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Background Learning of procedural skills is an essential component in the education of future health professionals. There is little evidence on how procedural skills are best learnt and practiced in education. There is a need for educators to know what specific interventions could be used to increase learning of these skills. However, there is growing evidence from rehabilitation science, sport science and psychology that learning can be promoted with the application of motor learning principles. The aim of this review was to systematically evaluate the evidence for selected motor learning principles in physiotherapy and medical education. The selected principles were: whole or part practice, random or blocked practice, mental or no additional mental practice and terminal or concurrent feedback. Methods CINAHL, Cochrane Central, Embase, Eric and Medline were systematically searched for eligible studies using pre-defined keywords. Included studies were evaluated on their risk of bias with the Cochrane Collaboration’s risk of bias tool. Results The search resulted in 740 records, following screening for relevance 15 randomised controlled trials including 695 participants were included in this systematic review. Most procedural skills in this review related to surgical procedures. Mental practice significantly improved performance on a post-acquisition test (SMD: 0.43, 95 % CI 0.01 to 0.85). Terminal feedback significantly improved learning on a transfer test (SMD: 0.94, 95 % CI 0.18 to 1.70). There were indications that whole practice had some advantages over part practice and random practice was superior to blocked practice on post-acquisition tests. All studies were evaluated as having a high risk of bias. Next to a possible performance bias in all included studies the method of sequence generation was often poorly reported. Conclusions There is some evidence to recommend the use of mental practice for procedural learning in medical education. There is limited evidence to conclude that terminal feedback is more effective than concurrent feedback on a transfer test. For the remaining parameters that were reviewed there was insufficient evidence to make definitive recommendations. Electronic supplementary material The online version of this article (doi:10.1186/s12909-016-0538-z) contains supplementary material, which is available to authorized users.

In press, Background: Movement control abilities are often reduced in persons with neck pain. In physiotherapeutic practice observational tests are frequently used to assess the impaired abilities. Several tests for movement control abilities are available, but no evidence exists on how to combine and interpret them. Objective: The aim was to investigate structural validity of a set of movement control tests with Rasch analysis. Design: Cross-sectional study Methods: Thirty persons with and thirty without neck pain were recruited for this study. All persons performed ten movement control tests. A partial credit model was applied to investigate item fit, ordering of the item response functions, dimensionality and hierarchy of the tests. Results: The majority of persons with neck pain had moderate disabilities and the mean value in the Neck disability index was 10.7. Functioning of the movement control tests to measure the construct “movement control abilities” was adequate for the majority of tests. Three movement control test showed considerable misfit. Possible explanations were a reactive movement control instead of an active control and a more challenging test position. Test difficulties and person abilities could be estimated for the complete sample. The most difficult test was “sitting rocking forward” (1.13 logits) and the least difficult test was “lifting the right arm” (-1.30 logits). The highest person ability estimate was 3.61 logits indicating that movement control tests are missing to evaluate persons with moderate neck disabilities. Conclusion: Modifying the existing set of tests is required to evaluate the complete spectrum of persons with neck pain.

Die Versprechen der Industrie zu Ganzkorpervibrationsgeraten sind faszinierend. Einfach draufstellen oder - setzen und schon werden Muskeln stimuliert und geformt und der Kreislauf angeregt. Dass das nicht ganz so einfach funktioniert, wissen Slavko Rogan und Roger Hilfiker. Sie beschaftigen sich im Rahmen ihrer Forschungsarbeiten mit Canzkorpervibrationen und zeigen hier, wie mit dieser Muskelkraftigung funktionieren kann.

The present randomized controlled pilot study was conducted to determine the feasibility of the study protocol and the effects of four-week-long sessions involving stochastic resonance whole-body vibration (SR-WBV) training on chair rising in elderly individuals. Twenty elderly participants were divided into a SR-WBV group or a sham group. Peak force, rate of force development, rising time, time to stabilization and total time during chair rising performance were investigated. Intraclass correlation coefficients, Mann–Whitney U-tests and Wilcoxon signed-ranked tests were used. Low volume SR-WBV over 12 training sessions might provide a safe treatment method.

Introduction: Patients with end-stage emphysema because of α-1 antitrypsin (AAT) deficiency represent a challenging clinical management problem, and studies of volume reduction therapy to date have largely excluded these patients. We report the outcome of bronchoscopic volume reduction with the insertion of Emphasys endobronchial valves (Emphasys Medical, Redwood City, CA, USA) in six patients with end-stage emphysema because of AAT deficiency. Case Series: Of 51 patients with end stage emphysema referred for transplantation, we studied six patients with AAT deficiency and utilized the BODE index and lung allocation score for survival estimation. Measurements and Main Results: The forced expiratory volume in 1 s improved from a median of 0.575 L to 0.905 L (P = 0.028). There was a median reduction in total lung capacity (TLC) of 0.61 L. The residual volume /TLC fell from 74.0% to 58.4%. Before treatment, four patients had a BODE index of greater than eight units, which correlates with a 4-year survival of 18%. After treatment, two patients improved their BODE index to below seven units, which correlates with an estimated 4-year survival of over 50%. Conclusions: The data from this case series suggest that this intervention may provide bridging therapy to subsequent transplantation for younger AAT patients with end-stage emphysema. Please cite this paper as: Tuohy MM, Remund KF, Hilfiker R, Murphy DT, Murray JG and Egan JJ. Endobronchial valve deployment in severe α-1 antitrypsin deficiency emphysema: a case series. Clin Respir J 2013; 7: 45–52.

To determine the optimal stochastic whole body vibration (SR-WBV) load modality regarding pelvic floor muscle (PFM) activity in order to complete the SR-WBV training methodology for future PFM training with SR-WBV.

Introduction La faiblesse musculaire des membres inferieurs chez les personnes âgees est un facteur de risque de chute. Par consequent, l’evaluation de la force des muscles et sa preservation au cours du vieillissement est d’une grande importance clinique. Elle contribue potentiellement au maintien de l’independance. Nous avons cherche a savoir, pour un usage clinique, quel groupe musculaire de la hanche demontre un niveau de distinction acceptable entre les personnes âgees qui chutent et celles qui ne chutent pas, au regard de l’historique des chutes au cours des 12 mois ecoules (gold standard). Nous avons cherche ensuite a decouvrir les memes resultats pour la force de prehension en tant qu’indicateur au regard de ce gold standard. Methode Nous avons evalue l’exactitude du diagnostic de la force de tous les groupes musculaires de la hanche au moyen de l’aire sous la courbe (area under the curve) ainsi que de l’indice Random Forest Mean Decreased Gini Index. La force des muscles de la hanche (force isometrique volontaire maximale et la rapidite du developpement de la force) a ete mesuree pour les muscles abducteurs, adducteurs, rotateurs internes et externes, extenseurs et flechisseurs de la hanche avec un dynamometre fixe a un cadre specialement concu a cet effet chez 60 personnes âgees de plus de 65 ans. La force de prehension a ete mesuree avec un Vigorimetre Martin chez ces memes personnes. Resultats La force isometrique volontaire maximale des muscles abducteurs de la hanche presente la meilleure exactitude pour distinguer entre les personnes âgees susceptibles de tomber et celles qui ne tombent pas du fait de la force des muscles de la hanche ou (force isometrique volontaire maximale des muscles abducteurs : 0,825, intervalle de confiance 95 % de 0,712 a 0,938) de la force de prehension. Conclusions Les resultats indiquent que la force isometrique volontaire maximale des muscles abducteurs de la hanche est tres probablement une mesure utile pour evaluer et par consequent traiter efficacement le risque de chute des personnes qui avancent en âge. Une etude future sur un plus vaste echantillon devrait s’attacher a l’exactitude du diagnostic de la force isometrique volontaire maximale des muscles abducteurs de la hanche pour evaluer le risque de chute. Signification Si l’influence de la force musculaire de la hanche peut etre demontree dans une phase ulterieure, cela serait un parametre prometteur pour un test qui permettrait d’evaluer les risques de chute et pourrait egalement permettre une intervention afin de reduire le nombre de chutes chez les personnes âgees.

