‐tDCS) can be used to enhance cortical excitability by priming the neuromuscular system for motor control exercise (MCE), thereby enhancing LM activation and movement control. This study aimed to determine the effects of a 6‐week MCE program combined with a‐tDCS on cortical topography, LM activation, movement patterns, and clinical outcomes in individuals with CLBP. Methods: Twenty‐two individuals with CLBP were randomly allocated to the a‐tDCS group (a‐tDCS; n = 12) or sham‐tDCS group (s‐tDCS; n = 10). Both groups received 20 min of tDCS followed by 30 min of MCE. The LM and erector spinae (ES) cortical topography, LM activation, movement control battery tests, and clinical outcomes (disability and quality of life) were measured pre‐ and post‐intervention. Results: Significant interaction (group × time; p < 0.01) was found in the distance between LM and ES cortical locations. The a‐tDCS group demonstrated significantly fewer discrete peaks (p < 0.05) in both ES and LM and significant improvements (p < 0.05) in clinical outcomes post‐intervention. The s‐tDCS group demonstrated a significant increase (p < 0.05) in the number of discrete peaks in the LM cortical topography. No significant changes (p > 0.05) in LM activation were observed in either group; however, both groups demonstrated improved movement patterns. Discussion: Our findings suggest that combined a‐tDCS with MCE can separate LM and ES locations over time while s‐tDCS (MCE alone) reduces the distance. Our study did not find superior benefits of adding a‐tDCS before MCE for LM activation, movement patterns, or clinical outcomes. [ABSTRACT FROM AUTHOR]

Purpose: To examine the effect of an additional 2‐week health professional‐led functional exercise programme compared to usual care for patients after hip fracture during a short‐term nursing home stay directly after hospital discharge. Method: One hundred and forty participants, 65 years or older with hip fracture, admitted to a short‐term nursing home stay were randomised to an intervention group or control group. Participants in the intervention group (n = 78) received the experimental programme consisted of functional exercises, performed by health care professionals up to four times a day, 7 days a week, in addition to usual care during a 2‐week short‐term nursing home stay. Participants in the control group (n = 62) received usual care alone. Primary outcome was Short Physical Performance Battery (SPPB). Secondary outcomes were Timed Up & Go, New Mobility Score, The University of California, Los Angeles Activity Scale, Fall Efficacy Scale International, The EuroQol five dimension five‐level questionnaire, and Numeric Rating Scale for pain. Outcome measures were assessed after 2 weeks in a short‐term nursing home stay and 3 months after hip fracture surgery. The activity monitor ActivPal registered activity during the 2‐week short‐term nursing home stay. Results: No statistically significant differences between groups was found in any outcomes after 2 weeks or 3 months (p > 0.05). There were statistically significant within‐group improvements in primary outcome SPPB and in most secondary outcomes at all time points in both groups (p > 0.05). Conclusions: A 2‐week health professional‐led functional exercise programme in addition to usual care demonstrated no difference in clinical outcomes compared to usual care alone up to 3 months after hip fracture. The patients with hip fracture are fragile and vulnerable in this early phase, and usual physiotherapy may be sufficient to improve their physical function. Trial registration: ClinicalTrials.gov NCT02780076. [ABSTRACT FROM AUTHOR]

Objective: To evaluate potential prognostic factors of self‐reported lumbopelvic pain 6 months postpartum for pregnant women with and without lumbopelvic pain. Methods: Questionnaires were answered at gestational weeks 34–37 and again at 6 months postpartum. Psychosocial determinants and lumbopelvic pain symptoms were investigated using a visual analogue scale to assess pain intensity, and further using the Disability Rating Index, the Nottingham Health Profile, the Pain Catastrophizing Scale and the Fear‐Avoidance Beliefs Questionnaire. Logistic regression analysis was used to analyse the data. Results: Of the 260 women who answered the questionnaires on both occasions, 186 did not suffer from lumbopelvic pain 6 months after pregnancy. The remaining 74 did. The results of the logistic regression analysis showed that fear‐avoidance beliefs was a significant predictor of lumbopelvic pain 6 months postpartum, with an odds ratio of 1.060 (p ≤.05). Conclusion: Women with high fear‐avoidance beliefs at 34–37 weeks of gestation had a higher risk of having lumbopelvic pain at 6 months postpartum. We theorize that early lumbopelvic pain intervention postpartum may be important in avoiding chronicity. Women at risk can be identified through clinically relevant questions which may help the clinician to choose appropriate rehabilitation strategies. [ABSTRACT FROM AUTHOR]

