Biomedical subjects

J A Oldham

Publications and source records attributed to J A Oldham.

At least 19 recordsLinked to original sources

PubMed2004

Supplementing a home exercise programme with a class-based exercise programme is more effective than home exercise alone in the treatment of knee osteoarthritis.

OBJECTIVE: The study aimed to compare the relative effectiveness of providing a home-based exercise programme versus home-based exercise supplemented with an 8-week class-based exercise programme in reducing pain and improving function in patients with knee osteoarthritis. METHODS: Patients (n = 214) with radiologically confirmed knee osteoarthritis were selected. Patients were randomly allocated to either home or home supplemented with class-based exercise programmes. Both groups were given a home exercise programme whilst the supplemented group also attended for 8 weeks of twice weekly knee classes. Assessments of locomotor function, walking pain and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores were made. Assessments were made pre- and post-treatment and also at 6- and 12-month follow-ups. Statistical analysis involved the use of a longitudinal linear model ANCOVA with baseline values entered as a covariate. RESULTS: Patients from the class-based group demonstrated significantly greater improvement in locomotor function (-3.7 seconds; 95% C.I. -4.9 to -2.5) and decrease in walking pain (-15 mm; 95% C.I. -20 to -11) than the home-based group, at 12-months follow-up. CONCLUSIONS: The supplementation of a home based exercise programme with a class-based exercise programme led to clinically significant superior improvement. These improvements were still evident at 12-month review. This is the first trial to evaluate this common physiotherapeutic practice, and based on this evidence, supplementation of home exercises with a class-based exercise programme can be recommended to patients, clinicians and service providers.

Analysis of Variance↗

PubMed2004

The reliability, validity and responsiveness of an aggregated locomotor function (ALF) score in patients with osteoarthritis of the knee.

OBJECTIVES: The aggregated locomotor function (ALF) score, a simple measure of observed locomotor function, using timed walking, stairs and transfers, was developed and evaluated for intra-tester reliability, criterion-related validity and responsiveness in a sample of patients with knee osteoarthritis. METHODS: Patients with knee osteoarthritis (n = 214) were recruited for inclusion in a randomized controlled trial investigating two methods of exercise provision. Before treatment, patients completed the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Short Form 36 health survey (SF-36) questionnaires and were timed whilst performing an 8 m walk, ascending and descending a set of gymnasium stairs and completing a test of transferring in and out of a chair. A group of 15 patients also undertook a replicate test-retest reliability study of the above outcome measures. Standardized response means were calculated for the ALF, WOMAC and SF-36 from data from the clinical trial. RESULTS: The ALF takes 10 min to administer and demonstrated excellent intra-tester reliability, with excellent intra-class correlation coefficient (ICC) statistics (ICC(2,k) 0.99; 95% CI 0.98-0.99), and low standard error of measurement (0.86 s) and smallest detectable difference (9.5%) values. Criterion-related validity with the physical function dimensions of the WOMAC and SF-36 was good, with correlation coefficients of 0.59 and - 0.53 respectively. Standardized response means were higher for the ALF (0.49) than for both the WOMAC (0.39) and the SF-36 (0.12). CONCLUSIONS: This work has demonstrated that the ALF can be used as a measure of physical function status and as a means of quantifying treatment response. The measure offers a simple and convenient outcome in the assessment and treatment of locomotor dysfunction. The ALF score is a reliable, valid and responsive outcome measure over 12 months and can be recommended for use in the evaluation of patients with knee osteoarthritis.

Aged↗

PubMed2004

Quadriceps atrophy: to what extent does it exist in patellofemoral pain syndrome?

