Physiotherapy Research International

The Berg Balance Scale is a reliable and valid measure that is used to assess characteristics of balance. The Dynamic Gait Index is a relatively new measure that has been used to record dynamic gait tasks in people with vestibular dysfunction. The purpose of the present study was to determine the concurrent validity of the Dynamic Gait Index with the Berg Balance Scale in people with vestibular disorders.

A retrospective review of the charts of people who met the criteria of having completed both the Berg Balance Scale and the Dynamic Gait Index during their first physiotherapy visit. Seventy patients (19 male, 51 female) were identified through the retrospective review of the charts of people referred for vestibular rehabilitation with varying diagnoses of vestibular and balance dysfunction. All were seen at a tertiary medical centre in an outpatient physiotherapy setting. Their age range was from 14 to 88 years (mean 65 years).

Correlation between the scores on the Dynamic Gait Index and the Berg Balance Scale was moderate but significant by use of the Spearman rank order correlation (r = 0.71; p<01). No difference was found between scores on the Dynamic Gait Index or Berg Balance Scale based on gender or diagnosis. A significant difference was identified on the Berg Balance Scale between older and younger people with vestibular disorders. Using previously established criteria to determine increased risk of falling, the Berg Balance Scale and the Dynamic Gait Index agreed 63% of the time.

The moderate correlation between the Dynamic Gait Index and the Berg Balance Scale establishes the concurrent validity of the Dynamic Gait Index in people with vestibular dysfunction. Both these measures provide valuable information to clinicians about patients' functional balance capabilities. However, the lack of perfect correlation indicates that the tests measure different aspects of balance. The Dynamic Gait Index appears to be a more sensitive assessment tool in identifying people with vestibular disorders who are at increased risk for falling, based on currently published criteria. Copyright © 2003 Whurr Publishers Ltd.

A new parallelogram goniometer was designed by the Rehabilitation Centre of the Royal Ottawa Health Care Group in 1983. The advantage of using such a goniometer is that the clinician is not required to estimate the joint axis of rotation when taking a measurement. The parallelogram goniometer has obtained a good intratester and intertester reliability when measuring active range of motion of hip abduction on eight individuals with hip pathologies. However, the validity of the parallelogram goniometer has not been examined. The purposes of this study were to examine the intratester and intertester reliability and the criterion validity of the parallelogram and universal goniometers for active knee flexion on healthy individuals.

Sixty healthy university students (44 females and 16 males; mean age of 20.6 yrs.) participated to this study.

Measurements with the universal and parallelogram goniometers were taken in two different positions, the smaller and larger angles of active knee flexion. All measurements were taken by two trained testers. A radiograph was taken in both positions to serve as the ‘gold standard’. The sequence of the measurements and radiographs were randomly selected. The intra and intertester reliability of both goniometers were established by calculating the intraclass correlation coefficients (ICCs) using the repeated‐measures ANOVA. The criterion validity was examined by calculating Pearson product‐moment correlation coefficients (r) between each goniometric and radiologic measurements. A 0.05 level of significance was chosen for each statistical test.

Intratester reliability ranged from good to excellent for the small angles (ICC=0.85 and 0.87) and the large angles (ICC=0.91 and 0.96) when using the parallelogram goniometer. Intertester reliability was fair for the small angles of flexion (ICC=0.43 to 0.52) and good to excellent for the large angles of flexion (ICC=0.82 to 0.88). The parallelogram goniometer was found to have greater validity when measuring the large angles of knee flexion (r=0.73 and 0.77) compared to the small angles of knee flexion (r=0.33 and 0.41). Similar results of reliability and validity were obtained with the universal goniometer.

The results of this study have clinical importance. The use of the parallelogram goniometer was found to be as reliable and valid as the universal goniometer when measuring active knee flexion. However, the parallelogram goniometer offered clinicians the advantages of obtaining precise angular measurements with fewer adjustments, and a faster application technique. Further studies on the parallelogram goniometer are necessary among individuals presenting with altered range of motion at different joints. Copyright © 1997 Whurr Publishers Ltd.

Individuals with concussion often complain of persistent dizziness and imbalance, and these problems have been treated with vestibular rehabilitation exercises. The purpose of this study is to describe the vestibular rehabilitation exercise prescriptions provided to individuals after concussion.

A retrospective chart review of vestibular rehabilitation home exercise programmes prescribed by physical therapists for 104 participants who were diagnosed with concussion was conducted. Each of the exercises was classified by exercise type, duration and frequency. Frequency counts of the most common exercise types were recorded. Exercise progression patterns were examined by determining how exercise types were modified from visit to visit.

Eye–head coordination exercises were the most commonly prescribed exercise type (in 95% of participants), followed by standing static balance exercises (in 88% of participants), and ambulation exercises (in 76% of participants).

Understanding the prescription patterns of expert clinicians may elucidate the vestibular‐related impairments of individuals after concussion and may provide a resource for therapists who may be starting vestibular rehabilitation programmes for management of individuals with concussion. To improve quality of care, future research should be directed to relate outcomes to the exercise prescription patterns. Copyright © 2012 John Wiley & Sons, Ltd.

The knee is the weight‐bearing joint most commonly affected by osteoarthritis (OA). The symptoms of pain, morning stiffness of short duration and physical dysfunction in the activities of daily living (ADL) can have an effect on many aspects of health, affecting quality of life. Regular and moderate physical activity adapted to individuals' life‐styles and education, and joint protection strategies have been advocated as conservative management. The purpose of the present study was to assess the impact of an exercise and walking protocol on the quality of life of elderly people with knee OA.

