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Biomedical subjects

Jennifer L Keating

Publications and source records attributed to Jennifer L Keating.

14 recordsLinked to original sources
PubMed2007

The effect of exercise on outcomes for older acute medical inpatients compared with control or alternative treatments: a systematic review of randomized controlled trials.

OBJECTIVE: To determine the effect of exercise interventions for acutely hospitalized older medical patients on functional status and hospital outcomes. DATA SOURCES: MEDLINE, CINAHL, EMBASE, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, PEDro, Current Contents and Sports Discus were searched until February 2006. Additional studies were identified through reference and citation tracking and contacting authors of eligible trials. REVIEW METHODS: Eligible studies were prospective randomized or pseudor and omized controlled trials comparing exercise for medical inpatients to alternate or no treatment controls. Of 3138 potentially relevant articles screened by two independent reviewers, seven randomized controlled trials and two pseudorandomized controlled trials were included. Two independent reviewers extracted data relating to patient and hospital outcomes and assessed the method quality. RESULTS: Pooled analysis of multidisciplinary interventions that included exercise indicated a significant increase in the proportion of patients discharged to home at hospital discharge (relative risk 1.08; 95% confidence interval (CI) 1.03 -1.14) and a small but important reduction in acute hospital length of stay (weighted mean difference - / 1.08 days; 95% CI - / 1.93 to - / 0.22) and total hospital costs (weighted mean difference - / 280 US dollars; 95% CI - / 493 dollars to - / 65 dollars) compared with usual care. Pooled analysis of exercise intervention trials found no effect on the proportion of patients discharged to home or acute hospital length of stay. The effect of exercise on functional outcome measures is unclear. There was no influence of exercise intervention on adverse events. CONCLUSIONS: Multidisciplinary intervention that includes exercise improves patient and hospital outcomes for acutely hospitalized older medical patients.

Acute Disease↗
PubMed2006

Trunk-strengthening exercises for chronic low back pain: a systematic review.

OBJECTIVE: The objective of this systematic review was to determine the effect of lumbar spine-strengthening exercises on outcomes for people with chronic low back pain. METHODS: Two independent reviewers followed Cochrane Back Review Group and QUORUM Statement guidelines to complete this systematic review. Exercise effects were reported as standardized mean difference (SMD) with 95% confidence intervals. RESULTS: Thirteen high-quality randomized controlled trials were included. For chronic low back pain, trunk strengthening is more effective than no exercise on long-term pain (SMD 0.95 [0.35-1.55]; intensive trunk strengthening is more effective than less intensive on function (pooled SMD: short-term, 0.58 [0.22-0.94]; long-term, 0.77 [0.33-1.20]). Compared with physiotherapy or aerobics, effects are comparable on pain and function. Motivation strategies increase effectiveness. After disk surgery, effects are significant for function (pooled SMD: short-term, 1.08 (0.76-1.41); long-term, 0.53 (0.03-1.04). For severe degeneration, trunk strengthening is less favorable than fusion on long-term pain (SMD, -0.50 [-0.99 to -0.01]) or function (SMD, -0.76 [-1.25 to -0.26]). Intensive trunk strengthening is less effective than McKenzie exercises for pain reduction (SMD: short-term, -0.29 [-0.54 to -0.05]; long-term, -0.31 [-0.55 to -0.06]). We estimated that moderate effect sizes (0.5) indicate that approximately 50% of participants and large effect sizes (0.8) indicate that approximately 80% of participants would achieve important improvement. CONCLUSIONS: Trunk strengthening appears effective compared with no exercise. Increasing exercise intensity and adding motivation increase treatment effects. Trunk strengthening, compared with aerobics or McKenzie exercises, showed no clear benefit of strengthening. It is unclear whether observed benefits are due to tissue loading or movement repetition.

Exercise Therapy↗
PubMed2005

The epidemiology of low back pain in primary care.

This descriptive review provides a summary of the prevalence, activity limitation (disability), care-seeking, natural history and clinical course, treatment outcome, and costs of low back pain (LBP) in primary care. LBP is a common problem affecting both genders and most ages, for which about one in four adults seeks care in a six-month period. It results in considerable direct and indirect costs, and these costs are financial, workforce and social. Care-seeking behaviour varies depending on cultural factors, the intensity of the pain, the extent of activity limitation and the presence of co-morbidity. Care-seeking for LBP is a significant proportion of caseload for some primary-contact disciplines. Most recent-onset LBP episodes settle but only about one in three resolves completely over a 12-month period. About three in five will recur in an on-going relapsing pattern and about one in 10 do not resolve at all. The cases that do not resolve at all form a persistent LBP group that consume the bulk of LBP compensable care resources and for whom positive outcomes are possible but not frequent or substantial.