BACKGROUND: Quadriceps atrophy is a commonly cited accompaniment to patellofemoral pain syndrome (PFPS), yet there is little valid, objective evidence for its existence. OBJECTIVE: To investigate atrophy and weakness of the quadriceps femoris muscle group in patients with PFPS using measures of cross-sectional area and peak extension torque. METHODS: A total of 57 patients with insidious onset of PFPS and 10 healthy control subjects had ultrasound scanning of the quadriceps femoris. The scans were analysed using computerised planimetry to estimate the cross-sectional area of the quadriceps femoris. Lower limb peak torque was also measured using a Biodex dynamometer. RESULTS: The mean of % differences revealed a 3.38% (95% confidence interval (CI) 1.3 to 5.45) difference in cross-sectional area (CSA) between the affected and unaffected limb in PFPS patients and a 1.31% (95% CI 0.06 to 2.55) difference in the dominant and non-dominant limb of the control group; the between-groups difference was not significant (p = 0.409). There was a 18.4% (95% CI 13 to 23.8) difference between the affected and unaffected limb in peak torque in PFPS patients and a 7.6% (95% CI 3.2 to 12) difference between the dominant and non-dominant limb in the control group; the between-groups difference was significant (p = 0.002). CONCLUSIONS: The mean of % differences of 3.38% quadriceps atrophy between limbs was considerably less than the only other study using ultrasound scanning on the quadriceps in PFPS and was not significant between the groups. There were greater and more significant between-group differences in lower limb peak torque indicating that muscle strength may not be related to muscle size. These results help to re-appraise of the amount of quadriceps atrophy in PFPS.

Adult↗

PubMed2004

Supplementation of a home-based exercise programme with a class-based programme for people with osteoarthritis of the knees: a randomised controlled trial and health economic analysis.

OBJECTIVES: To establish the relative effectiveness and cost of providing a home-based exercise programme versus home-based exercise supplemented with an 8-week class-based exercise programme. DESIGN: The trial was a pragmatic, single-blind randomised clinical trial accompanied by a full economic evaluation. SETTING: Patients were randomly allocated to either home-based exercise or home exercise supplemented with class exercise programmes. PARTICIPANTS: A total of 214 patients, meeting the American College of Rheumatology's classification of knee osteoarthritis, were selected from referrals from the primary and secondary care settings. INTERVENTIONS: Both groups were given a home exercise programme aimed at increasing lower limb strength, and endurance, and improving balance. The supplemented group also attended 8 weeks of twice-weekly knee classes run by a physiotherapist. Classes represented typical knee class provision in the UK. MAIN OUTCOME MEASURES: Assessments of locomotor function, using a timed score of three locomotor activities, walking pain and self-reported disability with the Western Ontario and McMaster's Universities osteoarthritis index (WOMAC) were made. General health, lower limb strength, range of movement and compliance with exercise were also measured. Patients were assessed before and after treatment, and also at 6- and 12-month follow-ups. The economic evaluation looked at health service resource use and assessed cost-effectiveness by relating differential costs to differences in quality-adjusted life-years (QALYs) based on patients' responses to the EuroQol-5 Dimensions. Data were obtained at baseline, 1 month, 6 months and 12 months through face-to-face interviews and, where appropriate, examination of hospital medical records. RESULTS: Patients from the supplemented group demonstrated significantly greater improvement in locomotor function and decrease in pain while walking at all follow-ups. The supplemented group also demonstrated smaller but significant improvements in balance, strength, WOMAC score, and the physical function and pain dimensions of the Short Form-36. However, not all of these improvements were maintained over the 12-month follow-up period. There was no evidence that compliance with the home exercise programme was different or that total costs or mean QALY gains were significantly different between the groups. However, costs were slightly lower and QALY gains slightly higher in the group with the supplementary class-based programme. The economic evaluation suggests that supplemented programmes are likely to be considered cost-effective, although there is uncertainty around this estimate, with approximately 30--35% probability that the intervention would not be cost-effective. CONCLUSIONS: The supplementation of a home-based exercise programme with a class-based exercise programme led to superior improvement in the supplemented group. These differential improvements were still evident at review 12 months after treatment had ceased. The additional cost of the supplemented group was offset by reductions in resource use elsewhere in the system. Compliance with the home exercise programme did not differ between the groups. Based on this evidence, the supplementation of a home-based exercise programme with an 8-week class-based exercise programme can be confidently expected to produce small improvements in locomotor function and clinically important reductions in pain. It is recommended that future research investigates methods of increasing compliance with home exercise programmes and evaluates the impact of these interventions in the primary care setting, where most patients with knee osteoarthritis are managed.

Aged↗

PubMed2003

Auditory cues can modify the gait of persons with early-stage Parkinson's disease: a method for enhancing parkinsonian walking performance?