Abstract: Aim: The aim of this study was to verify the effects of a multisensory exercise programme on the cognition and functionality of institutionalized older adults. Methods: Forty‐five volunteers were randomly allocated to 2 groups, the multisensory exercise programme (n = 24) and the control group that received no treatment (n = 21). The programme consisted of 3 50‐min sessions of progressive exercises per week for 16 weeks that challenged their strength, balance, coordination, multisensory stimulation, and flexibility in different tasks. Cognition (Montreal Cognitive Assessment), balance (Berg Scale), mobility (Timed Up and Go), and functional performance (Physical Performance Test) were measured preintervention and postintervention. Statistical analyses were performed using Student's t test and 2‐way ANOVA. Results: The multisensory exercise programme showed statistically significant improvements (p < .05) on cognition (effect size [ES]: 0.92), balance (ES: 0.77), mobility (ES: 0.51), and functional performance (ES: 0.86) as compared with the control group, which showed no statistical significant differences at the postintervention time point. Conclusions: The multisensory exercise programme improved the cognition and functionality of institutionalized older adults. The introduction of a motor and multisensory‐based approach in care routines may improve residents' health and engagement to the environment. [ABSTRACT FROM AUTHOR]

Background Immediate breast reconstruction has been increasingly incorporated as part of breast cancer treatment, especially for the psychological benefits. Currently, there are many options for breast reconstruction surgery, but the impact of the different techniques on body posture has not been widely studied. One study demonstrated that immediate breast reconstruction with a Beker-25 prosthesis could help to preserve body posture after mastectomy; however, there is no evidence regarding the effect of surgery on the body posture of women after breast reconstruction when using autologous tissue. Purpose The purpose of this paper is to compare the body postures of women who underwent immediate breast reconstruction using an abdominal flap with those of women who underwent mastectomy alone. Design This is a cross-sectional study. Subjects Seventy-six women diagnosed with breast cancer underwent mastectomy, between 1 and 5 years after the diagnosis, are the participants of the study. Two groups were defined: women who underwent mastectomy and immediate breast reconstruction ( n = 38) and women who underwent mastectomy alone ( n = 38). Procedure To assess body posture, specific anatomical points for obtaining photographs were located and marked in anterior, posterior and right-side and left-side views. The photographs were analysed using Postural Analysis Software/Software de Análise Postural (PAS/SAPO). Results In the left lateral view, there was a significant difference in the vertical alignment of the trunk (4.2 vs 3.1; p = 0.05). There were no significant differences between the two groups for the variables in the anterior, posterior or right-side views. Conclusion Women who underwent mastectomy alone, compared with women who underwent immediate breast reconstruction with abdominal flaps, showed differences in the vertical alignment of the trunk, with greater asymmetry between the acromion and greater trochanter, which can mean trunk rotation. No significant differences were found between the two groups in the alignment of the head, shoulders, scapula, or pelvis. Copyright © 2015 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Background and purpose The most effective treatment approach to improve walking in people with multiple sclerosis (MS) is not known. The aim of this trial was to assess the efficacy of treadmill training and progressive strength training on walking in people with MS. Methods A single blinded randomized parallel group trial was carried out. Eligible participants were adults with MS with Expanded Disability Status Scale score ≤6. A total of 29 participants were randomized and 28 received the allocated exercise intervention, treadmill ( n = 13) or strength training ( n = 15). Both groups exercised 30 minutes, three times a week for 8 weeks. Primary outcome was The Functional Ambulation Profile evaluated by the GAITRite walkway. Secondary outcomes were walking work economy and balance control during walking, measured by a small lightweight accelerometer connected to the lower back. Testing was performed at baseline and the subsequent week after completion of training. Results Two participants were lost to follow-up, and 11 (treadmill) and 15 (strength training) were left for analysis. The treadmill group increased their Functional Ambulation Profile score