Introduction Un tiers des personnes âgees hospitalisees developpent une invalidite, meme lorsque la maladie sous-jacente est traitee avec succes. Nous avons voulu savoir si les interventions liees a la physiotherapie pourraient prevenir ou reduire ces inaptitudes associees aux hopitaux. Methode Une revue systematique et meta-analyse a ete effectuee en consultant les bases de donnees PubMed, CINAHL, EMBASE et Cochrane CENTRAL jusqu’en juin 2016. Nous avons inclus les etudes randomisees controlees qui portaient sur des patients hospitalises ou apres leur sortie de l’hopital, âges de 65 ans ou plus, atteints d’affections ne generant pas d’elles-memes une invalidite a long terme. Les etudes portaient sur un groupe de soins habituel et un groupe d’intervention avec physiotherapie intensive. Notre critere principal de jugement concernait les activites de la vie quotidienne mesurees en termes de performance, des mesures ou questionnaires basees sur l’observateur. Deux evaluateurs ont selectionne les articles de facon independante, extrait les donnees et evalue le risque de biais et la notation GRADE. Nous avons calcule les differences moyennes normalisees (DMN) avec des intervalles de confiance correspondant a 95 % a l’aide d’un modele d’effets aleatoires. Resultats Nous avons selectionne 1319 articles et inclus 7 etudes ; 3 rapportaient des interventions a l’hopital, 3 des interventions apres la sortie de l’hopital et 1 portait sur une intervention debutant a l’hopital et qui a continue apres la sortie. Pour l’intervention a l’hopital et l’intervention pendant et apres le sejour a l’hopital, les differences entre les groupes sont faibles : DMN 0,28 (IC 95 % : −0,01 a 0,57) et 0,24 (IC 95 % : −0,01 a 0,48), respectivement. Pour l’intervention apres la sortie, l’effet est important : DMN 0,78 (IC 95 % : −0,47 a 1,09). De maniere generale, le niveau de preuve est de qualite tres faible (notation GRADE). Conclusions De cette revue systematique et la meta-analyse comprenant 7 etudes randomises controlees (692 patients), nous avons tire 3 conclusions principales : (i) bien que la prevalence d’invalidite associee a l’hopital soit importante, il existe tres peu d’etudes qui evaluent les interventions completes de physiotherapie pendant et apres la phase d’hospitalisation ; (ii) pendant la phase d’hospitalisation, en comparaison aux soins habituels, seuls quelques effets ont ete trouves pour la prevention des invalidites associees a l’hopital ; (iii) apres l’hospitalisation, de grands effets de reduction des invalidites associees a l’hopital ont ete decouverts, mais les resultats ne reposent que sur quelques etudes. Signification Les professionnels de la sante – dans et hors de l’hopital – doivent mettre en œuvre et evaluer les programmes destines a prevenir et reduire les invalidites liees a l’hospitalisation.

Introduction La capacite a se mouvoir des patients atteints de maladies chroniques des muscles squelettiques joue un grand role en physiotherapie. Parfois, le physiotherapeute est confronte au fait que le patient s’estime a un niveau de mobilite qui ne correspond a celui qu’il observe. Dans ce cas, on parle de l’efficacite percue par le patient. Celle-ci peut etre determinee au moyen d’un questionnaire. Son utilisation depend cependant de la capacite de lecture et d’ecriture de la personne interrogee. Il est cependant possible de contourner cet obstacle en recourant a des questionnaires illustres. Cette etude visait a determiner la fiabilite et la validite du questionnaire Modified Version of the Spinal Function Sort (M-SFS) illustre, qui a ete developpe recemment. Methode Soixante-deux personnes atteintes de maladies chroniques des muscles squelettiques liees a leur travail ont ete interrogees. La validite interne du M-SFS a ete evaluee selon le test Alpha de Cronbach et la validite de cette approche a ete testee sous forme de 4 hypotheses a priori. La validite structurelle a ete evaluee par analyse factorielle. La fiabilite du test-retest et sa concordance ont ete evaluees avec le coefficient de correlation intra-classe (CCI), l’erreur de mesure a ete evaluee avec le test « limits of agreement » (LoA). Resultats Le M-SFS atteint 54,4 (ET 16,4) points ; le test-retest 56,1 (16,4) points. La repartition des items ne montre aucun effet cache. L’alpha de Cronbach du test est de 0,94, celui du test-retest de 0,95. L’analyse factorielle montre la presence de quatre composantes qui expliquent conjointement 74 % de la variance. Les items de communautes sont > 0,6 pour 17 des 20 items. Le coefficient de correlation intra-classe est de 0,90, le test de limits of agreement de ± 12,6/16,2 points. Les correlations au sein du M-SFS atteignent 0,89 ; elles se situent a 0,49 avec le SFS initial, a −0,37 avec l’index d’impotence due a la douleur, a −0,33 avec l’echelle numerique de la douleur, a −0,52 avec la gene occasionnee ressentie par les patients atteints de mal de dos chronique et a 0,50, 0,56 a 0,59 avec trois tests de soulevement effectues. Aucune hypothese definie a priori en matiere de validite de la structure n’est rejetee. Conclusions Le M-SFS permet d’estimer la justesse de la perception liee aux tâches professionnelles de maniere fiable et valable. Son utilisation peut etre recommandee. D’autres investigations doivent examiner la validite predictive du nombre de points du M-SMS Signification Le M-SFS permet une evaluation fiable et valable de l’efficacite percue par le patient pour les tâches d’ordre professionnel. Il peut etre recommande pour les patients atteints de maladies chroniques des muscles squelettiques.

ObjectiveInstruments such as the Radboud Skills Questionnaire [RASQ] and the Disability of Arm Shoulder and Hand Questionnaire [DASH] are not commonly used in general practice because they take too much time to complete. By assessing the concurrent validity, we examined whether the Visual Analog Scale [VAS] could serve as an alternative simple proxy to measure functional limitations in patients suffering from complex regional pain syndrome 1 [CRPS 1] of the upper extremities.MethodsWe asked patients afflicted with CRPS 1 of the upper extremities to indicate their functional limitations on the VAS and assessed the concurrent validity by comparing the results with the scores from the RASQ and the DASH.ResultsFifty-seven patients [37 females] with a median disease duration of 1.9 years [interquartile ranges 0.9–4.3] were included. Self-perceived activity limitations on the VAS were 5.4 ± 2.2. Average score for the RASQ was 140.1 ± 39.2 and for the DASH 64.3 ± 17.3. We found a good correlation between the VAS...

The purpose of the study was to determine the reliability of vertical ground reaction force (VGRF) parameters during stair ascent and descent in the elderly. Forty-two elderly subjects (80.1 SD 6.4 years) were asked to perform three stair ascents and descents at their self-selected normal speed. VGRF were measured during two consecutive steps on an instrumented staircase. Force-time curves where then parameterized into force, force-time and time variables, according to a previously suggested protocol. In addition, force and force-time variables were normalized to body weight. Intraclass correlation coefficients (ICC) type (2, 1) and coefficients of variation (CV) were calculated. Force variables showed moderate to good reliability for the normalized values with ICCs ranging from 0.537 to 0.836 and CVs between 2.52% and 6.51%. Variability of Fmax1 and Fmin appeared to be higher in stair descent with CVs of >5.20% as compared to stair ascent (

Hintergrund: Von den in der Praxis tatigen Physiotherapeuten wird vermehrt evidenzbasiertes therapeutisches Handeln erwartet. Dies setzt voraus, dass sie sich kontinuierlich uber die neusten Forschungsergebnisse informieren. Die jahrlich zunehmende Anzahl an Neupublikationen vor allem im Bereich der (randomisierten) klinischen Studien macht es Berufsangehorigen im Gesundheitswesen zeitlich oft schwer, sich neben ihrem Praxisalltag auf dem neusten Wissensstand zu halten. Mit systematischen Literaturstudien und Metaanalysen kann dem zunehmenden Information overflow auf eine effiziente Art und Weise entgegengewirkt werden. Ziel/Methode: Die vorliegende Arbeit bringt Hintergrundinformationen und die Systematik systematischer Literaturstudien und Metaanalysen in einen physiotherapeutisch verstandlichen Kontext. Ergebnisse: Metaanalysen stellen eine systematische und quantitative Methode der Zusammenfuhrung evidenter Ergebnisse aus individuellen vergleichbaren Studien dar, um wichtige (physio-)therapeutische Fragestellungen zu beantworten. Schlussfolgerung: Fur praktizierende Physiotherapeuten besitzt die Fahigkeit des Lesens und des kritischen Interpretierens von Metaanalysen einen grosen Stellenwert in Bezug auf das evidenzbasierte therapeutische Handeln.

Objective: To study the relationship of waist circumference (WC) and bioelectrical impedance analysis (BIA) and degree of agreement between anthropometric index (AI) and BIA, using BIA as a reference or ‘gold standard’. The second objective isto study the relationship between body mass index (BMI) and BIA in subjects with spinal cord injury (SCI). Study design: Comparative cross-sectional study. Setting: Convenience sample at outpatient clinic of spinal cord center. Outcome measures: Estimation of obesity was made in 23 men with motor complete paraplegia (>1 year postinjury). Bland and Altman statistics were used to define level of agreement between AI and BIA, Pearson’s r to describe correlation between WC and BIA and BMI and BIA. Results: Good agreement between BIA and AI with a small systematic difference in fat mass (FM) (mean difference: −0.28%, Pearson’s r: 0.91) was found. The correlation between WC and the BIA (% FM) was very high (Pearson’sr: 0.83). The correlation between WC and BMI (% FM) was just over moderate (Pearson’sr: 0.51). Conclusion: AI seems to be a valid proxy measure to estimate obesity in males living with SCI. Measurement of obesity in persons with SCI based on WC is promising. BMI showed not to be valid to estimate obesity in persons with SCI.