The study design was a randomized controlled clinical trial. The subjects comprised 50 elderly people, aged 65 or more, with knee OA who had been referred to the geriatric outpatient unit for rehabilitation. Changes in severity of pain and quality of life were compared between a control group (CG) and an experimental group (EG). Both groups participated in an educational session and the EG also received a 12‐week exercise and walking protocol. Both groups were assessed at baseline and after three and six months by an independent observer. The Lequesne Index of Knee OA Severity (LI), the Health Assessment Questionnaire (HAQ) and the Medical Outcomes Short‐Form Health Survey (SF‐36) were used as measurement instruments.

In the CG, the measures of quality of life (SF‐36), the HAQ and the LI between subjects did not yield statistically significant differences over the three measurement points. For the EG, there was a significant improvement in function, measured by HAQ, and decreasing OA symptom severity, measured by LI. For the SF‐36 there were significant improvements in physical function, functional role limitation and pain. Comparisons between the groups showed statistically significant differences after three and six months for all measures, except for the SF‐36 emotional domains.

The exercise protocol and walking programme had a positive effect on the quality of life of elderly individuals with knee OA. Copyright © 2003 Whurr Publishers Ltd.

Many individuals with peripheral arthritis blame decreased balance as a reason for limiting their physical activity. It is therefore important to assess and improve their balance. The purpose of the present study was to evaluate the applicability and the reliability of some clinical balance assessment methods for people with arthritis and various degrees of disability.

To examine the applicability and reliability of balance tests, 65, 19 and 22 patients, respectively, with peripheral arthritis participated in sub‐studies investigating the applicability, inter‐rater reliability and test–retest stability of the following methods: walking on a soft surface, walking backwards, walking in a figure‐of‐eight, the balance sub‐scale of the Index of Muscle Function (IMF), the Timed Up and Go (TUG) test and the Berg balance scale.

For patients with moderate disability walking in a figure‐of‐eight was found to be the most discriminative test, whereas ceiling effects were found for the Berg balance scale. Patients with severe disability were generally able to perform the TUG test and the Berg Balance Scale without ceiling effects. Inter‐rater reliability was moderate to high and test–retest stability was satisfactory for all methods assessed.

Applicable and reliable assessment methods of clinical balance were identified for individuals with moderate and severe disability, whereas more discriminative tests need to be developed for those with limited disability. Copyright © 2001 Whurr Publishers Ltd.

Ultrasound (US) and low‐level laser therapy (LLLT) are commonly employed for myofascial trigger points (MTP) despite lack of evidence for usage as stand‐alone treatments. The aim of the study was to determine, on MTP of the upper trapezius muscle (uTM), the effects of US and LLLT per se, as delivered in accordance with the procedures reported by surveys about their usage among physiotherapists.

Design was set as a double‐blind, randomized, placebo‐controlled study. Sixty participants with at least one active MTP in uTM (28 women and 32 men; mean age 24.5 ± 1.44 years) were recruited and randomly assigned to one out of five groups: active US (n = 12), placebo US (n = 12), active LLLT (n = 11), placebo LLLT (n = 11) and no therapy (control, n = 14). The participants and outcome assessor were blinded to the group assignment and therapy delivered. Three outcome measures were assessed at baseline, after a 2‐week treatment and 12 weeks after the end of the intervention (follow‐up): pressure pain threshold, subjective pain on a numerical rating scale and muscle extensibility performing a cervical lateral flexion. All subjects assigned to the intervention groups were treated five times weekly for overall 10 treatments given. Two‐way ANOVA was used to compare differences before and after intervention and among groups at each time‐point.

After the 2‐week intervention, all groups showed pressure pain threshold, numerical rating scale and cervical lateral flexion significant improvements (p < 0.05), which were confirmed at the follow‐up. When performing multiple comparisons, controls scored significantly less than both the active therapies and placebos, whereas no differences were detected between active therapies and placebos.

Ultrasound and LLLT provided significant improvements in pain and muscle extensibility, which were superior to no therapy but not to placebos, thus raising concerns about the suitability, both economically and ethically, of administering such common physical modalities as stand‐alone treatments in active MTP of the uTM. Copyright © 2014 John Wiley & Sons, Ltd.

Although vertebral artery (VA) blood flow is adequate in normal circumstances, reduction in the dimensions of the vessel because of atherosclerosis, or compression or stretching, may lead to hindbrain hypoxia with serious clinical manifestations. Such effects may be more pronounced in VAs that are naturally smaller than the norm. Because normative data for the suboccipital (VA₃) and intracranial (VA₄) vertebral artery are not readily available, it was the aim of the present study to measure the dimensions of these distal parts of the VA, to inform professional practice of the possible influence of different vessel dimensions on blood flow to the hindbrain.

The study was a laboratory‐based observational or descriptive study. A total of 40 and 54 left and right, suboccipital and intracranial parts of the VA (n = 188 vessels), obtained from cadavers of females and males aged 20–80 years, was processed for light microscopic study and measurement of the dimensions of the vessels. The left and right inner and outer diameters, cross‐sectional areas and the tunica media thicknesses were calculated in each part of the vessel and compared by use of t‐tests.

The histological structure of the VA was typical of a muscular or distributing artery. Although, in the total number of specimens, no statistically significant differences were found between left and right sides in either part of the vessel, a larger left than right VA₄ was demonstrated in the females. The VA₃ was significantly larger than VA₄ in males and females, and all dimensions in both parts of the vessel were greatest in the older age group.

Reduced VA blood flow, whether because of atherosclerosis or compression or stretching of the vessel, is more likely to occur in arteries that are smaller than normal. This information is of value to clinicians in avoiding further compromising the VA and its blood flow during professional practice. Copyright © 2004 Whurr Publishers Ltd.