significantly compared with the strength training group ( p = .037). A significant improvement in walking work economy ( p = .024) and a reduction of root mean square of vertical acceleration ( p = .047) also favoured the treadmill group. Discussion The results indicate that task-specific training by treadmill walking is a favourable approach compared with strength training to improve walking in persons with mild and moderate MS. Implications for Physiotherapy practice, this study adds knowledge for the decision of optimal treatment approaches in people with MS. Copyright © 2015 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Background Patellofemoral pain syndrome is an extremely common condition, believed to be caused by altered activation of vastus medialis obliquus (VMO), leading to maltracking of the patella. Aim This study aimed to investigate the effect of altering knee movement and squat depth on the ratio of VMO and vastus lateralis (VMO : VL) during squat exercises. Method Eighteen (7 male and 11 female) healthy, asymptomatic participants performed semi-squat exercises with three squat depths (20°, 50° and 80° of knee flexion) while following three knee movement paths (neutral, varus or valgus). Normalized VMO : VL ratio from linear envelope surface electromyography was analysed. Results No significant effect was found for gender ( p = 0.87), leg dominance ( p = 0.99) or knee position ( p = 0.44). A significant effect was found for squat depth ( p < 0.001) with both the 50° and 80° squats showing increases in VMO : VL ratio ( p = 0.031 and p = 0.028), respectively. The VMO : VL ratio was not influenced by gender, leg dominance or knee position in semi-squat exercises. Discussion and Conclusion Increases in relative VMO activation did occur in 'deeper' squat depths (50° and 80° knee flexion) compared with the 20° condition. Further research is needed in this area concerning the effects of such exercise modifications on a symptomatic patellofemoral pain syndrome population. Copyright © 2015 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Background and Purpose This study sought to answer the following questions: What are the outcomes of physiotherapy post lumbar total disc replacement (LTDR) compared with patient self-mediated rehabilitation? Is a difference in outcomes related to the number of physiotherapy sessions? Methods This is a retrospective observational study of 600 patients post TDR. Patient outcomes for self-mediated rehabilitation (Group 1), 1-3 sessions of clinic-based physiotherapy (Group 2) and ≥4 sessions of clinic-based physiotherapy (Group 3) were analysed. Outcomes measures included the Oswestry Disability Index (ODI), Roland Morris Disability Questionnaire (RMQ), Short Form-36 Physical (SF-36 PCS) and Mental Subscale Components (SF-36 MCS), Visual Analogue Scale (VAS) for back and leg pain intensity. Patient's pre-operative baseline measures and post-operative follow-up measures at 3, 6, 12 and 24 months post-operatively were analysed. Results Oswestry Disability Index and RMQ had significantly lower scores in Group 3 compared with Group 1 at 3, 6, 12 and 24 months follow-up. Significantly lower scores for Group 2 compared with Group 1 were observed for the ODI at 3 months follow-up and for the RMQ at 3 and 6 months follow-up. Significantly lower scores were observed in Group 3 compared with Group 1 for VAS back pain at 3 months and VAS leg pain at 6 months follow-up. Significantly higher scores in Group 3 compared with Group 1 were also observed in the SF-36 PCS at 6, 12 and 24 months. Significantly higher scores in Group 2 compared with Group 1 were observed at 6 months follow up. These trends were also observed when investigating the percentage of patients with a greater 50% improvement in the outcome measure. Conclusions Physiotherapy post-LTDR produces statistically significant and possibly clinically important improvements in functional disability, pain and quality of life outcomes compared with self-mediated rehabilitation. Copyright © 2015 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Background and purpose The objective of this study is to compare the balance and gait of 11 people with multiple sclerosis (MS) to 11 healthy controls and to investigate the immediate change after a single intervention based on the Bobath concept on these activities in the MS group. Methods Balance was assessed by ground reaction forces (GRF) and centre of pressure movements during single limb standing (SLS), the Lateral Reach Test (LRT) and the Four Square Step Test (FSST). Gait was evaluated by GRF, ankle kinematics and spatiotemporal measures. Results Baseline measures in the MS group showed significantly greater vertical GRF variability ( p = 0.008) during SLS reached less distance on the LRT ( p = 0.001) and were slower completing the FSST ( p < 0.001). During gait, the MS group walked slower ( p = 0.005) and had less ankle plantarflexion (PF) ( p = 0.001) than the control group. Less peak vertical GRF ( p < 0.001) and peak propulsive GRF ( p = 0.004) at terminal stance and increased vertical GRF in midstance ( p = 0.005) were observed. The measures of balance and gait were re-assessed in the MS group immediately after a 20-min intervention based on the Bobath concept delivered to the most impaired foot and ankle. After the intervention, the MS group had significant changes towards the control group values with reduced mediolateral ( p = 0.002) and vertical ( p = 0.016) GRF variability in the SLS task, faster FSST time ( p = 0.006) and increased ankle PF during gait ( p = 0.002). Discussion This study provides further evidence of balance and gait limitations in people with MS and indicates that a single treatment based on principles of the Bobath concept to the foot and ankle can result in immediate improvements in balance and ankle PF during gait in people with MS. Copyright © 2015 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Background and purpose Obese adults are at an increased risk for mobility-related problems. National guidelines recommend calorie restrictions and exercise for obese adults as a means to improve functional fitness capacity and to increase mobility. Yet, lifestyle weight loss interventions often fail to measure fitness changes. The aim of this study was to assess whether a 1-month, intensive behavioural change, diet and fitness intervention for overweight and obese adults would result in statistically significant and clinically meaningful changes in functional exercise. Methods A pre-post test design was used in this study. Seventy-two participants (40 women, 32 men; mean baseline body mass index (BMI) = 42.6 + 9.0; mean age = 45.8 + 16.8) completed a modified 6-minute walk test (6MWT), performed on a treadmill, at baseline and at end of treatment. Results Significant improvements included decreased BMI (2.7 + 1.7 kg m−2, p < 0.001) and increased 6MWT distance (66.4 + 73.0 m, p < 0.001). The 6MWT improved by 66 m on average, a reported clinically meaningful difference. Greater improvements in the 6MWT were significantly correlated with greater weight loss and BMI reduction. Discussion Our findings suggest that rehabilitation beyond weight loss may be derived from participation in a brief, intensive behavioural change, diet and fitness programme. Physiotherapists are in a prime position to address the physical and motivational challenges participants face while living with severe obesity: targeting functional exercise capacity is one key strategy for addressing immobility associated with obesity. Copyright © 2015 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Purpose The aim of this study is to evaluate the effectiveness of a rehabilitation programme based on the Bobath concept in order to improve walking activity in patients with chronic stroke and to show the usefulness of the International Classification of Functioning, Disability and Health (ICF) as a tool for gathering functioning information. Methods This study is a repeated measures study. The setting of this study is an outpatient neurological rehabilitation centre based on a multidisciplinary approach. Twenty-four participants suffering from chronic stroke (>1 year and a half and <5 years post-stroke) and mean age of 65.58 (standard deviation 10.73) were the participants of the study. Multidisciplinary approach based on the Bobath concept principles with three weekly individual physiotherapy sessions of 45 min each over a 6-month period was the intervention for this study. The measures used were Modified Emory Functional Ambulation Profile, 10-m walk test, 6-min walk test, muscle strength testing and subsequent codification of these results into ICF qualifiers. Results The results of the study showed significant improvement in activities of walking long distances, on different surfaces and around obstacles. There was no significant improvement in the activity of walking short distances or for muscle power functions. Conclusion A rehabilitation programme based on the Bobath Concept improved walking activities in people with chronic stroke. For this intervention, the use of the ICF qualifiers was sensitive in perceiving post-treatment changes. Copyright © 2014 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Background and Purpose Playing an instrument implies neuroplasticity in different cerebral regions. This phenomenon has been described in subjects with stroke, suggesting that it could play a role in hand rehabilitation. The aim of this study is to analyse the effectiveness of playing a musical keyboard in improving hand function in subjects with multiple sclerosis. Methods Nineteen hospitalized subjects were randomized in two groups: nine played a turned-on musical keyboard by sequences of fingers movements (audio feedback