The purpose of this study was to describe the morphological characteristics in German amateur soccer players based upon their ranking in the championship table and the position of the players. Seventy-two male Fifth Division soccer players from four clubs volunteered for this study. The examination of the teams was conducted within 10 days of the preparation period for the second half of the season when teams A through D were ranked 6 th , 5 th , 2 nd and 11 th in the Division. Anthropometric measurements included body weight and height, skinfold thickness (biceps, triceps, subscapular, suprailiac, calf), biepicondylar humerus and femur breadths, upper arm (flexed and tensed), thigh and calf girths. Somatotypes were calculated using the Heath-Carter equations.No differences were found between the means of the different anthropometric variables of the four teams (p

Visual cues from persons with impairments may trigger stereotypical generalisations that lead to prejudice and discrimination. The main objective of this pilot study is to examine whether visual stimuli of impairment activate latent prejudice against disability and whether this connection can be counteracted with priming strategies.In a field experiment, participants were asked to rate photographs showing models with mental impairments, wheelchair users with paraplegia, and persons without any visible impairment. Participants should appraise the models with regard to several features (e.g. communicativeness, intelligence). One hundred participants rated 12 photo models yielding a total of 1183 observations. One group of participants was primed with a cover story introducing visual perception of impairment as the study's gist, while controls received neutral information.Photo models with mental impairments were rated lowest and models without visible impairment highest. In participants who did not have prior contacts with persons with impairments, priming led to a levelling of scores of models with and without impairment. Prior contacts with persons with impairments created similar effects as the priming. Unexpectedly, a pattern of converse double discrimination to the disadvantage of men with mental impairments was revealed.Signs of stereotypical processing of visual cues of impairment have been found in participants of the Swiss general population. Personal contact with persons with impairments as well as priming participants seems to reduce stereotyping.

Introduction/Background Persons aged over 65 years have an increased risk of falling and falls often trigger serious consequences like independency loss and increased mortality. An early detection of persons at risk of falling and a well-targeted fall prevention is thus of great interest. Previous studies showed that hip abductor strength is the muscle groups among all hip muscles, which is particularly related to the fall risk of older persons. Therefore we aimed to investigate the diagnostic accuracy of hip abductor strength by using history of falls as the external criterion. Material and method Hip abductor maximum voluntary isometric strength (ABD MVIS) and rate of force generation (ABD RFG) were assessed with a dynamometer fixed to a custom made frame in 60 persons aged over 65 years. The diagnostic accuracy [sensitivity (sens), specificity (spec), positive predictive value (PPV), negative predictive value (NPV), positive and negative likelihood ratios (LR+, LR−)] was assessed at a clinically important 90% sensitivity level. Cutoff values were calculated. Results Hip ABD MVIS (Sens. 90.6%, Spec. 57.1%, PPV 70.7%, NPV 84.2%, LR+ 2.11, LR− 0.16, cutoff value ≤ 1.06 N/kg) shows a slightly higher diagnostic accuracy than hip ABD RFG (Sens. 90.6%, Spec. 46.4%, PPV 65.9%, NPV 81.3%, LR+ 1.69, LR− 0.20, cutoff ≤ 8.47 N/kg/s). The results indicate that hip abductor strength shows a comparable diagnostic accuracy as other fall risk or mobility assessment tools (e.g. timed up and go test and short physical performance battery). Conclusion Hip abductor strength shows a good diagnostic accuracy to discriminate between older fallers and non-fallers and therefore might be an interesting parameter for fall risk prediction and a targeted intervention program. This very promising parameter should further be investigated in prospective studies.

The aim of this study involving 170 patients suffering from non-specific low back pain was to test the validity of the spinal function sort (SFS) in a European rehabilitation setting. The SFS, a picture-based questionnaire, assesses perceived functional ability of work tasks involving the spine. All measurements were taken by a blinded research assistant; work status was assessed with questionnaires. Our study demonstrated a high internal consistency shown by a Cronbach's alpha of 0.98, reasonable evidence for unidimensionality, spearman correlations of >0.6 with work activities, and discriminating power for work status at 3 and 12 months by ROC curve analysis (area under curve = 0.760 (95% CI 0.689-0.822), respectively, 0.801 (95% CI 0.731-0.859). The standardised response mean within the two treatment groups was 0.18 and -0.31. As a result, we conclude that the perceived functional ability for work tasks can be validly assessed with the SFS in a European rehabilitation setting in patients with non-specific low back pain, and is predictive for future work status.

Objective: To explore whether it is possible to construct clinical measures of functioning by integrating information obtained across the categories of the International Classification of Functioning, Disability, and Health (ICF) using the ICF Core Set of osteoarthritis (OA) as a case in point. Study Design and Setting: Psychometric study using data from 437 patients with OA from Germany, Italy, Hungary, Serbia, and Singapore. The analyses were performed with the ICF categories of the comprehensive ICF Core Set for OA addressing functioning and using the Rasch model for ordered response options. Results: A clinical measure with 74 country-specific and seven common ICF categories was created with the pooled data of all countries but Hungary. The overall fit statistic according to the ?2 was , P = 0.054, and the Z-fit statistic was Zmean = ?0.041 (Zstandard deviation [SD] = 1.01) for items and Zmean = ?0.15 (ZSD = 1.19) for persons. The Person Separation Index r? was 0.92. Conclusion: For the first time, a cross-cultural clinical measure of functioning was constructed which integrates ICF categories. The results of this investigation are promising and can contribute to the acceptance and usefulness of the ICF in clinical practice.

To explore whether it is possible to construct clinical measures of functioning for patients with ankylosing spondylitis (AS) by integrating information obtained across categories of the International Classification of Functioning, Disability and Health (ICF).Sixty-eight ICF categories that were identified as relevant by patients with AS and that covered body functions, structures, and activity and participation were analysed based on the Rasch model for ordered response options. The following properties were studied: unidimensionality, reliability, fit of the ICF categories to the Rasch model, the appropriateness of the order of the response options of the ICF qualifier, and the targeting between the ICF categories and the person's abilities.After accounting for disordered thresholds and misfitting ICF categories, a clinical measure of functioning for AS was proposed that contained 64 ICF categories. On the basis of a transformation table, the raw scores obtained by adding the answers to the 64 ICF categories can be transformed to the Rasch logit scale and to a meaningful interval scale ranging from zero to 100.For the first time, it has been shown that clinical measures of functioning, in principle, can be constructed based on the comprehensive ICF framework covering body functions and structures and activities and participation domains. The results of this investigation are preliminary and must be validated, but they are promising and can contribute to the acceptance and usefulness of the ICF in clinical practice.

Background: According to the Bayes-theorem the posterior probability of a hypothesis is a function of empirical evidence and prior infor- mation. To date results of physiotherapy inter- vention studies are practically solely interpreted from a frequentist point of view. Integration of Bayesian statistics in empirical research is not yet perceptible. Objectives: To raise problematic issues of the frequentist approach and to examine alternative analysis methods in empirical physiotherapy re- search; to illustrate interpretation problems in classical statistical empirical research results; analysis of objective and subjective alternatives. Methods: Probability concepts are elucidated. Bayes statistics are presented and visualised with a data simulation. The objective and subjec- tive part of the Bayes theorem are analysed. Results: Probability statements on therapeutic effects, especially in small sample studies for- mally demand a certain subjectivity. P-values as well as confidence intervals should be interpre- ted with caution. P-values overestimate the evi- dence against the null hypothesis. Bayes factors are valid objective alternative to P-values. The frequentist approach can be considered as a spe- cial case of the more general Bayesian approach. Conclusions: As measures of evidential strength against the null hypothesis and as alternative for p-values objective data-based Bayes factors are recommended. Minimum Bayes factors are ratios of data probabilities under the null hypothesis and under the maximum likelihood estimator. In parts P-values massively overestimate the evi- dence against the null hypothesis and have no scientific basis.