OBJECTIVE: To investigate whether systematically adjusting the rate of auditory cues induces corresponding modulations of the temporal and spatial parameters of gait of patients with early-stage Parkinson's disease. DESIGN: Subjects performed a series of 15 9-metre walks along a level floor under uncued and four cued conditions; the order of cued conditions was randomized. SETTING: A physiotherapy gymnasium, Manchester, UK. SUBJECTS: Eleven subjects with early-stage idiopathic Parkinson's disease. INTERVENTIONS: Preferred pace was established from the initial three uncued walks. The rate of auditory cues delivered throughout subsequent walks was systematically adjusted for each subject, representing 85, 92.5, 107.5 and 115% of their mean cadence at preferred walking pace. MAIN OUTCOME MEASURES: Mean cadence, mean stride length and mean velocity. RESULTS: Repeated measures ANOVA indicated that the mean velocity and mean cadence of subjects' gait significantly (p < or = 0.01) increased relative to baseline values at cue rates of 115 and 107.5% of cadence at preferred pace and decreased at cue rate of 85%. Mean stride length was unaffected by variations in cue rate. CONCLUSION: The rate of auditory cues, within the range tested, can modulate cadence and thus velocity of gait of subjects with early-stage Parkinson's disease. The provision of auditory cues provides a potential strategy for enhancing walking performance in these patients.

Adult↗

PubMed2001

Paraspinal muscle EMG fatigue testing with two methods in healthy volunteers. Reliability in the context of clinical applications.

OBJECTIVE: Comparison of the accuracy of surface electromyogram for back muscle endurance assessment with two different tests. DESIGN: Test-retest measurements in 16 healthy volunteers on two separate occasions for each test under controlled conditions. BACKGROUND: Back muscle endurance is considered important in low back pain rehabilitation. Reliability of paraspinal muscle endurance assessment is a pre-requisite for accurate and meaningful clinical applications of the technique. METHODS: All participants performed each test twice. A direct comparison was made between two popular fatigue testing methods, the modified Biering-Sørensen and a 60% maximum voluntary isometric contraction in the upright position during which time fatigue was assessed from the electromyogram spectral and amplitude analysis. RESULTS: Reproducibility of initial median frequency was excellent for both tests. Normalised median frequency slope values were more reliable with the 60% maximum voluntary contraction upright test. The clinical applicability of these measures in detecting significant differences after patient rehabilitation is recommended. Root mean square had very large between-day error for both tests.

Adult↗

PubMed2001

Reliability and sensitivity measures of the Greek version of the short form of the McGill Pain Questionnaire.

The translation of existing healthcare measurement scales is considered a feasible, efficient and popular approach to produce internationally comparable measures. The short form of the McGill Pain Questionnaire is one of the most widely used and translated instruments to measure the pain experience. The Greek version of the short form of the McGill Pain Questionnaire (GR-SFMPQ) has recently been developed and demonstrated satisfactory levels of internal consistency. The objective of the present study was to assess the instrument's reliability and sensitivity.Eighty patients with spinal or knee pain were included. The test-retest reliability of the instrument was estimated for measurements within the same day and after 15 days. The sensitivity of the measure was examined before and after the application of a physiotherapy therapeutic regime. The correlation coefficients (Intraclass Correlation Coefficient and Spearman's) ranged from 0.87-0.98 for within-day measurements and from 0.70-0.92 for administrations between days. All indexes of the GR-SFMPQ (total score, sensory and affective scores, total count of used words, visual analogue score, present pain index) managed consistently to detect the changes in pain experienced (p<0.05), after a therapeutic intervention, when assessing for the sensitivity of the questionnaire. An explorative discriminant analysis of the GR-SFMPQ indexes managed to correctly classify up to 85% of the patients; a classification rate comparable to the full version MPQ rating capacity. It can be argued from the results of this study that the Greek version of the SFMPQ fulfils the criteria of reliability and sensitivity to fluctuations of pain and can be utilized with confidence in cross-cultural comparative research trials.

Adult↗

PubMed2001

Electromyographic fatigue characteristics of the quadriceps in patellofemoral pain syndrome.