Journal Article↗
PubMed2005

Classification in nonspecific low back pain: what methods do primary care clinicians currently use?

STUDY DESIGN: Postal survey. OBJECTIVES: To describe the signs and symptoms that clinicians think represent nonspecific low back pain (NSLBP) subgroups, and to report the labels that clinicians give to those subgroups. SUMMARY OF BACKGROUND DATA: The cause of most low back pain (LBP) cannot be diagnosed. Consequently, approximately 80% of primary care LBP presentations are most accurately labeled as NSLBP. Most Australian primary care clinicians think that NSLBP is heterogeneous and treat patients differently based on that heterogeneity. This research sought to identify the subgroups clinicians believe are recognizable within that heterogeneity. METHODS: Analysis of survey data from 651 primary care clinicians from 6 professional disciplines: physiotherapy, manipulative physiotherapy, chiropractic, osteopathy, general medicine, and musculoskeletal medicine. RESULTS: There was little consensus among participating clinicians regarding the signs and symptoms that identify NSLBP subgroups. Most clinicians give labels to NSLBP subgroups that imply putative pathoanatomy, however, the evidence that these labels are valid is scant and controversial. CONCLUSIONS: A lack of consensus among participating clinicians regarding NSLBP subgroups and a lack of evidence for the validity of NSLBP subgrouping are a compelling argument for further research into this clinical practice.

Consensus↗
PubMed2005

Constraint-induced movement therapy following stroke: a systematic review of randomised controlled trials.

This systematic review investigated the effects on function, quality of life, health care costs, and patient/carer satisfaction of constraint-induced movement therapy (CIMT) for upper limb hemiparesis following stroke. A comprehensive search of the complete holdings of MEDLINE, CINAHL, EMBASE, Cochrane Library, PEDro and OTseeker to March 2005 was conducted. Fourteen eligible randomised controlled trials were identified and relevant data extracted by two independent reviewers. Effect sizes were calculated and results were pooled where possible. Method quality of the trials, assessed using the PEDro scale, had a mean score of five (range three to seven). Thirteen trials compared CIMT to an alternative treatment and/or a control group. One trial compared two CIMT protocols. Acute, subacute, and chronic conditions were studied. Effect sizes could be estimated for nine trials. Results were significant and in favour of CIMT in eight of these for at least one measure of upper limb function. The pooled standardised mean difference could be calculated for five outcome measures producing moderate to large effect sizes, only one of which attained statistical significance. Results indicate that CIMT may improve upper limb function following stroke for some patients when compared to alternative or no treatment. Rigorous evaluation of constraint-induced movement therapy using well-designed and adequately powered trials is required to evaluate the efficacy of different protocols on different stroke populations and to assess impact on quality of life, cost and patient/carer satisfaction.

Activities of Daily Living↗
PubMed2004

A low back-specific version of the SF-36 Physical Functioning scale.

STUDY DESIGN: A prospective repeated measures design was used to produce a back-specific version of the Short Form-36 Physical Functioning scale (SF-36 PF) by Rasch analysis of a pool of items from the SF-36 PF, Oswestry Disability Questionnaire, and the Quebec Back Pain Disability Scale. OBJECTIVES: To identify items for a back-specific version of the SF-36 PF scale and to compare the psychometric properties of the new version with the original 10-item scale. SUMMARY OF BACKGROUND DATA: Adequate assessment of patient function requires the administration of a generic and a condition-specific questionnaire. A back-specific version of the SF-36 PF would facilitate comprehensive patient assessment in the clinical setting. METHODS: Consecutive patients with low back pain presenting for physiotherapy treatment were recruited at three public hospitals, three community health services, and four private practices. Patients completed questionnaires on two occasions 6 weeks apart. RESULTS: A scale of 18 items showed a better fit to the Rasch model than the original SF-36 PF scale. Items in the original scale that had a poor fit (INFIT/OUTFIT statistics outside the range 0.7-1.3) showed an acceptable fit in the new scale. The augmented scale had comparable reliability and improved responsiveness to the original 10-item SF-36 PF scale. The minimum detectable change (90% confidence) and the minimum clinically important difference were 12 points. Floor and ceiling effects were practically eliminated. The psychometric properties of the new scale were comparable to those of the Oswestry Disability Questionnaire. CONCLUSIONS: The Low-Back SF-36 PF18 comprises the 10-item SF-36 PF scale and four items each from the Oswestry and Quebec back pain questionnaires. The possible total score ranges from 0 to 100, with a higher score indicating better function. The new scale appears to offer advantages over the use of the original scale for the assessment of functioning in patients with low back pain.