The purpose of this study was to evaluate the immediate influence of eccentric muscle action on vertical jump performance in athletes performing sports with a high demand of explosive force development. In this randomized, controlled crossover trial, 13 Swiss elite athletes (national team members in ski jump, ski alpine, snowboard freestyle and alpine, ski freestyle, and gymnastics) with a mean age of 22 years (range 20-28) were randomized into 2 groups. After a semistandardized warm-up, group 1 did 5 jumps from a height of 60 cm, landing with active stabilization in 90 degrees knee flexion. One minute after these modified drop jumps, they performed 3 single squat jumps (SJ) and 3 single countermovement jumps (CMJ) on a force platform. The athletes repeated the procedure after 1 hour without the modified drop jumps. In a crossover manner, group 2 did the first warm-up without and the second warm-up with the modified drop jumps. Differences of the performance (jump height and maximal power) between the different warm-ups were the main outcomes. The mean absolute power and absolute height (without drop jumps) were CMJ 54.9 W.kg(-1) (SD = 4.1), SJ 55.0 W.kg(-1) (SD = 5.1), CMJ 44.1 cm (SD = 4.1), and SJ 40.8 cm (SD = 4.1). A consistent tendency for improvement with added drop jumps to the warm-up routine was observed compared with warm-up without drop jumps: maximal power CMJ +1.02 W.kg(-1) (95% confidence interval [CI] = +0.03 to +2.38), p = 0.045; maximal power SJ +0.8 W.kg(-1) (95% CI = -0.34 to +2.02), p = 0.148; jump height CMJ +0.48 cm (95% CI = -0.26 to +1.2), p = 0.182; SJ +0.73 cm (95% CI = -0.36 to +1.18), p = 0.169. Athletes could add modified drop jumps to the warm-up before competitions to improve explosive force development.

BACKGROUND Patients after primary hip or knee replacement surgery can benefit from postoperative treatment in terms of improvement of independence in ambulation, transfers, range of motion and muscle strength. After discharge from hospital, patients are referred to different treatment destination and modalities: intensive inpatient rehabilitation (IR), cure (medically prescribed stay at a convalescence center), or ambulatory treatment (AT) at home. The purpose of this study was to 1) measure functional health (primary outcome) and function relevant factors in patients with hip or knee arthroplasty and to compare them in relation to three postoperative management strategies: AT, Cure and IR and 2) compare the post-operative changes in patient's health status (between preoperative and the 6 month follow-up) for three rehabilitation settings. METHODS Natural observational, prospective two-center study with follow-up. Sociodemographic data and functional mobility tests, Timed Up and Go (TUG) and Iowa Level of Assistance Scale (ILOAS) of 201 patients were analysed before arthroplasty and at the end of acute hospital stay (mean duration of stay: 9.7 days +/- 3.9). Changes in health state were measured with the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) before and 6 months after arthroplasty. RESULTS Compared to patients referred for IR and Cure, patients referred for AT were significantly younger and less comorbid. Patients admitted to IR had the highest functional disability before arthroplasty. Before rehabilitation, mean TUG was 40.0 s in the IR group, 33.9 s in the Cure group, and 27.5 s in the AT group, and corresponding mean ILOAS was 16.0, 13.0 and 12.2 (50.0 = worst). At the 6 months follow-up, the corresponding effect sizes of the WOMAC global score were 1.32, 1.87, and 1.51 (>0 means improvement). CONCLUSIONS Age, comorbidity and functional disability are associated with referral for intensive inpatient rehabilitation after hip or knee arthroplasty and partly affect health changes after rehabilitation.

Background: In the field of vertical jump diagnostics, force plates (FP) are the reference standard. Recently, despite a lack of evidence, jump mats have been used increasingly. Important factors in favor of jumping mats are their low cost and portability. Objectives: This validity study compared the Haynl-Elektronik jump mat (HE jump mat) with the reference standard force plate. Materials and Methods: Ten healthy volunteers participated and each participant completed three series of five drop jumps (DJ). The parameters ground contact time (GCT) and vertical jump height (VJH) from the HE jump mat and the FP were used to evaluate the concurrent validity. The following statistical calculations were performed: Pearson's correlation (r), Bland-Altman plots (standard and for adjusted trend), and regression equations. Results: The Bland-Altman plots suggest that the HE jump mat measures shorter contact times and higher jump heights than the FP. The trend-adjusted Bland-Altman plot shows higher mean differences and wider wing-spreads of confidence limits during longer GCT. During the VJH the mean differences and the wing-spreads of the confidence limits throughout the range present as relatively constant. The following regression equations were created, as close as possible to the true value: GCT = 5.920385 + 1.072293 × [value HE jump mat] and VJH = -1.73777 + 1.011156 × [value HE jump mat]. Conclusions: The HE jump mat can be recommended in relation to the validity of constraints. In this study, only a part of the quality criteria were examined. For the final recommendation it is advised to examine the HE jump mat on the other quality criteria (test-retest reliability, sensitivity change). Keywords: Plyometric Exercise, Reproducibility of Results, Sports Medicine

Objective To measure if a decision-supportive tool based on the WORRK model, developed to predict non-return to work (nRTW) after orthopaedic trauma, improves the allocation to various vocational pathways according to patients’ “nRTW” risk, for use in clinical practice. Material/patients and methods Randomized-controlled trial using vocational inpatients after orthopaedic trauma (n = 280). In the intervention group, the nRTW risk estimated using the WORRK tool was given to the clinician team before allocation of the vocational pathway, while in the control group it was not. Three pathways are available: simple (SP) and coaching (CP) (patients with low to intermediate nRTW risk, average of 5 week hospitalization and 17 hrs of therapy/week) and evaluation (EP) (high risk of nRTW, average of 3 week hospitalization and 14 hrs of therapy/week, less individual therapies, evaluation without training in the vocational workshop). The following indications were given: the higher the percentage of the WORRK score, the lower the predicted chance of RTW; a score 70% indicates that probably the EP is most adapted to the patient. The primary outcome was the proportion of patients allocated to the EP. Results Four hundred and fifty patients were assessed for eligibility, 280 included, 139 randomized to the control group (mean age 42.3 years) and 141 to the intervention group (mean age 43.2 years). The two groups were similar regarding risk profile, age, education, native language, pain and quality of life. The patients in the intervention group were more often referred to the EP compared to the control group, having a 31% higher chance, but this difference was not statistically significant (risk ratio 1.31 [95% CI 0.70–2.46]). The NNT was 30. Discussion - conclusion The effect of the WORRK tool was smaller than expected, possibly because: clinicians did not have confidence in the score provided, being given inadequate guidelines for when to refer patients to which pathway, clinicians avoid using the EP by fear of disadvantaging patients or because the EP is not adapted to our patients.

Introduction Les blessures liees aux chutes entrainent une perte de confiance, une peur de tomber et une restriction des activites ainsi que des effets prejudiciables sur l’independance et la qualite de vie [1] , [2] . Les tests actuellement utilises pour evaluer le risque de chute (p. ex. batterie de tests de performances physiques, timed-up-and-go et tests de mobilite axe sur la performance) se revelent moyennement efficaces en ce sens. De plus, aucun d’entre eux ne reflete specifiquement la force des muscles de la hanche dans le plan frontal dont on sait depuis peu qu’elle est necessaire au maintien de l’equilibre, a la gestion des obstacles et a l’evitement des chutes [3] . Notre objectif etait de determiner si la force des muscles de la hanche dans le plan frontal pouvait a elle seule permettre de distinguer les personnes âgees ayant chute et n’ayant pas chute. Methode Soixante participants âges (+ de 65 ans) ont ete recrutes et repartis entre le groupe des personnes ayant fait une chute (1 chute ou plus durant les 12 derniers mois) et le groupe des personnes n’ayant pas fait de chute (0 chute durant les 12 derniers mois). Les participants ont effectue un test de force d’adduction et d’abduction de la hanche en position couchee ( Fig. 1 ). Ils ont exerce une pression aussi forte et rapide que possible avec leur jambe sur le dynamometre fixe a un cadre concu a cet effet. Trois tests ont ete effectues par jambe, pour l’abduction et l’adduction. La moyenne des trois tests de force maximale volontaire isometrique (FMVI) et du taux de developpement de la force (TDF) a ete retenue pour les statistiques. Les differences entre les groupes ont ete evaluees au moyen d’une Anova a interaction unique effectuee avec le logiciel SPSS version 21. Resultats Nous avons analyse la force de l’abducteur de la hanche de 60 participants (âge moyen de 81,98 ans, ecart-type (ET) 6,61). La force moyenne de l’abducteur de la hanche pour la FMVI est de 64,82 N (ET 35,67) et de 428,77 N/s (ET 344,36) pour le TDF. En analysant les sous-groupes, nous avons trouve une FMVI moyenne de 46,89 N (ET 37,32) pour les personnes ayant chute et de 85,31 N (ET 37,19) pour les personnes qui n’avaient pas chute. Le TDF moyen etait de 186,03 N/s (ET 157,49) pour les personnes ayant chute et de 612,76 (ET 388,82) pour les personnes qui n’avaient pas chute. Pour l’echantillon total, la sensibilite de la FMVI de l’abduction de la hanche est de 68,75 % et la specificite est de 88,00 %. Une valeur seuil de 0,900 N/kg a ete utilisee. Le TDF a montre une sensibilite de 87,50 % et une specificite de 57,14 %. Le cut-off optimal etait situe ≤ 50,5 N pour la FMVI et ≤ 545 N/s pour le TDF. 78,33 % des participants ont ete correctement classes pour la FMVI et 73,33 % pour le TDF. Les resultats finaux sont attendus courant 2016. Discussion et conclusion La force des muscles de la hanche dans le plan frontal semble a elle seule permettre de distinguer le groupe des personnes ayant chute et n’ayant pas chute. Identifier des facteurs de prediction facilement mesurables et cibles est essentiel du point de vue clinique. Cela permet aux cliniciens d’obtenir une nouvelle evaluation du risque de chute, mais egalement des informations cruciales sur un parametre cible. Nos resultats intermediaires valident sur le plan clinique les mesures de la force des muscles de la hanche dans le plan frontal en tant qu’evaluation importante du risque de chute. Si les analyses finales confirment ces resultats, ce projet favorisera le developpement d’interventions therapeutiques specifiques et innovantes pour la prevention des chutes.