present) and 10 performed the same exercises on a turned-off musical keyboard (audio feedback absent). Training duration was half an hour per day for 15 days. Primary outcome was the perceived hand functional use measured by ABILHAND Questionnaire. Secondary outcomes were hand dexterity, measured by Nine-Hole Peg Test, and hand strength, measured by Jamar and Pinch dynamometers. Two-way analysis of variance was used for data analysis. Results The interaction time × group was significant ( p = 0.003) for ABILHAND Questionnaire in favour of experimental group (mean between-group difference 0.99 logit [IC95%: 0.44; 1.54]). The two groups showed a significant time effect for all outcomes except for Jamar measure. Discussion Playing a musical keyboard seems a valid method to train the functional use of hands in subjects with multiple sclerosis. Copyright © 2014 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Study Design The study design is a case control study. Objectives The objective of this study is to evaluate how chronic low back pain (CLBP) affects the performance of Star Excursion Balance Test (SEBT). Background Chronic low back pain is associated with paraspinal and other trunk muscle weakness and reduction in coordination of low back muscles. This reduction in muscular strength and coordination contributes to decreased postural stability, balance and neuromuscular control in subjects with CLBP. SEBT is a simple, reliable and valid method of dynamic performance and is an alternative to more sophisticated instrumented methods. However, no study has evaluated the effect of SEBT on CLBP patients. Methods and Measures Ten patients with CLBP (localized back pain, lasting more than 6 months and radiating no further than the buttock with normal neurological examination) and 10 normal age and sex matched subjects (mean age 34.30 + 8.67(range 22-50) participated in this study. All participants completed the SEBT on their dominant leg, and distance measures were collected and compared between groups. Results The dependant variable was analysed using independent t-test with p < 0.05. The CLBP group demonstrated significant reductions in excursion distances for all directions of the SEBT compared with the control group, except for the posterior (P) direction (0.281) Conclusion Star Excursion Balance Test is an effective and simple tool to identify and measure reach deficits in patients with CLBP. We recommend using SEBT as an outcome measure to identify dynamic balance, multi-planar excursion and postural control in patients with CLBP. Copyright © 2014 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Background and Purpose The aim of the present study was to evaluate the immediate effects of therapeutic mobilization of the talocrural and subtalar joints on ankle mobility and postural control in elderly subjects. Methods Nineteen subjects (83.1 ± 6 years, 159 ± 1 cm; 56.1 ± 9.7 kg − mean ± standard deviation) participated in this study. The centre of pressure (COP) displacements along the anterior-posterior and medial-lateral axes was recorded in static and dynamic conditions on a force platform before and after therapeutic mobilization of the feet and ankles without blinding the subjects. Results In static conditions, the sway area is reduced contrarily to dynamic conditions where the sway area is increased. In the two experimental sessions, subjects showed comparable COP displacements and the total length of the oscillations. Results demonstrated a significant improvement immediately after mobilization for ankle range of motion in dorsal flexion (right +4.7°; left +3.2°) and plantar flexion (right 5.2°; left +4.2°). Conclusion These results suggested that postural control is improved in static conditions and decreased in dynamic conditions. Therapeutic mobilization of feet and ankles in the elderly provides an immediate improvement in joint range of movement in dorsal and plantar flexion. Copyright © 2014 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Objectives The aim of this research was to compare the difference in disability caused by back pain using scores from the Oswestry Disability Questionnaire (ODQ) and the Quebec Back Pain Disability Scale (QUE) according to gender, acute and chronic low back pain (LBP) groups, specific and nonspecific LBP groups and to identify the factors influencing the degree of LBP disability. Methods One hundred and thirty-three patients with LBP participated in this study. The Visual Analogue Scale (VAS) of ODQ and QUE were used to compare the differences between men and women, acute and chronic and specific and nonspecific LBP groups. We identified the factors influencing the disability of LBP using a stepwise multiple regression. Results In comparison with the nonspecific LBP group, the VAS, ODQ and QUE scores were significantly higher and the pain duration was significantly longer in