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Biomedical subjects

Val J Robertson

Publications and source records attributed to Val J Robertson.

7 recordsLinked to original sources
PubMed2007

Manual forces applied during cervical mobilization.

OBJECTIVE: Manual therapists routinely use passive accessory mobilization techniques to treat patients with mechanical neck disorders, but little is known about the manual forces applied. The aim of this study was to quantify the manual forces applied to the cervical spine during joint mobilization. METHODS: Ten physiotherapists performed posterior-to-anterior mobilizations to C2 and C7 (both centrally and unilaterally, 1 right and 1 left, grades I-IV) on a single asymptomatic male subject. Manual forces were measured in 3 planes using an instrumented treatment table. RESULTS: The instrumented table showed excellent reliability (intraclass correlation coefficient [2,1], 0.99; 95% confidence interval, 0.97-1.00) and accuracy (mean absolute error; vertical force, 1.1 N; SD, 1.5). There were considerable differences between therapists for mean peak force, force amplitude, and oscillation frequency for each technique and grade. Mean peak forces (grade I, 21.8 N; SD, 15.0; grade II, 34.9 N; SD, 20.9; grade III, 58.2 N; SD, 27.5; grade IV, 61.0 N; SD, 29.9) were considerably lower than previously reported lumbar mobilization forces. Intratherapist repeatability for all mobilization parameters was high. Force amplitude and oscillation frequency measures indicated that therapists generally adhered to the published definitions of the grades of mobilization when applying force, but when asked, provided quite different definitions of the grades. CONCLUSIONS: This study provides preliminary evidence that cervical mobilization forces vary considerably between therapists, but intratherapist repeatability is high.

Adult↗
PubMed2006

Manual forces applied during posterior-to-anterior spinal mobilization: a review of the evidence.

OBJECTIVE: The objective of this review was to evaluate the evidence for the consistency of force application by manual therapists when carrying out posterior-to-anterior (PA) mobilization techniques, including the factors that influence the application and measurement of mobilization forces. METHODS: Studies were identified by searching 6 electronic databases up to April 2005, screening the reference lists of retrieved articles, and contacting experts by e-mail. Relevant articles were defined as those that described the measurement of forces applied during spinal mobilization or discussed the reliability of measurement of manual forces. RESULTS: Twenty studies described the quantitative measurement of applied force during a PA mobilization technique, with most focusing on the lumbar spine. When defined by magnitude, frequency, amplitude, and displacement, PA mobilization forces are extremely variable among clinicians applying the same manual technique. Variability may be attributed to differences in techniques, measurement or reporting procedures, or variations between therapists or between patients. CONCLUSIONS: The inconsistency in manual force application during PA spinal mobilization in existing studies suggests that further studies are needed to improve the clinical standardization of manual force application. Future research on mobilization should include forces applied to the cervical and thoracic spines in addition to the lumbar spine while thoroughly describing force parameters and measurement methods to facilitate comparison between studies.

Evidence-Based Medicine↗
PubMed2006

No rest for the wounded: early ambulation after hip surgery accelerates recovery.

BACKGROUND: Level 3 evidence-based guidelines recommend first walk after hip fracture surgery within 48 h. Early mobilization is resource and effort intensive and needs rigorous investigation to justify implementation. This study uses a prospective randomized method to investigate the effect of early ambulation (EA) after hip fracture surgery on patient and hospital outcomes. METHODS: Sixty patients (41 women and 19 men; mean age 79.4 years) admitted between March 2004 through December 2004 to The Alfred Hospital, Melbourne, for surgical management of a hip fracture were studied. Randomization was either EA (first walk postoperative day 1 or 2) or delayed ambulation (DA) (first walk postoperative day 3 or 4). Functional levels on day 7 post-surgery, acute hospital length of stay and destination at discharge were compared. RESULTS: At 1 week post-surgery, patients in the EA group walked further than those in the DA group (P = 0.03) and required less assistance to transfer (P = 0.009) and negotiate a step (P = 0.23). Patients in the EA group were more likely to be discharged directly home from the acute care than those in the DA group (26.3 compared with 2.4%) and less likely to need high-level care (36.8 compared with 56%). A failed early ambulation subgroup had significantly more postoperative cardiovascular instability and worse results for all outcome measures. CONCLUSION: EA after hip fracture surgery accelerates functional recovery and is associated with more discharges directly home and less to high-level care.