Introduction La fatigue liee au cancer (FLC) est l’un des symptomes les plus communs et les plus penibles du cancer et de son traitement. Elle peut etre presente avant le debut du traitement et s’accentue generalement pendant celui-ci. Comparee a la fatigue ressentie par des individus sains, la FLC est plus importante, plus penible et moins facilement soulagee par le repos. La prevalence globale de la FLC a ete estimee entre 25 et 99 %, en fonction de la population, du type de traitement et de la methode d’evaluation. La FLC peut persister jusqu’a 5 ans apres la fin du traitement, voire plus [1] . L’objectif de cette meta-analyse de comparaisons indirectes (ou de reseau) etait d’evaluer les effets relatifs de differents types d’activite physique ou d’exercice therapeutique sur la FLC pendant et apres le traitement contre le cancer. Nous avons actualise l’etude deja presentee sous forme de poster en 2014. Methodes Nous avons consulte des bases de donnees electroniques et recueillis les articles publies jusqu’a juillet 2015. Nous avons inclus des etudes randomisees portant sur les effets de tous les types d’exercices ou d’activites physiques, ainsi que les traitements cognitivo-comportementaux ou les traitements de relaxation chez les patients atteints de fatigue liee au cancer pendant ou apres les traitements contre le cancer. Tous les types de cancer etaient inclus. Le risque de partialite a ete evalue. La fatigue etant evaluee au moyen de questionnaires differents ; nous avons utilise la difference moyenne standardisee (DMS) comme mesure d’efficacite. Synthese de donnees Nous avons utilise la meta-analyse de reseau bayesienne (modeles d’efficacite aleatoire) pour comparer l’efficacite des differentes interventions etudiees. Pour classer les interventions, nous avons calcule la probabilite que chaque intervention soit la plus efficace, la deuxieme plus efficace, etc. Nous avons calcule la probabilite de SUCRA (surface sous classement cumulatif) ; cette valeur est egale a 1 si l’intervention est systematiquement classee comme la plus efficace ou a 0 si elle est systematiquement classee comme la moins efficace. Resultats Le nombre d’etudes incluses est passe de 176 en 2014 a 204 (97 pour la phase « pendant le traitement » et 107 pour la phase « post-traitement »). La probabilite de surface sous le classement cumulatif indique que la relaxation, le yoga, la danse et l’entrainement contre resistance sont probablement les interventions les plus efficaces. Discussion et conclusion Les conclusions de la meta-analyse des comparaisons indirectes indiquent que l’entrainement contre resistance et la relaxation sont les plus efficaces pendant le traitement contre le cancer, alors qu’une association d’aerobic et d’entrainement contre resistance ou de Tai Chi peut s’averer etre la meilleure option apres le traitement contre le cancer.

Introduction Une prevalence elevee des chutes et surtout des chutes multiples chez les personnes âgees augmente le risque de fracture, de perte d’autonomie et de placement en maison de repos [1] , [2] . Les chutes laterales et postero-laterales ont un potentiel de blessure de la hanche plus eleve que d’autres chutes [3] . La perte de force de la hanche dans le plan frontal est supposee augmenter le risque de chute, ce qui suscite un interet grandissant pour ce domaine de recherche. Notre objectif etait d’analyser la fiabilite des mesures de la force maximale volontaire isometrique (FMVI) des muscles adducteurs et abducteurs de la hanche et du taux de developpement de la force (TDF). Methodes Nous avons recrute 38 participants âges (plus de 65 ans) repartis dans un groupe de personnes qui avaient chute (1 chute ou plus au cours des 12 derniers mois) ou qui n’ayant pas chute (0 chute au cours des 12 derniers mois). Les participants etaient allonges sur le cote. Nous leur avons demande d’effectuer aussi vite que possible trois alternances abduction-adduction ( Fig. 1 ) mesurees sur un dynamometre fixe a un cadre concu a cet effet. La FMVI et le TDF moyens ont ete retenus pour les analyses. Apres une pause d’une a trois heures, la meme procedure a ete repetee. Les statistiques ont ete effectuees au moyen du logiciel SPSS version 21. La fiabilite a ete calculee au moyen du coefficient de correlation intra-classe (concordance ICC). Resultats L’analyse a porte sur l’abduction de la hanche de 37 participants (âge moyen 80,76 ans, ecart-type (ET) 7,31) et sur 38 participants pour l’adduction (âge moyen de 80,44 ans, ET 6,78). La force moyenne d’abduction etait de 72,71 N (ET 42,73) pour la FMVI et de 416,88 N/s (ET 386,46) pour le TDF. Pour l’adduction, le resultat etait de 49,52 N (ET 42,96) pour la FMVI et de 290,46 N/s pour le TDF. La concordance ICC des mesures du FMVI de l’abduction de la hanche est de 0,96 (95 % avec un intervalle de confiance de 0,93–0,98) et de 0,87 (0,75–0,94) pour l’adduction. Pour le TDF, la concordance ICC est de 0,92 (0,85–0,96) pour l’abduction et de 0,89 (0,82–0,92) pour l’adduction. Discussion et conclusion La concordance ICC de la force de la hanche dans le plan frontal est excellente. Les valeurs sont comparables au coefficient de correlation intra-classe des tests fonctionnels actuellement utilises pour les evaluations des risques de chute (batterie de tests de performances physiques, timed-up-and-go et tests de mobilite axes sur la performance). L’evaluation critique montre que les caracteristiques des evaluations fonctionnelles du risque de chutes actuellement utilisees peuvent etre optimisees. Des etudes complementaires doivent donc examiner si les mesures de la force de la hanche peuvent a elles seules permettre de differencier les personnes qui ont chute des personnes qui n’ont pas chute. Si cela est demontre, les cliniciens disposeront d’un nouveau parametre de risque de chute, mais aussi d’informations cruciales sur un parametre cible et mobifiable au-travers d’un entrainement. Nos resultats montrent que la force de la hanche dans le plan frontal (FMVI et TDF) peut etre mesuree de maniere fiable chez des personnes âgees de plus de 65 ans allongees sur le cote au moyen d’un dynamometre fixe a un cadre concu a cet effet.