the specific LBP group ( P < 0.05). A multiple regression equation with VAS and LBP classification explained the 45.4% variance in ODQ and an equation with VAS, LBP classification, pain duration and gender explained 31.1% of the variance in QUE. Conclusions The degree of disability from back pain assessed using the ODQ score was influenced by a pain severity and LBP type. Also, QUE score was influenced by a pain severity, LBP type, pain duration and gender. To assess the disability caused by back pain accurately using the ODQ and QUE, various factors affecting the scores of the questionnaire must be considered. Copyright © 2014 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Background and Purpose. Patellofemoral pain (PFP) is associated with a wide range of local and global physical factors possibly contributing to pain and thus requires detailed assessment and individualized treatment. Yet, no cohort study was found that assessed the value of individualized physiotherapy, probably because this approach lends itself to clinical practice but not to scientific research. Most studies focus on a 'knee' or 'hip' treatment approach irrespective of individual global differences in lower limb alignment, movement patterns and muscle tightness. Therefore, this study aimed to determine the effectiveness of supplementing local treatment of PFP with individualized treatment targeting global contributing factors. Secondarily it aimed to subgroup the patients according to variations in lower limb alignment/laxity, movement patterns, biarticular muscle tightness and joint degeneration. Method. Forty-one patients (60 knees) with PFP who had followed a programme of local quadriceps strengthening, quadriceps stretching and taping for one fortnight were prescribed an individualized programme based on assessment. This global assessment included lower limb postural alignment, movement patterns, muscle tightness and range of motion. Another fortnights treatment was prescribed accordingly and included specific, individualized postural and movement retraining, stretching and functional weight-bearing, strengthening exercises. Seven outcome measures, namely four pain measures, isokinetic quadriceps strength, quadriceps length and eccentric knee control, assessed improvement. Results. All outcome measures showed further significant improvement following individualized treatment ( p < 0.03). Patients fell into four broad physical subgroups: hypermobility (often with malalignment), hypomobility (with three of four tight muscle groups), faulty movement patterns (mostly dynamic knee valgus) and patellofemoral osteoarthritis. Conclusions. Individualized treatment supplementing local standard physiotherapy for PFP leads to further significant improvement over 2 weeks. This study highlights the importance of assessing patients globally in order to optimize treatment and ongoing improvement. Recognition of different subgroups may guide treatment that should include both local and deficit-targeted global treatment. Copyright © 2014 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Background and Purpose People with multiple sclerosis (PwMS) commonly have mobility impairments that may lead to falls and limitations in activities. Physiotherapy interventions that might improve mobility typically take several weeks. Balance-based torso-weighting (BBTW), a system of strategically placing light weights to improve response to balance perturbations, has resulted in immediate small improvements in clinical measures in PwMS, but changes in spatiotemporal gait parameters are unknown. The purpose was to investigate the effects of BBTW on gait parameters in PwMS and healthy controls. Methods Design This study is a non-randomized controlled experiment. Participants This study included 20 PwMS and 20 matched healthy controls Procedures People with multiple sclerosis walked on an instrumented mat at their fastest speed for three trials each in two conditions: without BBTW then with BBTW. Healthy controls walked in both conditions at two speeds: their fastest speed and at velocities equivalent to their matched PwMS. Results Averaged gait trials showed that, with BBTW, PwMS had significantly increased velocity ( p = 0.002), cadence ( p = 0.007) and time spent in single-limb support ( p = 0.014), with decreased time in double-limb support ( p = 0.004). Healthy controls increased velocity ( p = 0.012) and cadence ( p = 0.015) and decreased support base ( p = 0.014) in fast trials with BBTW; at matched velocities, step length ( p = 0.028) and support base ( p = 0.006) were significantly different from PwMS. All gait variables in healthy controls at fast speeds were significantly different from PwMS walking at their fastest speeds. Discussion All participants showed increases in gait velocity and cadence during fast walk with BBTW. Improvements in time spent in single-limb and