Adolescent↗
PubMed2004

Do within-session changes in pain intensity and range of motion predict between-session changes in patients with low back pain?

Physiotherapists commonly use post-treatment changes in a patient's pain intensity and range of motion to guide treatment selection and predict possible longer-term outcomes. This study tested the validity of this practice by evaluating the predictive value of within-session changes in pain intensity and range of motion in 53 patients with low back pain. Pain intensity and range of motion measurements of spinal flexion, extension, lateral flexion, and straight-leg-raise were taken by the patient's therapist before and after one treatment session, and were repeated by a blinded therapist at the beginning of the patient's subsequent treatment session. Regression analysis revealed that the strength of association between within-session and between-session changes ranged from r = 0.35 to r = 0.80 for range of motion measurements, and from r = 0.24 to r = 0.47 for pain intensity. Odds ratios for pain and range of motion ranged from 3.5 (95% CI 0.9 to 14.6) to 37.0 (95% CI 4.1 to 330), indicating greater odds of improving between-session if improvement was obtained within-session. These results provide preliminary support for the practice of using within-session changes in pain intensity and range of motion to guide treatment selection when treating impairments in patients with low back pain.

Adolescent↗
PubMed2003

Trunk extension effort in patients with chronic low back dysfunction.

STUDY DESIGN: Single-session measurement was performed. OBJECTIVE: To measure trunk extension strength and assess trunk extension effort in patients with chronic low back dysfunction using a novel test protocol and the DEC parameter. SUMMARY OF BACKGROUND DATA: In normal subjects, the DEC parameter effectively and reproducibly differentiates between maximal effort and feigned weakness of the trunk extensors, but its applicability to patients with chronic low back dysfunction has not yet been explored. METHODS: Isokinetic trunk extension strength was measured in 44 patients with chronic low back dysfunction (22 women and 22 men) who were not involved in litigation process. Tests were conducted using a range of motion of 20 degrees, angular velocities of 10 degrees and 40 degrees per second, and an isometric preactivation force of 50 N. The average strength at these velocities served for calculation of the DEC score, which is the difference between the eccentric and concentric strength ratios at these velocities. RESULTS: The strength scores resembled the characteristic physiologic moment-angular velocity relation, and were much reduced, as compared with the scores of normal subjects. The DEC scores for 39 patients (89%) were less than the cutoff value, which in normal subjects differentiates maximal effort (below cutoff) from feigned weakness (above cutoff) at tolerance limits of 99%. This figure was slightly lower (84%) at a corresponding 95% level. A principal finding in the false-positive cases was a particularly low concentric strength at 40 degrees per second. CONCLUSIONS: This study indicates that under the current protocol, the large majority of patients perform at a maximal level of effort.

Abdomen↗
PubMed2003

Injury in the Australian sport of calisthenics: a prospective study.

The aims of this study were to determine the rate, anatomical regions, onset, severity, and type of injury in the sport of calisthenics and compare injuries reported by elite and non-elite participants. Prospective reports of injuries were collected over a 12-month period from 550 elite and non-elite calisthenics participants. The participants recorded the number of training sessions, competition, and performances per week, hours of training, and information on any injuries sustained each week during the survey period. Five hundred and fifty participants reported 190 injuries during the survey period, 0.4 injuries per participant year or 0.3 injured participants per participant year. The odds ratio of injury in the elite to the non-elite group was 2.0 (95% CI 1.3 to 2.9). Injuries to the lower back (32.4% of all injuries), hip thigh and groin (25.4% of all injuries) were most common. Activities involving lumbar extension (29.8% of all injuries and 61.0% of lower back injuries) were perceived by participants to have led to injury. In general, injuries were minor and mainly involved soft tissue structures (95.6% of all injuries). Participants had difficulty in identifying why their injuries had occurred. Calisthenics participants did not report high injury rates, but activities that involve lumbar extension are implicated in low back injuries and warrant further attention

Adolescent↗
PubMed2002

The effect of preload on variability in dynamometric measurements of knee extension.

The unwanted variability in dynamometric measurements limits accurate interpretation of these measurements. Although unpredictable variability in measurements has been identified repeatedly, few studies have investigated strategies for reducing measurement error. This study investigated the effect of preload on variability in dynamometry. Preload is the force that must be overcome before the lever arm begins to move at a preset speed. On the basis of related research, it was hypothesised that under higher preloads, subjects would perform more consistently. Twenty subjects (ten male and ten female), aged 19-24 years, performed repeated right concentric knee extension tests. Using the Kin-Com dynamometer and a lever arm speed of 60 degrees x s(-1), extension torques were recorded for each subject under four different preload conditions. Preloads were 5%, 25%, 45% and 65% of the torque achieved during each subject's maximal voluntary contraction (MVC). Each subject performed six test repetitions under each preload. Variability in peak torque was significantly smaller under the 65% preload compared to the 5% preload. In addition, the regression of preload against group mean variability indicated that as preload increased, the variability in peak torque decreased in a highly predictable way. The results from this study suggest that subjects perform more consistently under conditions of higher preload than under lower preloads. By adopting higher preloads for dynamometry testing, measurement accuracy and the potential clinical utility of measurements is improved.