Introduction Les chutes sont un des problemes principaux de sante qui affectent la qualite de vie des personnes âgees. Certains facteurs de risque de chute seraient fortement associes a la qualite de vie des personnes âgees. Pour agir sur ces facteurs, des programmes d’exercices ont ete mis sur pied. Bien que les effets de ces programmes d’exercices aient ete demontres, leur efficacite sur la reduction du risque et du nombre de chutes depend fortement du taux d’acceptation de participation et du taux d’adhesion une fois prise la decision d’y participer. L’objectif de cette etude exploratoire etait d’evaluer la faisabilite d’une future etude randomisee controlee dont l’intervention consisterait en un nouveau programme d’exercices a domicile concu et implemente pour favoriser l’adhesion a long terme de la pratique d’exercices concus dans le but de reduire le nombre de chutes et d’ameliorer la qualite de vie des personnes âgees. Methodes Cette etude exploratoire, randomisee controlee, comparait les effets de deux programmes d’exercices a domicile, « T&E » et « OTAGO », sur le nombre de chutes, la qualite de vie, le risque de chute et la peur de chuter. Des physiotherapeutes specialement formes ont suivi les participants durant 24 semaines en Valais, dans la region lausannoise et dans le canton de Zurich. Afin d’evaluer la faisabilite, nous avons analyse les processus et les taux de recrutement, les processus d’implementation et de suivi des programmes du groupe-intervention et du groupe temoin. Nous avons egalement evalue les couts en ressources humaines et materielles, le processus de recueil des donnees ainsi que les nouveaux outils developpes pour le programme « T&E ». Resultats Grâce au reseau que nous avons mis en place pour le recrutement, 25 sujets ont ete identifies comme eligibles par nos institutions socio-sanitaires partenaires. 84 % (n = 21) ont accepte d’y participer. 18 personnes ont ete reparties en 2 groupes : 9 pour le programme « T&E » et 9 pour le programme « OTAGO ». 87,5 % (n = 14) des 16 sujets qui ont commence l’etude l’ont suivie et envoye leurs calendrier durant les 24 mois prevus. Le depassement de 6 % au budget prevu est imputable au developpement, non prevu, d’une application Android et a l’achat de tablettes. Discussion et conclusion L’analyse des processus a permis la reformulation des criteres d’eligibilite, l’ajustement des modalites d’implementation des programmes d’exercices aupres des participants et l’anticipation d’un processus de recueil des donnees pour une etude prevue avec 440 sujets. Selon les participants et les physiotherapeutes, la brochure « T&E » a donne toute satisfaction. Quelques ameliorations doivent etre realisees concernant la grandeur des videos de la tablette. L’experience et les resultats de cette etude exploratoire ont permis la creation d’un reseau interdisciplinaire, inter-cantonal et bilingue. L’echantillon des personnes recrutees repond aux criteres de la population-cible recherchee. La satisfaction et la motivation des participants soutiennent nos travaux exploratoires.

Introduction Ameliorer la mobilite des personnes âgees est un des buts principaux de la readaptation geriatrique. Les exercices autoregules avec des manuels d’instruction sont utilises pour accroitre le volume d’entrainement, mais l’adhesion aux instructions est souvent faible. Les jeux d’entrainement peuvent ameliorer l’adhesion. Cette etude a donc compare les jeux d’entrainement aux exercices autoregules avec manuels d’instruction. Methode Une etude randomisee controlee a pole unique a ete menee avec echantillonnage aleatoire central au sein d’un centre de readaptation pour patients hospitalises en geriatrie. Les patients inclus avaient plus de 65 ans et des restrictions a la mobilite tout en etant capables de realiser des exercices autoregules. Ils ont ete affectes aux exercices de jeux d’entrainement sur Windows Kinect ® (Groupe d’entrainement) ou aux exercices autoregules avec des manuels d’instruction (Groupe conventionnel). Les physiotherapeutes ont guide durant 2 seances de 30 minutes les exercices autoregules qui devaient etre faits pendant 10 jours, deux fois par jour, pendant trente minutes. Les patients ont donne des indications sur leur adhesion (resultat principal), leur plaisir et leur la motivation jour apres jour. L’equilibre pendant la marche a ete mesure en aveugle avant et apres la phase de traitement avec un accelerometre. L’analyse a ete realisee en intention de traiter. Des mesures repetees ont melange les modeles et les ampleurs de l’effet Cohen (AE, modere si > 0,5, important si > 0,8) avec 95 % d’IC utilises pour evaluer les effets inter-groupe sur la duree. Alpha a ete situe a 0,05. Resultats De juin 2014 a decembre 2015, 217 patients ont ete evalues et 54 inclus, 26 dans le groupe d’entrainement et 28 dans le groupe conventionnel. Des effets defavorables ont ete observes chez deux patients du groupe d’entrainement ; ils ont du arreter du fait de douleurs pendant l’entrainement. L’adhesion est comparable au jour 1 (entrainement : 38 min ; conventionnel : 42 min) et significativement plus grande dans le groupe d’entrainement au jour 10 (entrainement : 54 min ; conventionnel : 28 min, p = 0,007, ES 0,94, 0,39–0,151). Les benefices en faveur du groupe d’entrainement sont aussi observes en ce qui concerne le plaisir ( p = 0,001, ES 0,88, 0,32–1,44) et la motivation ( p = 0,046, ES 0,59, 0,05–1,14). Il n’y a pas d’effet intra-groupe pour l’equilibre durant la marche. Conclusions Les exercices autoregules avec manuels d’instruction sont superieurs aux jeux d’entrainement en ce qui concerne l’adhesion, le plaisir et la motivation dans un environnement d’hospitalisation geriatrique. Les effets sont de moderes a importants. Il n’y a pas de difference entre les groupes pour l’equilibre durant la marche. Signification Des ameliorations dans les jeux d’entrainement et des etudes randomisees controlees evaluant leur efficacite comparee a celle d’autres methodes de s’exercer de facon autoregulee sont necessaires avant qu’un usage generalise en readaptation geriatrique puisse etre envisage.

Background Aging is associated with loss of balance and activity in daily life. It impacts postural control and increases the risk of falls. The current study was conducted to determine the feasibility and long-term impact of stochastic resonance whole-body vibration (SR-WBV) on static and dynamic balance and reaction time among elderly individuals. Methods A randomized crossover pilot study with blinding of the participants. Twenty elderly were divided into group A (SR-WBV 5 Hz, Noise 4/SR-WBV 1 Hz, Noise 1) or group B (SR-WBV 1 Hz, Noise 1/SR-WBV 5 Hz, Noise 1). Feasibility outcomes included recruitment, compliance and safety. Secondary outcomes were Semi-Tandem Stand (STS), Functional Reach Test (FRT), Expanded Timed Get Up-and-Go (ETGUG), walking under single (ST) & dual task (DT) conditions, hand and foot reaction time (RTH/RTF). Puri and Sen Rank-Order L Statistics were used to analyse carry-over effects. To analyse SR-WBV effects Wilcoxon signed-ranked tests were used. Results With good recruitment rate (55%) and compliance (attrition 15%; adherence 85%) rates the intervention was deemed feasible. Three participants dropped out, two due to knee pain and one for personal reasons. ETGUG 0 to 2 m (p = 0.143; ES: 0.36) and ETGUG total time (p = 0.097; ES: 0.40) showed medium effect sizes. Conclusions Stochastic resonance training is feasible in untrained elderly resulting in good recruitment and compliance. Low volume SR-WBV exercises over 12 training sessions with 5 Hz, Noise 4 seems a sufficient stimulus to improve ETGUG total time. The stimulation did not elicit changes in other outcomes. Trial registration This trial has been registered at the U.S. National Institutes of Health under ClinicalTrials.gov: NCT01045746.

The aim of this systematic review was to identify and evaluate the evidence of the efficacy of stochastic resonance whole-body vibration (SR-WBV) on static, dynamic and functional balance in the elderly and in patients with neurodegenerative diseases. English and German studies were consulted in the CINAHL, Cochrane Central Register of Controlled Trials, ISI Web of Knowledge, PEDro and PubMed databases. Eight of 138 eligible studies were included, involving 381 participants. The included studies showed a low to high risk of bias. Three studies focused on long-term effects after SR-WBV. One study evaluated SR-WBV impact over three days while four studies examined its immediate effects. There is only limited evidence that SR-WBV may be effective in improving static, dynamic and functional balance among elderly individuals and patients with neurodegenerative diseases. In the future, more studies of high methodological quality are needed to improve the level of evidence.

Introduction Functional evaluation of upper limb is not only based on clinical findings but requires self-administered questionnaires to address patients’ perspective. The Hand Function Sort (HFS©) was only validated in English. The aim of this study was the French cross cultural adaptation and validation of the HFS© (HFS-F). Methods 150 patients with various upper limbs impairments were recruited in a rehabilitation center. Translation and cross-cultural adaptation were made according to international guidelines. Construct validity was estimated through correlations with Disabilities Arm Shoulder and Hand (DASH) questionnaire, SF-36 mental component summary (MCS),SF-36 physical component summary (PCS) and pain intensity. Internal consistency was assessed by Cronbach’s α and test–retest reliability by intraclass correlation. Results Cronbach’s α was 0.98, test–retest reliability was excellent at 0.921 (95 % CI 0.871–0.971) same as original HFS©. Correlations with DASH were—0.779 (95 % CI −0.847 to −0.685); with SF 36 PCS 0.452 (95 % CI 0.276–0.599); with pain −0.247 (95 % CI −0.429 to −0.041); with SF 36 MCS 0.242 (95 % CI 0.042–0.422). There were no floor or ceiling effects. Conclusions The HFS-F has the same good psychometric properties as the original HFS© (internal consistency, test retest reliability, convergent validity with DASH, divergent validity with SF-36 MCS, and no floor or ceiling effects). The convergent validity with SF-36 PCS was poor; we found no correlation with pain. The HFS-F could be used with confidence in a population of working patients. Other studies are necessary to study its psychometric properties in other populations.