This study compared the fatigue characteristics of the vastus medialis oblique (VMO), vastus lateralis (VL) and rectus femoris (RF) muscles. Ten healthy subjects with 10 patients with patellofemoral pain syndrome (PFPS) performed an isometric leg press for 60 seconds at 60% MVIC with data collected using surface EMG. The power spectrum was analyzed and the extracted median frequency normalised to calculate a linear regression slope for each muscle. A repeated measures ANOVA revealed no significant differences, neither between the groups (P=0.592) nor the muscles (P=0.434). However, the slopes for the VMO and VL were different between the two groups with similar slopes for the RF. There was much larger variability of MF values in the PFPS group. The VMO:VL ratio calculated from these slopes for the healthy subjects was 1.17 and for the PFPS group was 1.78. These results may indicate unusual features in the fatigue indices of the quadriceps in PFPS.

Adult↗

PubMed2001

Intermittent isometric fatigue study of the lumbar multifidus muscle in four-point kneeling: an intra-rater reliability investigation.

Back muscle endurance is considered important in low back pain (LBP) rehabilitation. Specific training of multifidus may also be necessary to restore normal low back function. The reliability of surface electromyogram (EMG) to assess endurance of the multifidus muscle during intermittent isometric exercise was evaluated. Multifidus endurance was monitored in the four-point kneeling exercise position using the power spectral analysis method. Twenty healthy volunteers were tested on three separate occasions. Subjects performed repeat 10 s high-intensity voluntary contractions of multifidus for 3 min. The median frequency (MF) and the integrated-rectified (I-R) EMG signal displayed the fatigue pattern of multifidus. Intraclass correlation coefficients indicated fair-good reproducibility for MF (0.48-0.67) but poor reliability for IR-EMG. In conclusion, problems concerning functional testing protocols for the back muscles remain and careful development is necessary for more realistic rehabilitation monitoring.

Adult↗

PubMed2001

A comparison of two types of electrical stimulation of the quadriceps in the treatment of patellofemoral pain syndrome. A pilot study.

OBJECTIVE: To compare a commercially available electrical muscle stimulation regime with a new form of stimulation for the rehabilitation of the quadriceps in patients with patellofemoral pain syndrome. SETTING: A research facility within a teaching hospital. METHODS: Sixteen patients (four men, 12 women) with patellofemoral pain, demonstrable quadriceps atrophy, but normal gait parameters were randomly allocated to one of two treatment groups. One group received a sequential mixed frequency stimulation pattern from a standard device. The other group received a new form of stimulation from an experimental stimulation device that contained simultaneous mixed frequency components. OUTCOME MEASURES: Isometric and isokinetic extension torque, muscle fatigue rate, pain, functional questionnaire, step test, knee flexion, and quadriceps cross-sectional area. RESULTS: These showed significant improvements for both groups after treatment (p < 0.05) in all outcome measures except flexion and fatigue rates, but no significant differences between the two stimulation regimes (p > 0.05). CONCLUSION: Both stimulators performed similarly on patients with patellofemoral pain giving significant improvements for all patients for muscle strength, pain, self-reporting function and step testing. There were no significant differences between the two types of stimulation.

Analysis of Variance↗

PubMed2000

The reproducibility of multi-joint isokinetic and isometric assessments in a healthy and patient population.

DESIGN: Test re-test reliability design. OBJECTIVE: To determine a reproducible protocol for lower limb simultaneous multi-joint assessments on a healthy group of subjects and a patient group with patellofemoral pain syndrome. BACKGROUND: Although single joint assessment with isokinetic dynamometers has been utilised for many years in knee rehabilitation, simultaneous multi-joint assessment has not attracted comparable attention. METHODS: Twenty healthy volunteers mean age 30.6 years and 16 patients with patellofemoral pain syndrome mean age 29.6 years performed isometric maximum voluntary contractions and concentric isokinetic contractions of the lower limb. Data were collected on three separate days for resultant extension/flexion peak torque, average power and total work which were analysed using intraclass correlation coefficients with a 95% level of confidence. RESULTS: In healthy subjects, intraclass correlation coefficients estimates were > or =0.75 for isokinetic peak torque and >0.83 for average power and total work. The intraclass correlation coefficients estimate for isometric peak torque extension was 0.82. In the patient group, intraclass correlation coefficients estimates were >0.82 for isokinetic peak torque and > or =0.75 for average power and total work. The intraclass correlation coefficients estimate for isometric peak torque extension was 0.89. Discarding the first session's data for both groups improved the intraclass correlation coefficients estimates for virtually all assessments. CONCLUSIONS: This study has demonstrated high reproducibility of lower limb multi-joint testing for peak torque, average power, and total work on healthy subjects and then has employed the protocol to demonstrate similarly high reliability on a patient group. It has also highlighted the need for a practice session before the data can be said to be reliable. RELEVANCE: Reliability studies often use healthy subject groups, which although useful, have limited relevance to patient populations. This study has not only gained comprehensive reproducibility data on multi-joint assessment in healthy subjects, it has also shown that multi-joint testing can be used safely and reliably in patients with patellofemoral pain syndrome. Clinicians may now be able to measure objectively lower limb function in this patient group both pre and post treatment.