Adult↗
PubMed2002

An investigation of factors predictive of independence in transfers and ambulation after hip fracture.

OBJECTIVES: To compare the predictive value of measurements of mobility on the second day postsurgery with previously established outcome predictors after hip fracture and to establish a statistical model for the prediction of independence in transfers and ambulation. DESIGN: Prospective, validation cohort study. SETTING: Primary care center. PATIENTS: Two samples of 50 patients admitted with primary diagnosis of hip fracture. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Independence in transfers and ambulation within 2 weeks of surgery. Predictor variables considered were age, mental state, prefracture mobility, and 4 measurements of transfers and ambulation on the second day postsurgery. RESULTS: In bivariate logistic regression analysis, all variables were significant predictors. In multiple logistic regression analysis, only distance walked and assistance required in transferring supine to sitting on day 2 postsurgery were significant. The multiple logistic regression model produced from the analysis had an outcome classification accuracy of 88% when tested on an independent sample. CONCLUSIONS: Measurements of mobility on day 2 postsurgery are significant and reliable predictors of independence in transfers and ambulation. Further consideration of the variables age, mental state, and prefracture mobility do not appear to improve the accuracy of the prediction.

Activities of Daily Living↗
PubMed2002

A comparison of five low back disability questionnaires: reliability and responsiveness.

BACKGROUND AND PURPOSE: The aim of this study was to examine 5 commonly used questionnaires for assessing disability in people with low back pain. The modified Oswestry Disability Questionnaire, the Quebec Back Pain Disability Scale, the Roland-Morris Disability Questionnaire, the Waddell Disability Index, and the physical health scales of the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) were compared in patients undergoing physical therapy for low back pain. SUBJECTS AND METHODS: Patients with low back pain completed the questionnaires during initial consultation with a physical therapist and again 6 weeks later (n=106). Test-retest reliability was examined for a group of 47 subjects who were classified as "unchanged" and a subgroup of 16 subjects who were self-rated as "about the same." Responsiveness was compared using standardized response means, receiver operating characteristic curves, and the proportions of subjects who changed by at least as much as the minimum detectable change (MDC) (90% confidence interval [CI] of the standard error for repeated measures). Scale width was judged as adequate if no more than 15% of the subjects had initial scores at the upper or lower end of the scale that were insufficient to allow change to be reliably detected. RESULTS: Intraclass correlation coefficients (2,1) calculated to measure reliability for the subjects who were classified as "unchanged" and those who were self-rated as "about the same" were greater than.80 for the Oswestry and Quebec questionnaires and the SF-36 Physical Functioning scale and less than.80 for the Waddell and Roland-Morris questionnaires and the SF-36 Role Limitations-Physical and Bodily Pain scales. None of the scales were more responsive than any other. DISCUSSION AND CONCLUSION: Measurements obtained with the modified Oswestry Disability Questionnaire, the SF-36 Physical Functioning scale, and the Quebec Back Pain Disability Scale were the most reliable and had sufficient width scale to reliably detect improvement or worsening in most subjects. The reliability of measurements obtained with the Waddell Disability Index was moderate, but the scale appeared to be insufficient to recommend it for clinical application. The Roland-Morris Disability Questionnaire and the Role Limitations-Physical and Bodily Pain scales of the SF-36 appeared to lack sufficient reliability and scale width for clinical application.

Adult↗
PubMed2000

Measurements of ankle dorsiflexion in stroke subjects obtained using standardised dorsiflexion force.

This study investigated the reliability of measurements of ankle dorsiflexion obtained using the Lidcombe Template, an instrument that allows the magnitude and direction of force applied to dorsiflex the foot to be measured and standardised. Ten unimpaired physiotherapy students and 21 subjects who had suffered stroke were tested twice. Twenty minutes separated tests. Measurements of passive dorsiflexion range were highly reliable for both groups (r > 0.92) when the mean of three measurements was used. Significantly more variability occurred in measurements of impaired subjects than unimpaired subjects. For the subjects tested, for 95 per cent confidence that real differences exist between measurements taken 20 minutes apart, 7 degrees and 3 degrees must be allowed around measurements of impaired and unimpaired subjects respectively. These small error margins confer confidence in the potential utility of this instrument for measuring ankle dorsiflexion.

Journal Article↗