Background Knee pain is associated with radiographic knee osteoarthritis, but the relationships between physical examination, pain and radiographic features are unclear. Objective To examine whether deficits in knee extension or flexion were associated with radiographic severity and pain during clinical examination in persons with knee pain or radiographic features of osteoarthritis. Design Cross-sectional data of the Somerset and Avon Survey of Health (SASH) cohort study. Methods Participants with knee pain or radiographic features of osteoarthritis were included. We assessed the range of passive knee flexion and extension, pain on movement and Kellgren and Lawrence (K/L) grades. Odds ratios were calculated for the association between range of motion and pain as well as radiographic severity. Results/findings Of 1117 participants with a clinical assessment, 805 participants and 1530 knees had complete data and were used for this analysis. Pain and radiographic changes were associated with limited range of motion. In knees with pain on passive movement, extension and flexion were reduced per one grade of K/L by −1.4° (95% CI −2.2 to −0.5) and −1.6° (95% CI −2.8 to −0.4), while in knees without pain the reduction was −0.3° (95% CI -0.6 to −0.1) (extension) and −1.1° (−1.8 to −0.3) (flexion). The interaction of pain with K/L was significant ( p = 0.021) for extension but not for flexion ( p = 0.333). Conclusions Pain during passive movement, which may be an indicator of reversible soft-tissue changes, e.g., reversible through physical therapy, is independently associated with reduced flexion and extension of the knee.

Assessing sensorimotor abilities, such as movement control, becomes increasingly important for the management of patients with neck pain because of the potential contribution to the development of chronic neck pain. Our aim was to evaluate whether sensorimotor tests could discriminate between persons with neck pain and persons without neck pain and to assess correlations among the assessments. A matched case-control study with 30 persons with recurrent neck pain and 30 controls was conducted. We tested two-point discrimination (TPD), joint position error (JPE), muscle activation with the craniocervical flexion test (CCFT), laterality judgment accuracy and movement control (MC). We administered the Fear Avoidance Beliefs Questionnaire (FABQ), the Neck Disability Index (NDI) and the painDetect questionnaire. According to the areas under the curve (AUC), tests for the JPE (0.69), CCFT (0.73), MC (0.83) and laterality judgment accuracy (0.68) were able to discriminate between persons with and without neck pain. Among the five tests, laterality judgment accuracy exhibited moderate to large correlations with the JPE and MC, and moderate correlations were observed between the TPD and CCFT (r between � 0.4 and � 0.5). We recommend the assessment of various aspects of sensorimotor ability and of central representation of the body schema, even in patients with mild neck pain. For clinical practice, we recommend the craniocervical flexion test, testing of laterality judgment accuracy and three movement control tests (cervico-thoracic extension, protractioneretraction of the head and quadruped cervical rotation).

BackgroundWorkers with persistent disabilities after orthopaedic trauma may need occupational rehabilitation. Despite various risk profiles for non-return-to-work (non-RTW), there is no available predictive model. Moreover, injured workers may have various origins (immigrant workers), which may either affect their return to work or their eligibility for research purposes. The aim of this study was to develop and validate a predictive model that estimates the likelihood of non-RTW after occupational rehabilitation using predictors which do not rely on the worker's background.MethodsProspective cohort study (3177 participants, native (51%) and immigrant workers (49%)) with two samples: a) Development sample with patients from 2004 to 2007 with Full and Reduced Models, b) External validation of the Reduced Model with patients from 2008 to March 2010. We collected patients' data and biopsychosocial complexity with an observer rated interview (INTERMED). Non-RTW was assessed two years after discharge from the rehabilitation. Discrimination was assessed by the area under the receiver operating curve (AUC) and calibration was evaluated with a calibration plot. The model was reduced with random forests.ResultsAt 2 years, the non-RTW status was known for 2462 patients (77.5% of the total sample). The prevalence of non-RTW was 50%. The full model (36 items) and the reduced model (19 items) had acceptable discrimination performance (AUC 0.75, 95% CI 0.72 to 0.78 and 0.74, 95% CI 0.71 to 0.76, respectively) and good calibration. For the validation model, the discrimination performance was acceptable (AUC 0.73; 95% CI 0.70 to 0.77) and calibration was also adequate.ConclusionsNon-RTW may be predicted with a simple model constructed with variables independent of the patient's education and language fluency. This model is useful for all kinds of trauma in order to adjust for case mix and it is applicable to vulnerable populations like immigrant workers.

dRehabilitation Centre Clinique Romande de Readaptation, Service de readaptation de l’appareil locomoteur, Sion, Switzerland Summary OBJECTIVE: To determine the test-retest reliability of the Orebro Musculoskeletal Pain Screening Questionnaire (OMPSQ) and of the Situational Pain Scale (SPS) in patients with chronic low back pain (CLBP). METHODS: CLBP patients (n = 30) who were capable of reading French completed the OMPSQ and the SPS twice with a 1-week interval in one rehabilitation centre in French-speaking Switzerland. To study the test-retest reliability, we calculated intraclass correlation coefficients (ICCs) for the reliability of the overall scores of the two questionnaires. RESULTS: The ICC for the OMPSQ overall score was 0.89 (95% confidence interval [CI] 0.79‒0.95). For the overall scores of the SPS, the ICC was 0.87 (95% CI 0.74‒0.93). The standard error of the mean, expressed as percentage of the mean, was 6.6% for the SPS and 10% for the OMPSQ. CONCLUSIONS: The reproducibility of these two questionnaires in a sample of patients with CLBP is considered good at the overall score level. The French translation of the OMPSQ could be considered as a tool to examine the evolution of psychosocial factors.

Introduction L’apprentissage des competences procedurales constitue une part importante de la formation des physiotherapeutes [1] . Le but des programmes d’etudes de physiotherapie est que les diplomes soient capables d’appliquer des procedures selectionnees de maniere sure et efficace. La competence procedurale est menacee par le nombre croissant et l’evolution permanente des procedures integrees aux programmes universitaires [2] . Pour atteindre un haut niveau de competence procedurale, les etablissements d’enseignement ont besoin d’outils d’evaluation fiables et valables. Les outils d’evaluation peuvent entre autres servir a evaluer individuellement les etudiants. Les organismes d’accreditation peuvent utiliser les outils d’evaluation pour comparer les performances de differents programmes de physiotherapie en termes de competences. Enfin, il est demontre que les outils d’evaluation peuvent aider a l’apprentissage. L’objectif de cette etude etait de developper et d’evaluer un outil d’evaluation des competences procedurales au sein des programmes d’etudes de physiotherapie. Methodes L’outil d’evaluation a ete developpe en trois etapes. Une revue systematique de la litterature a d’abord ete effectuee afin d’identifier et d’evaluer les meilleures outils disponibles pour l’evaluation des competences procedurales dans les etudes de physiotherapie. Un tableau d’items a ete cree afin de developper un outil d’evaluation preliminaire. Ce tableau a ete developpe selon les directives decrites par Wilson [3] . Enfin, la theorie de la reponse par item a ete utilisee dans une etude pilote afin d’analyser l’outil d’evaluation sur un echantillon de 30 etudiants en physiotherapie. Resultats Nous avons developpe un outil d’evaluation comprenant 6 sous-categories (preparation, connaissance, prise de decision, communication, execution de la procedure et confort) et 29 items. Un item d’evaluation global est evalue au sein de chaque sous-categorie. De plus, les items detailles existants evaluent les caracteristiques specifiques a chaque sous-categorie. Le score moyen des 30 etudiants etait de 48,42 points (50,97 %) avec un ET de 19,05 (20,06 %). Le pourcentage des valeurs manquantes etait de 2,92 %. L’outil d’evaluation a montre une coherence interne elevee avec un coefficient alpha de Cronbach de 0,96. Un modele de theorie de la reponse par item a ete calcule avec les 29 items de l’outil d’evaluation. La difficulte moyenne des items du modele etait de 0,00 logits. La moyenne des statistiques Infit etait de 0,91 (moyenne quadratique) et de –0,5 (statistiques t). Neuf items presentaient des statistiques de moyenne quadratique hors norme alors qu’aucune n’a ete detectee pour les statistiques t. Discussion et conclusion Un nouveau type d’evaluation des procedures des programmes d’etudes en physiotherapie a ete introduit. Le modele statistique de l’Assessment of Procedural Skills in Physiotherapy Education (APSPT) presente un bon degre d’adequation avec la plupart des items. La sous-categorie execution de la procedure est probablement la sous-categorie la plus proche du cœur des competences procedurales acquises. La sous-categorie est composee de sept items (six items detailles et un item d’evaluation globale). L’adequation des sept items est excellente selon les deux statistiques d’adequation. Les etudes a venir devraient valider l’evaluation de cet outil.