double-limb support by PwMS with BBTW may reflect greater stability in gait. Future research might ascertain if these immediate improvements could enhance effectiveness of longer-term physiotherapy on functional mobility in PwMS. Copyright © 2014 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Background and purpose Physiotherapists are expected to practice in an evidence-based way. Evidence-based practice (EBP) should be an integral part of the curriculum to ensure use of the five EBP steps: asking clinical questions, searching for and appraising research evidence, integrating the evidence into clinical practice and evaluating this process. The aim of this study was to compare self-reported EBP behaviour, abilities and barriers during clinical placements reported by five cohorts of final year physiotherapy students' with different EBP exposure across the 3-year bachelor programme. Methods A cross-sectional study was conducted among five cohorts (2006-2010) with third year physiotherapy students at a University College in Norway. In total, 246 students were eligible for this study. To collect data, we used a questionnaire with 42 items related to EBP behaviour, ability and barriers. Associations were investigated using the Spearman's rho ( r). Results In total, 180 out of 246 third year physiotherapy students, who had recently completed a clinical placement, filled out the questionnaire (73 %). The association between the level of EBP exposure and students' self-reported EBP behaviour, abilities and barriers was low for most items in the questionnaire. Statistically significant correlations were found for eight items, related to information need, question formulation, use of checklists, searching and perceived ability to search for and critically appraise research evidence. The strongest correlation was found between the level of EBP exposure and ability to critically appraise research evidence ( r = 0.41, p < 0.001). Conclusions An association between the level of EBP exposure and physiotherapy students' EBP behaviour was found for elements such as asking and searching, ability to search for and critically appraise research evidence, and experience of critical appraisal as a barrier. Further research need to explore strategies for EBP exposure throughout the curriculum, regarding content, timing, amount and type of training. Copyright © 2014 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Background and Purpose Healthy individuals have a top-down coordination pattern when turning while walking; they first rotate the head, then the shoulders, the pelvis and, finally, the feet. The aim of this study was to compare spatial and temporal characteristics of head and trunk rotation in sitting between people early after stroke and healthy participants, and investigate change over time. Methods This was a pilot, quantitative, longitudinal study. We recruited participants from stroke wards and local groups. People with stroke were assessed at 3, 6 and 12 weeks after stroke. Healthy participants were examined with the same weekly intervals. Participants were in a seated position and were asked verbally to rotate their head and look at a visual signal placed at 90° to the left and to the right of the subject. CODAmotion (Charnwood Dynamics Ltd, Rothley, UK) was used for 3-D motion recording and analysis. Results Healthy participants (two women and four men; mean age 66 years) showed significant rotation of the head before rotation of the shoulders at all three time points; people with stroke (one woman and five men; mean age 71 years) did not show this top-down pattern of movement. There was no significant difference between start times of head and shoulder rotation at 3 ( p = 0.167), 6 ( p = 0.084) and 12 weeks after stroke ( p = 0.062). Conclusions. The results of our pilot study warrant further investigation into the recovery and pattern of axial coordination after stroke. Future studies could provide insight into the mechanisms behind impaired postural control in people after stroke. Copyright © 2011 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Background. The impact of walking speed has not been evaluated as a feasible outcome measure associated with peak plantar pressure (PPP) distribution, which may result in tissue damage in persons with diabetic foot complications. The objective of this pilot study was to determine the walking speed and PPP distribution during barefoot walking in persons with diabetes. Methods. Nine individuals with diabetes and nine age-gender matched individuals without diabetes participated in this study. Each individual was marked at 10 anatomical landmarks for vibration and tactile pressure sensation tests to determine the severity of sensory deficits on the plantar surface of the dominant limb foot. A steady state walking speed, PPP, the fore and rear foot (F/R) PPP ratio and gait variables were