Adult↗

PubMed2000

The development and validation of a Greek version of the short-form McGill Pain Questionnaire.

BACKGROUND: The short form of the McGill Pain Questionnaire (SFMPQ) is a widely used instrument for assessing the quality of pain where use of the full form is not possible. To date however, this instrument has not been translated into the Greek language. AIMS: It is the aim of this study to validate an adopted Greek version of the short form of the McGill Pain Questionnaire. METHODS: A systematic translation procedure was followed before development of the final version. Sixty spinal and osteoarthritis chronic musculoskeletal pain patients completed the questionnaire. A large percentage of the subjects (43%) was of elementary educational level. RESULTS: The analysis of the results indicated that an internally consistent (Cronbach's alpha = 0.71) and content valid (all 15 descriptors were used at least by the 33% of the subjects) instrument has been developed. It has been shown to be suitable, easy to understand and administer for this sample of chronic musculoskeletal patients. CONCLUSIONS: A Greek version of the SFMPQ (the GR-SFMPQ) has been constructed which has the properties of internal validity and consistency. It is easy to administer, easy to understand even for an elementary educational level and it is capable of describing multidimensionally the pain experience of chronic musculoskeletal pain patients.

Adult↗

PubMed2000

An investigation of the validity of 'simulated' work related tasks in relation to 'real-life' situations in the fire service training environment.

Many researchers have developed work simulated tasks that can successfully predict fitness for work. In the fire service there are few tests available to make such predictions. This study was designed to evaluate the validity of four simulated fire-fighting tasks developed by Manchester Fire Service. Twenty-seven subjects each performed, in random order, three repeats of four simulated and four real-life tasks: under-running a 9 m ladder, dead lift, placing a 13.5 m ladder on an appliance and hauling an extended line. Comparisons between real and simulated tasks were assessed by measuring total time and amount of muscle activity. Recommendations were made to reduce the weight and to revise the lifting and grip positions for the 13.5 m ladder and dead lift, respectively, whereas the simulated 9 m ladder and hauling an extended line simulated tasks were sufficiently similar to the real-life activities to not warrant any change.

Adolescent↗

PubMed2000

An evaluation of a new pattern of electrical stimulation as a treatment for urinary stress incontinence: a randomized, double-blind, controlled trial.

OBJECTIVE: To evaluate a new pattern of electrical of electrical stimulation as a treatment for stress incontinence. DESIGN: A randomized, double-blind, controlled trial. SETTING: The study took place on three clinical sites. SUBJECTS: Patients (n = 27) with urodynamically proven stress incontinence recruited via consultant referral. INTERVENTIONS: Patients were randomly allocated to one of two groups: the new pattern of stimulation or sham stimulation. MAIN OUTCOME MEASURES: Patients were assessed pre, mid and post treatment using: perineometry, digital assessment and pad testing. The following were only used pre and post treatment: seven-day frequency/volume chart, SF-36, the Incontinence Impact Questionnaire and the Urogenital Distress Inventory. RESULTS: No significant between-group differences were highlighted except when quality of life was assessed with the Urogenital Distress Inventory (p = 0.01). A significant reduction in scores was observed in the stimulation group (p = 0.03) However, improvements were seen in both the strength and endurance characteristics of the pelvic floor musculature, although these changes were not translated into a reduction in symptoms. CONCLUSION: Although promising, the improvement in pelvic floor function did not result in a reduction in symptoms in all patients. Further research is required to investigate the effects of the new stimulation in combination with pelvic floor exercises and to compare the new stimulation pattern with existing forms of electrical stimulation.