Aged↗
PubMed2006

High-Level Mobility Assessment Tool (HiMAT): interrater reliability, retest reliability, and internal consistency.

BACKGROUND AND PURPOSE: The High-Level Mobility Assessment Tool (HiMAT) assesses high-level mobility in people who have sustained a traumatic brain injury (TBI). The purpose of this study was to investigate the interrater reliability, retest reliability, and internal consistency of data obtained with the HiMAT. SUBJECTS: Three physical therapists and 103 people with TBI were recruited from a rehabilitation hospital. METHODS: Three physical therapists concurrently assessed a subset of 17 subjects with TBI to investigate interrater reliability. One physical therapist assessed a different subset of 20 subjects with TBI on 2 occasions, 2 days apart, to investigate retest reliability. Data from the entire sample of 103 subjects were used to investigate the internal consistency of this new scale. RESULTS: Both the interrater reliability (intraclass correlation coefficient [ICC]=.99) and the retest reliability (ICC=.99) of the HiMAT data were very high. For retest reliability, a small systematic change was detected (t=3.82, df=19), indicating a marginal improvement of 1 point at retest. Internal consistency also was very high (Cronbach alpha=.97). DISCUSSION AND CONCLUSION: The HiMAT is a new tool specifically designed to measure high-level mobility, which currently is not a component of existing scales used in TBI. This study demonstrated that the HiMAT is a reliable tool for measuring high-level mobility.

Adult↗
PubMed2005

The effect of heat on tissue extensibility: a comparison of deep and superficial heating.

OBJECTIVE: To compare the effects of deep heating (shortwave diathermy [SWD]) and superficial heating (hydrocollator packs) on tissue extensibility. DESIGN: A double-blind, repeated-measures study. Possible effects of sex and intervention order were controlled. SETTING: A clinical laboratory. PARTICIPANTS: Twenty-four subjects with no neurologic or musculoskeletal pathologies affecting their lower limbs. INTERVENTIONS: Three intervention conditions: deep heating (SWD), superficial heating (hot packs), and no heating were applied in preallocated order to each subject at least 36 hours apart. MAIN OUTCOME MEASURES: Ankle dorsiflexion in weight bearing was measured by using an inclinometer to ascertain changes in the extensibility of the calf muscles and associated soft tissues. RESULTS: Deep heating increased the range of ankle dorsiflexion by 1.8 degrees +/-1.9 degrees . The change in ankle dorsiflexion after superficial and no heating was 0.7 degrees +/-1.5 degrees and -0.1 degrees +/-1.0 degrees , respectively. CONCLUSIONS: Deep heating, in the absence of stretching, increases tissue extensibility more than superficial heating or no heating. Superficial heating is more effective than no heating, but the difference was not statistically significant.

Adult↗
PubMed2005

Pilot study using transcutaneous electrical stimulation (interferential current) to treat chronic treatment-resistant constipation and soiling in children.

BACKGROUND: Chronic constipation in children may have organic or behavioral causes. The purpose of the present study was to investigate the effect of treatment with transcutaneous electrical stimulation (using interferential current) in children with chronic treatment-resistant constipation with proven organic disorders. METHODS: Eight children (7-16 years) with at least 4 years of chronic treatment-resistant constipation and soiling, who had failed diet, laxative treatment and behavioral therapy were given 1 month of transcutaneous electrical stimulation. The three most severe cases had appendicostomies with antegrade washouts every 2-3 days to prevent impaction and reduce their soiling. Children and carers kept a daily diary of bowel habits, recording number of spontaneous defecations, episodes of soiling, use of bowel washouts and medications. Transcutaneous stimulation using interferential current was applied three times per week for 3-4 weeks using four surface electrodes, two to the paraspinal area of T9-10 to L2 and one to either side of the anterior abdominal wall beneath the costal margin. Diaries were recorded for 1 month before, during, and after stimulation and for 2 weeks 3 months later. RESULTS: Transcutaneous electrical stimulation using interferential current stopped soiling in 7/8 children and increased the frequency of spontaneous defecations in 5/8. Defecations remained high and soiling low for 3 months in 3/6 children (with data). CONCLUSIONS: These results suggest that transcutaneous electrical stimulation using interferential current has a beneficial effect for children with chronic treatment-resistant constipation. Further trials using larger series of patients are needed to confirm this benefit, to determine the ideal stimulation parameters and to investigate why electrical stimulation might be effective.

Adolescent↗