measured during barefoot walking. Results. Persons with diabetes had a significantly slower walking speed than the age-gender matched group resulting in a significant reduction of PPP at the F/R foot during barefoot walking ( p < 0.05). There was no significant difference in F/R foot PPP ratio in the diabetic group compared with the age-gender matched group during barefoot walking ( p > 0.05). There was a significant difference between the diabetic and non-diabetic groups for cadence, step time, toe out angle and the anterior-posterior excursion (APE) for centre of force ( p < 0.05). Conclusion. Walking speed may be a potential indicator for persons with diabetes to identify PPP distribution during barefoot walking in a diabetic foot. However, the diabetic group demonstrated a more cautious walking pattern than the age-gender matched group by decreasing cadence, step length and APE, and increasing step time and toe in/out angle. People with diabetes may reduce the risk of foot ulcerations as long as they are able to prevent severe foot deformities such as callus, hammer toe or charcot foot. Copyright © 2011 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Background and Purpose. This study assessed the potential therapeutic benefit of using HandTutorTM in combination with traditional rehabilitation in a post-stroke sub-acute population. The study compares an experimental group receiving traditional therapy combined with HandTutorTM treatment, against a control group receiving only traditional therapy. Method. An assessor-blinded, randomized controlled pilot trial, was conducted in the Reuth rehabilitation unit in Israel. Thirty-one stroke patients in the sub-acute phase, were randomly assigned to one of the two groups (experimental or control) in sets of three. The experimental group ( n = 16) underwent a hand rehabilitation programme using the HandTutorTM combined with traditional therapy. The control group ( n = 15) received only traditional therapy. The treatment schedules for both groups were of similar duration and frequency. Improvements were evaluated using three indicators: 1) The Brunnström-Fugl-Meyer (FM) test, 2) the Box and Blocks (B&B) test and 3) improvement parameters as determined by the HandTutorTM software. Results. Following 15 consecutive treatment sessions, a significant improvement was observed within the experimental group (95% confidence intervals) compared with the control group: B&B p = 0.015; FM p = 0.041, HandTutorTM performance accuracy on x axis and performance accuracy on y axis p < 0.0003. Conclusion. The results from this pilot study support further investigation of the use of the HandTutorTM in combination with traditional occupational therapy and physiotherapy during post stroke hand function rehabilitation. Copyright © 2010 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Background and purpose Functional limitations in stroke survivors are sometimes associated with fatigue. This study assessed the functional limitations due to fatigue in community-dwelling stroke survivors undergoing physiotherapy. The differences in functional limitations due to fatigue were determined between sexes, stroke types, sides of affectation, age categories and levels of disability. Relationships between functional limitation due to fatigue and these variables were also determined. Methods This was a cross-sectional study involving 63 stroke survivors (35 male survivors and 28 female survivors) with ages ranging from 45 to 79 years (mean = 53.68 ± 10.95 years). Functional limitation due to fatigue was assessed with the modified fatigue impact scale (MFIS). Modified Rankin scale was used to categorize the disability of the participants. Data were analysed using descriptive (mean, standard deviation, percentage and frequency) and inferential (Mann-Whitney U-test and Spearman correlation analysis) statistics. Significance was set at 0.05 α level. Results/findings The mean MFIS score was 31.74 ± 12.39. Many participants (58.7%) had moderate functional limitations due to fatigue. The result of Mann-Whitney U-test showed significant difference in functional limitation due to fatigue between participants with slight disability and those with moderate disability ( p = 0.000), with participants with moderate disability having higher MFIS scores (more functional limitations). There was also a significant correlation between functional limitation due to fatigue and level of disability ( ρ = 0.625, p = 0.000). Discussion Functional limitation due to fatigue occurs frequently in stroke survivors and is related to level of disability. Functional limitations due to fatigue should be assessed frequently in all stroke survivors with varying degrees of disability and the outcome should be considered during rehabilitation and retraining of physical function. Copyright © 2014 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]