Systematic reviews of randomized controlled trials and statistical combination of results from different trials in meta-analysis have risen to such prominence that few question their usefulness in evidence-based clinical practice. Although systematic reviews are indeed generally useful, the results of meta-analyses must be cautiously interpreted [1]. If the estimates of the trials included in the meta-analysis deviate from the truth in a systematic fashion, the summary estimate from the meta-analysis will likely be biased as well. There is strong empirical evidence showing that the meta-analyses of clinical trials in which the allocation of patients to treatment groups was not concealed, or in which the assessment of outcomes was not blinded, overestimate the treatment effects [2e5]. It is now widely accepted that the quality of a trial should be assessed before including it in a meta-analysis. Likewise, it is a good practice to ascertain if the results differ between trials at greater or lesser risk of bias. As yet, however, there is no consensus as to how this assessment should be done. In this commentary, we discuss the scoring of trials using quality scales, using the example of a scale widely used in trials of physiotherapy. We contrast the use of summary scores with an alternative approach, which is based on an assessment of individual components such as concealment of allocation and blinding. Quality scales assess several criteria related to the design, conduct, and analysis of trials, and each earns points that are aggregated into an overall score. The score determines the classification of the study as one of the higher or lower methodological quality, with the implication that bias has been prevented to a greater or lesser degree. Chalmers et al. [6] in 1981 were among the first to develop such a scale, with possible summary scores ranging from 0 to 44. Since then, many other scales were developed

Patients with end-stage emphysema because of α-1 antitrypsin (AAT) deficiency represent a challenging clinical management problem, and studies of volume reduction therapy to date have largely excluded these patients. We report the outcome of bronchoscopic volume reduction with the insertion of Emphasys endobronchial valves (Emphasys Medical, Redwood City, CA, USA) in six patients with end-stage emphysema because of AAT deficiency.Of 51 patients with end stage emphysema referred for transplantation, we studied six patients with AAT deficiency and utilized the BODE index and lung allocation score for survival estimation.The forced expiratory volume in 1s improved from a median of 0.575L to 0.905L (P=0.028). There was a median reduction in total lung capacity (TLC) of 0.61L. The residual volume /TLC fell from 74.0% to 58.4%. Before treatment, four patients had a BODE index of greater than eight units, which correlates with a 4-year survival of 18%. After treatment, two patients improved their BODE index to below seven units, which correlates with an estimated 4-year survival of over 50%.The data from this case series suggest that this intervention may provide bridging therapy to subsequent transplantation for younger AAT patients with end-stage emphysema.

Background. Robot-assisted gait training (RAGT) has been suggested as an intervention to improve walking capacity in patients with multiple sclerosis (MS). Objective. This study aimed to evaluate whether RAGT (Lokomat) is superior to over-ground walking training in terms of quality of life, activity level, and gait. Methods. A total of 67 patients with MS with the Expanded Disability Status Scale (EDSS) 3.0 to 6.5 were randomized to walking or RAGT, in addition to multimodal rehabilitation. Primary outcomes were walking speed, activity level (estimated metabolic equivalent, metabolic equivalents [METs], using an accelerometer), and quality of life (Well-Being Visual Analogue Scale (VAS) and EQ-5D European VAS. Results. In all, 49 patients finished the interventions. Mean age was 56 years (range 36-74 years), mean EDSS was 5.8 (3.0-6.5), and the preferred walking speed at baseline was 0.56 m/s (0.06-1.43 m/s). Before rehabilitation, participants spent on average 68 min/d at an MET ≥3. The walking group improved gait speed nonsignificantly more than the RAGT; the upper bound of the confidence interval (CI) did not exclude a clinically relevant benefit (defined as a difference of 0.05 m/s) in favor of the walking group; the lower bound of the CI did exclude a clinically important benefit in favor of the Lokomat. Quality of life improved in both groups, with a nonsignificant between-group difference in favor of the walking group. Both groups had reduced their activity by 8 weeks after the rehabilitation. Conclusion. It is unlikely that RAGT is better than over-ground walking training in patients with an EDSS between 3.0 and 6.5.

Background This systematic review was performed to summarize the current evidence for whole body vibration (WBV) interventions on postural control in elderly. Methods English and German language papers in Medline, PEDro, Cinahl and the Cochrane databases were searched. Two reviewers extracted data on patients' characteristics, type of WBV intervention and outcomes. Two independent reviewers rated the methodological quality of these studies. Data were pooled using random-effects meta-analysis. Results Fifteen papers reporting quantitative data were included. Results from 15 papers could be pooled for a meta-analysis. The studies involved 933 participants. In 7 studies the authors investigated the effects of vibration plates generating vertical sinusoidal vibrations (VS-WBV) and 7 papers described the use of side-alternating sinusoidal vibrations (SS-WBV). One study investigated both VS-WBV and SS-WBV. Weak to moderate evidence of an overall effect as a result of VS-WBV and SS-WBV was observed for (a) static balance for post-intervention values with a standardized mean difference (SMD) -0.06, 95% CI -0.31 to 0.18 and for change values SMD -0.26, 95% CI -1.09 to 0.57, and (b) dynamic balance for post-intervention-values SMD -0.34, 95% CI -0.60 to -0.08. For functional balance (c) an overall outcome for post-intervention values with SMD of 0.34, 95% CI -0.19 to 0.87 was found. Conclusions The 15 studies reviewed were of moderate methodological quality. In summary, SS-WBV seems to have a beneficial effect on dynamic balance in elderly individuals. However, the current results should be interpreted with caution because of the observed heterogeneity of training parameters and statistical methods. Future studies are warranted to evaluate the effects of WBV on postural control in an elderly population.

Background The literature suggests a beneficial effect of motor imagery (MI) if combined with physical practice, but detailed descriptions of MI training session (MITS) elements and temporal parameters are lacking. The aim of this review was to identify the characteristics of a successful MITS and compare these for different disciplines, MI session types, task focus, age, gender and MI modification during intervention. Methods An extended systematic literature search using 24 databases was performed for five disciplines: Education, Medicine, Music, Psychology and Sports. References that described an MI intervention that focused on motor skills, performance or strength improvement were included. Information describing 17 MITS elements was extracted based on the PETTLEP (physical, environment, timing, task, learning, emotion, perspective) approach. Seven elements describing the MITS temporal parameters were calculated: study duration, intervention duration, MITS duration, total MITS count, MITS per week, MI trials per MITS and total MI training time. Results Both independent reviewers found 96% congruity, which was tested on a random sample of 20% of all references. After selection, 133 studies reporting 141 MI interventions were included. The locations of the MITS and position of the participants during MI were task-specific. Participants received acoustic detailed MI instructions, which were mostly standardised and live. During MI practice, participants kept their eyes closed. MI training was performed from an internal perspective with a kinaesthetic mode. Changes in MI content, duration and dosage were reported in 31 MI interventions. Familiarisation sessions before the start of the MI intervention were mentioned in 17 reports. MI interventions focused with decreasing relevance on motor-, cognitive- and strength-focused tasks. Average study intervention lasted 34 days, with participants practicing MI on average three times per week for 17 minutes, with 34 MI trials. Average total MI time was 178 minutes including 13 MITS. Reporting rate varied between 25.5% and 95.5%. Conclusions MITS elements of successful interventions were individual, supervised and non-directed sessions, added after physical practice. Successful design characteristics were dominant in the Psychology literature, in interventions focusing on motor and strength-related tasks, in interventions with participants aged 20 to 29 years old, and in MI interventions including participants of both genders. Systematic searching of the MI literature was constrained by the lack of a defined MeSH term., BMC Medicine, 9, ISSN:1741-7015

Objective: to determine the effects of power training with high movement velocity compared with conventional resistance training with low movement velocity for older community-dwelling people. Design: systematic review of randomised controlled trials. Data sources: the Cochrane Central Register of Controlled Trials, PubMed (Medline), EMBASE, CINAHL, PEDro and Scholar-Google. Trials: all randomised or quasi-randomised trials investigating power training with high movement velocity versus conventional resistance training with low movement velocity in elderly persons over the age of 60 years. The primary outcomes were measures of functional outcomes; secondary outcomes were balance, gait, strength, power, muscle volume and adverse effects. Results: eleven trials were identified involving 377 subjects. The pooled effect size for the follow-up values of the functional outcomes was 0.32 in favour of the power training (95% CI 0.06 to 0.57) and 0.38 (95% CI �0.51 to 1.28) for the change value. The pooled effect from three studies for self-reported function was 0.16 in favour of power training (95% CI �0.17 to 0.49). Conclusion: power training is feasible for elderly persons and has a small advantage over strength training for functional outcomes. No firm conclusion can be made for safety.