Double-Blind Method↗

PubMed1999

A comparison of dominant and non-dominant hand strengths.

This study compares dominant and non-dominant hand strength in both right- and left-handed participants. Maximum voluntary contraction (MVC) of the first dorsal interosseous (FDI) muscle, power grip strength and pulp-to-pulp pinch strength were assessed under carefully controlled conditions. No significant differences were observed between dominant and non-dominant hands in left-handed participants for all tests. Small but significant differences (0.1-3%) were observed between dominant and non-dominant hands in right-handed participants for all three tests. These differences were much smaller than those reported in other studies. Furthermore, considerable variability was observed in the relative strengths of the two hands for each participant. We conclude that clinicians must be cautious when using the '10% rule' to make comparisons between injured and uninjured hands.

Adult↗

PubMed1996

The reliability of measuring quadriceps cross-sectional area with compound B ultrasound scanning.

Many therapists use thigh circumference as a measure of quadriceps size to evaluate the effect of an injury or effectiveness of an intervention. However, this technique has been shown to be unreliable, thus more accurate methods of measuring muscle size are required. The purpose of this study was to investigate the validity and reliability of measuring quadriceps cross-sectional area (CSA) with static compound B ultrasound scanning at the level of the mid-thigh. Repeated measures of known linear distances and CSAs were made with a planimetry device. Both face and criterion validity were demonstrated indicating that the device is reliable when measuring CSAs. A single rater located quadriceps muscle borders and measured CSAs on a series of ultrasound scans. A mean coefficient of variation (%CV = 1.7) was observed, signifying high intra-rater reliability. Two raters performed six scans on each of 15 subjects. Initial observation of these results suggest that the measurement of quadriceps CSA with compound B ultrasound scanning is reliable, mean %CVs = 2.8 and 1.9 for the two raters and 2.4 when their results were combined. When raters performed scans on 18 subjects on two occasions on the same day intra-class correlation coefficients (ICC) were high, 0.991 and 0.980 for raters A and B, respectively. Paired Student's t-tests revealed a significant difference (p < 0.05) for Rater B between CSAs measured for initial and relocated scans. However, this difference was calculated as 1.4-2.9% and was not of clinical importance. A significant difference (p < 0.05) was observed between measurements of CSAs made by both raters on the same subject. A calibration factor was calculated for transforming the measurements of Rater B, the use of which gave comparable values. ICCs using a fixed model for inter-rater reliability were 0.963 and 0.974 for actual and transformed values, respectively. This study observed differences between measures obtained by different raters and recommends that the calculation and employment of a calibration factor may be useful when comparing sequential measures made by different raters.

Adult↗

PubMed1996

The role of quadriceps exercise in the treatment of patellofemoral pain syndrome.

In recent years there has been increased interest in the role of exercise in the alleviation of patellofemoral pain syndrome. Contradictions which result in a lack of a consensus amongst clinicians and researchers as to the most beneficial type of exercise are reviewed. The popularly held belief that there are imbalances between some components of the quadriceps femoris is also reviewed and conflicting evidence that quadriceps contractions can be enhanced by altering hip and knee positions is found. Some traditional exercises, previously considered essential to any regime for this common condition, were not found to be as beneficial as previously thought. Consequently, some of these exercises should be less prominent in a rehabilitation programme for patellofemoral pain syndrome.

Contraindications↗

PubMed1994

The use of patterned neuromuscular stimulation to improve hand function following surgery for ulnar neuropathy.

A 60-year-old man with wasting and weakness of the right hand following ulnar nerve entrapment at the elbow was referred for electrotherapy. An ulnar nerve transposition had been performed 2 years previously. This had produced some improvement in nerve conduction without significantly improving hand muscle function. The right first dorsal interosseous muscle (FDI) was stimulated for 4 hours per day over a 6-week period with a stimulus pattern replicating the discharge of a single motor unit from a healthy, fatigued FDI (patterned neuromuscular stimulation or PNMS). The response was assessed using a single case design. Significant improvements in the strength and fatigue resistance of the FDI were observed, associated with improvements in general hand function. PNMS may be useful in restoring hand function in patients with muscle atrophy following entrapment neuropathy.

Action Potentials↗